When We Choose to Die” by Mark W. Harris
October 21, 2012 – First Parish of Watertown
Call to Worship – “Late October” by Maya Angelou
the leaves of autumn
sprinkle down the tinny
sound of little dyings
And skies sated
of ruddy sunsets
of roseate dawns
cobweb greys and turn
see the fall
a signal end to endings
a gruffish gesture alerting
those who will not be alarmed
that we begin to stop
in order simply
Reading – from Learning to Fall by Philip Simmons
My sermon today is the equivalent of an election sermon, but I am couple of weeks early due to scheduling. “Death with Dignity” is question 2 on the ballot. Each of you also has an insert marked “Budget for All” asking you to consider a non binding referendum (Question 5).
Sermon – “When We Choose to Die” – by Mark W. Harris
This year Massachusetts voters have the opportunity to cast our ballots about a moral issue. Some of us might say that every candidate we vote for reflects a moral decision on our part, but I am not publicly going to suggest that we consider some aspirants for office immoral, and others more saintly. I am not about to tamper with the separation of church and state. Here in Massachusetts we will be voting in November on a bill called Death with Dignity, which will give persons near the end of their lives the opportunity to use prescription medications to hasten death. On Friday, Liz Walker, the journalist, and recently minted minister editorialized in the Globe against this bill, partly stating that she opposed it because a ballot question is no way to deal with such a difficult issue. But what is? Should we let the politicians or the courts decide? On this highly personal and private issue shouldn’t people have the choice, especially when many precautions are taken?
In our reading this morning, Philip Simmons asks us to reflect on those moments when we stand at the edge. He notes how fall is a season when everything is dying; leaves go out in a blaze of glory, and a killing frost covers the earth. He goes on to describe armed men roaming the woods, waking us with their rifle shots. Being an urban dweller now, I forget that this time of year once evoked near holiday elation for some family members and friends who would lace their boots, and don colorful hunting gear, red plaid pants and florescent orange vests, grasp their shotguns from the wooden racks, load them with lethal shells and trek into the woods to kill deer and pheasant. I grew up eating some of these delicacies, mostly killed by non-family members, as my father was a terrible shot, whom we would joke, “could not hit the broad side of a barn.” And I detested hunting, waiting in the cold, frozen underbrush to shoot something dead, while the recoil of the rifle gave me a bruised and sore shoulder, and the noise was deafening. This was not my idea of fun. I preferred the warmth of my mother’s kitchen, and not the cold brutality of hunting. Yet today some opponents of death with dignity consider it a cold brutal taking of life. One of the final straws for my mother occurred when my neighbor made rabbit stew, and she found hair floating in the broth. After that the practice and spoils of hunting lost its luster in my family.
Yet one hunting expedition indelibly left its mark on me. This painful episode occurred when I was on a hike with the wonderful dog, and sometime hunting companion, I grew up with, a black Lab named Sam. Sam had been a faithful childhood friend to me for many years; curled by the fireplace, or romping in the woods as he was this day. Much of western Massachusetts was once cleared for farming, and so what is now woods was once pasture land divided by old and decaying stone walls. As we walked along that day, Sam, who could not see or smell as he once did, spotted a rabbit, and took off in full chase. Going at break neck speed, he never noticed that the rabbit’s course was set to go through a small opening in one stonewall. The rabbit made it, but my dog did not. My old, frail but determined hunter crashed headlong into these unforgiving stones. He lay sprawled out on the ground. His bleeding head had a terrible gash, and the position of his body made it clear he suffered several broken bones. I called for my parents who came in a flash. Soon a warm blanket appeared and my Dad and my older brother rushed Sam to the vet. It was his final trip to the vet. While at the doctor’s, it was determined that, in light of his condition, the most humane thing to do would be to put him down. There was talk of chronic pain, and severity of injury and advanced age. My parent’s said, “it is for the best.” Sam’s death was a great sadness to us all. I cried and cried. We buried him behind the house, near those woods that once were his playground.
It may be that I began to form my views of death with dignity, or assisted dying, or even assisted suicide, if you will, on that day we said goodbye to our family dog. We all had a loving relationship with that animal, and could readily see that whatever life he had left, might be spent in terrible suffering. And so my understanding even then was that we helped him to die to relieve his own suffering, but also it was in response to the compassion we felt for him because of our relationship. While we place a higher value on human life than dogs, these kinds of situations give us entrée to an understanding of this issue, or at least remind us to begin to have or continue conversations with those we love about end of life issues.
