God & Nature Magazine
  • 2025-#1 Issue
    • Letter from Editors 2025-1
    • Schrotenboer, Lying Dormant
    • Strauss, God Laughs & Smiles
    • Carr, Creation Stories
    • King, Falleness Physical World
    • Colon, A Hike
    • Thuraisingham, Identity
    • Bostrom 251 Every 6 Steps
    • Clifford 251, Just Starting Out
    • Johnson 251
    • Eyte, Touch
    • Budek-Schmeisser, Quitting
  • 2024-#4 (Fall) Issue
    • Letter from the Editors F24
    • Madison, 5 Smooth Stones
    • Dickenson, Genesis & Evolution
    • Berg, Is Genesis History?
    • Pinkham, Cells and Organs
    • Mitchell, Questions for AI
    • Taskinen, Alexander Grothendieck
    • Bostrom, On Camera F24
    • Clifford, Across the Pond F24
    • Johnson, Food for the Soul F24
    • Strand, Morning Prayer
    • Budek-Schmeisser, Sonrise
  • 2024-#3 (Summer) Issue
    • Letter from Editors Summer 24
    • Horst, Death through Adam
    • Bradley, Game Theory & Theology
    • Defoe, Science and Faith
    • Pickett, Wonder & Miracle
    • Touryan Wonder of Math
    • Wright, In The Beginning, God
    • Clifford Sum24
    • Johnson,, Summer 24
    • Eyte, Kaleidoscope
    • Budek-Schmeisser Bohemian Gravity
  • Past Issues
    • Spring 2024 Issue >
      • Editor's Letter Spring 2024
      • Miller, Sense of Place
      • Quick, Georg Cantor
      • Niemeyer, Research to Thriller
      • Carpenter, Creationism Inter-Textual
      • Defoe, Wittenberg Circle
      • Madison, Buttercups
      • Bostrom, Birds' Eye View
      • Clifford, What's the Use
      • Budek-Schmeisser, The Choice
      • Anderson, Van Gogh's Sunflowers
      • Lange, Summer Meadow
    • Winter 2024 Issue >
      • Garte and Albert W24
      • Fagunwa, Origen: Black Scientist
      • Gonzalez, Being Human
      • Defoe, A Pastor/s Journey
      • Curry, Birds of New Zealand
      • Lin, Environmental Problems
      • Garte, Genetics of Race
      • Pohl, Third Culture in Church
      • Bostrom, Mentors
      • Clifford, Hidden Figures
      • Albert; Poem. A Goldfish Sings a Tentative Psalm
      • Ardern Contact Points
    • Fall 2023 Issue >
      • Letter from Editors Fall 23
      • Owen, Mystery of the Trinity
      • Albert, Denialsim: A Case Study
      • King, Elements in the Bible
      • Carpenter, When was Day One?
      • Spaulding, Guided Differentiation
      • Greuel, Vision for the ACB
      • Bostrom, Lady Bugs
      • Clifford, Small Things
      • Gentleman, 30/80 Anno Domini
    • Summer 2023 Issue >
      • Letter from Editors Summer 23
      • Touryan, Feathers
      • Stenerson, Horseshoe Crabs
      • Hull, Evolving Scotus
      • Silva, Younger Ages
      • Williams, Dense Obscurity
      • Bostrom, Water Cries
      • Clifford, To Church Repair
      • Craig, Heavenly Lights
      • Valerius, Nothing to Something
      • Pinkham, Wisedrop
    • Spring 2023 Issue >
      • Letter from Editors Spring 2023
      • Rummo Lewis and the Cross
      • Pagan Biodiversity
      • Funck Assembly Theory and Life
      • Williams Thus Far
      • Mitchell Making Mistakes
      • Phillippy Living in Paradox
      • Bostrom Rain Shadow
      • Clifford Sustainable Cooking
      • Budek-Schmeisser, Completion
    • Winter 2023 Issue >
      • Letter From the Editors
      • Braden, A Modern Bestiary
      • Garte, Assembly Theory
      • Defoe, The Heavens Declare
      • Greenberg, Bonding
      • Barrigar, God's Big Story
      • Phillippy, Overcoming Paradox
      • Bostrom, Near
      • Clifford, Hidden Figures
    • Fall 2022 Issue >
      • Letter Fall22
      • Curry, Attentiveness
      • Russo, Deconstruction
      • Touryan, Four Forces
      • Mittchell, Three Words
      • Philippy, Math Theology Fall 22
      • Bostrom, Goodbyes
      • Clifford FAll 22
      • Linsley, Mystic Exile
      • Hall, A Call to Arms
    • Summer 2022 Issue >
      • Letter Summer 2022
      • Engelking, Neurotheology
      • Kelley, Environmentalism
      • Garte, Sandpipers
      • Madison, Cultivating Contentment
      • Collins, Answers on Evolution
      • Touryan, Tentmakers
      • Oord, Ever-Creative God
      • Bostrom, Mentors
      • Clifford, Carbon and Sin
      • Campbell, Just, In Time
    • Spring 2022 Issue >
      • Letter from the Editors Spring 2022
      • Curry, Knowldege and Truth
      • Pinkham, On a Car Emblem
      • Murray, Candling the Egg
      • Carr, Music, Math, Religion
      • Smith, Wonder and Longing
      • Linsky, Cyber Service
      • Bostrom, Buteo
      • Obi, Coincidences
    • Winter 2022 Issue >
      • Garte &Albert Letter Winter 2022
      • Thuraisingham Pondering Invisible
      • Cornwell Mediations from Molecular Biologist
      • Fagunwa Blsck Scientist & Church Father
      • Garte A Dialogue
      • Gonzalez Being Human
      • Klein Naturalist in Two Worlds
      • Bostrom Creeds
      • Clifford Winter 2022
      • Ardern Contact Points
      • Cooper Imagine No Christmas
    • Fall 2021 Issue >
      • Garte &Albert Letter Fall2021
      • Johnson, God Winks
      • Cottraux, Ancient Aliens
      • Arveson, Anti-Vax Email
      • Gammon, Evolutionary Insights
      • Mitchell, No One Told Me
      • Rummo, Faith in the Invisible
      • Bostrom, Fall Furrows
      • Lemcio, A Franciscan Weekend
      • Funk, Plant Haiku
      • Robinson & Lim, Who is God?
    • Summer 2021 Issue >
      • Garte &Albert Letter Sum2021
      • Warren, Immunization and Salvation
      • Defoe, Bernard Ramm
      • Cornwell Canine to Divine
