Issues of Death and Dying

a sermon by Reverend Lynn Thomas Strauss

Unitarian Universalist Church of Rockville, December 3, 2006

Meditation

Meditation by L. Strauss

We rest on a foundation of something that we do not know.
We ask this day for the wisdom to live in the moment.
For the patience to go deep and wait,
Trusting that all that comes to us in this moment is precious.

We rest on a foundation of something that we do not know.
May we treasure our loss and our pain as the sings of life that they are.
Let tears freely flow from sorrow to sorrow,
As our suffering blesses us with new insight.

We rest on a foundation of something that we do not know.
May we trust enough to lean…and to let go.
Thus will we fall into the vast sea of love that will in time, wash away our wounds.

And in time, we will again sing praises, feel deep joy, know that we are deserving.
May blessings be up us all this day.
May we, strengthened by this community of faith
Go forward to live each day until the end,
Assured, that we rest on a foundation of something we do not know.
Something that is broad and deep, solid and good…
Something that holds us even unto death.

Reading

by Epicopal Bishop John Shelby Spong

Reading goes here. Seperate from sermon with a rule.

The time has come, I believe, to embrace death not as an enemy to be defeated, but as an aspect of life’s holiness to be embraced. We do not honor life when we fail to see that death and finitude are what give our humanity its precious quality. Death is an aspect of life, a vital aspect that gives life its deepest flavor, its defining sensitivity.

As your minister, I must sometimes speak to you of difficult things. This morning is one of those time. It is my intention to speak of death and dying and end of life choices and grief. For these are things we need to help each other with. And it is something that our faith, our principles and values help us with also.

I speak of these things at this time of the year, because with the holidays come memories and grief, with winter comes the season of dying and drawing back, the season of cold and loneliness. This is a good time to be aware of the presence of death and grief in our lives.

Nothing hones our questions about life and its meaning more than facing death. I have a lot of questions. We all have a lot of questions, or perhaps some of us have one question that plays in our heads over and over. This sermon is full of big questions.

What is a good death? There is no single answer. A good death is as individual and unique as a good life.

Some things I have learned as a pastor:
One; there are as many ways to die as there are ways to live.
Two; Sometimes we have the opportunity to make choices and sometimes we don’t.
Three; when you come close to death, you will know what to do. It’s amazing the strength and courage people show in the face of death.
And four; others will walk by your side. Whether its doctors, nurses, hospice workers, ministers spouses, partners, children, grandchildren or friends- you will not be alone. You will have help, you will have companions.

I thank you for being here this morning. I thank you for engaging with this difficult subject, with these tough questions. We all come having experienced a death in the family. We all come as mourners. It is written in scripture; “Blessed are those who mourn. We all come this morning having been blessed, part of the great family of mourners.

My intention is to speak of death and dying and end of life decisions o that you will feel more free to speak of these things. So that when you stand in intensive care making decisions for a parent or a spouse, you will know their wishes, and you will not be afraid to ask the medical staff your questions. My intention is to offer practical information and the guidance of our faith, for like it or not, today , as every day, we are preparing to face death, either our own or the death of someone we love.

We are so lucky to be Unitarian Universalists, for our liberal faith offers the moral strength, the rational guidance, and the spiritual depth that we need to face death.

With our faith’s emphasis on this life, rather than the afterlife, with our respect for individual autonomy and responsibility, with our embrace of science and the understanding of the interdependence of all life; we UU’s come to face death and dying with intellectual clarity and appropriate humility about our place in the order of things. Unitarian Universalists tend to face death squarely with reason and candor and courage.

UU minister of All Souls D.C., A. Powell Davies wrote; “take death for granted. It is a good thing. The world could not move on without it. Live with that particular reckoning behind you and you will grow old much more cheerfully.

The words of Dr. Davies remind me to set some things aside, some kinds of death aside…for death is not a good thing when a child dies, And death is not a good thing when it comes as a suicide as a result of mental illness. And death is not a good thing when it comes as an accident rather than from age. And death is not a good thing when it comes in war or violence.

Yet death comes to all living things. UU minister David Rankin writes in a poem called “Good Dying”;
“Everyday is a preparation for the end, and every end should be a reflection of all the days that have gone before. Good living and good dying are a single, healthy stream.”

