Gwande's piece is terrific, as are all his other articles on medicine. It does entirely lack, however, any consideration of faith or religion. While Gwande deeply examines end of life issues from the perspective of the professional, it is astounding that he fails to consider the spiritual beliefs of a dying person and how those affect end of life decisions. This is more astounding when the Coping with Cancer study that he references has performed a great deal of research on how one's faith affects their end-of-life decisions. If/when you examine this topic, please also talk to those researchers at the Coping with Cancer study. They have looked at how one's faith affects medical choices and have found some surprising results. For example, patients do better when their spiritual caregiver is their doctor. When one's spiritual caregiver is a pastor, the patient usually has worse than normal end of life outcomes. These kinds of intersections between faith and medical decisions (which do more to drive the outcomes of patients than any other) are the most important but are entirely neglected in Gwande's piece. Finally, please be aware of the robust Christian tradition of ars moriendi. This tradition has long served to guide believers. I've written about this in my book, The Art of Dying: Living Fully into the Life to Come. And other writers have as well, such as John Fanestil in his book, Mrs. Hunter's Happy Death. Many Christians are giving this tradition another look in our age of extended and complicated dying.
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