The new University College hospital trust building, £420m of glass and steel, has been described as a 21st- century answer to cathedrals. It's an interesting comparison, for like the great medieval cathedrals, the magnificence of university hospital buildings, so evident particularly in the US, reveals a great deal about the hopes and fears of the societies that built them. They also say much about the attitudes of their respective communities to death and dying.
According to the book of Ecclesiastes: "For everything there is a season, and a time for everything under heaven, a time to be born and a time to die." But when is the right time to die? We used to have a sense of these things: three score years and 10 was the shorthand. It was a time-span made sense of by the rhythms and responsibilities of community life. Shakespeare wrote of the seven ages of man. But the idea of having "a good death" makes little sense to us now, for the expectations of how long we live are no longer related to patterns of community life, or to a sense of our responsibilities discharged, but to the state of medical technology - very expensive medical technology celebrated in glass and steel.We now die when the medics have failed us, when the doctor cannot do anything more. We no longer share a sense of what a natural life-span might be or of any appropriate time for our life to come to an end.
This lack of public consensus could open an enormous economic black hole. For if there is no sense of an appropriate end to human life, then there is potentially no end to the resources we ought to commit to extending it. Some scientists now tell us that there is no reason, in theory, why we cannot extend our lives indefinitely. This may be more science fiction than science, but, just like science fiction itself, it tells us much more about the present than it does about the future. The Queen Mum lives to 102 and all our life-span expectations are imperceptibly raised. Is it now "premature" to die in one's 80s? I don't think we know.
And worse, I don't think we are in possession of the emotional and political maturity for proper debate on the subject. The language of individual rights surely won't help us either, for what we need here is a language that attempts to understand what human life is for. It's a language we are no longer very good at speaking. Yet it's a language we must develop in considering the proper allocation of resources within the NHS.
The first stage in this debate must be to recognise the unrealistic expectations that are loaded into our popular conceptions of medicine. For medicine remains the one area of contemporary life still affected by the Enlightenment dream that a combination of science, reason and human ingenuity can make all things possible. Indeed, these great glass and steel hospitals are surely a reflection of the great hubris of the Enlightenment and of its belief in the power of progress. No surprise these buildings look like multinational corporate headquarters, for the capitalist machismo of their architecture is a natural compliment to the state of contemporary medical science. But hubris has a price, for the dream of unfettered scientific progress combined with a lack of any sense that human life has a natural or appropriate end is a recipe for economic disaster. It's a recipe for emotional disaster too, for no longer having any idea of what a "good death" might mean, we become increasingly dyslexic in our articulation of grief or fear. This incapacity breeds multiple superstitions about death and all sorts of fearful fantasies about its processes. If all we ever do is try desperately to keep death at bay, at any price, it is inevitable we become hysterical about it.
Priority in heath service resource allocation must be given to the care of patients (not clients or consumers). It's beds in the corridors and horrendous waiting lists we need to tackle, rather than spending money on expensive innovative technologies that search for ever more ingenious ways of keeping us alive. In fact, it's an ancient wisdom we need to recover. In the fifth century St Benedict shaped the future of monasticism by arguing that every guest, whatever their condition, must be treated and cared for as one might care for Christ. Monasteries set aside spaces for the care of their guests and the hospital was born, the word hospital deriving from the Latin for guest. Hospitals were originally places of hospitality. The hospice movement is the nearest contemporary equivalent, understanding that the advances in medical science must not be seen as an end in themselves, but ought to be subservient to the care of their guests. It is a part of what can make hospices such wonderfully life-affirming places. And that's precisely what we now need in the NHS.
Rev Dr Giles Fraser is the vicar of Putney and lecturer in Philosophy at Wadham College, Oxford .
giles.fraser@parishofputney.co.uk