Religious communities, a place where one would hope these conversations could occur, have sometimes made these difficult issues even more difficult, especially when they have said that life is a gift from God, and it is God alone who must call the soul back home, and any human interference denies God’s will. Yet increasingly in modern life machines, medicines and interventions can prolong life, thus giving humans and their medical professionals a much larger role in end of life questions. I noticed a few weeks ago, even with as simple a procedure as a colonoscopy, that I was interviewed by a nurse prior to the procedure to determine if I wanted them to take any extraordinary measures if something went wrong. Andrea knows how I feel, but does my 33-year-old son? What if I had a massive stroke, and he rushed into the hospital and said he wanted my life preserved at all costs? Are your wishes known?
Nothing is more important than to have conversations with loved ones, and yet it is a topic we like to put off to another day. There will be time and opportunity we say. One physician advised her family that if they were faced with a snap decision they should: “choose comfort, choose home, choose less intervention, choose to be together, at my side, holding my hand, singing, laughing, loving, celebrating, and carryin on.” Perhaps our parents never had these kinds of discussions with us, but that should help us see how necessary they are, especially if we end up making decisions without knowing what they wanted. Find out what matters to them, to you, and talk about it.
It is the dying who teach us how to die. I have had the privilege over the course of more than thirty years in the ministry to be let into the lives of people who suffered from life threatening diseases, and slowly have withered away. There was the lifelong smoker who came down with lung cancer in his fifties. He went through several rounds of treatment, felt sicker and sicker, and finally decided that he would end his chemotherapy and prepare for his final months, but it was only after many conversations with his physician, his wife, and his children. Each of us must use our sense of personal responsibility to choose what we mean by living life, and determine what we would choose for taking or refusing treatment. In moments of silence and sharing I witnessed his deep love for others, in the beauty of his smile, and in the strength of his hand. In a few short weeks, I had the honor of conducting Richard’s funeral. In that rural culture, it was a funeral service, where a last family portrait was taken around the open casket. I stood there, too.
For most of us, though it is our parents who will teach us how to die. Because both my parents died of cancer, I feel as though that, too, will be the disease that will afflict me. Cancer is often drawn out over months and years, and we may believe that because of that, it is a fatal disease that will provide the opportunity to say goodbye. Those whose parents suffered heart attacks, and went quickly, may affirm that that form of death is better because it seems quick and relatively painless, perhaps even easier on those who are left behind. But others would say they never had a chance to say goodbye. These are our teachers. Some who wanted more and more treatment, and others who said no extraordinary measures, but in each case, we hoped to listen to what they wanted, so they could feel some measure of autonomy and dignity in their waning days.
This is what the death with dignity ballot proposal purports to give each of us. The Massachusetts law would be similar to what is already legal in Oregon and Washington, and the Supreme Court has upheld. It offers a chance for terminally ill adults with less than six months to live to choose a painless death that will forestall needless suffering. It is not done in isolation. It is also not a death panel where someone determines who should live and who should die. In fact, it reflects that more and more people are taking responsibility for their own health. While opponents say there is room for abuse, there is little evidence that this occurs, and the ultimate decision is in the patient’s hands. One of the commonly quoted reasons for opposition to this law is that it does not protect life. There may be an assumption that it is always better to be alive than to be dead. I had a former parishioner who when I asked him how he was, would reply, “better than nothing.” But is that so? Is it the worst thing that can happen to a person that he or she should die?
Have we not somehow forgotten to affirm that death is a natural part of life, and so our culture often wants to stave it off at all costs? Sure we want, as Albert Schweitzer said, reverence for all life, but in the same breath, we also must have compassion for all life. Are we being compassionate for a hopelessly ill person or are we respecting their individual freedom to make choices abut their lives, if we keep them alive at all costs? Last spring my wife Andrea was spending long hours sitting with her brother-in-law as he died from throat and tongue cancer. One of the arguments against this law is that you cannot always predict if the person has six months or less to live. While that may be true in some instances, most of us who have been around terminal cancer patients know, at a certain point, it is clear that their life is ending. While in Tom’s case his treatments ended, and he was home, he continued to live for some time. What if he had requested a drug to end his life to lessen his own suffering, or to lessen the trauma on his loved ones, if it was done at his request after a conversation with a physician? While some religious leaders might say that enduring suffering is a way for people to emulate Jesus, I think Jesus himself, who had a compassionate heart, would have said no one needs unnecessary pain and suffering when they are terminally ill. The more drawn out a death is, the more traumatic it becomes. Everyone begins to wonder if this death is ever going to occur, which only adds to the terrible anxiety.
