‘Lord, he whom you love is ill’
Christian wisdom and the Care of the Sick
Introduction
The problem of suffering is not a very cheerful topic. I have been drawn to this topic while teaching bioethics for a number of years. On a more personal note, I have been drawn to it through a friendship with a man about my age who was diagnosed in 2010 with ALS. After he began recognizing symptoms but before diagnosis, he focused on discovering the cause and cure of the disease. After diagnosis, he has focused on developing spiritual maturity, on discovering the meaning of his suffering, and on understanding how to continue, as best he can, to play the roles of husband and father. This search for a meaning in suffering and the effort to continue his place in his family’s life provoked a serious conversion of mind and heart.
Medical science exists to alleviate suffering, yet bioethics literature says little about suffering. In an effort to bridge that gap in a bioethics course, I included some writings by Christian saints reflecting on death. There is St. Ignatius of Antioch, martyred in the Roman Colosseum, who is positively jubilant that the lions' mouths will become his path to eternal life. There is also St. Thomas More, who earnestly does not want to die, observes that Jesus didn’t either, and struggles to share Christ’s willingness for self-sacrifice.
The Christian approach to suffering and death contains a somewhat obvious paradox that nonetheless balances ethical reflection on suffering. Christianity recognizes that both suffering and death are evil and to be avoided. But it also recognizes that each might be accepted under certain circumstances to bring about some good. The difficulty is to understand which circumstances and for what good. Working through this difficulty is a very personal process, as one can see when reading the saints as they reflect on suffering and on preparing for death. Nevertheless, people recognize some rather impersonal moral boundaries about using medical means to alleviate suffering, even when they disagree about the boundaries.
Proponents of euthanasia, for example, argue that this practice rightly eliminates suffering by accepting death, or more precisely, causing death. The practice uses medical technology to cause death when someone, usually the patient but sometimes a medical or legal authority, judges that the intensity of suffering surpasses the value of life. Opponents of euthanasia, of course, argue that suffering from disease should be accepted, when it cannot be alleviated, to avoid the moral suffering of deliberately causing death.
To take another example, the overuse of life prolonging technology is a kind of mirror image of the practice of euthanasia. The clinical situation is similar. Medical technology can do little to improve the patient’s health. The ethical question falls to the opposite extreme. Medical technology is used wrongly to prevent death rather than to cause it. In this scenario, however, the ethical question is less clear and thus ethical principle requires more interpretation. The question is less clear because it is difficult to know when the use of medical technology becomes overuse. The ethical principle--extraordinary or disproportionate means--allows that the use of a particular medical intervention becomes optional before the point of overuse is reached and allows that people may disagree about when use becomes overuse.
These disagreements are often presented as disagreements about values. The value, or meaning, of suffering is certainly one of those values because medicine exists to eliminate suffering, medical interventions sometime impose suffering, and people recognize good reasons for accepting suffering, even though they disagree about the reasons. Medical treatment directly addresses certain kinds of suffering, influences others indirectly, and leaves others untouched. Thus the problem of suffering changes as treatment becomes less effective and as disease deprives the patient of bodily functions, of future projects, and finally of life. As a kind of default position in developed nations today, people expect that medicine can prevent most suffering from disease most of the time. Yet people also recognize that medicine cannot prevent some suffering, especially spiritual suffering, such as a guilty conscience. Eventually disease forces a patient away from that default position and into a position of accepting worse health and possibly more burdensome treatment. As disease progresses, the problem of suffering becomes more a mystery to be understood than a problem to be solved. For this reason, addressing suffering requires non-medical human activities, such as education, meditation, and prayer.
This article explores the kinds of suffering involved with disease and shows that the kind of suffering that motivates requests for euthanasia and hastening death is the kind that medicine is ill equipped to address directly. The article then proposes a Christian interpretation of suffering capable of grasping both the depth of evil in suffering and the variety of goods possible with its acceptance, with the hope of eventually offering a framework for considering the use of medical technology to address suffering.
