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Evans, Abigail Rian. Is God Still at the Bedside? The Medical, Ethical, and Pastoral Issues of Death and Dying. Grand Rapids, MI: Eerdmans Publishing Company, 2011. Pp. ix + 484. $22.23.


[1] In Is God Still at the Bedside? Abigail Rian Evans presents a comprehensive survey of how Americans view the roles of medicine and religion given contemporary understandings of the meaning of life and death. Particular attention is paid to ethical issues that can arise when different values are held in tension, as well as how clergy and other spiritual support providers are an underutilized resource for healing. Her central question asks whether a modern focus on freedom of choice in pursuing or foregoing medical technology has usurped the role of God’s presence at the bedside, therefore squelching the need for spiritual care. Evans uncovers a false “tension between aggressively pursuing medical treatment to stave off death at any cost and turning the process over to God, or choosing how or when to die.” (xvii) In wrestling with this tension throughout her book, Evans identifies medical resources and healthcare professionals as gifts of God, but denies that these trump the resources of spiritual care. Evans engages crucial questions concerning the meaning of life, sickness, suffering, grief, bereavement and death, including: What does it mean to be a person?  What is the meaning of health?  What are the criteria for death?  When should a person be allowed to die? How do pain and suffering differ? What is a good death? Each chapter begins with a poem, narrative, or song that invites the reader into greater contemplation, and would be useful group reflections and devotionals.

[2] Part I addresses American understandings of life and death. Evans’s treatment of human life begins by distinguishing between vitalism, instrumentalism, and conditionalism. She then discusses different foundations for grounding the value of human life, turning to a Judeo-Christian understanding of human nature and health, sacredness of personhood, sanctity of human life in general, and the case for protection of human life. Evans skillfully navigates the opportunities and blind spots of each of these positions for developing an ethic of valuing human life, and concludes with the images of life as a gift and life as a journey or pilgrimage,with a discussion of how these images can help us better describe what it is that we value about life.

[3] Evans begins her discussion of contemporary attitudes on death by describing the medicalization of death, which causes a shift in location of death from the home to the hospital, the loss of ritual to name and chart the dying process, and the reduction of care for the dying from an art to a science. A noteworthy inclusion, Evans also pays attention to death by human institution, which she describes as a spiritual death caused by institutionalized oppression, prejudice, poverty, and health disparities. She again introduces images; in this case those that help us describe death: we perceive death as inevitable, welcome, feared, punishment, gateway to life, and immortality of the soul. This chapter also includes an overview of the current state of funerals, noting economic factors, an increase in cremation, changes in funeral customs, and a comparative overview of funerals in the United Kingdom.

[4] In Part II, Evans explores the phenomena of “negotiated death”—her term to describe American prioritization of autonomy, understood as absolute freedom of choice, in choosing when and how to die. Ironically, in practice negotiated death is less a buffet-style smorgasbord of choices and more a moral conundrum in evaluating which medical options help us live well while dying given our varying images of the meaning and value of life and death. Evans uplifts the patient-physician relationship as the context for contemplating questions concerning death and dying, which repositions patient autonomy in responsibility to the commitments of health professionals. This chapter then moves to an overview of key terms and debates, including euthanasia, allowing to die, refusal or withdrawal of treatment, ordinary/extraordinary treatment, and palliative sedation, among others. The ethical perspectives on end-of-life issues espoused by Joseph Fletcher, Richard McCormick, Paul Ramsey, Edmund Pellegrino, and Peter Singer round out this discussion. A key conclusion of this chapter is “that the vast majority of health care professionals, ethicists, religious bodies, and the general public oppose active euthanasia,” which she emphasizes “is not the same as cessation or refusal of treatment, palliative sedation, or necessarily aid-in-dying.” (109) This chapter includes a helpful table that charts different religious positions on treatment termination, removal of feeding tubes, and assisted suicide/active euthanasia.