This morning I speak about our hope for good dying , at whatever age death comes, we hope to experience it as part of good living. We hope to face it as an inevitable law of the universe, as a sacred part of life itself.

We all want to live long and full lives. We do all we can to stay healthy and safe. In ways large and small, day after day, we take care, we choose life. Day after day, we choose good living.

Continue to choose life, this is the grounding principle with which to measure every ethical decision, does it serve life? Am I choosing life? Life whose essence is dignity and worth.

This is the highest of religious values, that all life is sacred. This principle should guide every decision, every intention, every exploration we make into end of life questions. All life is sacred. All life is a gift. We should not give up on life cheaply or quickly; our own or others- we should live as fully as we can as long as we can.

In preparing this sermon, I reflected on many deaths. Some have been good deaths, like the elderly woman who died quietly in her sleep. Or the young father who with hospice help and his loving wife and children by his side died at home over the course of months- a dying that felt natural and whole, in spite of his young age. It felt like a good death because of the severity of the illness (we know he wouldn’t get better) and because everything that could be done, had been done. Because some good and loving choices had been made.

I also remember some not so good deaths. I remember vividly when I was four years old being taken weekly to visit my grandmother who was dying of cancer. She lived with my aunt and lay in a big bed in a small dark room. She did not speak or move, she was in constant pain and lingered for months and months. My father is still angry and full of pain over the suffering his mother was forced to endure.

I remember too the woman who, knowing that great pain and indignity lay ahead as her illness progressed chose, with the help of a loving family , to end her life at a time of her choosing. This woman had long been a member of the Death with Dignity movement and had made her desires concerning the manner of her dying known long before her cancer was diagnosed.

And I thought of a recent experience when an older man who’d lived a good long life was suffering extreme breathing difficulty, with pneumonia and many other medical challenges related to aging, he was declining quickly as he lay in the hospital and doctor came in to check on him. And the question was asked, asked very directly by his daughter, “Doctor, is he dying?” And the doctor looked her in the eye and said, “Yes he is.” “And he won’t get better?” “No, he won’t”.

“But I want to keep him with me one more day,” the doctor said, “I will see that he’s comfortable. If you want we can move him into comfort care, tomorrow they’ll move him down the hall into a different part of the hospital where they focus on comfort care rather than saving lives. But let me keep him here for today.”

The family was so relieved at the direct and caring honesty of the doctor. Medication was given to ease the suffering. The doctor followed him closely and he died peacefully the next night.

Things have changed in hospitals. Doctors and nurses are much more attuned to treating the whole person, rather than just the disease, and they pay better attention to the whole family system, and they communicate better.

The growth of the hospice movement and the increased awareness of many people about end of life choices, the resource of the internet, where we all can learn a lot more about the course of illness and its treatment options, all this is making a real difference in how the conversation goes.

And yet we may stand at the hospital bedside with many anguished questions. Still we may be faced with excruciating decisions. What are the values and principles of Unitarian Universalism that will guide us when that time comes? I’ve identified five.

The first principle is- that all life is sacred, and that individual dignity is of paramount importance.

Second, it is important to realize that our faith does not inherently value suffering. We do not believe that suffering demonstrates faithfulness.

Third, UU’s hold autonomy, personal choice and individual conscience as a high value. We believe that autonomy is essential to moral action. For Uus there is no authority to tell us what is right and what is wrong, we must discern these matters for ourselves after much thought and soul searching. Thus we don’t assume what others might want, we ask, what do you wish for yourself when you come to die? If the worst happens, what are your wishes?

Fourth, we Uus value tolerance and open-mindedness and the exercise of freedom of choice; therefore we try not to judge one another. What is right for me, what for me, constitutes a good death will be different for you. My end of life choices, will not be your end of life choices.

And finally, a grounding principle of our faith is the significance of human relationships, the value of community. We acknowledge that we are connected to one another , that we carry obligations for one another, that all life and death decisions affect the whole family, social network and community.

Summarizing these UU ethical guideposts… When we reflect on end of life decisions for ourselves or for loved ones, we take into account, the sacredness of life, the degree to which suffering can be relieved, the ability of each person to make an informed choice, the extent to which we are accepting of the choices of others, and the welfare of the larger community.

