Dying in Full Command of one’s Senses

Thursday, 01 February 2018

From 1900 to 2100

Medico-Chirurgical Hall

Very Rev Professor Sir Iain Torrance, Pro-Chancellor of the University, Dean of the Chapel Royal & Dean of the Order of the Thistle of Aberdeen

Professor Sir Ian Torrance was born in Aberdeen and is a graduate of Edinburgh, St Andrews and Oxford.  He is a minister of the Church of Scotland who served initially in Northmavine, Shetland.  He subsequently taught in Birmingham then returned to Aberdeen’s University Department of Divinity in 1993.  He was Dean of the Faculty of Arts and Divinity before his election as Moderator of the General Assembly of the Church of Scotland in 2003.  He served as President of Princeton Theological Seminary in New Jersey until December 2012.  Since 2013 he has been Dean of the Chapel Royal in Scotland and Pro-Chancellor of the University and from 2014 Dean of the Order of the Thistle.  He was recently knighted for services to higher education and theology.

The talk will reflect the speaker’s interest in The Ethics in Everyday Life published by Michael Banner in 2014.  The exemplary value ascribed to Christ’s death has led to Christians striving to imitate it in as much as they have tried to be active rather than passive in death.  The implication that Christian’s must aspire to die in a state of grace produced anxieties.  The strands of the “pro-choice” and the “palliative care people” surprisingly overlap as the major concern of both is to have a death in full command of one’s senses.  Michael Banner goes on to say that for many people today death is not at all being in command of one’s senses but what he elegantly calls “dwindling”.  The objectives are to set Banner’s view in a traditional context, to provide some understanding of the spiritual peace sought by Christian’s at death and to illustrate even simple ways in which that anxiety can be alleviated.


Presentation used by Professor Torrance

The President welcomed the company and congratulated the main speaker on is knighthood announced in the recent New Year’s Honours list. He reported on a successful Burns supper on 26th Jan along with the University Medical Society at which some 160 attendees attended. Marilene’s Address to the Haggis and Professor Greaves’ Immortal Memory were given special mention and the audience were advised that the Douglas Hotel had been booked for the event on Friday 25th January next year. Reminders were given about the Spring Ceilidh on 24th March and the charity concert on 12th May. The President also announced that nominations would open shortly (until 31st March) for the next President Elect and that vacancies still exist immediately for a Buildings & Furnishings Officer and for a new Honorary Secretary after the current session ends.

The President then introduced Professor Sir Iain Torrance to give his lecture entitled ‘Dying in Full Command of One’s Senses’. Professor Torrance introduced the subject by saying that life and death issues are important in, for example, Judaeo-Christian and Islamic faiths where there is sanctity of life, and a distinctiveness of persons created. Traditionally, Christianity has opposed doctor-assisted death although in Canada, where such is legal, the churches neither support nor oppose it. In Holland, the church has for some time supported end of life assistance from physicians. Former Archbishop of Canterbury, George Carey and Bishop Desmond Tutu were listed among those who have supported the concept of death with dignity.

It is agreed that issues surrounding interventions in life and death have complex arguments for and against, and the topic has therefore been a favourite in moral philosophy teaching. Examples were given of how scenarios can be written which challenge the moral basis for action or inaction and include the thorny question of whether there is any equivalence between acts of omission and commission. The ‘doctrine of double effect’ was also highlighted where, for example, morphine given primarily to alleviate pain and suffering, is also likely to incidentally hasten death. How to prioritise such potentially conflicting actions in such circumstances may be developed differently if focussed on processes or outcomes. It was noted that Muslim ethics put particular emphasis on the intentions of actions.

Professor Torrance suggested pragmatic management of death with or without medical involvement was perhaps too complex for a straightforward ‘rights versus consequences’ (or deontological v consequentialist) analysis. He then introduced the work of Stanley Hauerwas, the son of a bricklayer who became and eminent academic theologian and ethicist who worked for many years at Duke University in North Carolina, USA. Professor Hauerwas was described as an ‘anabaptist’ promoting a version of Christianity that was ‘serious’ rather than ‘social’. From this standpoint, he was very much anti-war, and interested in what was referred to as  an ‘earthed or grounded’ Christian perspective which can, perhaps be approached by the protagonist thinking ‘Who am I?’ before asking ‘What should I do?’ when a decision has to be made.  Hauerwas has advanced the belief that there is a great need for considering effects on ‘community’ in moral decision making; while (liberal) realists and (conservative) romantics have much philosophical overlap, both focus on individuality in relation to private actions (including, for example, sexuality and dying) while ignoring any broader institutional context for which individual conduct or decisions may yet have consequences. The speaker referred back to the views of Carey and Tutu being solely about how an individual may decide about his own death. Hauerwas suggests that there is a moral duty on individuals to show others that they can endure suffering in life – and that its attempted avoidance may not, therefore, be morally justified. It was further stated that while Hauerwas says, in relation to ‘voluntary’ dying that while there is nothing to say we must keep everyone alive, there is a need to consider the inherited wisdom of community, rather than an individualistic opinion, on what constitutes a ‘good’ death.