      • Mix, Running with Nature
      • Pinkham, Scuba Divers
      • Cao, Physics and Bible
      • Bostrom, Sugar Birds
      • Clifford Sum21
      • Oostema, Evolution of Faith
      • Hall, Generation upon Generation
    • Spring 2021 Issue >
      • Garte and Albert Letter Spring 2021
      • Loikanen, Divine Action
      • Madison, Humus and Humility
      • Lappin, Puddles and Persons
      • Cornwell, God's GPS
      • Touryan, Contolled Fusion
      • Russo, Vaccine and Salvation
      • Bostrom, Short-eared Owl
      • Redkoles, Expect Unexpected
      • Clifford, Boring
      • McFarland, Imposition of Carbon
      • Lemcio, Manis Mastodon
    • Winter 2021 Issue >
      • Winter 2021 Contents >
        • Garte and Albert Letter from the Editors
        • Burnett How iit All Started
        • Isaac Director's Corner
        • Ruppel Herrington, First Editor
        • Burnett Origin of Lire
        • Hearn Balance
        • Middleton Natural Theology
        • Story Antibodies and Randomness
        • Lamoureux I Sleep a Lot
        • Warren Overloaded Brains
        • Isaac Knowledge of Information
        • Bancewicz Wonder and Zebrafish
        • Oord Photoessay
        • Albert Hope in Winter
        • Clifford Storytelling & Drama in Teaching
        • Pohl The Column (Poetry)
    • Fall 2020 Issue >
      • Letter from Editors
      • Pohl, Panpsychism and Microbiome
      • Reyes, Communion During Loss
      • Griffin, Hands On
      • Azarvan, Science and Limits
      • Cornwell, Search Engines for God
      • Thuraisingham, Duality of Humans and Particles
      • Touryan, Prayers of Petition
      • George, Perfect Vision
      • Declare the Glory, Green: Awe
      • Bostrom Purpose
      • Oord, Theological Photoessay
      • Clifford, Food, Water, Waste
    • Summer 2020 Issue >
      • Summer 2020 Contents >
        • Editors Letter Summer2020
        • Jones, Science Faith Duopoly
        • Mix, God and the Virus
        • Warner, COVID-19 and Goodness of Creation
        • Gonzalez, Pandemic and Groaning of Creation
        • Johnson, Star Wars Food
        • Pyle, It Takes a (Medical ) Village
        • Arveson, Use for 3D Printers
        • Peterson, Pandemic and Research
        • Zeidan, Mentorship Online
        • Oleskeiwicz, Dragonfly on Water
        • Carr, COVID-19 and Climate Change
        • Nierrman, The Squirrel
        • Cornwell, COVIS-19 Bucket List
        • Bostrom, Grass Thoughts
        • Clifford, Summ20 Conflict
    • Spring 2020 Issue >
      • Letter from the Editors SP20
      • AD
      • Murphy, Nature and Calvary
      • Dickin, The Flood and Genesis 1
      • Gruenberg, Empiricism and Christian Spirituality
      • Ungureanu, Science, Religion, Protestant Tradition
      • Russo, How does it End?
      • Siegrist, Problems with Materialism
      • Ohlman, 20/20 in 2020
      • Warren, Rock Frogs
      • Edwards, Sanctuary
      • Bostrom, Clothed
      • Clifford, The Lent of Lockdown Spring 2020
      • Hall, 1:30 AM on a Tuesday (Poem)
    • Winter 2020 Issue >
      • Letter from the Editor Winter 2020
      • AD
      • Wimberly Inheritance, Meaning and Code
      • Defoe; A Pastor's Journey
      • Mix The Ends of the World
      • Pevarnik Limits of Physics
      • Greenberg "Godly" Science
      • Pinkham Teleological Thinking
      • Alexanian How to Witness
      • "Declare the Glory" Neal, Cross, Gait
      • Clifford "Across the Pond" Winter 2020
      • Oord "Theological Photoessays" Winter 2020
      • Salviander The Objective Man (Poem)
      • Ohlman Orphan of the Universe (Poem)
      • Lemcio Grey's Anatomy (Poem)
    • Fall 2019 Issue >
      • Letter from the Editor Fall 2019
      • Phillippy Mathematics and God
      • Pohl & Thoelen Databases
      • Garte Limits of Science
      • Mitroka Healthy Lifestyle
      • Sigmon Science and Revelation
      • Mariani Compatibility Creation and Evolution
      • Anders Theistic Evolution
      • Touryan Are we alone
      • Johnson Purpose and Source
      • Declare the Glory Curry, Smith, Best
      • Clifford "Across the Pond" Fall 19
      • Oord "Theological Photoessays Fall 19
      • Eyte Cross Cascade "Poem"
    • Summer 2019 Issue >
      • Letter from the Editor Summer 2019
      • Arveson Is There a “Theory of Everything”
      • Anderson The History and Philosophy of Science and Faith
      • Tolsma Science in Church
      • Salviander Black Holes and Atheism
      • Johnson Practical Problems for Literal Adam
      • Hall God and the Assumptions of Scientific Research
      • Linsky Overcoming Misconceptions
      • Wilder Sanctity of Creation
      • Clifford "Across the Pond" Summer19
      • Oord "Theological Photoessays" Summer 2019
      • Flaig Time and Me (Poem)
    • Spring 2019: Creation Care and Environment >
      • Letter from the Editor Spring 2019
      • Bancewicz;Sustainability Pledge: Why the Environment is My Problem
      • Lin; Environmental Problems as a Place for Compromise and Dialogue
      • Garvey; Where the Fall Really Lies
      • Lewis; Solar-Powered Life: Providing Food, Oxygen and Protection
      • Garte; Time and Human Impact on the Environment
      • Mays; Reforming Science Textbooks
      • Carr; Cosmic Energy First, Then Matter: A Spiritual Ethic
      • Kincanon; The Young Earthers and Leibniz
      • Declare the Glory Gauger
      • Clifford "Across the Pond" Spring 2019
      • Oord; Photoessay. Theological Photo Essays
