An Ars Moriendi For the 21st Century

CHRISTOPHER P. VOGT, PH.D. ST. JOHN’S UNIVERSITY, NEW YORK

CATHOLIC HEALTH ASSOCIATION THEOLOGY AND ETHICS COLLOQUIUM MARCH 27, 2015 Improving the Quality of Care

 Dying in America  12 recommendations that together address physical, emotional, social, and spiritual well-being of the dying.  Honoring Individual Preferences Near the End of Life  Many of these reforms are critical and urgently needed, but incomplete. Why Retrieve the Ars Moriendi?

 Restoring a role for the dying person.  Experts are at the center; dying persons have marginal (if any) role where sole focus is on cure and elimination of disease  Remember, articulate, nurture virtues needed to fulfill that role well  Counter-force to medicalized dying  Medicine cannot undue the medicalization of death  We live in an era of battle vs. death, not of dying well. As long as our deaths are given over to experts rather than being located in family and community there will be no dying well.  Churches and their practices must re-form and feed our imaginations  The otherness of this tradition can precipitate dialogue. Images from the early Ars Moriendi tradition

 Crafte and Knowledge for to Dye Well  English translation of the French Tractatus artis bene moriendi  Dated from ca. 1490  Plate 1: Temptation to Unbelief  Plate 2: Faith  Angel: “Stand firm in faith” (banner)  Mary, Jesus, God the Father, Moses, and numerous saints as a cloud of witnesses.  Whatever one prays for by faith will be done (Mk 11:24) Despair vs. Hope Impatience vs. Patience The Good Death

- To the right – Christ breathing his last and commending his own spirit. - Mary Magdalene is at the cross; witness to the resurrection - A monk ministers to the dying man (helping him hold up a candle). - The man’s soul departs his body and is received by angels - Below frustration and anger among the demons as this man’s soul slips away from their grasp The Ars Moriendi of the 16th & 17th Centuries

 Erasmus: Preparing for Death (1533)  Shift of focus away from deathbed temptations  Link between ars moriendi & ars viviendi (i.e., between dying well and living well)  Takes up similar virtues and vices/temptations (faith, hope, patience, etc.)but in a different way  Definition of virtue (from Jean Porter):  “…a trait of character or intellect which is in some way praiseworthy, admirable or desirable. When we refer to somebody’s virtues, what we usually have in mind are relatively stable and effective dispositions to act in particular ways.” Other Important Ars Moriendi Texts

 William Perkins (Puritan):  Salve for the Sicke Man (1595)

 Robert Bellarmine, S.J.:  The Art of Dying Well (1619)

 Jeremy Taylor (Church of England)  Rule and Exercises of Holy Dying (1651) Practices and Transformation

 Practices can transform us  Alastair MacIntyre:  Socially established / cooperative  Goods internal to that form of activity are realized in the course of trying to achieve those standards of excellence which are appropriate to and partially definitive of that form of activity.  Result: human powers to achieve excellence are systematically extended (i.e., you grow in virtue) Key Practices

 Frequent Examination of Conscience + Confession  Daily before sleep + sacramental confession regularly  In part due to fear of dying unexpectedly in state of sin  More importantly…as a practice – habituation  Learn technique/skill of confessing and “purging” sin  Faith in God and knowledge of God’s mercy – especially when combined with participation in liturgy  Perkins: regularly giving up sins to God’s mercy and endeavoring to live by faith = key to growth in faith and hope  Expressions of mercy and forgiveness for others  Makes us merciful and loving (in imitation of God)  We grow in awareness of God’s mercy for us, and learn to love God more deeply (i.e., grow in faith) Key Practices

 Visitation of the sick and dying  Erasmus – Visitation gives opportunity to learn by others’ example. Learn by presence at bedside of those who die well.  Perkins – Christian duty to support others in the faith. An act of compassion and mercy.  Only true support/salve for the dying is hope in God’s mercy grounded in faith in Jesus Christ.  Visits teach compassion  Nurtures faith because to give true comfort you must know scripture, basis of hope is faith in Jesus Christ, etc. Learning Patience

 Patience as enduring suffering well and learning to be obedient to God’s will.  Endure life’s small sufferings in anticipation of dying  Perkins: “He that would be able to beare the crosse of all crosses, namely death itselfe, must first of all learne to beare small crosses, as sicknesses in body & troubles in mind, with losses of goods and of friends, of good name, which I may fitely tearme little deaths . . . we must first of all acquaint our selues with these little deaths before we can well be able to beare the great death of all”  Learning obedience / embracing suffering as just punishment  Taylor: “He is patient that calls upon God, that hopes for health or heaven, that believes God is wise and just in sending him afflictions; that confesses his sins and accuses himself, and justifies God; that expects God will turne this into good;” Obstacles to Retrieval