Professor Torrance then turned to the work of Professor Linda Woodhead, a leader in the field of Sociology of Religion, who works at Lancaster University. She has proposed a 3-element generic model of a religion incorporating perennial (every day), ritual (special events) and doctrinal (rationalised) components. Attempting to use the analogy of life within a marriage to illustrate the three terms, the respective elements were roughly likened to saying ‘Good Morning’, recognising and celebrating e.g. birthdays, and saying ‘I love you’. With extensive data sets underpinning her views, Professor Woodhead believes that strong religions focus on the perennial, while weak religions focus on the doctrinal aspects.

Next the audience was introduced to the work of Michael Banner, Dean of Trinity College, Cambridge, and his 2014 book entitled ‘The Ethics of Everyday Life’. In considering the ethics of death, Banner explores the two models of ‘hospice care’ and ‘euthanasia’. While each approach has differences, they also have considerable overlap – but are again focussed on individualisation rather than having any real ‘community’ dimension; they do not address the concept of ‘long dying’, in describing which he uses the term ‘dwindling’.

In describing the evolution of concepts of death with reference to Christianity we begin with the fact that Jesus died and hence, perhaps, accept that death is inevitable. Much later, however, greater attention was given to how he died – for example, forgiving enemies, being kindly to friends, harbouring no blame for his killers, etc. Thus the notion grew that the death of Jesus was exemplary and all Christians should aspire to emulate it when their time came. Also, the formulated concept of judgement – which initially followed some time after death, progressively changed to being contemporaneous with the end of life and hence this too impacted on an ‘idealised scripting’ of how Christians should die.

So-called ‘good deaths’ then with such attachments as ‘his wife was with him at the end’ or ‘she was in control of things to the last’ perhaps feeds into some aspects of both hospice provision, or euthanasia, while both, nevertheless, have tendencies to criticise the over-medicalisation of dying. Elizabeth Kubler-Ross (d.2004; best known for her stages of bereavement) was quoted as suggesting that ‘dying nowadays is lonely, mechanical and dehumanised’; this was perhaps overstated and hence unfairly critical. However, Banner’s insights included the view that the hospice model bids to preserve and maintain the ‘project of self’ for as long as possible while euthanasia brings forward the time of death so that its occurrence preceded the loss of ‘self’; both therefore have the similarity of focussing on ‘self in death’. Any legal recognition of medically assisted dying carries with it implications for all deaths in terms of whether any individual has the right to choose not to die (in relevantly straitened circumstances). The corollary of this construct is that permitting assisted dying has consequences for all deaths – and hence can raise the question of whether this is just.

Professor Torrance went on to discuss Banner’s view that neither Hospice nor Euthanasia approaches embrace the model of ‘long dying’. Data was offered indicating that perhaps 20% of people have a relatively clearly heralded death while for the 40% having a dwindling death there is little opportunity to assume the ‘dying role’. The notion that ‘long dwindling’ may raise issues beyond the reach of classical bioethics, leads to the philosophical possibility of turning to a social anthropology framework. Consequently the speaker offered an analysis combining the writings of both Banner and Woodhead in looking for ways to put forward a ‘scripting’ for long dying. Banner ‘s book refers to various studies on attitudes and experience relating to death and dying in various different communities around the world.  These suggest that there is something more complex afoot in approaching a death than simply the ‘loss of self’ and so perhaps a traditional (western) view of personhood hinging on cognition may be less appropriate than one which considers ‘embodied memory’. This view will, of course, have implications for how end of life care may be approached and delivered and so perhaps a modern enlightened view of dying – especially of dwindling – requires more anthropological research. A scripting of  ‘dwindling’, it was suggested, could perhaps be considered as a combination of first day at school (which can be varied to some extent) and turning thirty (which inevitably happens when it happens). Like dwindling, these are ‘adventures in which we can be accompanied and encouraged’. It was the speaker’s conclusion that much of modern philosophy around death and dying are beyond traditional ethics – and perhaps is, indeed, more dependent on anthropology.

An enthusiastic discussion followed with topics including the reluctance of modern medical students to use the word death – perhaps evidence of prevailing denial in medical culture, the need for compassion in medical care, the concept of ‘the soul’ and how that fits into the arguments presented, the long-standing difficulties for (young) doctors in having to deal with the practical administration around discussing death with families and addressing death certification, and a suggestion that hospice care had perhaps come someway from its beginnings that now did, after all, embrace some of the elements encompassed in the dwindling construct.

At the end of the presentation and discussion, Professor Torrance expressed his willingness to share the content of his text slides and these have been uploaded above.

The meeting concluded with the President offering a vote of thanks and reminding the company of the next meeting of the Society on 1st March.

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