      • Rivera; Photoessay. Digital Artwork: Images of Jesus
      • Albert; Poem. A Goldfish Sings a Tentative Psalm
      • Armstrong; Poem Holy Sonnet XI
    • Winter 2019: Education and Outreach 2 >
      • Letter from the Editor, Winter 2009
      • Applegate; Project Under Construction: Faith Integration Resource for High School Biology
      • LaBelle; Sidewalk Astronomy Evangelism - Taking it to the Streets!
      • Reed; Speaking to the Heart and Mind of Students about Evolution and Creation
      • Marcus; The Conflict Model
      • Rivera; The Implicit Assumptions behind Hitchen's Razor
      • Russo; Redeeming Bias in Discussion of Science and Faith
      • Fischer; Origins, Genesis and Adam
      • Clifford Column, Winter 2019
      • Gait; Photoessay - Stripes
      • Lee; Poem. In Chaos and Nothingness
    • Fall 2018: Education and Outreach 1 >
      • Letter from the Editor Fall 2018
      • Glaze; A Walk within Two Worlds: Faith, Science, and Evolution Advocacy
      • Johnson; Teaching the Controversy in Texas
      • Cootsona; Mere Christianity, Mainstream Science and Emerging Adults
      • Kindstedt; Creating a Third Culture
      • Zeidan; An Effective Way to Integrate Supportive Communication and Christian Belief into Virtual Classrooms
      • Marshall; A New Model of Causation
      • McClure; Nothing in the Bible Makes Sense Except in the Light of Grace
      • Frank; Christianity, Science and Teamwork
      • Assad/Reyes; Interview. Discovering a Renewed Sense of Awe and Wonder about God
      • Clifford Column Fall 2018
      • Menninga; Photoessay. What do These Stones Mean?
    • Summer 2018: Judgment and Peer Review >
      • Letter from the Editors Summer 2018
      • Jones; Peer Review: Avoiding Judgmentalism
      • Arnold; Discovering Spiritual Information Through Peer-Reviewed Science
      • Peterson; Peering at Double-Blind Peer Review
      • Smith; A Philosophical Influence from the Scientific Revolution on Scientific Judgment
      • Mix; The Poetry of Probability
      • Mobley; Randomness vs. the Providence of God?
      • Gordon; Chances are Good: Design and Chance in Genesis 1
      • Siegrist; But the Multiverse...!
      • Reyes; The Community Table: Interview with Marianne Johnson
      • Clifford Column Summer 2018
      • Hill; Poem. Synthesis
      • Lemcio; Poem. I Could See Where This was Going
      • Oord: Photoessay
    • Spring 2018: Chance & Design >
      • Letter from the Editors
      • Bishop; God, Love and Chance
      • Bonham; Quantum Reflections
      • Spaulding; God as Designer
      • Garte; Teleology in Evolution
      • Hall; God, Chance and Buridan's Ox
      • Pohl; Why We Need a Third Culture in Church
      • Dorman; Liturgical Brain
      • Warren; Galapagos
      • Blanchard; On Christian Science
      • Touryan; The Cross as a Cosmic Filter
    • Winter 2018: Race & Inheritance >
      • A Note from the Editors
      • Essay: “Some Pastoral Considerations of CRISPR CAS 9 Gene Editing” by Mario A Russo
      • Essay: “The Genetics and Theology of Race” by Sy Garte
      • Essay: "Grieve the Segregation of Science" by S. Joshua Swamidass
      • Poem: "Cardboard Man" by Ciara Reyes
      • Featured Interview: “Love Is Risk” with Carolyn Finney
      • Essay & Poem: “Abortion Languages: Love, fear, confusion and loss”
      • Essay: "Why the Church Needs Intersectional Feminism" by Emily Herrington
      • Essay: “Elected to Salvation (and other things?)” by Bill Leonard
      • Essay: “Local Colour: A reflection on family, history, and heritage” by Mike Clifford
      • Interview: Corina Newsome, environmentalist and animal keeper
      • Essay: “Spiritual Kin Selection” by Steve Roels
      • Photo Essay: "Trouble in Paradise: Plastic pollution in the Bahamas" by Grace Swing & Robert D Sluka
      • Essay: “Race & Inheritance: Personal reflections and annotations” by Walt Hearn
      • Interview: Carla Ramos, molecular biologist
      • Clifford Column; Discipine Hopping
      • Lemcio; Waves
      • Harris Artwork
      • Hearn; Eulogy - Beyond Science,
    • Summer 17: Cosmology & Theology >
      • Letter from the Editors: Summer 2017
      • Essay: "The News from My Home Galaxy" by Walt Hearn
      • Interview: "Deep Incarnation & the Cosmos: A Conversation with Niels Henrik Gregersen" by Ciara Reyes & Niels Henrik Gregersen
      • Photo Essay: "Breath & Dust" by Kathleen Eady
      • Essay: "Why the Eagle Nebula Just Doesn’t Do It For Me" by Mike Clifford
      • Essay: "The Cosmos in My Hand" by Lucas Mix
      • Interview: “What is Life? On Earth and Beyond” with Andreas Losch
      • Artwork by Missy Pellone
      • Essay: "When God & Science Hide Reality" by Davis Woodworth
      • Essay: "​In Search of Wonder: A Reflection on Reconciling Medieval and Modern Cosmology" by Monica Bennett
      • Essay: "If Christianity and Cosmology Are in Conflict, Whose Side Is Philosophy on?" by Vaughan Rees
    • Winter/Spring 17: "Flesh & Blood" >
      • Letter from the Editor: Winter/Spring 2017
      • Essay: "Probiotics, Prebiotics, Synbiotics: On microbiomes and the meaning of life" by John F. Pohl
      • Essay: "With All Your Mind" by Paul S. Kindsedt
      • Essay: "The Stuff of Life" by Mike Clifford
      • Essay: "Experiencing God’s Love in a Secular Society: A Christian experience with socialized medicine" by Alison Noble
      • Poem: "The Problem with Pain" by Eugne E. Lemcio
