Death with dignity
Sunday, January 14, 2017
Text: Job 6:1-13; John 10:10
Idea for the day: This is the ending sermon in the series and it is one that has recently been in the news with Brittany Maynard’s suicide in Oregon. Was it right? Look what we do for our animals. Sometimes when someone is suffering we keep them alive for the wrong reasons. Is there a difference between using drugs to put them to death or just cutting off all sustaining support? When do we commit murder in the administering drugs? How do we decide? What does the Bible say?
Do you remember the ancient story of Job? It is one of the oldest stories in the Bible and it is about a righteous man who got caught in the middle of a cosmic wager to see if he would still worship God if everything he loved were taken away. It was a tough story with an even tougher outcome for poor Job. He lost his flocks and herds, his estate, his health, his friends, and even his family. When he was in the early stages of woe, when his body was covered with boils and open sores and he felt that God had unloaded so much tragedy upon him that just to look at him turned people’s stomachs. He was downright repulsive to others and to himself so what does he do? He prays to God. Step on me God! Squash me like a bug! Kill me now for I have passed my limits!
Poor Job knew how to live. He proved that. Now in his misery he was trying to learn how to die.
Think of how many generations have passed since this story was told around campfires. Think of how many times over the years the tellers of the story were clear about how to live well but stumbled and stuttered over how to die well. I would say that with all our knowledge, with all our technology, with all the philosophies and theologies to guide us we still have difficulty talking about something that will happen to each of us in this room – death. So today I am going to take on this very difficult topic.
Will you join me in prayer…
There is hardly a week that goes by that I am not sitting in a room at the hospital with a family and patient dealing with end of life issues. To be honest this was not what I expected when I entered the ministry but it is something that I have become really good at. It sounds strange to say that I have learned to help people die well, but just as midwives and doctors become really good at welcoming babies into this world, I have become really God at transitioning people into God’s kingdom. I think part of it is that I believe death is a part of life and to participate in someone’s death is an honor.
Let’s be honest today’s conversations about death have become more complicated because of technical and medical breakthroughs. It used to be as little as four or five decades ago that when you contracted cancer or suffered from a stroke or heart attack you had limited options. The doctor gave you his or her best treatment option and after receiving it you went home and you either made it through or you died surrounded by your family.
Now look at the new techniques, the experimental medications, the procedures that surgeons are just waiting to perform, the rooms in hospitals filled with every new piece of machinery and linked to computers to monitor your every breath. There are new ways to leave the hospitals and new facilities to make sure you keep on living even if means machines are doing it for you.
The advances in medical technology, medications, and treatments have far surpassed our advancements in medical and spiritual ethics and if we don’t start talking about death and life in new ways, we are going to keep coming to the end of our lives with more fear and anger than with dignity and hope.
Several years ago, Carol and I had our first Golden Retriever put down. We vowed at the time it was going to be our last because of how hard it was to put him down when he was filled with cancer. I remember delaying it as long as possible so that we would not have to face that one moment. We told each other lies – like I think Dakota is getting better today because he didn’t limp as much on his walk. But we knew. I can still remember when we brought him to the vet and she asked a very blunt and difficult question. “Who are you keeping your dog alive for? You or your dog?”
That blunt question opened a conversation Carol and I had been avoiding for a long time. It raised issues of quality versus quantity of time. I can remember the day that we brought him in to the vet and I sat on the floor and he cuddled in my lap. I loved him all the way out of this life and honored his passing.
About that same time, I remember that one of my congregants was in the end stages of life and was suffering greatly. With only a few months to live the doctors did not want to give him enough morphine to kill the pain because they were worried that he might become addicted. I remember him begging the doctors around him to let him die but they were bound by codes to do no harm. So, he suffered and suffered for months of indignity.
In the end, I concluded we treat our animals with more compassion than we often treat our fellow human beings.
