Unitarian Universalist Fellowship of Charlotte County

Facing the Final Days
October 17th, 1993 by Rev. Sam Trumbore

Bill, a member of my church in Oakland, had suffered a stroke which had paralyzed the right half of his body. He was first sent to a veterans hospital then to a nursing home. I remember vividly going to see him and walking up to the front door. I was greeted by an audience of eyes lined up in wheel chairs silently inspecting all comers and goers. I found Bill's room and tried to speak with him, which was difficult, for his thinking was confused and speech slurred. He was quite depressed by his condition and his poor prospects for much recovery, as well as a wife who would rather have him stay there than return home. From the room across the hall came a hideous, wretched cry for help. When the staff passed the room without notice, I realized that the woman must be suffering some form of dementia. About every 30 seconds came the same anguished plea. That image of a once-vital human being trapped in a decaying body that would not die haunted me as I left the nursing home that day and remains with me as we consider the end of life together this morning.

The subject of our service is euthanasia, and let me waste no time in telling you that I am pro-choice when it comes to terminating one's life. I do not advocate it. I accept that there are circumstances that dictate it. I feel it has its place and should be available as an option. I know of cases where I would have been willing to be the one to pull the plug. Many of you here have heard the pro and con arguments and have already thought about this very deeply. Many of you are members of the Hemlock Society.

I feel human birth and life is extremely valuable, even in the final days. Last week I spoke about the value and meaning which can be found in the final phase of life. This week I wish to consider what is probably the most important aspect of the euthanasia issue: how we come to the personal decision to end our own suffering or to terminate the care of a loved one. The abstract issue of whether it is right or wrong covers the more important personal issue: is it right or wrong for me?

Suicide has been with us since before recorded history. There is no condemnation of it in the Bible. Roman citizens raised it to an art form during the hedonistic decline of their empire. Those who suffered most, the slaves, were prohibited from killing themselves to prevent the loss of their labor. Soldiers were prevented from killing themselves because they were needed to protect the state. The prevention of suicide was a practical concern. I'm sure the Greeks and Romans didn't think twice about the morality of an aging, ill, parent drinking a cup of poison.

Early persecuted Christians reveled in having their lives taken by the oppression of the Romans because it meant that they would be glorified in the next life. Christianity in those times (and still today) focused to an extreme on the end-times when Jesus would come again and good Christians would inherit the earth. When Christianity became the religion of the Roman Empire, under St. Augustine's direction, this escape from the suffering of this world to get a box seat at the right hand of God began to be curbed. The Romans needed Christianity to continue the domination of the world religiously rather than militarily. This domination continues today. The Council of Braga in 563 specifically condemned suicide, and this condemnation was affirmed by later councils. St. Augustine developed the argument that because life is a gift from God, the rejection of life is a rejection of God and God's will. This remains the predominant religious argument against suicide.

In more modern times, the medicalization of suffering has created the fiction of a healthy functional adult. Any deviation from this healthy happy, prosperous, energetic picture springs from a disease which can be fixed or at least controlled if properly diagnosed and treated. The assumption is that any people who are healthy would want to continue their lives. If Romeo had just had proper therapy and some Prozac, he would be happy and adjusted without Juliet. If Lady MacBeth had just had a chance to work on her self-esteem, she could have washed the blood from her hands.

My purpose here is not to make light of the value of psychotherapy, but rather to direct your attention to a modern myth that everything can be fixed with the right drug. No wonder teenagers turn to drug abuse when they witness their parents taking many medications to "normalize" their lives. The chemical is the answer.

But there can come a time when one's suffering is a greater burden than one can bear. We are finite frail creatures that can only endure so much misery. Yes, there are experiences of grace which can transform suffering. I have had them. I expect many of you have had them. I encourage you to open to these tremendous experiences. But some of us cannot endure the wait. The haunting sound of the woman in the nursing home crying for help, I suspect, is typical of our fears of being out of control of our destiny, enduring needless empty suffering. None of us can fully understand or appreciate the depth of another's agony. Some of us may desire to take the matter into our own hands.

The biggest challenge, I think, is deciding when that time has come to take matters into our own hands. Let me present to you one simple method of evaluating the reasons for ending one's life. I realize this isn't a perfect world and we will likely have a mixture of thoughts and feelings as the final days approach. These are suggestions not commandments. We must all take responsibility for our choices in the dying process.

In the process of deciding to shuffle off this mortal coil, one must carefully consider one's motivations for doing it. If the motivation has fear as the root, I submit it is a suspect motive. If the motivation has love as the root, it is an acceptable motive.

The most suspect motive is the fear of possible pain and suffering. We are quite fortunate today that many effective pain management techniques, medications, and procedures exist to make the dying patient more comfortable. Morphine is quite a remarkable medication. The actual pain and suffering we experience may turn out to be more manageable than our imagination would lead us to believe. Rather than turning away from pain, turning towards it as a way of studying a universal experience of living creatures can teach us a great deal. As steel gains its strength by the annealing process, one's character can be purified in the fire of pain. The growth of character enriches the experience of living even in the final days which could be some of the best of our days.

The great teaching that can come from enduring pain is the realization that we are more than our bodies. Many religious traditions use self-torture in the hope of religious ecstasy. We can laugh at them as primitive savages or we can investigate to see if they know something we don't. If we're stuck with the pain, it's nice to know it can have some usefulness.