      • Essay: "Thoughts of Death in a Cruel World: Job’s suicidal ideation and the “right” Christian response to depression" by Jennifer Michael Hecht and Emily Herrington
      • Essay: "Tissues at Issue" by Walt Hearn
      • Essay: "The Dilemma of Modern Christianity" by Tony Mitchell
      • Poem: "Light" by Billie Holladay Skelley
      • Essay: "Some Theological Implications of Science: Revisiting the Ant" by Mario A. Russo
    • Summer/Fall 16: "Stewardship of Words" >
      • Letter from the Editor: Summer 2016
      • Levity: "Walt Being Walt: Excerpts from the ASA newsletter" by Walt Hearn (compiled by Jack Haas & Emily Ruppel)
      • Poem: "A Prayer Tribute to Walt and Ginny Hearn" by Paul Fayter
      • Essay: "Authentic Science & Authentic Christian Faith" by Paul Arveson
      • Essay: "On Modern-Day Saints & Epistles" by Emily Ruppel
      • Essay: "​Mathematics and the Religious Impulse" by Karl Giberson
      • Poem: "The Wasteful Gene" by Eugne E. Lemcio
      • Three Poems by Dan Eumurian
      • Excerpts from: "The Dictionary of Daily Life in Biblical and Post-Biblical Antiquity" by Edwin Yamauchi
      • Essay: "A Comprehensible Universe: The blessing from God that makes science possible" by Bob Kaita
      • Poem: "The Epistolarian" by Emily Ruppel
    • Spring 16: "Brain Science" >
      • Letter from the Editor: Spring 2016
      • Essay: "Ancient Q, Modern A (?)" by Walt Hearn
      • Essay: "Souls, Brains and People: Who or what are we?" by Gareth D. Jones
      • Essay: "A Functional Theology of Psychopathology" by Edgar Paul Herrington IV
      • Three Poems by Richard Gillum
      • Essay: "Thoughts of Death in an Unkind World: Job’s suicidal ideation and the “right” Christian response to depression" by Jennifer Michael Hecht
      • Short Story: "Malefic" by Jeffrey Allen Mays
      • Essay: "An Engineer Visits a Mindfulness Workshop" by Mike Clifford
      • Essay: "Traces of Trauma in the Body of Christ: The case of The Place of Refuge" by Elizabeth Hernandez
      • Essay: "Did God ‘Create’ Science? Christianity and the uniqueness of the human brain" by William H. Church
    • Winter 16: "Quantum Physics/Epigenetics" >
      • Letter from the Editor: Winter 2016
      • Essay: "God and the New Evolutionary Biology" by Sy Garte
      • Essay: "Quantum Mechanics and the Question of Divine Knowledge" by Stephen J. Robinson
      • Essay: "Creation Out of... Physics?" by Joshua Scott
      • Essay: "Of Books and Bosons" by Mike Clifford
      • Essay: "Words, Words, Words" by Walt Hearn
      • Poem: "Encountering Ernst Haeckel’s 'Ontogeny Recapitulates Phylogeny'" by Eugene Lemcio
      • Essay: "The Extended Evolutionary Synthesis: New conversations and theological questions at the horizons of modern science" by Michael Burdett
      • Poem: "The Difference" by Emily Ruppel
      • Essay: "Maupertuis's Ghost: Finding God in 'action'" by Colin C. Campbell
    • Fall 15: "Technology" >
      • Letter from the Editor: Fall 2015
      • Essay: "‘Braving the New World (Wide Web): Mapping Theological Response to Media" by Justin A. Bailey
      • Poem: "Entropy and Enthalpy" by Glenn R. McGlaughlin
      • Essay: "‘How Proactive Should Christians Be in Learning about Emerging Biomedical Technologies?" by D. Gareth Jones
      • Essay: "‘Can We Fix It? Erm..." by Mike Clifford
      • Poem: "To My Dear Parents" by Sarah Ruden
      • Essay: "‘Which Side, Lord?" by Walt Hearn
      • Poem: "The Column" by John F. Pohl
      • Essay: "‘Technology and the Church" by Derek Schuurman
      • Poem: "On the Shores of Oroumieh" by Emily Ruppel
      • Essay: "‘Technology as Discipline" by Johnny Wei-Bing Lin
    • Summer 15: "Doubt" >
      • Letter from the Editor: Summer 2015
      • Essay: "‘The Road Not Taken’: A personal reflection on careers, counterfactuals and callings" by Tim Middleton
      • Essay: "The Gift of Doubt in My Life" by Rev. Paul Herrington
      • Poem: "The Marsh Birds" by Sarah Ruden
      • Essay: "On St Brendan and the Pendulum of Postgraduate Study" by Mike Clifford
      • Essay: "Doubt: The Invisible Conversation" by Karl W. Giberson
      • Essay: "Doubt, Faith, and Crevasses on My Mind" by Peter M. J. Hess
      • Poem: "Magdalene" by Leonore Wilson
      • Essay: "Breaking Barriers, Ministering in Relationships, and Exemplifying the Gospel" by Stephen Contakes, et al.
      • Poem: "On the Extinction of Matter Near a Black Hole" by Ruth Hoppin
      • Essay: "Sometimes I Doubt..." by Walt Hearn
      • Essay: "The Risks of Love and Life's Big Questions" by Thomas Jay Oord
    • Spring 15: "Animals/Imago Dei" >
      • Letter from the Editor: Spring 2015
      • Essay: "50 Years of Wilderness: a Christian perspective" by Peter van der Burgt
      • Essay: "All Creatures Great and Small " by Walt Hearn
      • Essay: "Let There Be Less: A Christian musing on nature, faith, and farmers’ markets" by Emily Ruppel
      • Poem: "The New Plant and Animal Kingdoms" by Steve Roels
      • Essay: "Of Wonder and Zebrafish" by Ruth Bancewicz
      • Essay: "The Lion, the Spider and the Image of God" by Mike Clifford
      • Cat Poem 1: "Lullaby for Stomp the Cat" by Sarah Ruden
      • Cat Poem 2: "Letting the Dog In" by Emily Ruppel
      • Cat Poem 3: "Reading on the Couch" by Carol Ruppel
      • Essay: "Angry Discussions: A Wrong Way to Stand for Creation Care or Science Advocacy " by Oscar Gonzalez
      • Essay: "Ethical Eating on a Catholic Campus: Some thoughts from a student of environmental studies" by Grace Mican
    • Winter 15: "Information" >