Kinds of Suffering from Disease
The word suffering refers to the imposition of pain, injury, or distress. In this definition, the word "imposes" carries a general meaning of “set against the will of the one who suffers," but does not usually mean deliberately imposed by another. Disease imposes pain and injury to the body and distress to the mind. The patient discovers the disease when it causes pain or during a routine physical examination. One knows that something is wrong with one’s body and experiences distress. The presence of disease may come as a shock. Emotionally, the patient suffers grief. Having recognized the disease, the patient must submit to the condition with its pain, distress, and grief.
All of these kinds of suffering--pain, distress, grief, and submission--might intensify as the patient begins to consider the future. The patient recognizes that some of his body's systems have tilted against his well being. Pain might increase and spread and eventually be considered what some today call “unbearable suffering.” The present grief will extend across time and perhaps intensify. Others have studied the progression of the disease and can predict future suffering. The patient might experience a mixture of the will to know and not to know about whatever suffering the future will bring.
Suffering also has the meaning of loss. Disease typically deprives the patient of bodily functioning and thus loss of control over the actions supported by the lost functions. The patient suffers distraction from desirable activities when pain and concern occupy the mind. He may have to abandon important projects rendered impossible by the loss of function in his body. The disease may compromise his social, professional, and familial roles and force a change in relationships accompanied by the threat of marginalization or abandonment. The patient may suffer a strained relationship with his body, which gives him his very earthly existence as well as a place for suffering.
Suffering also carries the meaning a trial, of having to undergo some terrible experience. Every disease eventually ends either in cure or in death, and the path to one or the other may involve a long period of infirmity. Some patients will suffer the uncertainty of which it will be. They may go through different stages of grief and pain and suffer the burdens of treatment and care. Medical treatment and care involve a host of relationships with caregivers and those who pay for care. These relationships might turn out to be detrimental rather than beneficial and in any case require effort by the patient or proxy to maintain.
Suffering also has the sense of being punished for sin, i.e., "to suffer punishment." Some ancient peoples believed that the sick person's sin caused disease. Modern science has outlined the biological causes of disease and enabled us to distinguish more clearly the consequences of pathological processes from those of deliberate actions. As a result, most people do not blindly assume that their diseases must have been caused by sins.
Suffering, however, can exacerbate the weaknesses in a patient’s personal habits and relationships. By bringing these weaknesses to light, suffering from disease can intensify the moral and emotional sensitivity to one's actions and lifestyle. One might view oneself as suffering not only from disease but also from an underdeveloped, malformed, or damaged character, carrying with it the incapacity to perform certain good actions and the tendency to perform certain bad ones. Examining one’s conscience might be experienced as both suffering and relief. Those who have neglected the examen of conscience will suffer its unfamiliarity, while its ongoing practice may bring greater understanding of self and sin and may bring the moral healing of repentance.
Various experiences of being sick may give rise to shame, another kind of suffering. The requirements of examination and treatment and the thoughtlessness of caregivers might compromise a patient's modesty. Weaknesses in a patient's character might bring poor behavior and shame in retrospect. Illness might make the patient dependent upon family and friends, expose weaknesses in those relationships, and bring shame. The judgements of others about the behavioral causes of the illness might, rightly or wrongly, bring shame. Finally, the patient may have to face the fact that medicine, while it might help others, cannot help him.
Suffering from disease makes one vulnerable to the sins and mistakes of others. Others' sins might be the main cause of a patient's medical condition or of a psychological condition that leads indirectly to illness or compromises the ability to cope. Professionals might make mistakes in diagnosis, treatment, and care. Caregivers might make unfair judgements about the patient's quality of life. As a result, the patient might be killed or might end up bearing the consequences of those sins and mistakes in his body as an ongoing reminder of the harm done. Emotionally, the patient might suffer a sense of indignation at undeserved physical suffering.
All of these kinds of suffering might lead the patient into a kind of suffering called “existential suffering” in bioethics literature. Existential suffering is associated with the loss of a sense of purpose in one’s life or of the ability to act for that purpose, with the loss of supportive relationships and the consequent onset of loneliness, with the loss of a sense of mystery and purpose about the things one cannot control, and with the loss of personal dignity.
