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 1

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by William R. Nesbitt 

A 94-year-old man with end-stage congestive heart failure who was on life support in the ICU has gone into cardiac arrest and is undergoing CPR. The family insisted he be a full code (in which doctors respond with interventions any time the patient's breathing or heartbeat stops), since “just two weeks ago he was driving and living on his own." An 86-year-old woman with end stage Alzheimer’s disease has shriveled to 79 pounds, and is lying in a nursing home mute, with contracted spindly limbs, wincing and moaning in pain every time she is turned. The family wants a feeding tube placed because of her poor intake. “We can’t just let her die of starvation.” A 57-year-old man with pancreatic cancer spread to his spine, liver, lungs, and brain is being wheeled into the cancer center; his bright yellow skin stretched over his skeletal frame. The family has enrolled him in an experimental protocol because, “What do you expect us to do? Just give up and let him die? Where there’s life there’s hope.”

With all of the advances in western medicine our society has all but banished death from being a part of our culture. Whatever is wrong with you should be able to be diagnosed by an MRI and treated with a laser. Preventive health practices and better management of chronic illness have made it so that if you reach 65 years of age, statistically you should be able to live into your eighties. We now can assess disease with electron microscopes, functional MRIs, PET scans, and innumerable blood and body fluid tests. Gene therapy, immunotherapy, and nanotechnology promise future cures beyond what we could hope from pharmacologic advances alone.

Sensational media reports of medical breakthroughs have raised our expectations of how we can repair just about any breakdown in the biochemical machines we call our bodies. “Disease” is public enemy number one. It steals our years and compromises our quality of life. We seem to accept just about any treatment or procedure that will keep our machine functioning. Accepting that death is inevitable is just not an option in our modern culture. This is not only true for the lay community but it is also the widespread feeling in the medical community as well.

The odds are overwhelming that if you go to your doctor, he or she will focus on what is malfunctioning in your body and you will likely receive a prescription to correct the misbehaving physiology. Failures of the body to respond to treatment often bring about frustration in the clinician. The treatments begin with the drug likely to do the most good and cause the least harm. When responses are not meeting expectations, higher doses, or different or additional drugs are prescribed. If the disease fails to respond and the patient continues to decline, riskier and more complicated therapies are often used. But, ultimately the patient, every patient, will die.

A patient’s death is often met by the doctor with a sense of failure, despite the inevitability of the course of the disease. “What more could I have done?” This fear of failure frequently motivates physicians to order tests and treatments even in a patient with a poor prognosis. What compounds the problem is that most physicians are very poor at assessing prognosis. Studies show the average physician will overestimate a patient’s life expectancy by a factor of three.

Fortunately, in the past few years, there has been a shift in focus in medical care for those nearing the end of life. Instead of primarily focusing on the patient’s “disease,” a new class of doctors, hospice, and palliative care specialists are trying more to focus on the patient’s “illness,” which is the patient’s experience of his or her disease. This more patient-centered approach (rather than the traditional disease-centered approach) incorporates the inevitability of universal mortality into the larger context of the patient’s overall care plan. More importantly, this approach incorporates most patients’ natural and intuitive understanding of their own approaching departure from this realm of existence. This capitulation to such universal exigencies can dramatically reduce suffering, increase quality of life, and in many cases increase quantity of life as well.

It is ironic that probably this most significant advance in twenty-first century medicine is from re-discovering philosophical principles from 2500 years ago. It was then that Lao Tzu wrote the Tao Te Ching. The book’s general theme is that there is a “tao,” or “way,” of the universe. Struggling against the way things are, against the realities of the universe, creates disharmony and suffering. By yielding to these principles, everything seems to go more smoothly, more easily, and with much less effort and anxiety. Much of the time goals are achieved not by “doing” things, but rather by “not doing” things. Hospice care is based around such principles. Embracing the reality that dying is as natural as being born sets the stage for compassionate assistance in a person’s final transition from life.

Eligibility for hospice is achieved when a patient’s prognosis is for less than six months survival if the illness runs its normal course. Patients with terminal conditions are interviewed by members of the hospice team to help them determine their goals of care, rather than continue to attack the disease at whatever cost to the patient and the patient’s quality of life. Most of the time a patient has the sense that he or she is dying, often before the physician is willing to admit it.  These patients find that they would rather reprioritize their lives and prefer to live out the rest of their lives in comfort at home with their families rather than going back and forth to the hospital, consuming their precious last days with futile treatments and unnecessary tests.

When the patient elects hospice his or her care is managed by the hospice interdisciplinary team (IDT), which consists of a nurse, a physician, a social worker, a chaplain, and a home health aid. The patient’s primary physician may direct the care or turn over the care to the hospice medical director who is usually more skilled and qualified at dealing with difficult issues of end of life medical management. The goal is to help the family or other caregivers to learn to provide end of life care for the patient at home or in any facility where the patient resides. Should symptoms such as pain, shortness of breath, nausea or agitation require prolonged direct supervision by the nurse, the patient can be put on “continuous care” status until symptoms are again manageable by the family or facility. If symptoms are too severe to be managed at home the patient can be put on “general in-patient” status either in the hospital or a skilled nursing facility, where medications can be rapidly adjusted under close medical supervision and yet remain under the care of the hospice team. If the family needs a break either due to being overwhelmed by care-giving or a need to attend to urgent matters out of town, the patient may be admitted to a skilled nursing facility for up to five days under “respite care.”

Medicare pays the hospice organization a per diem rate, based on the levels of care, as mentioned above, for all care and medications related to the patient’s terminal diagnosis. Medicaid and many private insurances make similar arrangements with the hospice. Medicare does not pay for nursing home stays for hospice patients except for the days the patient is at a skilled nursing facility on general in-patient status or respite status. However, Medicaid can cover long term nursing home stays. Patients can revoke hospice services at any time if they change their minds and wish to pursue aggressive/curative care. Patients can be discharged from hospice if their condition (and therefore their prognosis) improves. There is much more about the financial and regulatory aspects of hospice, beyond the scope of this article, which can be obtained on the internet or from a local hospice organization.

Under hospice, comfort and quality of life replace function and cure as the primary goals. However, the team tries as much as possible to let the patient determine their desired balance between alertness vs. sedation. Working with the patient’s primary physician, the patient’s medication regimen is simplified as much as possible. Preventive medications such as cholesterol meds, blood thinners, and vitamins are usually discontinued. As the patient’s general condition deteriorates, all medications except comfort medications are discontinued. Ironically, in many cases, some patients improve dramatically once all their medications have been stopped, as it was side-effects and interactions of the medications they were taking (literally sometimes dozens of different drugs) that were actually responsible for their decline. Hospice comfort medications are formulated so that in most cases they can still be administered without IVs or injections even to the patients who can no longer swallow or are no longer conscious.

The team also addresses misconceptions that patients may have regarding medications, especially regarding narcotics. Fears regarding addiction, over-sedation, suppressing breathing, or hastening death are largely unfounded according to the latest research. Opiate narcotics are generally very safe at the prescribed doses. There are few side-effects or drug interactions, and true allergic reactions to narcotics are rare. In many cases patients can actually become much more functional when their pain is adequately controlled.


(Continued on the next page)

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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