Death With Dignity
I’ve chosen to approach this morning’s sermon topic with a news report:
A massive study published a few days ago in the Journal of the American Medical Association concludes that in hospitals across the country far too many doctors are unaware of, or ignore, the last wishes of dying patients, needlessly prolonging their pain and suffering. With a $28 million grant, hundreds of doctors and nurses in five major teaching hospitals observed over 4,000 desperately ill patients and found the following: First, poor communication – while a third of the patients had asked not to be revived, half the time DO NOT RESUSCITATE was never written on their charts. Second, nearly 40% of patients spent at least 10 days in intensive care, kept alive only by breathing machines. “We don’t decide to let patients die in peace until amost the last moment,” says one director of the study. “This is hard on patients, their families, and the health professionals who care for them.”
Convinced that the problem was caused largely by lack of communiction, the researchers launched the second phase of their study, involving more than 4,000 different terminally ill patients. This time half got traditional hospital care while the others were monitored by specially trained nurses who consulted with patients and their families, forced them to confront the realities of dying, and kept doctors informed about their patients’ conditions and wishes. They were stunned to find that it did not make any difference, that the tools they thought would work didn’t. The reasons, they decided, are ingrained in our society. As one of them said, “Physicians are taught to save lives, that death is failure. Patients and families have come to expect miracles in every case.” The result is an enormous amount of needless suffering and staggering cost, issues which the AMA has promised to address with greater urgency than ever before.
My guess is that most of you have already decided you do not wish to be kept alive by artificial means when there is absolutely no hope for quality of life, but that is not quite what the person had in mind who wrote requesting this morning’s sermon. His or her question was phrased like this: “Do people in terrible pain, with a hopeless disease, have the right to choose the moment of their death?” I have no idea who sent me the question, but I do know a woman, too sick to be present these days, who said to me recently, “I am old and worn out, with no life now and none possible in the future. I am of no use to myself or to anyone else. Frankly, I’d like to end it, but my Baptist upbringing won’t let me.”
I remembered reading how during his long lifetime the great Roman orator, Seneca, gave much thought to old age. He said, “I will not relinquish old age if it leaves my better part intact. But if it begins to shake my mind, if it destroys its faculties one by one, if it leaves me not life but breath, I will depart from the putrid or tottering edifice. I will not escape by death from disease so long as it may be healed, and leaves my mind unimpaired. I will not raise my hand against myself on account of pain, for so to die is to be conquered. But I know that if I must suffer without hope of relief, I will depart, not through fear of the pain itself, but because it prevents all for which I would live.” Since he lived long before there were Baptists, and choosing one’s own moment under such circumstances was considered noble, he was true to his word at the last.
I have read recently a brutally frank but brilliant book called How We Die, in which this paragraph occurs in a chapter on suicide and euthanasia: “Taking one’s own life is almost always the wrong thing to do. There are two circumstances, however, in which that may not be so. Those two are the unendurable infirmities of a crippling old age and the final devastations of terminal disease.” The adjectives are the crux of the issue: unendurable infirmity, crippling old age, terminal disease. The physican who wrote this book abhors ordinary suicide so much that even when all the adjectives apply, he approves of what Seneca did only after “consultation, counsel, and the leavening inflence of a long period of mature thought.” Then he adds this profoundly thoughful sentence: “A decision to end life must be as defensible to those whose respect we seek as it is to ourselves.”
“Against such a standard,” the author says, “the suicide of Percy Bridgman was close to being irreproachable. Bridgman was a Harvard professor whose studies in high-pressure physics won him a Nobel Prize in 1946. At the age of 79 and in the final stages of cancer, he continued to work until he could no longer do so [and then left] a suicide note in which he summed up a controversy that has since embroiled an entire world of medical ethics: ‘It is not decent for Society to make a man do this to himself. Probably, this is the last day I will be able to do it myself.’” The professor hated not having help, arguing that when the ultimate end is inevitable “the individual has a right to ask his doctor to end it for him.” Says the doctor who quotes him, “If a single sentence were needed to epitomize the battle in which we are all now joined, you have just read it.”
The literature on this issue is so vast I can’t even summarize it in these few minutes, and I am uncomfortable aware that some of you are wishing we were discussing heaven or the Holy Spirit or how to be happy — anything but that natural event in human life we call death. So a sermon dealing with that topic, in any fashion, can hardly expect to be popular, but I’m convinced the church has to talk about this universal experience and not retreat to some never-never land when difficult questions are asked. It might be easier for you if you had gone as often as I have, through the demands of my profession, to see a patient everybody knows can live only days or weeks longer but who is connected by wires and tubes to a maze of machines, and who cries out, “Isn’t there some way out of this?” Some of you listening are young in years (I hope we are all young in spirit) and you may be thinking this subject is not for you. Let me remind you of something. First, in facing the idea of death realistically early in life, life is very likely to hold much more meaning and greater fulfillment, and second, you will become our doctors, legislators, theologians and nurses in the near future, and you will be giving counsel and leadership in matters of death and dying. Life does not get worse because you remember death. It gets better. So, even if you are young, join the rest of us in listening and thinking for the next few minutes about the single issue raised by one of you: do people who have .have lost everything that makes life meaningful — hopelessly ill, in constant pain – have a right under such circumstances to choose the moment of their death?
