Enhancing Life Near Death: A Q&A with Dr. Daniel P. Sulmasy

In many ways, contemporary medicine accepts the illusion that death is not inevitable, says Daniel Sulmasy, a professor of medicine and ethics and the director of the Program on Religion and Medicine at The University of Chicago. Sulmasy’s research for The Enhancing Life Project examines the relationship between life and death by exploring the ethical and spiritual care of dying human beings. Life, he contends, can continue to be enhanced even as a person is dying.

What was the spark for the research you’re pursuing for the Enhancing Life Project? Are these new questions, or an extension of past research, or both?

I’ve been interested in ethical questions regarding care at the end of life for a very long time. When I was a medical student, I was caring for a woman who was dying of breast cancer, and I’d figured out that she might have a very serious condition, a tumor pressing onto her spinal cord. But then the neurologist walked into the room in his long white coat, and he said, “Lady, you’ve got a big fat tumor on your spinal cord and we’re going to give you some radiation so you don’t get paralyzed.” And then he left the room, and I was left with a weeping mess of a woman, trying to help her figure out what this meant. It was really at that moment that I decided there was a better way to do medicine—there are ways to enhance the lives of people who are dying. This project gives me the opportunity to bring together and extend work I’ve done on the spiritual and ethical care of patients who are dying.

What is the difference between ethical and spiritual care at the end of life?

Questions about ethics are about what we ought to do in medical care at the end of life: ought we discontinue the ventilator for this patient, ought we try this new heroic measure to save this patient’s life? Whereas questions of spirituality are about meaning, value, and relationship: how to make sense of our dying, how to relate to members of our family, how to hold on to a sense of our own value. They’re not questions about what to do so much as how to be, how to live, how to cope. I think that clinicians have an underdeveloped recognition of the moral obligation to facilitate patients’ grappling with those spiritual questions.

What does “enhancing life” mean for you?

It’s very shortsighted to think that possibilities for growth, flourishing, and enhancement are diminished as a person is dying. I’ve seen people facing their own mortality in ways that exhibit supernatural theological virtues like faith, hope, and love. It’s deeply instructive to the rest of us who will survive them. Often we fail to recognize the ways in which the dying can be teachers for us about what it means to live a good life. And yet they deeply question their own value. We need to respond in ways that build up their sense of their own intrinsic dignity as they’re dying. Questions of relationship are also deeply spiritual. Why is it that brokenness in body reminds patients of the brokenness in their relationships? Can we establish conditions in which it’s possible to facilitate reconciliation? We should honor that as a need many dying patients have and see it as part of what we should do as healthcare providers.

What do you think Enhancing Life studies can offer your discipline, and why?

I want to remind clinicians of the possibilities for growth that humans have as they’re dying. To not see death as defeat, as something that merely points to the limits of medicine. It’s not just the end, but it can also be a time of great meaning and purpose and love.

How do public debates shape your work? What are you hoping to offer those debates?

The debate about the issue of end of life care is really two extremes: one group of people demanding legal euthanasia and assisted suicide and another group demanding treatments that even the doctors think won’t work. There’s an insistence on autonomy and a failure to come to terms with human limitation that I think is at the heart of both camps. The view that I propose is that as the body has its limits, so does the medical craft. Both physicians and patients have to learn to come to grips with those limits. We ought to withhold and withdraw life-sustaining treatments that are more burdensome than beneficial and treat patients’ symptoms in a way that facilitates their growth as persons at the end of life. But we neither take the extreme of ending that life prematurely or trying to extend it beyond what’s reasonable. 

You don’t spend all of your time doing research and teaching! What’s your favorite place to travel, or your most recent travel? 

This summer, my wife and I went to the Grand Canyon and Zion National Park. Our daughter teased her mom—it’s just a lot of rocks. But they’re beautiful rocks. And one of the most amazing things about them is the way life flourishes among those harsh conditions. In the crevices between the rocks, life springs forth.