What's Tony Thinking

With the End in Mind


With the End in Mind is the title of a book I’m just into at the recommendation of a good friend. It is by the British palliative care physician Kathryn Mannix.

With the End in Mind is a series of well-drawn and often dramatically told stories from Mannix’s 3o years of practice of palliative medicine. I suspect the British medical system handles palliative care better than our American system, prone as ours is to technological intervention and a tilt toward “heroic measures,” not to mention the larger “corporatization” of medical care.

Mannix reminds us of what we have forgotten: that death is a natural part of life with predictable patterns. It need not terrify us and cause us to shroud the whole experience in silence and euphemism.

She also reminds us that until fairly recently human beings and communities knew these things about death and had ways of supporting both the dying and the grieving. But recent generations of medical practice have tended to isolate the dying from the living and to rely on technology. It has placed people at special removes like hospitals and ICU’s. As a consequence, death has been medicalized and the rest of us have become unfamiliar with death and so frightened of it. COVID, obviously, added a whole new level to this terrible isolation of the dying.

As a pastor and a family member I have had the privilege of being present at the time of dying. When my own time comes I hope that I will be able, as my sister was, to be at home and in the care of family and friends.

As a pastor, you are more often present as people are in the process of dying and after death has taken place than at the actual moment when death comes. But sometime I have been there for that. And again, I am grateful for those experiences and that I have been able to provide some guidance and comfort particularly to the family members of the dying. It is a time when people need reassurance and a guide in much the way that a midwife provides these things at the time of birth.

In the latter years of my ministry I began to offer a service of “Worship at the Time of Death.” If I wasn’t there at the time of death itself, a family would call shortly after and we would have a service and time of remembrance with the body of the deceased still present. Usually, there’s no huge need to rush to have the body removed quickly. Some cultures and faiths, in fact, have rituals to cleanse and care for the body of someone who has died.

I was so grateful when my sister, Regan, died that her dear friend, Rhoda, said that she wanted to dress Regan in one of her favorite dresses, which she did. Rhoda fixed her hair and applied just a touch of make-up. And as it was the time of year when sweet peas were in bloom — a flower Regan loved — we gathered a bouquet. Rhonda placed the flowers in Regan’s folded hands. She was peaceful and beautiful as we paid tribute and prayed together offering her to God’s care.

So, I recommend With the End in Mind, which I’m only a third of the way into at this point. So I’ll probably have more to say about it in a future blog. I would add just this one thought at this point. The isolation of the dying has not only contributed to our fear of death, but has I suspect, heightened society’s turn to physician assisted suicide. Fearing the unknowns of death and dying, we have wanted to gain control over it. While there may be times for medically assisted suicide, I suspect knowing more about the dying process and its patterns, as well as providing good palliative care, would result in fewer instances of turning to medically assisted suicide.

In the meantime, we have returned to the Wallowas after a brief, happy visit to Seattle to celebrate the 8th birthday of granddaughter, Lila. Here’s a photo of a happy Grandpa with, in order, Colin, Levi, Lila, Cora and Olive.

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