Facing Death: Where Culture, Religion, and Medicine Meet.

By Howard M. Spiro, Mary G. McCrea Curnen, Lee Palmer Wandel (New Haven: Yale University Press, 1996. xxii plus 212pp. $27.50).

The strength of any collection of papers tends also to be its weakness: the amount of territory it covers. The problem is alleviated in this volume by the fact that all the papers came from one Yale conference (most of the authors of the twenty-two chapters are Yale-connected professionals). But after dividing the contributions equally into two loose categories - "Part I Witnessing Death: The Medical Battle"; "Part II Framing Death: Cultural and Religious Responses" - the editors are left with a collection of very uneven contributions to this vast, important topic.

On the plus side, the book offers something to almost everyone concerned with issues surrounding death and dying. Further, the author list comprises a refreshing mix of well-known and less familiar names. Among the former are Sherwin B. Nuland, Joanne Lynn, John Demos, and William J. Bouwsma. Among the latter are the authors of the Part II chapters that address religious responses. Sylvia Vatuk takes up "The Art of Dying in Hindu India;" James A. Ponet offers "Reflections on Mortality from a Jewish Perspective;" Valerie Hansen looks at "The Law of Spirits: Chinese Popular Beliefs;" and Ira M. Lapidus undertakes to explain "The Meaning of Death in Islam;" while Harald Wagner lays out some of "Catholic Theology's Main Thoughts." The success of these efforts is a function in part of how much readers know about these religions; the available space is insufficient to do more than introduce other ways of viewing death.

Lapidus comes close to acknowledging this explicitly, when he indicates he is giving "a sampling of Muslim beliefs and practices." (p. 148) Ponet, insisting that Moses's death is "dignified, simple, paradigmatic," (p. 132) nonetheless makes clear that how one ought to look at death is not simple for Jews. He sums up with the paradox that "God the Creator is God the mourner." (p. 135) Similarly, each exploration of a particular religious tradition leaves much to be said. The chief value may lie in inspiring readers to turn elsewhere for additional information.

Standing much more solidly on its own is the searingly perceptive and instructive essay by Peter S. Hawkins, "Ars Memoriandi," in which he explores and explains the NAMES Project AIDS Quilt. One could wish, on the other hand, that Frederick J. Streets ("Bearing the Spirit Home") had made some of his points more clearly. To say dying "is a social act for many people who are religious" (p. 181) verges on the banal; are we to believe that those who do not perceive themselves as "religious" find death necessarily an asocial experience?

The final two chapters are among the most valuable. William B. McCullough might well have replaced the "versus" in his title ("Witnessing Death versus Framing Death") with "and," given that he points out (indirectly) the importance of both. "The physician today more often confronts death in its raw form, as it is happening or about to happen," he says. "The religious 'framing' of death has the advantage of perspective, distance, and time." (p. 184) Bouwsma ("Conclusion: Retrospect and Prospect") puts in perspective what was said by the others and what they left out. The central question for him remains critical for all of us: "What, if anything, can be done to alleviate the fear of death that [is] so much a part of our own time?" (p. 195)

For many readers, Part I will be the more satisfactory half of the collection. Those unfamiliar with the history of the hospice movement in this country are bound to find helpful Florence S. Wald's "The Emergence of Hospice Care in the United States." Alan C. Mermann ("Learning to Care for the Dying") raises what may be the key issue in the book: "how do we learn to care for the dying in personal ways that are as skillful and significant as the clinical and research techniques we prize in the trained physician and investigator?" (p. 52) Lynn ("Caring for Those Who Die in Old Age"), with characteristic blunt brilliance, zeroes in on fundamental points: "Consider how often we forget the humanity while we intervene to fix the physiology" (p. 91); "I do not want to see us 'stop treatment and switch to palliative care.' I want palliative care all the time"; "Dying patients encounter a system dominated by concerns adverse to their interests. It is easier to get open-heart surgery than Meals on Wheels." (p. 99)

Lee Palmer Wandel's Introduction ("Defining a Life: The Western Tradition"), however well intentioned, is not one of the strengths of the book. She undertakes far too much with her wild race through Western thought. Thus, despite Daniel Callahan's incisive Foreword and Howard M. Spiro's clear Preface, readers who begin at the beginning may be put off. Certainly they will get a misleading impression of the book; better to skip the Introduction or leave it for last.

Constance E. Putnam Tufts University