Atul Gawande has a beautiful piece in last week's New Yorker on hospice care and end of life issues. Having had end of life experiences in recent years with my son, my mother and my aunt, it really hit home for me. But I found myself pressing back when I read these sentences:
Like many people, I had believed that hospice care hastens death, because patients forgo hospital treatments and are allowed high-dose narcotics to combat pain. But studies suggest otherwise. In one, researchers followed 4,493 Medicare patients with either terminal cancer or congestive heart failure. They found no difference in survival time between hospice and non-hospice patients with breast cancer, prostate cancer, and colon cancer. Curiously, hospice care seemed to extend survival for some patients; those with pancreatic cancer gained an average of three weeks, those with lung cancer gained six weeks, and those with congestive heart failure gained three months. The lesson seems almost Zen: you live longer only when you stop trying to live longer...
It is probably a small thing, I know: Zen is Likely a combination of Buddhist and Taoist ideas and practices, so Gawande is not far off the mark. But there are some great Taoist references for the idea his is offering here. Take, for instance, passage 50 of the Tao Te Ching:
People born into life enter death.
Constant companion in life and in death, this body is the kill-site animating their lives. And isn't that because they think life is the fullness of life?
I've heard those who encompass the whole of life could walk on and on without meeting rhinoceros or tiger, could charge into armies without feeling shield or sword. A rhinoceros would find nowhere to gore them, a tiger nowhere to claw them, a sword nowhere to slice them.
And isn't that because for them there's no kill-site?
This is Hinton's translation, and I know there will be those who take issue with it (where is the reference to "three in ten"? - see Chinese text and alternate translation here). But he gets at the basic idea here, which is a bit complicated.
There is a bit of ambiguity here. At first the "kill-site" (i.e. the thing that we worry about and which can ultimately bring about our death) of our body is our constant companion because we "think life is the fullness of life." That is, we worry about the distinction between life and death, the boundary between animation and non-being. But toward the end of the passage we learn that if we simply focus on living in the present, "encompass the whole of life," we can get away from the anxieties of death, in effect have no "kill site." The ambiguity arises in the contrast of "think life is the fullness of life" and "encompass the whole of life." They seem rather similar. The Legge translation, and others, draw a clearer line between "excessive endeavors to perpetuate life" and "he who is skillful in managing the life entrusted to him." The classical Chinese is difficult, but Legge lets us see the main point, which is essentially Gawande's.
And that is: if we fight to hold on to life, we will lose it; but if we just give ourselves over to the natural unfolding of life then there is no "kill-site;" we will live serenely to the end of our days and melt back into Way without injury from rhinoceros or tiger or sword.
Perhaps that is what hospice allows us to accomplish.
Hello Professor Crane,
Although I have to admit I am completely unaware of other passages in the Tao Te Ching, I was wondering if one could interpret the line - "encompass the whole of life" - in a slightly different way.
Personally, I think that "encompass the whole of life" is different from saying 'living in the present', as you point out in your post. Here's my logic:
Initially, the passage says "People born into life enter death", which to me suggests that life and death are the part of the same continuum. That, say, the "whole" life of a soul (or, the one who lives), encompasses the life it lives when it is in the body, and the life it lives when it is without it. I guess my understanding of this line is affected by my own understanding of the concept of the immortality of the soul in Hindu philosophy.
With this in mind, I wanted to come to the line "think life is the fullness of life"; I agree with you when you talk about the distinction that we create between life and death. The phrase, in essence, seems to talk about our ignorance in equating the life we live in our body (the 'first' 'life' in the phrase) to being the only life that we live (and so we consider it to be our "full life"). In line with my earlier contention, it seems to me that this phrase is trying to suggest to us to think of a "full life" as having both the animate stage and the in-animate stage, and not to think of the "fullness of life" as only relating to our bodily existence.
Again, with all these considerations in mind, it seems to me that when the text says "encompass the whole of life", it suggests that we should understand that life is not merely about the present animate stage but that there is something beyond; we were 'living' before we were born and we will go on 'living' after our body gives way. This seems to be different from saying 'we should live in the present' or "we (should) give ourselves to the natural unfolding of life", as you point out.
Once we realize that 'life' encompasses an animate and an inanimate aspect, we have no kill-spot because we can never be killed. Life, in it's fullest sense, can never be taken away from us.
Feel free to correct me Professor. But this post made for very a interesting read.
I hope your summer is going well.
Sincerely,
Aayush
Posted by: Aayush | August 13, 2010 at 11:00 PM
Aayush,
Very interesting points. And I think you have a good sense of the Daoist notion of life. But I would hesitate to extend the "fullness" of life idea too far - at least I don't think Daoism would extend it as far as Hinduism. That is, while, yes, a Daoist would question the distinction between life and death, animate and inanimate, being and non-being, there is no expectation of a previous or next "life." At least not for a philosophical Daoist. There's no karma. But there is a continuing and endless unfolding of Way, in which the physical stuff of our body is, after death, dispersed. We go on "living" only in the sense that the dust of our bodies might randomly mix with other molecules to form some new physical presence. Not quite the same as reincarnation....
Posted by: Sam | August 14, 2010 at 01:17 PM
Hello Professor!
The sense that "we go on living only in the sense that the dust of our bodies might randomly mix with other molecules to form some new physical presence" is very interesting (and, might I add, something quite novel to me) indeed.
Yet this does make me think about how Daoists would respond to the question(s): What does it mean to die? When they say the body is the kill-site, what is it a kill-site of? Who dies, if, upon being sliced by a blade, you keep on "living", in some "new physical presence" like you mention?
Let me try to explore this issue a bit myself as well: the most convenient way for me to resolve this confusion would be to assume a duality between soul and body, that when the body is sliced by a blade, the soul keeps on living. But is there a concept of this duality in Daoism? Based on what you've mentioned in your response, the answer, it would seem, is that such a duality does not exist - that the individual who lives is just the body. Maybe I am mistaken in making this conclusion.
But then again, how can the individual just be the body if, even after the death of the body, he goes on living through what was once a part of his body? Maybe we could say that the particles of the body do not die, but then if the particles do not die, then the body, which is a combination of all these particles, cannot possibly die as well right? It seems a bit paradoxical.
I'm sorry if this comment is not expressed particularly well. I am quite confused about the issues I have brought up which, I believe, would explain my lack of coherence. Haha!
But thank you for your response Professor!
Sincerely,
Aayush
Posted by: Aayush | August 15, 2010 at 03:56 AM