The second text for today comes from the book of John and Jesus is talking about life. “I came to bring life and life abundantly.” The word for abundantly is “zoe.” It means full, overflowing, life with quality and dignity. How do we balance the quantity of life and look at the quality – the zoe of life?
How do we learn to not only live well but to die well? There is a relatively new law about dying well called the Death with Dignity law. For those who are not familiar with the Death with Dignity laws in our country let me give you some background. There are only five states that have voted Death with Dignity laws into the books – Oregon, Washington, Vermont, California, and Colorado and the District of Columbia. There are two states – Montana and New Mexico – where they have been brought in by judicial decision.
The Washington Death with Dignity law was enacted in 2009 and was patterned after the one in Oregon that was enacted in 1997. It is interesting to note that of the people who have used the law had an average age of 71, were married, were white, usually educated with a BA or more, and lived on the west side of the mountains. These findings contradict some of the early warnings by the opponents that might be used with those who are most vulnerable, uneducated, minorities, and the poor.
Losing one’s autonomy and not being able to engage in activities that make life meaningful and give life dignity were the top reasons for choosing the Death with Dignity option. It was not pain management as critics predicted.
The law is well written and restricts anyone who is depressed from using death as an escape. The person must be 18 or older, mentally competent, and must have two unconnected doctors verify that he or she is terminally ill with six months or less to live and that they are not suffering from depression. There can be no coercion or manipulation by family, insurance companies, or doctors. And to me one of the best provisions of the law and the one that sets this law up as a wonderful model for other states to follow if they go down this road – there needs to be a conversation between the person and his or her family.
That is critical because there are no surprises and the family members get to express their concerns and support and in doing so there is not the anger and resentment usually associated with suicide.
Even though Oregon and Washington’s laws have been around for a while there has not been that much controversy until a few years ago when a 29-year-old woman named Brittany Maynard reignited the firestorm. She had been diagnosed with terminal brain cancer and was going through a tremendous amount of pain. She and her newlywed husband moved from California to Oregon so that she could die with dignity if it became necessary. Let me show you her video and you will see that her choice was not without critics.
As I read up on Brittany I realized that she really wanted to live and not to die, as some of her critics said. She wanted desperately to live and start a family. She was not depressed or angry at the world. She was very clear that it was the cancer that took her life she just hastened death’s arrival.
She was accused by some of giving up too easily and not fighting through the pain. We all know that pain effects each of us differently and there are some who have a high tolerance and some wince when a mosquito bites. In this debate pain is not relevant. Quality of life is. She, as most who have taken advantage of the Death with Dignity law, feel that losing autonomy, joy, meaning, and dignity makes life not worth living.
Theologians and spiritual leaders from all over the world weighed in on her decision. The Pope, as compassionate as he has been on so many other issues, condemned the action and the movement to what is also called physician-assisted suicide. He called it a “sin against God, our Creator.” One of his spokesmen went on to say, “Assisted suicide is an absurdity. Dignity is something different to putting an end to your own life. What we are talking about here is a society that does not wish to shoulder the cost of disease and this risks becoming the solution.”
Other theologians argue that Death with Dignity laws take God out of equation and we are given permission to do what only belongs to God. Some say that it is a sin because it defies the sanctity of life itself. The United Methodist Church generally accepts the individual’s freedom of conscience to determine the means and timing of one’s death but it is not something we talk about a lot.
The harshest critics say that it is a slippery slope and once you give one group permission to take their lives then it opens the door to more and more groups and very soon you have people who can take their lives because they are disappointed in their career path or marriage.
The greatest supporters of this law contend that this is one of our basic human rights of life, liberty, and the pursuit of happiness contained in the Declaration of Independence. Every person should be able to determine for themselves how to live fully and when and how to die with dignity. It is part of our pursuit of happiness.
There are a lot of differing opinions on this issue and the longer I work in the hospital I realize there are a lot of gray areas around this issue. For instance, what about someone who stops taking medicine that is necessary to fight a disease or keep the heart in rhythm. Or what about someone who stops chemo when they have been told it might possibly extend life? Or what about someone who has his or her pacemaker turned off? Or what about the person who refuses food and water? Each of these actions hastens death but the only difference is there is no deadly pill or poison to take.