      • Letter from the Editor: Winter 2015
      • Essay: "What Does it Mean to Know?" by Mark Shelhamer
      • Essay: "Knowledge of Information" by Randy Isaac
      • Photo Essay: "Being Here" by Carol Ruppel
      • Essay: "Truth Anyone?" by Walt Hearn
      • Poem: "Transformation" by Ruth Hoppin
      • Interview: "Unpacking Chance, Providence, and the Abraham's Dice Conference" by Olivia Peterson
      • Essay: "On Knowledge and Information–Tales from an English childhood" by Mike Clifford
      • Poem: "Space Travel" by Ruth Hoppin
      • Essay: "Resuming the Science/Faith Conversation" by Jamin Hubner
    • Archives >
      • Past Contributors
      • Fall 14: "History of Science & Christianity" >
        • Letter from the Editor: Fall 2014
        • Essay: "Orchids: Why the founders of modern science cultivated virtue" by Ruth Bancewicz
        • Essay: "Science Falsely So Called: Fundamentalism and Science" by Edward B. Davis
        • Essay: "The Other 'Atom' in Christianity and Science" by Karissa D Carlson
        • Poem: "The Hermit" by Ciara C. Reyes
        • Essay: "Players" by Walt Hearn
        • Essay: "Using Storytelling and Drama in Engineering Lectures" by Mike Clifford
        • Essay: "Is There Anything Historical About Adam and Eve?" by Mike Beidler
        • Essay: "Finding Harmony in Controversy: The early years of the ASA" by Terry Gray and Emily Ruppel
        • Levity: "Fish n' Chips" by Mike Arnold
        • Essay: "Stories" by Walt Hearn
      • Summer 14: "Christian Women in Science" >
        • Letter from the Editor: Summer 2014
        • Essay: "I Really Did That Work: A brief survey of notable Christian Women in Science" by Lynn Billman
        • Essay: "He + She = We" by Walt Hearn
        • Photo Essay: "The Faces of Nature" by Susan Limone
        • Essay: "On Grass that Withers: Overloaded brains and spiritual discernment" by Janet Warren
        • Interview: "Ancient Humans and Modern Choices" with Briana Pobiner
        • Essay: "Crystallographer, Quaker, Pacifist, & Trailblazing Woman of Science: Kathleen Lonsdale’s Christian Life 'Lived Experimentally'” by Kylie Miller and Stephen M. Contakes
        • Artwork: "Eden, Zion" by Harold Sikkema
        • Essay: "Asking the Right Question" by Dorothy Boorse
        • Interview: "Not So Dry Bones" with Mary Schweitzer
        • Essay: "Is Being a Mother and a Scientist Worth It?" by Abby Hodges
        • Essay: "Playing God: A theological reflection on medicine, divine action, and personhood" by Ann Pederson
        • Column: Great Gravity! "BNL 1976 – 2000 (Part 1)"
      • Spring 14: "G&N: The 2-year tour" >
        • Letter from the Editor: Spring 2014
        • Essay: "Political Science?" by Walt Hearn
        • Comic: "Education"
        • Essay: "Finding Hominids with Kamoya Kimeu" by Fred Heeren
        • Poem: "Ziggurat (and Helix)" by Amy Chai
        • Creative Nonfiction: "One Summer" by Dave Harrity
        • Essay: "Do the Heavens Declare the Glory of God?" by Owen Gingerich
        • Comic: "Miracle Mechanics" by Emily Ruppel
        • Essay: "I Sleep A Lot" by Denis O. Lamoureux
        • Poem: "Angels and RNA" by Walt Hearn
        • Comic: "Seminary"
        • Essay: "The Elegance of Antibodies" by Craig M. Story
        • Photo Essay: "Conversing with Nature" by Thomas Jay Oord
        • Essay: "Under the Tutelage of Trees: Arboreal Lessons on Virtue, Kinship, and Integrity" by Peter M. J. Hess
        • Comic: "Humor"
        • Essay: "Science and Scientism in Biology" by Sy Garte
        • Interview: "Biopsychology and Faith" with Heather Looy
      • Winter 14: "Health & Medicine" >
        • Letter from the Editor: Winter 2014
        • Poem: I Have a Piece of Cow in My Heart
        • Essay: Acts of God: Are all mutations random?
        • Column: Beyond Science
        • Poem: Psalm 1859
        • Essay: The Tao of Departing
        • Essay: The Tao of Departing p 2
        • Photo Essay: Walking in Winter
        • Essay: A Christian Doctor on Evolution, Faith, and Suffering
        • Opinion: Making Friends with Frankencorn
        • Poem: Chiaroscuro
        • Interview: "Biopsychology and Faith" with Heather Looy
        • Essay: "The Elegance of Antibodies"
        • Artwork: "Helix" by Harold Sikkema
        • Column: Great Gravity! "Dissertations and Revelations"
      • Fall 13: "Environmentalism" >
        • Letter from the Editor: Fall 2013
        • Poem: Time
        • Essay: Is there Hope for the Ocean?
        • Artwork: "Earthly Tent" by Harold Sikkema
        • Essay: What is Responsible Eating?
        • Essay: Are We Too Obsessed with Food?
        • Poem: Conversation on Creation
        • Essay: Creation Care from the Perspective of a Conservation Geneticist
        • Essay: Mobilizing Scientists for Environmental Missions
        • Poem: Paleocene Spring
        • Interview: Dorothy Boorse
        • Column: Beyond Science
        • Essay: New Testament Motivation for Environmental Stewardship
        • Poem: Stone of House
        • Column: Great Gravity! "Running the Data"
      • Summer 13: "Science & Creativity" >
        • Column: Beyond Science
        • Letter from the Editor: Summer 2013
        • Column: Faith on the Field
        • Poem: Trying Not to Be Too Sunny
        • Comic: "Work in Progress"
        • Essay: Do the Heavens Declare the Glory of God?
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The Tao of Departing: How Hospice is Transforming Medical Care, Part 2