Different types of suffering require different kinds of responses, and the suffering of the person as a whole requires a comprehensive response. Medical treatment heals primarily the biological dimension of the body and indirectly the emotional, mental, and spiritual dimensions. Other means of healing are required to truly address those other dimensions of suffering. The spiritual challenge for patients and caregivers is to recognize the kinds of suffering present and the means adapted to address them. Another such challenge is to cultivate a willingness to accept well-adapted means and resist the temptation to use medical interventions to treat the kinds of suffering that require other means.
Reasons for requesting euthanasia and hastening death
Euthanasia is often presented as an attempt to control suffering but in reality leaves significant suffering unaddressed. Empirical research suggests that patients seek euthanasia in order to eliminate existential suffering, even though society at large typically accepts euthanasia on the grounds that it eliminates pain and unacceptable disability. One Swiss study by Susanne Fischer et. al. surveyed the records of 165 people who died by voluntary euthanasia to identify physicians' reasons for performing euthanasia and surveyed letters written by those patients to identify their reasons for requesting euthanasia. The authors found that various reasons account for persistence in seeking euthanasia and that the fundamental reason has more to do with relieving existential than physical suffering. Both physicians and the deceased frequently cited pain, the need of long term care, and neurological symptoms. The authors downplay these aspects of physical suffering because society accepts those reasons and legislation names them as requirements for seeking euthanasia.
This conclusion is sound up to a point. It is true that legal requirements can skew the public expression of reasons for certain actions. It is equally possible, however, that legal requirements reflect good reasons for practices commonly accepted in a polity. In this case it is significant that, even without social pressure to do so, patients give existential reasons such as “loss of dignity” and the desire to “control the circumstances of death” just as often as reasons that reflect the legal requirements for assisted suicide.
A study on hastening death shows that patients who discover meaning in life despite their suffering and who have companionship were less likely to persist in requests to hasten their deaths, if indeed they ever made them. In a recent systematic review of literature, Cristina Monforte-Royo et al. found that a patient’s expressing a wish to hasten death “does not necessarily imply a wish to die, and it appears as a response to an overwhelming emotional distress among patients in the advanced stages of disease.” The literature showed this distress developing as patients lost bodily function and thus control of action. This loss meant a loss of autonomy and human dignity, which the patient interpreted as a loss of meaning in life. This loss of the sense of life’s meaning led to a loss of hope. The bodily and spiritual deterioration culminated in the wish to hasten one’s death.
The authors of this article identify the expression of a wish to hasten death with a cry for help and companionship. The conditions of increasing dependence upon yet alienation from others work against each other so that, in effect, the patient expresses a wish to die without truly wishing to die. Tellingly, in the literature they discern the theme “desiring to live but not in this way” and explain that it “expresses a veritable paradox, a cry for help, since at the same time as expressing their wish to die these patients are seeking help and companionship.”
Finally, the authors conclude that the wish to hasten death is an effort to maintain control over one’s life and that this wish to hasten death is usually abandoned. They observe that the wish to hasten death is “rarely transformed into action, and was more akin to ‘having an ace up one’s sleeve, just in case.’” In other words, a wish to hasten death is in reality a wish to possess a failsafe ability to eliminate suffering.
If the conclusions of the studies reviewed above regarding euthanasia are correct, existential suffering comes from the patient’s fear of abandonment by others and the patient’s distress at losing control of the body. Medical procedures are quite limited in addressing these types of suffering. In reality, no human technology or action can eliminate suffering in all its forms, and a variety of methods to address the different dimensions of suffering are all necessary. A comprehensive resolution to the problem of suffering happens through a conversion that occurs within the person. Regardless of one’s philosophical or religious convictions, this conversion involves considering the meaning of suffering and the reasons for accepting it.
