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Let no one say America is a death-denying society. Our newspapers are full of articles reporting on battles over how we die. The Terri Schiavo controversy was not a blip of newsworthy gruesomeness on the pages of otherwise cheerful publications. Schiavo's story replicated others, on and off the front pages, that have been going on for more than 30 years. Death, once again, is changing in America, and we have been arguing about how to handle these changes since they began decades ago.

One hundred years ago, science made its first serious advances in pushing death later and later in life. Diseases like tuberculosis, pneumonia, cholera, and influenza struck towns and cities regularly until scientists discovered they were caused by germs that spread uninhibited in open sewers, trash heaps, and other unclean city sites. With the help of inoculations and public health initiatives, diseases of old age became the leading causes of death, especially heart disease and cancer.

Once again, death is changing. Stephen P. Kiernan writes in his new book Last Rights that further advances in medicine and public policy have displaced quick killers such as heart attacks, strokes, traffic wrecks, and other accidents. Instead, long-term illnesses have become the nation's leading killers. "In a recent fifteen-year span, deaths from chronic respiratory disease increased 77 percent. Fatalities from Alzheimer's disease have doubled since 1980. … People now succumb to congestive heart failure, lung disease, diabetes that leads to kidney failure, ALS (or Lou Gehrig's disease), Parkinson's, osteoporosis that results in falls, confusion and immobility." Despite massive research, AIDS and cancer, two other gradual killers, are on the rise.

For patients and their families, gradual death requires more sophisticated knowledge. This treatment or that one? At what point should treatment in pursuit of a cure end? For Christians, the instruction of the church in these situations is vital now that most of our information on the end of life no longer comes from personal experiences with the dying or the communal funeral rituals church communities once held, but from the media. Newspaper accounts of these situations do more to confuse a culture already bewildered by death, especially because of the difficulty in distinguishing between allowing a disease to take its course and actively pursuing death.

Last week, The Sydney Morning Herald reported on a controversy generated when an Italian man, after he spent years pleading for his respirator to be removed, finally succeeded. Piergiorgio Welby died soon after the respirator was removed. The Diocese of Rome refused permission for Welby to have a church funeral. In response, the former archbishop of Milan, Cardinal Carlo Maria Martini, wrote a letter to the Vatican asking for a reconsideration of its current position on end-of-life issues.

The Sydney Morning Herald, along with The New York Times, reported the story as a "right-to-die" case. The Vatican, they said, opposes euthanasia. While Cardinal Martini protested that "the wishes of the patient cannot be ignored," The Age made clear that the cardinal distinguished between active euthanasia—causing death by lethal injection or other means—and refusing "unreasonably obstinate" treatments. Yet The Age did not follow up with that distinction. It simply said, "The issue of euthanasia is regularly raised in many countries with some … more tolerant than others."

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February (Web-only) 2007, Vol. 51