 Shift in nature / causes of despair  Problematic theology of suffering  Advocated “commending death”; no room for lament  Dualism & “detachment” in dying  Changes in what is to be endured  Diversity in the Contemporary Context:  15% of Americans report “No religion”  Decline in influence/importance of religion even among allegedly religious people  Diversity of belief systems and value commitments Responding to the Reality of Diversity

“Generic” Ars Moriendi Explicitly Christian Ars Moriendi The Ongoing Need for a Christian Ars Moriendi

 There is no generic story; no neutral narrative  Demand for neutral or inclusive ars moriendi itself emerges from a specific worldview and meta-narrative  Centrality of Christian narrative and value commitments for Christian discipleship.  Existing medicalized narrative can only be dislodged by rich narrative linked to and “owned” by a specific community that can support beliefs and practices.  Christian Ars Moriendi remains unknown even to most Christians.  Best approach to diversity is to have richly-articulated, deeply held beliefs put forward in intellectual solidarity. Engaging Diversity

 Intellectual Solidarity:  “…intellectual solidarity calls for engagement with the other through both listening and speaking, in the hope that understanding might replace incomprehension and that perhaps even agreement about the good we share in common could result. …Because intellectual solidarity demands mutual listening and speaking it can only occur where all are genuinely free to set forward their visions of the common good and the reasons why they hold it. But it also depends on people having something to say and being unafraid to say it.” -David Hollenbach The Common Good and Christian Ethics A Christian Ars Moriendi for the 21st Century

 Ars Viviendi – Ars Moriendi via virtues  Faith & Hope (+ understanding of meaning of death)  Patience (understood in a new way)  Compassion / Love / Solidarity  Practices – Personal and Social  Formation in virtue  Ministry to / Visitation of the Sick and Dying  Cultivation of community of support and discernment The Virtues: Faith & Hope

 A hope linked to faith that can coexist with death, disappointment and lament.  Facilitates a certain level of freedom:  Paul’s freedom  Freedom to give ourselves to the cause of God  Freedom to use technology and medicine well because it is no longer the basis for our hope. The Virtues: Patience

 Distinguished from Stoic patience  Individualistic; A form of self-sufficiency and detachment  Linked to theological anthropology:  Acknowledging and accepting dependence upon God & others  David Bailey Harned (from Patience: How We Wait Upon the World)  It is often difficult to be a patient and an object, hard to accept our dependence on others, and never easy to receive as gifts what we would much prefer to acquire for ourselves. But perhaps there is no better preparation for hearing the gospel, which is a story about gifts. The recognition of our need to rely on others can cure us of illusions of independence and of the satisfactions of self-reliance and other expressions of pride. The Virtues: Patience

 Jesus as a model  Avoid suffering when possible, but endure it when necessary  Patience and Providence  Waiting  Willingly enduring a loss of total autonomy  Patient out of and for the sake of love  Tasks of the ars viviendi:  Discernment of God’s will and learning to embrace it  Enduring suffering for the sake of others  Consciousness of our finitude and ultimate dependence The Virtues: Compassion / Love

 Key elements of compassion:  Listening to the voice of the suffering  Experiencing the sufferer’s pain as one’s own  Acting to ease of eliminate suffering  Restoring voice; giving opportunity to lament  Supporting the patience and hope of the one who suffers  Elimination of the one who suffers is not an option  Assuring those who suffer of their ongoing place in community; integrating those who suffer into community  Important for caregivers and for the dying  Key task in dying well is forgiveness; giving and receiving love Social / Structural Support for Ars Moriendi

 Reforms of Dying in America report needed in order to make space for family and community to practice and participate in ars moriendi.  Must not hand dying over to “experts” but create opportunities for ongoing family, church, and community involvement.  Hence, practice #1 = political engagement around end-of-life. Formation

 Key task of formation in the virtues is consciousness of finitude, mortality, and dependence.  Momento mori – expanded to account for dependence and broader notion of finitude  “Celebrated” during Lent; link between liturgical celebrations and catechesis / dialogue Practices: Visitation and Care of the Sick & Dying

 A ministry of compassion:  Listening  Provision of direct or respite care  Support patience and hope  Assures ongoing concern of community and standing in it.  Dialogical, pastoral, and catechetical dimension  Raises consciousness of one’s own ultimate dependence / interdependence.  Opportunity to witness dying well  Ministry should be integrated into the liturgical life of the community (possible RCIA model) Practices: Catechesis & Dialogue

 Dying in America calls for:  Increased advance care planning  Increased conversations around “values”  Allen Verhey:  Church-centered gatherings for advance care planning  Venue for conversation that goes deeper than “who decides”  Opportunity for catechesis re hope, patience, interdependence, etc.  Endeavor to become a community of moral discourse (where we can dialogue and discern together)  Collaborate with healthcare systems to bring clinical expertise into mix of discussion. Conclusion

 The virtues of living and dying well  Patience  Compassion  Faith and Hope  Courage / Serenity  Agency in dying / Dying as a moral act  Embodying virtue  "Please forgive me," "I forgive you," "Thank you," and "I love you"