REVIEWED BY PATRICK McCRUDEN
Is God Still at the Bedside?
By Abigail Rian Evans
Wm. B. Eerdmans Publishing Co., 2010
502 pages, $30
Is God Still at the Bedside? is a carefully organized and thorough account to which author Abigail Rian Evans brings a distinguished career as a pastor, theologian, teacher and administrator. Recently retired from Princeton Theological Seminary, she consistently combines careful philosophical and theological scholarship with empirical data and the lived experiences of patients, families, health care professionals, pastors and others involved in the care of the sick, dying and bereaved. Evan's text is comprehensive in its scope, well researched and documented while simultaneously filled with enough narrative and vignettes to make the reading consistently lively, interesting and thoroughly practical.
Evans explores a familiar enigma. Ours is a nation with deep religious roots, and these roots have contributed much of the language and ideas that inform and support our common beliefs around death and dying and the morality of end-of-life decisions. But as death has become more medicalized, the experiences of dying, death and bereavement have lost their connection to a practical theology that can make sense of pain, suffering and death and give guidance to the moral questions that frequently arise at the end of life.
Early in the text, Evan's observes, "There are many people who believe in God, but when they address serious illness or death, they turn solely to the medical profession and do not try to understand how God is involved." Obviously this statement is a generalization, but, I believe, a generalization that she adequately illustrates with careful observation and empirical data. When the remedies of medicine were few and often all the medical profession could do was provide supportive care while an illness ran its course, the role of the church and practical theology was evident in the care of the sick, dying and bereaved. With the advances in medical science in recent decades, dying and death have moved death from the home to the hospital and often exclude family, faith and other values in deference to medicine's laudable goals of preserving and extending life.
Just one example that will be familiar to many is the practice of keeping family from the emergency room or intensive care unit to allow the medical team room to practice. Evans shares several stories of how a medicalized death leaves the patient isolated from family members at the hour of death and leaves the bereaved with additional trauma from these last experiences. This kind of attention to the lived experiences of patients and families continues throughout the text.
The book itself is comprehensive in its scope. It begins with a prologue examining philosophical and theological concepts around human life and then moves to an analysis of contemporary attitudes towards death (including a novel and interesting section on after-death experiences.)
The second part of the book is an analysis of some of the major issues facing patients and families at the end of life, such as termination of life support, the distinction between killing and allowing to die, an examination of the "right to die" and physician-assisted suicide followed by a discussion of organ donation and important legal cases in the area of end-of-life care. For each section, Evans presents in a cogent fashion the moral questions at stake and the major philosophical and theological positions examining these questions. Again she is careful to augment theoretical exposition with narrative experiences and the distinct voice of the Christian tradition and faith.
Part Three of the book examines the experience of dying, including a sensitive analysis of pain and suffering, the patient's response to a terminal diagnosis (in its various forms), an examination of the hospice and palliative care movements and a moving account of grief and mourning for the bereaved left behind.
In Part Four, Evans looks at the changing role of the clergy and faith community in caring for the sick and dying including parish nursing and the role of the faith community in funeral services and after care. The book concludes with several appendices including empirical data as well as helpful resources for patients, families, pastors and caregivers around such issues as end-of-life planning, advance directives and funeral planning.
As Evans notes in her preface, the book was written for a diverse readership. I believe this volume would be a solid addition to the library of any chaplain, pastor or parish nurse program or indeed for health care professionals seeking greater insight into the theological ramifications of medical care at the end of life.
PATRICK McCRUDEN is executive vice president, mission and ethics, St. Joseph's Mercy Health Center, Hot Springs Ark.