The Troubled Dream of Life: Living with Mortality.

THE TROUBLED DREAM OF LIFE

Living with Mortality

Daniel Callahan

Simon & Schuster, $21,272 pp.

A fellow passenger on a Delta flight glanced at my review copy of Daniel Callahan' s The Troubled Dream of Life and said, "Well, at least, the title is true." After having read it, I must also report that it is a beautiful book, richly suggestive and wise, beyond the capacity of this limited precis to convey. As a veteran of the classroom, I try to freshen my motive for teaching by assigning books from which I can continue to learn. Callahan's book will immediately supplant another in my course on the humanities and medicine; and I have several dozen friends, professional and personal, on whom I will personally urge this wonderfully spacious and healing meditation on the human condition.

The book puts the rampant debate about our contemporary responses to suffering and death in a new light. Conventionally, ethicists have discerned opposing moral drives behind modem, aggressive medicine and the reactive movement of active euthanasia. The modern medical establishment sees death as the supreme evil, defines the doctor as a fighter against death, and mobilizes all the technological resources of the profession in a pitched battle against disease and death. In effect, medicine attempts to remove the mark of mortality from our frame.

In reaction, supporters of active euthanasia abhor suffering, not death, as the supreme evil and thus would give up the battle against death, indeed kill, in order to spare the patient who so chooses, pain and suffering. In effect, they would solve the problem of suffering by eliminating the sufferer.

But Callahan sees a single moral obsession behind each movement. Both seek compulsively to solve the problem of human existence through control. Modern medicine springs from the larger attempt of modern science and technology to extend human control over nature--first, over the waywardness of the external environment and, more recently, over the contingencies of the human body itself. But the effort to counter disease and death ultimately reaches a limit. It cannot eliminate the ineliminable, our mortality. Further, as medicine wages its unconditional fight against death, it hugely expands another human contingency, the pain and suffering of those whom medicine has kept alive. In response to this latter state of affairs, those who advocate euthanasia would reassert human control by letting the patient design his own death and therewith bring his own pain and suffering to an end.

Callahan concedes much good in both the impulse and the results of the modern attempt to control the natural world and human life. Few of us would voluntarily give up the amenities, the abundances, and the rescues from disease and untimely death with which modern technology has favored us. Few of us, moreover, would want to impose gratuitous suffering upon ourselves or our fellows when we can, to some degree, reduce it.

But, beginning with himself, Callahan recognizes something morally unsavory about the moral ideal of absolute control-- either the controlling person or the society committed to unconditional control. Callahan confesses, "in most of my life, I want and demand a great deal of control. But I came to feel--though not at first clearly to think--that perhaps I ought not to want to be that kind of person. I came to notice that, in other parts of my life, my desire for maximum control has not always served me well. It did not create a person I could invariably admire."

The ironies of the impulse to control abound. Psychoanalysts have recognized that the person who insists on controlling everyone and everything is, in fact, out of control. The society that has prided itself in dominating the external environment has succeeded in massively polluting it and contaminating its own life. The society that urges without let or limit a battle against suffering and death, often imposes worse suffering and more turbulent deaths upon its members. Thus the medical establishment ought to aim at a good death, not at eliminating death.

At the policy level, Callahan recommends that the old question--"when is a patient dying, and thus a candidate for the abatement of lifesaving treatment?"-- should yield to the more appropriate question--"at what point, or within what range, should lifesaving treatment be abated to enhance the likelihood of a good death?" This new way of putting the question will not eliminate absolutely all pain and suffering, but it will help avoid those evils that beset us when we claim the right to control our fate totally.

Like the ancient Greeks, Callahan opposes excess. Adjectives that constantly appear in the text are "excessive," "obsessive." He is skeptical of the imperial self--the self that refuses to accept limits--either those limits which mortality itself imposes upon us or the limits borne of our finite and diminishing powers and our mutual dependency. The subtitle of the book Living with Mortality--nicely expresses the equilibrium we should seek. Manic aggressive medicine has sought to eliminate mortality and inflicted upon us longer lives and worse health, longer illnesses and slower deaths; longer aging and increased dementia. Enthusiasts for active euthanasia mn up against the pain and suffering of dying and the embarrassment of depending on others, and promptly opt out of living. We need to cultivate those virtues that allow us to live with our mortality.

As befits a classical teleologist, Callahan chooses aesthetic images to express our proper vocation within the limits of our condition. He likens us to sculptors who must respect and honor the limits and specificity of the materials on which they work or the flower arranger who learns how to work with the materials at hand, not longing for flowers not available. Religiously put, Callahan' s book can be read as an antignostic tract, against those who would use knowledge--and technology-- and medicine--to distract us from coming to terms with our mortal, limited condition.

Along the way, Callahan declares, "I am not a believer," but a kind of natural piety suffuses the book, and the epistemologieal optimism of his Catholic heritage in natural theology governs the work. He writes with a view to recovering what, in a sense, we already partly know and to reaching a consensus even though a consensus may entail some reshaping of our national character. He also writes with an unself-conscious humility (what other kind is there?) that is eloquent. Here is a man who more than anyone helped to create and congregate the pool of experts who write as medical ethicists, but he himself writes with a tone and spirit that reminds us of the moralist in us all. As Samuel Johnson put it, "We are all moralists perpetually, geometers only by chance."

In a closing coda, the provisionally skeptical Callahan still keeps the door open, "Can death, and the life in which it is embedded, be transcended? I do not see this for myself, but I hope to live the remainder of my days in a way that at least puts me in a position to be (as Wordsworth put it) 'surprised by joy.' It is unlikely but perhaps not impossible. I wait and watch."

In this passage, Callahan perhaps too quickly associates the transcendent solely with a life that somersaults beyond death. His own closing pages on "Solidarity and Death" suggest that he already knows, but does not name, a transcendent that perdures immanently in and through the "living sacrifices that human existence as such requires ." Do we not already participate here and now in the transcendent, as we live limitedly with and for others? Matthew 25 seems to suggest so in another version of surprised by joy.