"Life," says the French physiologist Bichat, "is the sum of the forces by which death is resisted." Life, in other words, is dead matter set in motion by the forces of efficient causation. If this all sounds eerily like a description of the modern intensive care unit, then Bishop has made his point. This is how doctors think.
Yes. But as Sulmasy himself goes on to note, the situation is actually far worse than that. It's the way that we all think:
Once this metaphysics is coupled with the politics of population statistics . . . Bishop argues that only two forces remain to fight for control over life and death: the modern state and the sovereign self. Each fights it out at the bedside, wielding the efficient causation of political power to determine whether the lifeless matter of the body continues in motion or dies.
If that brief snippet of the review leaves you feeling as if you live in a world where your life is nothing more than a lump of raw meat that is protected—albeit temporarily—by fast-changing laws, mores, and your own, futile attempts to preserve your life, then you are right. There is nothing sacred or transcendent in the calculus of modern medicine.
And heaven help you if you are unborn, in the ICU, Cardiac Care, or just too damned old—or not, really, because heaven is an irrelevancy. So scratch the reference to heaven and let's just acknowledge that if you are too slow to get off the starting block—or when you inevitably slow down at the end—you are just plain out of luck.
Dr. Bishop is no egghead (although I did tell him once that he should get a new hobby instead of a new degree). He is also an MD and he has been a firsthand witness to the practice of medicine. Together with another colleague, we wrote an article some years ago that dealt with related issues and we made the point that life and its end were, at one time, part of a sacred mystery.
In the medieval world, you lived out your life in connection with God. As you died, if circumstances allowed, you made your final confession, received the Eucharist, and you were anointed with oil in what we call last rites. Life's final moments—just as surely as all its other moments, were embraced by the presence of God. That's not the case any longer, but it could be and it should be.
Contemporary thinking will tell you that this is religious mumbo jumbo, the product of obsolete convictions about the value and nature of human life, wrapped up in a giant fantasy. But that simplistic assertion hides the fact that there is no approach to medicine and life that is not thread through with powerful assumptions. Remember, for a moment, that it was the Nietzsche-loving Adolf Hitler that gave us the death camps and it was that religiously deluded fool, Dietrich Bonhoeffer, who left the comfortable environs of Manhattan to die eventually in solidarity with German Jews and Christians in 1945. So, the hollowing out of religious convictions is no guarantee of moral sanity.
This isn't Nazi Germany, of course. But the way in which we treat life is deeply conditioned by the place we start. Begin with the assumption that life is sacred—a God-given gift—and you will move slowly, carefully to honor it. Start by thinking that we are all just slabs of meat, protected temporarily by a string of laws and fragile assertions about the value of our lives, and it is much harder to claw your way back to a place of reverence.
From a Christian and spiritual point of view, we will never get back to that place at the hands of the government and public debates about the appropriate limits on health care. No matter how much sensitive rhetoric is wrapped around it, in the final analysis those efforts are the feeble attempt to backload what has already been lost: a reverence for life rooted in the notion that you and I are made in the image of God.
The modern western world revolves around "efficient causation." So, the public debate over health care will be about life expectancy, mortality statistics, budgets, and human rights—such as they are, when humans are no longer anything particularly special. In that environment the Christian perspective on the sacred nature of life will remain unwelcome and unintelligible to many. That should sadden us and motivate us, but it should not deter us.