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(Continued from previous page)

Hospice philosophy is guided by the four pillars of medical ethics: autonomy, beneficence, non-maleficence, and justice (i.e. what is fair to everyone). Each patient should have the right, as much as possible, to be free to determine for his or her self what will be allowed in their medical care. When patients become unable to express their own wishes, a decision-maker of their choosing needs to be appointed to act on their behalf to set and seek to achieve the goals that the patient would want if the patient were able to make an informed decision themselves. It should be made clear that the decisions should not be based on the surrogate decision maker’s personal values, but on what the patient would want for themselves. Clarification of this concept is extremely useful when a family member is required to consent to termination of life-sustaining treatment such as a ventilator or feeding tube. If the family member realizes that they are simply the messenger in delivering the patient’s wishes, there is much less anxiety and guilt than if the family member feels that they are responsible personally for making a life and death decision regarding the patient. 

Beneficence means the team is committed to doing what is good, right, and helpful for the patient. This does not mean that aggressive curative treatments must always be pursued. Dying is as natural as being born. Likewise, prolonging the dying process can be as harmful as preventing labor is to the baby in a pregnant woman at term. When it is impossible to prolong someone’s living, it is wrong to prolong their dying as it can greatly increase the severity and duration of suffering.  Instead, utilizing the principle of “doing by not doing,” we refrain from aggressive intrusions that disrupt the natural course of the body shutting down at its appointed time. We simply maintain the comfort and dignity of the individual as they prepare for their final departure.