Meaning of suffering on Christian principles
Christian theological tradition preserves a paradoxical view of suffering and death; they are evils to be avoided but nonetheless might be accepted in certain circumstances so that some good comes to the one who suffers or to others. It is possible to identify some commonly recognized goods that come of suffering, such as physical healing in which suffering could not have been avoided, preservation of moral integrity by avoiding sin, character development achieved through learning to manage suffering, atonement for sin, and the witness to love through suffering for others.
The Christian theological tradition sets the good that comes of suffering against a penetrating understanding of the evil of suffering and death. It allows us to understand more deeply the existential fear of being abandoned and of losing control over one’s body that the sick sometimes experience. In his apostolic letter Salvifici Doloris (SD) on the Christian meaning of human suffering, Pope John Paul II not only captures the commonly understood aspects of existential suffering but also identifies another important aspect of existential suffering: the radical dis-integration of the spiritual and bodily aspects of the person in death. He describes death as
“a definitive summing up of the destructive work both in the bodily organism and in the psyche. [It] primarily involves the dissolution of the entire psychophysical personality of man. The soul survives and subsists separated from the body, while the body is subjected to gradual decomposition…. [T]he evil which the human being experiences in death has a definitive and total character” (SD 15).
For the patient, especially the seriously ill patient, confronting this “dissolution” of the self begins with suffering from disease and with the loss of bodily functions and of one’s future projects. This disintegration of the body and self may become a sign for the patient of an inevitable “going out of existence.” This suffering may also make the patient feel like a burden to others and liable to be abandoned. The disintegration of relationships may become a sign of an eternal separation from humanity and from God.
One challenge, then, for Christian moral theology is to show how the Christian meaning of suffering addresses these different dimensions of the person and provides hope for an eternal union with God. Following a theological method that John Paul II explained in the "Theology of the Body" and in Veritiatis Splendor, Salvifici Doloris attempts to use divine revelation, especially a close reading of scripture, to develop a theological anthropology adequate to ground moral reasoning. In Salvifici Doloris, he focuses upon Jesus’ conversation with the Pharisee Nicodemus and upon Paul’s writings to argue that Christ’s willingness to suffer out of love for humanity ultimately invests human suffering, in all its dimensions, with meaning.
In the Christian tradition, confronting suffering ultimately has the meaning of overcoming sin and expressing love. In the biblical story, Jesus tells Nicodemus that he must be born again “of water and the Spirit” in order to enjoy eternal life (Jn 3:5). This rebirth involves the believer’s suffering because Jesus’s words about water and the Spirit refer directly to baptism, which is the new follower’s participation in Christ’s death as well as his resurrection. Jesus teaches Nicodemus that Jesus’s suffering will bring eternal life like “Moses lifted up the serpent in the wilderness” (Jn 3:14). Jesus overcomes human sinfulness by confronting death, as Moses risked death by lifting a serpent by the tail. Sin brings the risk of harm and death, but Jesus' willingness to place himself between the forces of good and evil demonstrates the kind of love capable of revealing the meaning of suffering. In Salvifici Doloris, John Paul II focuses on the verse illustrating this love: “For God so loved the world that he gave his only Son, that whoever believes in him should not perish but have eternal life” (SD 14, quoting Jn 3:16).
This verse refers not only to God’s love for humanity but also to the person’s need for faith to avoid “perishing” and to enjoy “eternal life.” But there is a serious difficulty in Jesus’ words because it is often faith that suffering undermines. As the story continues, Jesus even has stern words for the Pharisee, telling him that even though “God did not send his Son into the world to condemn the world, … whoever does not believe is condemned already” for people “loved the darkness rather than the light because their works were evil” (Jn 3:17-19). Jesus’s words seem to place responsibility for condemnation on the suffering person. Although it is true that unrepentant sinners condemn themselves, Jesus is not teaching Nicodemus about this issue. Rather, he seeks to temper Nicodemus' enthusiasm for the divine power that Nicodemus recognizes in Jesus. Notice that Nicodemus is attracted to Jesus by "these signs that you do" (3:2). When Jesus teaches Nicodemus that "one must be born again to enter the kingdom of God," Nicodemus thinks immediately, or perhaps facetiously, of returning to the womb. In either case, the Pharisee’s response displays a vision limited to the actions that humans, rather than God, perform. Thus it seems more accurate to read Jesus' condemnation here as a reproof, perhaps exaggerated for effect, of Nicodemus' attachment to powerful human works. It is the same kind of exaggerated reproof that Jesus gives Peter--"get behind me, Satan!"--when the latter insists that Jesus employ his power to avoid suffering. Jesus tries to turn the minds and hearts of Peter and Nicodemus away from the power of earthly means to eliminate suffering and toward the salvific power of suffering to overcome sin.