[5] In the next parts of her book, Evans engages social sciences, human experience, religious perspectives, the law, and ethical argumentation to present the current landscape of topics including suicide, physician-assisted suicide, organ donation, end-of-life choices, advance directives, pain and suffering, palliative care and hospice, and bereavement. The strength of these assessments lies in Evans’s interdisciplinary approach that brings differing perspectives into tension with one another to encourage greater understanding. For example, the chapter on organ donation brings together sociological and economic data on transplants and transplant waiting lists, criteria for matching donor and recipient, history of organ transplantation; ethical considerations, including informed consent and selection of donor and recipient, as well as a discussion of “gift” versus “harvest” of organs and wise allocation of scarce resources; moral grounds for donation, including beneficence, autonomy and stewardship of the body, the mutuality of persons in relationship, justice, covenant, fidelity, and social utility; a discussion of obligatory versus superogatory duties to donate; and finally a discussion of different religious communities’ attitudes toward organ donation and transplantation. The breadth of sources and depth of ethical engagement in addressing these topics will incite robust dialogue about how our meanings of life and death translate into practice as we confront the processes of dying and death.

[6] Part IV, “God at the Bedside,” makes the case that spiritual care plays an integral role in care for the dying. Clergy are called to minister to the sick and dying and their families, which can take on many roles: providing sacramental/liturgical worship resources, praying and reading scripture, wrestling with questions of theodicy and eschatology, giving meaning and hope to the dying, and providing spiritual assessment and care. Evans suggests that these roles are healing means available to clergy that complement healing performed by healthcare professionals. This chapter is an invaluable resource for the clergyperson who is unversed in the plethora of ways to assist ill and dying patients and their families. It also provides a comprehensive overview of spiritual care for the dying that can refresh and deepen the skills of experienced chaplains and pastors. This dynamic role of clergy at the bedside is situated within a cooperative model that fosters relationship between patients, family, healthcare professionals, clergy, and the integral “faith community nurse” (FCN). FCNs are registered nurses who have been educated to help patients experience a “good death,” espouse holistic perspectives on health and sickness, and usually serve as part of the ministry team of a congregation. Evans advocates for the role of the FCNs, and is confident that they, in partnership with pastors, can help empower and give voice to the patient as she wrestles with negotiated death. (349) This chapter could easily be used as a “how-to guide” to implement and strengthen FCN programs and help them connect parishioners to healthcare resources within a collaborative model. Since many FCNs are volunteers, the question is raised whether congregations, perhaps in partnership with community organizations and health care systems, ought to invest in FCN programs and provide positions with a living wage. This model holds a promising future for community-based health, and ought to be developed especially in communities that face institutionalized death.

[7] Evans’s concluding chapter reflects on how Christian faith informs funerals. Here she brings trends in funerals and images of death discussed in previous chapters into dialogue with Christian theological reflections on sin, hell, election, eternity, heaven, and resurrection.  She presents resurrection as the key event for grounding a Christian theology of death.  Considerable space is devoted to how this Christian theology of hope and resurrection informs funerals in the Reformed tradition.

[8] Ten appendices contain a wealth of knowledge, from information on advance directives and tools for engaging in end-of-life decision-making to resources for dealing with grief and the FCN Scope and Standards of Practice. These resources are geared toward clergy and caregivers, and are also accessible to the layperson confronting her own mortality. 

[9] Evans’s intended audience includes chaplains, pastors, nurses, physicians, FCNs, other healthcare professionals, bioethicists, and theologians. Those in healthcare mission and clinical ethics will also find this book useful. She makes a special appeal to clergy, stating “this book is especially meant to serve as a wake-up call for clergy who often find themselves ill-equipped to deal with death and dying.” (xv) Evans’s text provides the depth and breadth necessary to confront graduate students with the complex landscape of theological, ethical, legal, and pastoral issues faced in contemporary death and dying, yet remains accessible for students at the undergraduate level and would serve well as a textbook in a course on death and dying. God is, as God always has been, still at the bedside. Evans’s text shows clergy and healthcare professionals how to recognize God’s presence and allow God’s wisdom transform how we care for the dying.


Alyson Isaksson Capp is a third year PhD student in Loyola University Chicago’s Integrative Studies in Ethics and Theology program and a doctoral healthcare ethics intern at Columbia St. Mary’s Healthcare System in Milwaukee, Wisconsin.


© April  2015
Journal of Lutheran Ethics
Volume 15, Issue 4​