Non-malevolence means that although we do nothing to prevent the body from going through its natural process of shutting down, we do nothing to hasten death, either. Occasionally, patients or their families will “just want it to be over," and request something to “speed things up.” If the patient is in pain, having difficulty breathing, intractable vomiting, seizures, or lingering for days in a coma it would seem like the compassionate thing to do to “put them out of their misery.” These situations can be distressing to everyone, including the hospice team. Fortunately much can be done to improve the situation and allow the body to shut down. 

The first thing to do is to remove any impediments to the body shutting down naturally. It is natural to lose the sensations of hunger and thirst at the end of life. In traditional medicine, families will often force nutrition and liquids on a patient even though the patient finds oral intake repellant. Families will often beg, scold, cajole, or even force their loved ones to eat or drink. Part of the reason for this is that providing food and drink in our culture is the primary way we show love and friendship to others. But, as the body shuts down, forced intake can actually increase suffering and prolong the dying process. Families often fear that they will be causing their loved-one’s death due to hunger and thirst if they do not force intake. But “hunger” and “thirst” are subjective perceptions that abate toward the end of life. One cannot die of something one does not have. Allowing the patient to set the pace and request food or liquid before giving it allows the patient more autonomy and dignity.

Should all infections be treated with antibiotics? As we get weaker at the end of our lives the intricate process of swallowing naturally becomes more difficult. Food, liquids, and secretions inevitably find their way into the lungs, and pneumonias are common. In addition, declining oral intake reduces urine flow and increases the risk of urinary infections. Both respiratory and urinary infections are exceedingly common toward the end of life.

Rather than seeing infections at the end of life as additional complications that cause more suffering, these infections are actually expected and welcome friends that can allow the dying person to escape the greater and more prolonged suffering of the terminal phases of cancer, dementia, emphysema and other progressive conditions. In addition, antibiotics themselves can cause suffering from nausea and vomiting, yeast infections of the mouth and groin, severe diarrhea, psychosis, rashes, and many other problems. Furthermore, the original (non-antibiotic-derived) infections are a natural part of the end of life process and will keep recurring no matter how many times they are treated. Forcing a loved one to endure multiple infections by aggressively treating each one is counter to the goals of comfort and dignity. Instead of focusing on the infection (the disease), we focus on symptom relief (the patient’s experience, i.e. the illness) with medication for control of pain, fever, shortness of breath, and nausea.

Frequently, patients who are going through the dying process will be transferred to hospice on oxygen for their shortness of breath. But at the end of life, supplemental oxygen is an artificial intrusion into the body’s natural process of shutting down. Again, such intrusions have been shown to do more harm than good. Supplemental oxygen can make someone experience increased levels of pain through stimulation of certain parts of the brain. Supplemental oxygen has also been shown to prolong the dying process. Studies have clearly shown that the breathlessness patients may experience at the end of life is just as well treated by a fan gently blowing on the patient’s face. By removing the oxygen and providing adequate medication for pain and anxiety, the dying process is not prolonged, and the uncomfortable tubing on the patient’s face as well as the annoying loud motor of the oxygen concentrator is also gone, leaving a more peaceful and dignified scene for the family.

The liberal use of narcotic pain medication does not hasten death, unless the only thing keeping someone breathing is the adrenaline and other stress hormones produced by pain or the feeling of suffocation. Providing adequate comfort prevents unnecessary anguish and distress prior to death. Studies show that patients who have their pain adequately controlled do not die sooner than similar patients without adequate pain control. The amount of narcotic required to stop someone’s breathing is vastly greater than the amount needed to keep them completely comfortable. It is unfortunate that so many people are allowed to die in pain out of caregiver fears of hastening death with pain medication.

Getting back to our terminally ill trio at the beginning of this article, another misconception that needs to be addressed is the effectiveness and success of CPR (cardio-pulmonary resuscitation). On fictional television shows CPR is portrayed as effective in saving lives about 70% of the time. In reality, the numbers are much different. There have been many different studies with varying statistics, but it is clear that as we age, the response to CPR declines dramatically. Even in patients in their forties with reversible conditions who have a witnessed cardiac arrest in the hospital, the survival to hospital discharge is less than 20%. For frail elderly nursing home patients who arrest at their facility, the survival rate approaches zero. Much trauma and distress can be avoided at the end of life depending on how patients and families are asked to fill out their advanced directives.

I have heard nurses and even physicians ask terminally ill patients, “If something happens and your heart stops do you want us to try to restart it with CPR or just let you die?” If all disease is curable and death is not inevitable then that statement is possibly a reasonable one to make to a patient. If a more honest and realistic approach is taken, the conversation would go more like this. “You know your condition will eventually result in your passing. When that occurs, trying to restart your heart would not only be futile, but would likely result in injuries to you including multiple broken ribs, punctured lungs and lacerated organs such as your liver or spleen. By choosing instead to allow natural death we can be sure to keep you comfortable and prevent additional unnecessary suffering.”