John Paul II argues that this salvific power lies in Christ’s absolute goodness and innocence. Christ’s goodness lies in his consubstantial union with the Father, the source of all that is good. Yet this absolute version of the good can in Christ encounter evil as a sufferer. The encounter of absolute goodness with evil has “a depth and intensity of suffering … [that] is capable of embracing the measure of evil contained in the sin of man” (SD 17). The suffering of human beings cannot adequately address the evil of sin because human suffering comes in part from that same source, sin. By contrast, Jesus is good to the point of being perfectly innocent, and it is perfect goodness in confrontation with human sinfulness that both brings about suffering in Christ and overcomes the suffering of sin and death in human beings. Although the resurrection of Christ shows God’s ultimate response to human suffering, Christ’s passion shows its meaning--redemptive love--more clearly to human beings in the midst of suffering. Christ's willingness to suffer at this “depth and intensity” expresses a love of equal “depth and intensity.”
This most intense love of Jesus Christ does not seek to suffer but sustains a willingness to accept suffering. John Paul II draws attention to Christ’s prayer in the Garden of Gethsemane, which expresses a desire to avoid suffering, the possibility of good issuing from its acceptance, and Christ's acceptance of the latter: “My Father, if it be possible, let this cup pass from me,” but “if this cannot pass unless I drink it, thy will be done” (SD 18, quoting Matthew 26:39, 42.) Christ is good, innocent, and human and thus highly vulnerable to suffering and highly motivated to avoid it. Nonetheless he voluntarily embraces suffering, inflicted by others, for their own good, to unite them with himself. The person suffering from disease is in a similar, though not identical situation. The patient typically has not committed any action knowing that it would lead to illness and so is innocent. This kind of suffering is the most difficult to accept because the patient has done nothing to deserve it. Like Jesus on the “Way of the Cross,” the patient is vulnerable to an increase of suffering, including that inflicted by the sins of others. Unlike Jesus, the patient is vulnerable to his own tendency to commit sin, albeit for the noble goal of avoiding physical or psychological suffering, and vulnerable to increased moral suffering in conscience. The patient is highly motivated to avoid suffering unless there might be some good from accepting it.
St. Paul speaks of the good of “filling up what is lacking in Christ’s afflictions” (SD 24, quoting Col 1:24). John Paul II’s discussion of this doctrine in Salvifici Doloris identifies three ways in which the Christian’s suffering completes what is lacking in Christ’s suffering: the purification of the sinner from sin, the imitation of Christ’s defiance of suffering by accepting it, and a solidarity in suffering that heals relationships between “neighbors,” especially within the Church.(SD 24) In 2 Corinthians Paul attempts to reconcile with the Christian community in Corinth, which apparently had refused to defend him against a visiting Christian who had personally offended Paul and denied his Christian authority. Paul defends his authority by arguing that his willingness to suffer for the gospel proves the integrity of his faith in Christ and his authority to preach the gospel’s implications for human life.
One might object that Paul’s situation is vastly different from that of a patient suffering from disease. Paul's suffering is not primarily bodily but rather the suffering of social rejection. In reply, consider that Paul would certainly have experienced illness among his many trials, which included several near death escapes. In addition, Paul’s suffering involved the same physical, emotional, social, and relational dimensions that are involved in the experience of illness and discussed above. While Paul's situation in 2 Corinthians is not that of a patient, the understanding of suffering expressed in this letter draws upon a wide experience of suffering, including that from illness.