And still we are faced with painful personal decisions.
When does it make sense to stop the cancer treatment?
What will happen if the pain medication is increased?
If the worst happens, do you want to be placed on life support?
Should we insert a feeding tube?
Do you want your heart restarted?
Should I go home with hospice care?
Is there anything I can do to ease his suffering?
Do you wish to be an organ donor?

Who do you want to make these decisions for you, if you are unable to make them?

We never know how we will answer these questions until the time comes. Many people hold an opinion in the abstract, but experience shows that is often a moving line in the sand. We think we can’t tolerate radical surgery, or chemotherapy or amputation or loss of brain function, but when the moment of decision comes, we find that life still holds beauty and meaning and we’re not ready to let go completely, not until we absolutely have to.

The Unitarian Universalist Association has been and continues to be in the forefront of the death with dignity movement. In 1988 our General Assembly adopted a resolution that supports work for legislation that will create legal protection for the right to die with dignity in accordance with one’s own choice.

The resolution reads in part, “guided by our belief as Unitarian Universalists that human life has inherent dignity, which may be compromised when life is extended beyond the will or ability of a person to sustain that dignity, we advocate the right to self-determination in dying and we advocate safeguards against abuses by those who would hasten death contrary to an individuals’ desires.

The only state which now allow by law, a hastened death with assistance of a physician is the state of Oregon. People of that state voted for this right in 1997. Statistics show that a majority of Americans believe there should be more choices at the end of life, a majority of Americans believe that doctor assisted dying for the terminally ill should be a legal choice. There are careful safeguards in place in Oregon, requiring statements by two doctors, that the patient is dying, is suffering and all efforts to relieve that suffering have been tried…there must be two written requests by the patient, with a waiting period in-between and a physician must be present. There is no data showing any abuse resulting from this law.

We live in an age when medical technology and medications can keep a person alive beyond the point at which death would have occurred naturally in times past.

We celebrate these advances in medical science, and we are grateful for the added years that so many enjoy. Hopefully many of us will have our lives extended by the miracles of science and technology, there are some in this room who have received such an extension, such a gift of life already.

Although I agree with the spirit of the UUA resolution and the intent of the Oregon law, to offer the choice of self-determination in dying, as a minister, I still struggle with the questions. I must stand open to the whole range of choices. In order to stand with each of you and support whatever choices you make, I must remain open.

When we are caring for loved ones, we have to follow their lead. Respect their wishes. Put our opinions aside and listen carefully , and if they have given to us the privilege and responsibility to make medical decisions on their behalf, then know that they have placed all their trust in us and in our love for them.

I urge you to always ask, is this a choice that honors the sanctity of life?

I cannot offer certainty, but know that, as your minister, I am honored to be with you and your family when you confront death and dying. I will respect your choices and be present with you to the best of my ability.

I hope you will talk with your families about Advance Directives and Living Wills and Power of Attorney for Health care forms. These are available on the web, I’m sure. The action to take away from my message this morning is to talk to your family and/or closet friend about these matters and to make sure you have communicated your wishes.

Let me leave you with an image both beautiful and temporary, an image that symbolizes life itself.

It is the image of the sand mandala made by Buddhist monks. To bring home the impermanent nature of everything that lives, Tibetan monks create complex artistic creations out of colored sand and then destroy them.

They are called Mandalas, Sanskrit for circle, they are painstakingly, ritualistically created- a group of monks made one in our Tennessee church many years ago, they arranged the sand, grain by grain, over several days, making a beautiful symmetrical design. There was chanting as they created, for the act was in itself a meditation. When it was done, they swept it up and carried the sand to the river, returning it to its source. The elaborate representation of complexity and potential became a lesson in impermanence.

I still have many questions about death and dying, but as a religious humanist I honor and trust human love and courage in the face of death, I also trust the mystery and power beyond human control.

May I end and bless you with the words of Annie Dillard;
“I think that the dying person prays at the last, not “please”, but “thank you”.

Perhaps that’s the definition of a good death and a good life, that we can say a final “thank you.”

May it be so/Amen