Regarding our dementia patient, some of the points mentioned above need to be discussed with the family. Regarding the placement of feeding tubes in terminally ill patients, they are far more often requested for the family’s emotional needs than for the comfort or wellbeing of the patient. Slow spoon-feeding of end-stage dementia patients actually results in longer average survival than patients who have feeding tubes placed. 

End-stage dementia patients develop what is known as anorexia-cachexia syndrome. When this occurs, the body is in the process of shutting down and is no longer desiring or utilizing nutrition to build protein. Any weight that is gained by forcing nutrition is only fat and fluid, not muscle or protein. Protein (albumen) levels in the blood drop and it becomes increasingly difficult to hold fluid inside the blood vessels. If fluids are artificially pumped into the system (either by feeding tube or IV) the fluids seep out into the tissues causing wide-spread swelling (edema/anasarca) which in turn seeps continuously from any nick, scratch or tear of the skin. Fluid seeps into the brain tissue and can cause headaches, nausea and possibly seizures. Fluid seeping into the lung tissue increases shortness of breath and can also be the result of heart failure from fluid overload. Formula pumped into the stomach flows up the esophagus and into the lungs causing recurrent pneumonia. Fluids down the GI tract result not only in frequent painful repositioning for changing of wet and dirty clothing, diapers and bedding; and urine and feces contribute to skin breakdown and poor wound healing often resulting in deep painful bed sores. It is widely felt that tube-feeding in cancer patients simply diverts more calories to the most metabolically active tissue in the body, the cancer itself. 

The body was designed to shut down comfortably and peacefully if there is no intrusion of artificial interruptions in the process. As the body loses its desires for food and fluid an interesting process occurs to protect the patient from suffering. As fluid intake diminishes there is a build-up of helpful chemicals in the blood. Urea is a breakdown product of protein and is flushed out of the system by healthy people in the urine (named for the urea it contains). Urea builds up when the body’s fluid stores are down. As it builds up it has the effect on the body of naturally relieving pain and anxiety and eventually peacefully puts the patient to sleep. Concurrently, the natural reduction in caloric intake stimulates the breakdown of fat. Chief metabolites of fat breakdown are called ketones. Ketones can allow the dying person to experience euphoria and a sense of spiritual clarity. These effects help to explain why fasting has been a spiritual discipline of most of the world’s major religions. Pumping in calories and fluids in a dying person deprives them of the benefits of these wonderful natural chemicals as well as compounds the suffering by the processes mentioned above. Yielding to the body’s natural protections (doing by not doing) allows the patient the maximum comfort and the least distress.

If there is a disease that is truly evil it is cancer. Cancer occurs when normal cells lose their ability to control their reproduction. Like terrorists, cancer cells can go unnoticed until it is too late. They hide behind and among the normal healthy cells in the body, and most things that kill them will also kill normal cells, especially normal cells that reproduce rapidly such as skin, hair follicles, mucous membranes and the lining of the intestinal tract. Cancers are fragile and their cells break off into the lymphatic system and the blood circulation as they destroy the normal tissues around them. These cells are carried to distant places in the body where they lodge and grow new tumors called metastases. They hijack the body’s physiology and not only steal the nutrition the body takes in but forces the body to tear down its normal tissue to fuel its chaotic expansion, resulting in dramatic weight loss.

Artificial nutrition, as mentioned above may simply accelerate the growth of the cancer. Surgery, chemotherapy, and radiation are the mainstays of cancer treatments, but the body can only take so much cutting, poisoning and burning. When the disease reaches a certain point, the combined destruction of normal cells by both the disease and the treatment makes further aggressive care counter-productive. When the prognosis without treatment is less than six months, the patient needs to clearly understand if the potentially extended time from further treatment will be time they can enjoy. The issue of quantity of life versus quality of life and be a difficult decision due to unknowns regarding the relative success and side effects that they personally may experience. More and more people are choosing quality of life through hospice rather than ruining their final days in the misery of cancer treatment side effects and endless doctor visits and tests. Most studies show that end-stage cancer patients not only experience less suffering as well as a higher quality of life on hospice, but they actually survive longer on average than those seeking aggressive care until the end.

Patients and families on hospice report that they are in most cases highly satisfied with the care they receive while on the program. Many regret not starting hospice sooner. The concept of treating the person rather than the disease, and crafting the plan for this care in the context of universal mortality reduces suffering and preserves dignity. Trusting the design of the body to care for itself to a great degree at the end of life reduces the work, stress and cost of caring for the dying. Acceptance of the universality of death allows us to put our lives into a paradigm where we can celebrate aging and peacefully prepare for eternity. 

One wonders if we would have grieved and mourned in the womb if we had known that our delivery was imminent and the security, familiarity and intimacy of the only world we had ever know would be coming to an end. But, as wonderful as life in the womb must have been, we could have never known of the beauty of nature and the cosmos, all the sensory pleasures of life, the depths of relationships of marriage, family and friendship that awaited us after our birth; joys and pleasures, experiences far beyond our comprehension as a fetus. Perhaps the pangs of death are simply the travail for another birth; our final birth to a new life, one fantastic beyond our comprehension. As a hospice physician sometimes I feel more like a celestial obstetrician!

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God & Nature magazine is a publication of the American Scientific Affiliation, an international network of Christians in science: www.asa3.org