What meanings of suffering did Paul express in 2 Corinthians? He presented his suffering first and foremost as the test that proves his faith and moral character, and so defends the integrity of his ministry against the criticism of other Christian leaders. He appeals to “afflictions, hardships, calamities, beatings, [and] imprisonments” so that the Corinthians may find no fault in his ministry or obstacle to their trust in him (6:3-5). He distinguishes himself from Christians who base their authority on faith while lacking evidence of their willingness to suffer. Appealing first to their common faith and then to his willingness to suffer for it, Paul writes: “But whatever any one dares to boast of … I also dare to boast of that. Are they hebrews? So am I. Are they Israelites? So am I. Are they descendants of Abraham? So am I. Are they servants of Christ? I am a better one … with far greater labors, for more imprisonments, with countless beatings, and often near death” (11:21-23). Paul’s suffering is evidence of his fidelity to Christ and trustworthiness before the Christian community of Corinth. His suffering is a test, and he is passing it.
Although Paul boasts of his sufferings, he distinguishes necessary from unnecessary suffering. He does not seek to inflict unnecessary suffering either on himself or on his fellow Christians or even upon the visiting Christian who had offended him. For example, in order to reconcile with the Corinthian Christians, he thought it would cause less grief for everyone, including himself, to write rather than visit. His letter reveals his own internal struggle--affliction, anguish of heart, and tears (2:4)--along with his estimation that his presence would embarrass them: “For I made up my mind not to make you another painful visit. For if I cause you pain, who is there to make me glad but the one whom I have pained” (2:1-2)? He thought it better to reconcile with them by exchanging letters so that their reunion would be an occasion of joy.
Paul recognizes that the actions necessary to bring about reconciliation will bring suffering. He acts decisively, with honest intentions, but mixed feelings. Referring to that earlier letter, Paul writes: “For even if I made you sorry with my letter, I do not regret it (though I did regret it), for I see that that letter grieved you, though only for a while. As it is, I rejoice, not because you were grieved, but because you were grieved into repenting, for you felt a godly grief, so that you suffered no loss through us” (7:8-9). Suffering grief brought about a good--repentance--which in turn led to a variety of other spiritual goods, including what Paul calls “earnestness” and an “eagerness to clear yourselves” (7:11). It led also to a charitable correction of the offending Christian (2:6-7).
In 2 Corinthians, suffering also instills a sense of God’s sovereignty, coming in the form of God's merciful power to save. At the beginning of the letter, Paul recalls the afflictions that he and his companions had encountered in Asia Minor, which left them in despair and near death. Paul does not conclude that God had abandoned them but that those sufferings were meant “to make us rely not on ourselves but on God who raises the dead” (1:9). This experience raises in Paul the expectation that God will continue to deliver them from death. But Paul does not suppose that God’s deliverance will eliminate or even lessen their suffering nor does he conceive of God as an instrument whose role it is to spring them from trouble. Deliverance means bringing new life to the body by kindling a faith in God’s sovereignty, expressed here as a "transcendent power:"
But we have this treasure in earthen vessels, to show that the transcendent power belongs to God and not to us. We are afflicted in every way, but not crushed; perplexed, but not driven to despair; persecuted, but not forsaken; struck down, but not destroyed; always carrying in the body the death of Jesus, so that the life of Jesus may also be manifested in our bodies. For while we live we are always being given up to death for Jesus’ sake, so that the life of Jesus may be manifested in our mortal flesh. So death is at work in us, but life in you.” (4:7-12)
One might object that Paul's view of suffering here reduces human beings to instruments that God uses to glorify himself. But Paul's thinking here reflects the view that the glory of God expressed in suffering is the reunion of sinful humanity with himself, which Paul conceives as "the life of Jesus ... manifested in our bodies." Paul clearly applies this idea of God's glory to human relationships, since he suffers with the Corinthians in order to reconcile with them.
