Depart with Dignity

Feb. 5th, 2021 | By Ashley Talton BR ‘23

Pictured: blue pan with rising cupcakes.

Many of the people in the Zen Hospice end-of-life care facility, such as Mrs. M, are unable to eat. And yet, the most popular room in the house is the kitchen, where the aroma of freshly-baked cookies can be found, while people are chatting around the table.[1] Even though the people there can’t enjoy the taste of the cookies because of illness or decreased taste sensitivity from age, the joy that the smell of the cookies provides is unmatched.

Speaking from a strictly scientific perspective, eating is “nothing more or less than a transfer of energy between two organic systems.”[2] However, viewing the act of eating in this reductionist way strips away the essence of a meal. Food brings people together around a table, laughing. Food brings people dignity through the privilege of making decisions about what we eat, who we eat with, and when we eat. Food is a medium for compassion when its provision meets someone’s tangible needs. Food is not simply an essential of physiological survival; it is so much greater than that. Food provides “sustenance on several levels.”[3] Eating is a multi-sensory experience. Taste is not the only thing that is valued about food, but the holistic experience of the occasion of a meal is highly valued, too. Food is fellowship, compassion, and, most of all, dignity––the very elements that contribute to our humanity, our connections with one another, and what every person deserves. 

As a thirteen-year-old, Mrs. M had found joy in laughing and reminiscing over a celebration dinner with her friends after the soccer district championship game. During this period, she had more choices about what to eat, but less control over with whom she shared meals. In college, Mrs. M took time out of her busy schedule between classes to catch up with a friend over a meal, instead of spending that extra time working on a p-set. This was one of the first times in her life that she had complete control over where, with whom, and what she ate. Ten or twenty years later, she shared a meal around the table with her kids, asking about their day at school and discussing what happened at work with her spouse. As Mrs. M grew older, the number of choices she was able to make regarding her food increased abundantly. Volition, the power to make choices for yourself, is the core of what food provides for us when we choose when, when, where, and with whom to eat. Volition implies dignity.

Eating alone in a hospital room is very different than meals surrounded by friends and family at earlier stages in life. Physical challenges from aging or severe illnesses make the act of eating more difficult. Taste buds have atrophied and become less sensitive, and chewing is not as easy as it once was and may even cause discomfort. Food is also connected with memories, and a particular dish that once brought joy may bring pain forty years later.[4] A milkshake that reminds Mrs. M of the happy first date with her deceased husband now symbolizes an experience that she’ll never have again.

Choices that may have been taken for granted have now vanished, rendering the experience seemingly similar to life as a small child. The days of choosing to eat whatever you want at whatever time you please are long gone, as mealtime is whenever the food is served to you. In certain cases, medical interventions with artificial nutrition prolong the life of a person at the cost of their increased suffering because we are unable to accept death.[5] 

Food is a way we show our love for one another—starting at birth when our parents and caregivers provide us necessary nutrition as we are unable to help ourselves. As we age, food remains a popular way to show how much we care for someone, whether by taking someone out to dinner or baking goods for them. Jesus recognized the power that a meal has, and He can be seen time and time again providing for people out of love. Mark 2:15 says, “And as he reclined at [the] table in his house, many tax collectors and sinners were reclining with Jesus and his disciples, for there were many who followed him.”[6] The scribes and the Pharisees, those who valued religious traditions and the law, criticized Jesus for whom He chose to dine with.[7] Yet Jesus’ love extended to the tax collectors and sinners, those whom the Pharisees despised, because He had compassion on them. 

Since food is a way in which we show our love for others, it is hard for us to stop providing for our loved ones with food. However, an essential aspect of loving someone means preserving their dignity, even at the end of life, when so many choices they previously had with food have now disappeared. 

In 2 Samuel, Barzillai approached King David, saying “I am this day eighty years old. Can I discern what is pleasant and what is not? Can your servant taste what he eats or what he drinks? Can I still listen to the voice of singing men and women? Why then should your servant be an added burden to my lord the king?”[9] King David’s reply honors his request to live out his days on his own land and blesses Barzillai. King David indicated his love for him and links this love with his request for dignity.

Dave, a forty-two-year-old suffering from pancreatic cancer had been receiving intravenous feeding. His wife, Sharon, was hesitant to stop his intravenous feeding, afraid that it would be akin to starving him, as the fluids were his only source of nutrition.[8] However, the hospice staff recommended the withdrawal because his body was no longer absorbing any of the fats, sugars, or proteins from the fluids. The fluids were only serving to make his symptoms worse, with skin swelling and trouble breathing. 

Though decisions regarding medical interventions are ethically complex, we must not solely consider the benefits of providing nutrition to the person. We must remember the entire significance of a meal, because its value is not necessarily in the physical act of eating but also in the flavor, community, and choices that meals come with. If prioritizing the richness and fullness of life is at the center of what is desired for a loved one as they near the end of their life, one must entertain the idea that this may not include artificial nutrition. 

Sharon decided to discontinue Dave’s artificial nutrition, and he was able to eat a few bites of food, purely to enjoy the taste.[10] These last few days of enjoyment would not have been possible had the family not realized what they wanted to prioritize.

The importance of dignity, particularly at the end of life, cannot be denied. Although it is difficult to pin down an exact definition, dignity can be categorized into areas like communication, autonomy, respect, and empowerment.[11] What does dignity look like when considering all its aspects in relation to food? Communicating clearly with someone what their options are for eating and food. Giving someone autonomy to make choices instead of assuming what is best. Respecting someone’s decisions that they make regarding food: empowering and affirming them.

After a long night of unsuccessful fishing, Jesus appeared to his friends and invited them to breakfast.[12] He knew exactly what they needed, and He understood that food can be used to give people a fuller experience of life. Perhaps the invitation is where our dignity is retained, in knowing that someone else desires to spend time with us, to talk, and to listen. Surely, the taste of food matters, but it isn’t everything. The sooner we realize that, the sooner we may be able to accept our mortality. Taking away someone’s volition for the sake of helping them fails to recognize one of the core aspects of food — that it is dignity. Preserving dignity means having not only a holistic understanding that sees the food experience as more than simply a chemical exchange, but also an understanding of how the preservation of dignity and love go hand in hand. 

Notes

[1] Miller, BJ. “What Really Matters at the End of Life.” TED. Accessed October 16, 2020. https://www.ted.com/talks/bj_miller_what_really_matters_at_the_end_of_life/.

[2] Rappoport, Leon. “The McDonaldization of Taste.” In How We Eat: Appetite, Culture and the Psychology of Food. Toronto: ECW Press, 2003.

[3] Miller, “What Really Matters at the End of Life.”

[4] Rappoport, Leon. “You Are What You Eat.”

[5] Zitter, Jessica Nutik. “Food and the Dying Patient.” The New York Times, August 21, 2014. https://well.blogs.nytimes.com/2014/08/21/food-and-the-dying-patient/.

[6] All Biblical quotations from the ESV.

[7] Mark 2:16

[8] Gawande, Atul. “Letting Go.” In Being Mortal. Toronto, Ontario: Anchor Canada, 2017.

[9] 2 Samuel 19:35.

[10] Gawande, “Letting Go.”

[11] Kennedy, Grace. “The Importance of Patient Dignity in Care at the End of Life.” The Ulster medical journal 85, no. 1 (2016): 45–48.

[12] John 21:12.

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