October 4, 2009 Proper 27
Job 21ff (Moffatt) One day the angels again came to present themselves before the Eternal, and among them the Adversary. “Where have you been?” said the Eternal, and the Adversary answered “Roaming here and there, moving about the earth.” .....He still holds to his loyalty; it was idle of you to entice me to undo him” But the Adversary answered, “He has saved his own skin A man will let go all he has to preserve his life...”
The Book of Job is a virtual dog’s breakfast of the cultures and religions of Israel’s neighbors. Needless to say, this condition produces a kind of scholar’s feast which has prompted a wide variety of interpretations as to both it origins and meanings. Without much effort the vestiges of Edomite wisdom (a semi nomadic people who lived east of the Dead Sea and enjoyed a reputation for wisdom), the folklore of the Ancient near East, Egyptian pessimism as well as Babylonian scepticism have been found within the story. It is obvious to the eye but not necessarily to the ear that the book is composed of a prose prologue and epilogue which is quite traditional in its presentation, while the remainder is in a poetic style which belongs to the genre of wisdom literature. It is generally agreed that this division reflects the presence of two authors who used different sources to inform their work.
So then what is the Book all about? It has often been suggested that it was written to answer the question Why do the righteous suffer? Samuel Terrien has suggested that the ancient tale as well as the poem utilizes the problem of undeserved suffering for the pursuit of a broader and higher purpose. Because important and even crucial as the enigma of unrequited pain may have been for the time (the 6th century BCE) under whose feet a world had crumbled, a much more fundamental issue was at stake - what is the meaning of faith? If that be the case, then the issue here is about our knowledge of God and the working of the world which he has created.
Figuratively speaking we live in a era which feels more comfortable in its knowledge about the world than it does about the activity of God. But, Job’s life exists as our text reminds us in a patriarchal society in which knowledge of God is modeled after the role of monarchs who are free to act as they will. They do not give reasons but as our story reminds us they play games. So how do we match this story to our own situation? How do knowledge and faith meet in the 21st century?
I want to begin by suggesting that our current situation greatly shifts and complicates his problem but certainly does not eliminate it. Let’s begin with Job's affliction. While we cannot be sure of its exact nature, a good guess would be that it belongs to a group of conditions know as pemphigus, an autoimmune disease which produces painful blister like lesions. In its most severe form these develop in the mouth and larynx and without treatment it is almost always fatal. Its less severe form involves external lesions which are very painful. Today the treatment is most frequently corticosteroids. The actual cause of this disease remains unknown. So, it would not be unfair to say that today’s patients would not be out of line to ask - why me? when they receive the diagnosis.
Yet our situation is certainly very different from that of Job. We make the assumption that disease is a given aspect of the way in which nature works, frequently quite random in its operation (and here we are close to the arbitrary will of a king) but its cause should be knowable and treatment, if not cure, possible. Above all, we believe that the direction our response takes is a matter of human decision and this potentially leads us to the point where issues of life and death are inescapable. It is also clear that - to return to Job again - he specifically rejects taking a decision which would use certain theological death as a solution to his dilemma because it would involve renouncing God. (As an aside, note the clear similarity between the role of his wife and that of Eve in the Garden.) We are left hanging as it were because his wife is the voice of both love and common sense.
So what kind of a game our we being asked to play? Our God, is no longer known as the friendly and free to act despot and thus our faith is of a different quality. The way in which we live and die has built in uncertainty which we call risk while at the same time we are called to make what we have come to call God-like decisions. Today this drama is more often than not worked out in the way in which we die or choose to die. Odds are about 4-1 that most of us alive in Canada today will die in hospital. At the present time, if we follow the more developed statistics from the United States about costs, most of us in the last two years of our life will consume about 80% of all the health care dollars spent on us in our lifetime. For many of us who survive unto maturity our death will come about as a function of someone’s decision. With this as our lot, let me now try to unpack how this drama actually plays out.
The extension of active life into the 8th decade of life is an increasing feature of our existence. Not only is this the result of increasing attention to lifestyle actions such as diet, smoking and exercise but also the role of sophisticated technology extending active life where previously major disability of death was the only outcome. For example one of my colleagues at the Vic is presenting a paper entitled: Aortic vale replacement in symptomatic octogenarians - from Rocking chair to Rock N Role.
These very positive results illustrate the problem we are facing. The first is that it works only on a selective group and then it works very well. Two, it gives credence to the assumption that technology can always postpone death even when you old. Therefore death should occur only as the result of the discontinuation of life support technology. Sometime indeed, this result is reasonable. At the same time there is no cure for the disease of aging. But who should decide?
The controversy in the U.S. which developed in the debate over health care reform was sidetracked by those who proclaimed changes would include the creation of so-called death panels who would prevent elderly Americans from receiving medical care. The crucial discussion as to how we care for the dying without abandoning them has been pre-empted by assuming euthanasia is the only logical outcome. Also the matter of when active and intense treatment makes sense to avoid immediate death is buried in personal recrimination.
On the practical side I know that everyday in our hospital critical care units, doctors, patients and families are struggling to decide what to do next. Much of the time the discussion in hung up by unrealistic expectations from families who are bring a heavy load of personal but irrelevant baggage into the discussion. Sometimes patients and families are asked to make decision that should belong to the doctors. In some hospital cultures there is reluctance to offer adequate pain relief. All too often the patients has not talked with his wife or children about his own wishes and has not expressed these conversations in a Mandate. Frequently Mandates contain too specific requests about treatments which makes them useless in the care setting. What is lost is the opportunity to transform the end of life into the celebration and thanksgiving it deserves.
Today we would solve Job’ s problem with a series of corticosteroid injections and yet something would be missing. Job cries were the questions that each of us needs to carry throughout our lives.