No matter where you might find yourself in this issue, one thing I believe everyone can agree on is there needs to be a conversation about death with your family members and friends so that are more clear about your expectations and wishes.
But the conversation should not be limited to just your family. It should also include your faith community and should be wrapped in prayer. You should declare clear markers that loved ones would be able to recognize so that IF you cannot make future decisions for yourselves someone will know exactly what to do. This is especially important in the hospital when doctors or surgeons are eager to try the next procedure or when an oncologist is ready to recommend the next round of chemo. Our medical communities have been trained to fix things and they talk more about techniques than they do side effects during the recovery phase if there is one. There are times when the side effects are far worse than the disease.
So, if there is one thing and one thing only that you take away from this sermon it is that you need to have a conversation about your wishes, goals, and expectations for those ending moments of life. That includes those who are young and feel like they will live forever.
Let me end with a story of someone in my family who made this issue real to me. My sister-in-law Carol battled brain cancer for more than 30 years. Before being diagnosed, she was a phlebotomist and lab tech and was so good at what she did that when the hospitals needed to take blood from infants they would only call for her. She was a gifted artist, cook, and loved to hike. Thirty years ago, the treatment of this kind of cancer was crude by today’s standards and they ended up taking a large portion of her right frontal lobe and then bombarded her brain with radiation.
She lost her hearing in her right ear, lost her balance and had trouble walking, and lost a lot of her personality and memory. She persevered. She would go for long stretches where she would do fairly well and then have another side-effect or more growth of the original tumor. She went from working in the lab to working as a hospitality hostess at Walmart. She even lost that job.
Over the years she gained a great deal of weight and often lost her balance and her ability to even take short walks. She could no longer stay at home with her husband and was put in private home for seniors. The diagnosis got worse and she had to have another operation on her brain and they decided they could not stop the cancer but took out more of the brain so that the tumor could grow and she could live longer.
I met with her many times and talked about her life – or as she used to say, “her lack of life.” She would say that she had no purpose to live, no dignity while she was living, and was in pain. She and her husband decided to check out options and met with a group call “Compassionate Choices.” They met with two different doctors, had discussions with her family, and eventually bought the drugs that necessary to be combined for the poison. Then they waited and waited and waited.
This was a different situation for me than all the other deaths that I had attended. She was asking me over and over again if God would be mad at her, if this was the right thing to do, and what would happen when she took the medicine. I carefully and compassionately guided her through the process.
One day I asked her how she wanted her last day to be. She described it perfectly. She wanted to be out of the nursing home, to sleep in her own bed, to have her favorite meal and be surrounded by her family and dog. We made all those things happen. My wife Carol cooked her favorite meal. We told stories about her life and laughed and then told more stories.
She had two desserts that night and smiled for both.
The next morning my wife and I walked up to her house and we noticed something amazing. There was a bald eagle sitting in the tree overlooking the patio of their house. I went out to shoot a picture expecting it to immediately fly away but it stayed. It was like it was watching over my sister-in-law. I later learned from a Native American pastor, that they believe when a gentle person dies an eagle takes their soul to heaven. I am not sure of the theology, but I am sure that it was one of the strangest things to watch.
We gathered around her bed – one at a time – and she talked to each of us and told us how much she loved us. When she was all done two nurses came in and gave her the medicine. I thought that she would back out because of how big the decision was, but she drank it down.
Within a couple minutes she relaxed and you could tell that the drug to lower anxiety had hit. She asked her husband to sit next to her in bed and to hold her. The room shrunk to just the two of them and finally to just her. She smiled the entire way. When she died, there was no pain, no gasping for breath, and no fighting. She died with more dignity than she had felt in months.
It was a good death.
Let me show you a video of that evening and morning. I edited it so that you would not see the final moments.
Page 1