Some have argued that this choice to be autonomous in our decisions about ending life is too self-referential. One of Liz Walker’s concerns was that a person could end their life without talking to a spouse. But how likely is that to occur? A more legitimate concern has been voiced by disabled persons who say this proposal emanates from able-bodied people who are judging as unacceptable social and emotional issues of the disability community such as being a burden on others and losing control of their lives. Some proponents refuse to accept anything less than a fully functional body, and so they may want this kind of assisted death because they view this loss of autonomy as being a helpless dependent, who can’t do what they once did for activities. Are these legitimate reasons when some people live like this all the time? So, too the law limits who can take the lethal medicine, as those who are mentally ill or have a disease like ALS could not qualify. But we have to start somewhere. Having these kinds of conversations is more likely to deepen the relationships we have, and will broaden the possibilities in the future. We certainly must lessen any judgments that are made about the quality of life someone else lives with every day. Different people have different abilities to cope and work in relationship with others. Much of the decision-making is not simply about the person who is suffering, but acknowledges that we are caught in a web of relationships – parents, siblings, children, friends, and medical professionals. Death ends a life but it does not end a relationship, which continues on in the survivors’ mind and heart. No one wants to prevent the deepening of relationships in life – time with grandchildren or chances to see another sunset with a loving spouse, but when those become burdensome, painful and extremely difficult to experience for all involved, and make our memories only more painful, isn’t an agreed upon alternative worth considering?
In her editorial Walker also said people could receive the drug without being evaluated for depression, or without consulting with hospice. With the latter, studies show that those states that have this law have increased attention on better hospice and palliative care, and the care has improved. Most everyone in this position has this kind of care as an option. The idea of being evaluated for depression would be a thicket that might be hard to discern, because in my view it is quite normal to be angry at death, to deny its approach, and to be feel sadness at the thought of your own demise. Hopefully this law will begin to deepen broader conversations about death in our lives and in the culture. Most of the arguments about this law seem to center on the gift of life. Those against it may say ending your life with prescription drugs is denying life. Others may say that you are not accepting the changes in your life, and you could embrace them and even deepen your life experiences without having to end your life. But perhaps a deeper issue is that we never reflect that God’s gift of life is also a gift of death. This assisted dying can be a divisive issue. Having seen Tom and Richard and many others, I think the compassionate response is to be in favor of it. This is not active euthanasia, but a deeply human act to relive suffering in already desperate situations. But we also need to see how our culture for avoids death and refuses to embrace what is natural for all us. We also have a culture that values independence and individualism above all else, and what we gain from being dependent upon others, or asking for help, might help us grow spiritually.
We can all learn from each other. Dying is not about independence, but rather it is about being held in the arms of those who care. Dying is not about making decisions alone, but being with those we trust. While we do die alone, we also know that we lose a piece of ourselves when someone we love dies. Life cannot be tossed away carelessly. It is sacred. But upholding life at all costs, may also be a way to affirm a death denying culture, where death is always bad, and is to be avoided at all costs. We must have compassion in heart wrenching situations, and in those cases, reverence for life simply evolves into reverence for death. Dying is rarely easy, and talking about it is not easy either. As Philip Simmons says it is a time in our life when we stand on the edge. We don’t know where it leads. Other edge times like that are good moments to practice dying. Autumn leaves remind us that we fade as well. There is a season, for everyone, a time to be born, and a time to die. Simmons says that embracing death and the transitory nature of life will help us embrace the eternal that is possible in the moments we have together. This means seeing the love and joy in our baby’s eyes when we toss him in the air, or by crawling together on the floor. It means a hand to hold when we wait with anxiety for the results of a test, or a hand to hold as we coming into consciousness after an operation. Eternity may happen here at First Parish when you cry on a shoulder or just feel accepted for who you are. Sometimes our culture says, there is always something more that can be done. We say that sometimes that is not true, because what what must be done in some moments is nothing. Action and controlling fate become acceptance, and in that moment may we each know a reverence for death. It is not about life versus death, but about the manner of death. This is not a time for healing or for any more interventions, or a test of how much suffering you need to endure. We all need to be free to claim the moment of death, free from needless pain and suffering. The only thing that needs to survive at this point is love. That is why approving this law, is a loving act.
Closing Words – “Courage” by Anne Sexton
It is in the small things we see it.
The child’s first step,
as awesome as an earthquake.
The first time you rode a bike,
wallowing up the sidewalk.
The first spanking when your heart
went on a journey all alone.
When they called you crybaby
or poor or fatty or crazy
and made you into an alien,
you drank their acid
and concealed it.
. . . (missing stanza)
if you have endured a great despair,
then you did it alone,
getting a transfusion from the fire,
picking the scabs off your heart,
then wringing it out like a sock.
Next, my kinsman, you powdered your sorrow,
you gave it a back rub
and then you covered it with a blanket
and after it had slept a while
it woke to the wings of the roses
and was transformed.
when you face old age and its natural conclusion
your courage will still be shown in the little ways,
each spring will be a sword you’ll sharpen,
those you love will live in a fever of love,
and you’ll bargain with the calendar
and at the last moment
when death opens the back door
you’ll put on your carpet slippers
and stride out.