The idea that suffering is necessary to attain the good is both a commonplace experience and a serious objection to the existence of a merciful and loving God. The difficulty is that if God were so loving, he would not require suffering for salvation. Paul does not answer this objection but does indicate one line of thought necessary to address it, i.e., the idea of sharing in another’s suffering. Paul willingly shares in Christ’s suffering to bring the comfort of the gospel to his Corinthian community, among many others. Paradoxically, their comfort, he says, is to suffer as he does, but he does not think of this suffering as their destiny. Rather, he thinks of their suffering bodies as an “earthly tent” whose mortality, that is sinfulness, is “swallowed up by life” (5:1-5). Sharing in others' afflictions motivates one to give comfort, but God enables a person to give comfort by first giving comfort: "[God] who comforts us in all our affliction, so that we may be able to comfort those who are in any affliction" (1:4). Paul teaches that God's sharing human suffering enables human beings to share in each other's suffering.
When Paul rejoices about the good that has come from his suffering, it seems as if the goal of suffering is to become content with it: “For the sake of Christ, then, I am content with weaknesses, insults, hardships, persecutions, and calamities; for when I am weak, then I am strong” (12:10). In the final analysis, however, Paul is not suffering in order to become content with it. Rather, he has a kind of indifference toward suffering that might be defined as an aversion toward any suffering matched by an abiding willingness to accept whatever suffering he encounters. He clearly seeks comfort over affliction. For the right kind of comfort, he willingly accepts affliction, and this acceptance seems a necessary path to comfort: “For as we share abundantly in Christ’s sufferings, so through Christ we share abundantly in comfort too” (1:5). This attitude of indifference is based on the trust that somehow his suffering has a meaning, whether or not he is aware of it at a given moment. Paul's sufferings eventually enable him to convince the Corinthians of his authority to teach about the moral demands of the gospel. But he did not know that meaning at the time.
Conclusion
So what would I tell my friend who suffers from ALS? First, I am sorry that you are suffering. You have done nothing that deserves it. It would be better if it had never happened. You suffer innocently, and on that score like Christ, whose innocence and absolute goodness make his suffering more intense and more effective. I am happy that you have discovered ways to manage the existential suffering for which others in your circumstances have used medical technology to end their lives. I wish that medicine could cure the disease and am happy that it can alleviate some symptoms.
Then I would say that others, including myself, share your suffering, as much as we can, for our mutual benefit. You confront intensely the various kinds of suffering that the rest of us confront lightly, sometimes without noticing. We are afraid of enduring the same intense trial, but drawn toward you because we confront the same kinds of suffering. We learn something from you about the good that comes from suffering and understand our life’s purposes better because of it.
Lest you think that we merely “use” you to understand our life’s purposes, we recognize that your experience is not our science experiment, designed to generate data and solve problems. Most of the suffering we experience appears as a problem to be solved, an evil that can and should be eliminated. But even our small sufferings involve a mystery to be understood. We understand that mystery by caring for you and confronting, as you do, the suffering that we cannot resolve on our own, even as we employ medicine to relieve the symptoms we can.
We recognize your vulnerability to being, or just feeling, abandoned and without purpose. The fact that you are never really alone, because God is present, is not always apparent. We recognize that sometimes only our human companionship will convince you of love. We will also have to say that we are perfectly reliable neither in medicine nor in companionship. If the willingness to suffer refines character, overcomes sin, and has any power to reconcile neighbors, you may boast more than we and are the better servant of Christ.
I recognize how you must place your faith in a variety of people and things. There is the investment in technology that sustains life and comfort, and yet a misplaced ventilator tube quickly turns into a near death experience. There is the faith in the medical professionals who interpret the signs in your body and tell you what to expect. There is a great deal of faith in family and friends to take care of your needs. But none of these satisfy all of your needs, and you encounter a dimension of suffering that leads you to the question of God.
I appreciate in you the kind of attitude toward suffering that Christ and Paul practiced: a desire to avoid suffering, a willingness to accept it for some good, and a commitment the latter. When they had judged it good to avoid the evil of suffering, they strove heartily to eliminate it. When they judged it good to pursue the benefits associated with suffering, they nursed the suffering spirit in such a way as to make those goods possible.