I have in years past preached sermons of argumentation, pointing out that the Bible has nothing direct to say about this matter and that we are left, as is so often the case, to work it out for ourselves in ways we hope will be in harmony with the spirit of Christ. This morning, because narrative is likely to be remembered longer than argument, I would like simply to share a compelling personal story written by a reporter for a famous national magazine about how his mother chose to die on her own terms. No matter how you feel about her decision, her courage and grace will make you proud to be a member of the human race.
Having decided when she first heard of her ovarian cancer that she would not hang on to life when there was none, she told her son as she entered the final stages of her illness that she had always believed in planning things carefully and that she had gotten the necessary pills. “As long as there is even a remote chance of my getting well, I’ll go on with treatments,” she told him. “When they say that they are keeping me alive but without any chance of recovery, then I’ll stop. When it’s time, we’ll all know. I won’t do anything before then. Meanwhile, I plan to enjoy whatever time there is left.” Her son writes: “Everything that had been intolerable to my mother was made tolerable when she got those pills, by the sure knowledge that when life became unlivable it would stop. I would have to say that the eight months that followed, though they led inexorably to her death, were the happiest months of her illness; and that in some obscure way — despite, or perhaps because of, the suffering in them — they were the happiest months of our lives. Once we had all settled the future, we could live fully in the present, something that we had never really done before.
“Euthanasia,” he says, “offers a remarkable liberation, for the imminence of death, once it is fully acknowledged, can be the basis for a stripped and pure honesty that is not possible under ordinary circumstances. I should emphasize that the vomiting, the malaise, the hair loss, and the adhesions were all relentless; that my mother’s mouth was one great sore that seemed never to heal; that she had to save up strength for days to have one afternoon out; that she could eat almost nothing, was a mess of allergies, and shook so badly that she was often unable to use a fork and knife — yet the excruciating business of the continuing chemotherapy seemed suddenly unimportant, because these symptoms were permanent only until she decided she could take no more, and so the disease was no longer in control of her.
“My mother talked in that period about how much she loved us all, and unearthed the shape and structure of that love; she contrived in the course of a few months to resolve old family differences. She set aside a day with each of her many friends to say goodbye…..she made sure each understood the large place he or she occupied in her affections.” The son goes on to tell how his mother decided, after a final visit to the doctor and some very bad news, that the time had come. With her husband and two sons in the room with her, she scooped up her pills and swallowed them two or three at a time until all 40 were gone. “I’m so tired of taking pills,” she said wryly. “That’s one thing I won’t miss.
“Then we had about 45 minutes, during which she said all the last things she had to say, and we said all the last things we had to say. Bit by bit, her voice slurred…..”You were the most beloved children,” she said, looking at us. Until you were born, I had no idea that I could feel anything like what I felt then. I had read books all my life about mothers who bravely said that they would die for their children, and that was just how I felt. I would have died for you. I hated for you to be unhappy. I wanted to wrap you in my love, to protect you from all the terrible things in the world. I wanted my love to make the world a happy and joyful and safe place for you.” She held my hand for a second, then my brother’s. “I want you to feel that that love is always there, that it will go on wrapping you up even after I am gone. My greatest hope is that the love I’ve given you will stay with you for your whole life.
“Her voice was steady at that point, as though time were not against her. She turned to my father. ‘I would gladly have given decades of my life to be the one who went first,’ she said. ‘I can’t imagine what I would have done if you had died before me, Howard. You are my life. For thirty years, you have been my life.’ She looked at me — I was crying, though she was not — and her voice took on a tone of gentle reprimand. ‘Don’t think you’re paying me some kind of great tribute if you let my death become the great event of your life,’ she said to me. ‘The best tribute you can pay to me as a mother is to go on and have a good and fulfilling life. Enjoy what you have.’ Then her voice became dreamily torpid. ‘I’m sad today. I’m sad to be going,’ she said. ‘But even with this death, I wouldn’t want to change my life for any other life in the world. I have loved completely, and I have been completely loved, and I’ve had such a good time.’
“She closed her eyes for what we thought was the last time, and then opened them again and looked at each of us in turn, her eyes settling on my father. ‘I’ve looked for so many things in this life,’ she said, her voice as slow as a record played at the wrong speed. ‘So many things. And all the time Paradise was in this room with the three of you.’ My brother had been rubbing her shoulders. ‘Thanks for the backrub, David,’ she said, and then she closed her eyes for good.” Andrew Solomon goes on to talk about how lucky they were to be spared some of the complications of such a death, and how hard it is to help someone you love even when they have begged and you have promised, but having witnessed the comfort of that control when there is nothing good left he is convinced his mother made a right and courageous choice.
The words this morning are not intended to shape your convictions, but I am not of much use to you without honesty and I do know my own mind. I want no prolonging of days with absolutely no meaning. If I end up trapped in the final days of life that is no longer life, I hope to be granted a peaceful, dignified exit. If my only choice is to pick the moment and help myself, I would like to have the courage of the woman I have described.
Death, after all, is not the greatest loss in life. The greatest loss is what dies inside us while we live. The unbearable tragedy is to live without dignity or hope. Surely we can at least understand when some we know, caught in the irreparable ruin of extreme old age and illness, choose to exit in their own way.
If we should differ among ourselves, Eternal God, on the thoughts
of this morning, we are agreed on this much: that it is our mission
to make life worthwhile in every way we can for those we meet.
Help us do so, in the name of Christ our Lord. Amen.