The fear of loss of control over one's life is really a fear of loss of identity. To be a nameless face in a row of institutional beds dying in anonymity terrifies us. I spent a summer at the Delaware state mental hospital with people in this condition, sitting in chairs staring blankly at the wall. For some it was torment but for others it was a simple contented peaceful existence. They had no worries about what Medicare would cover, where the next meal would come from, doing the laundry or fixing the roof over their heads. They had their own pool. Professional recreation therapists offered entertainment. The television was always on. These people lived better than the majority of the world's population! I wouldn't choose to live there, believe me, but if I found myself stuck there as I did that summer, I could and did find meaning in that setting.

The fear of being a burden on your children bothers me. After raising children and putting them through college, you'd think they would like to show a little gratitude. Especially if they stand to inherit a large sum of money. Often the parent has the resources to help pay for the care; all they need is a place. In third world extended families, parents are usually cared for by their children. I understand that parents may not want to spend their final days with their children and I find this equally disturbing. Most parents would have no hesitation in allowing their son or daughter to return home to die of AIDS. Yet most parents wouldn't ask the same of their children. Is this because they don't want to be a burden ON their children or because they don't want to relinquish control TO their children?

The fear of the cost of dying is another concern that must be carefully considered. If you pause for a moment and think about it, it doesn't cost anything to die. It just happens when the breathing stops. What costs money is trying to prevent it. In many cases, with the support of hospice, visiting nurses and other agencies, the cost of care during the dying process can be minimized. The cost for my mother to die at home was very low compared to what a hospital or nursing home would have cost. It was a rare privilege for my sister, my father and me to be there to help her die peacefully. I want you to know how meaningful that was for me. She gave me a great gift by allowing me to witness her death. It's a whole lot less scary for me now. It's a whole lot more acceptable.

The worst fear is the loss of our mental capabilities, that we will be confined for years without mental function. None of us want to end our lives babbling gibberish with drool running down our chin. It is important to remember that even here nature does try to take its course. Before the age of antibiotics, the senile would usually die of pneumonia - the dying person's best friend - as their systems weakened. But in the hygienic nursing home setting, people are regularly maintained with a variety of drugs which ward off death-delivering diseases and infections. The problem is that the natural dying process is suspended. Dying of mental loss in an appropriate setting can be a very acceptable way to die with little physical pain for the patient who quietly fades away.

I need to say at least one small word in defense of nursing homes. Its the magic word of today's politics: J-O-B-S. Lots of people earn a meager living working in nursing homes. Often these people are just one step away from welfare and poverty. Money that goes into these pockets is money better spent than government handouts. These people are earning dignity as well as money by working hard for those forgotten and unwanted by a society that values productivity over the wisdom of age.

Having said all this, I believe there are acceptable reasons to extinguish one's flame. These reasons have more to do with love for creation, family and community than fear of the dying process. I believe taking one's own life can be an act of heroism.

The heroic self-destructions we admire have love as the root. We are inspired by the martyrs giving their lives for their faith and the visionaries sacrificing for their people, dying for the cause of human advancement. The man who rushes to pull someone else back from falling off a cliff or dives into an icy river to rescue a drowning child or a relief worker in Somalia braving bandits to deliver food risk their lives because of their love of life. The same spirit can be present when people commit suicide to save their family or community from suffering.

I saw a gripping foreign film probably ten years ago about a small village in the northern mountains of Japan. The elements were harsh and the villagers eked out a very meager existence. The star of the film was an unusual old woman who had reached the age of 70 in fairly good health. Since most who made it to this age were quite ill or infirm, they were a large burden on the community where there was just enough food for survival. Her continuing life meant the potential starvation of a new child. A tradition had developed out of the mists of memory that once a person reached 70 years old, he or she was to be carried by the firstborn son of the family on his back to the top of a local mountain where they would be left to die. It was a great source of honor for both the son and the parent. Unfortunately the star of the movie wasn't sick or weak and her son didn't want to lose her. She felt shamed that her son would not fulfill his social duty and smashed her beautiful teeth on a rock to make herself more hideous to him. Her death in the customary way affirmed her love of her village and her place in the social order. Her death is full of affirmative meaning which her son did not understand because he was consumed with his own fears and desires.

One cannot examine the problems of hunger, environmental degradation, topsoil erosion, rising crime, homelessness and unemployment without coming face to face with the problem of overpopulation. Life span extension only makes this problem worse. It can be an act of love toward our planet to relieve it of one more responsibility.

Children can be severely strapped financially trying to raise a family of their own. To ask them to deal with a parent who requires 24-hour care can be an overwhelming burden. Caring for an Alzheimer's patient is more than most of us can cope with. It can be an act of love to prevent this from happening.

It can be an act of love to dedicate the money that would have been spent on caring for the final stages of cancer towards finding a cure so that many more in the future will not lose breasts, colons and lungs.

I emphasize the importance of the motivation for suicide because certain religious traditions feel that the state of mind of the dying person is extremely important in determining the next life. In the Hindu tradition it is most auspicious to have the name of God on your lips as you die. Gandhi died saying "Ram." Since none of us knows what will happen after we die, I think it's worth hedging your bet on suicide which is frowned on by other religious traditions.

The most important thing I think I can say about euthanasia is that it must be carefully and rationally thought out over a period of weeks, consulting family, friends, understanding health care professionals, and your minister. I promise to you that I will not try to talk you into or out of the decision you choose. My only plea is that the decision to die by your own hand be carefully and rationally made.

On the scale of the life and death of stars and planets in the galaxies, how our life ends isn't that important. To those who love us and care for us, how our life ends is tremendously important with consequences that will affect the seventh generation of our children. We can die with dignity by our own timing in a way that affirms life. We can let nature take its course in a way that affirms life. The choice is ours.

May we lead the way as Unitarian Universalists toward a more humane and rational policy on euthanasia for our nation based on rational choice in service of ongoing creation.

Copyright (c) 1995 by Rev. Samuel A. Trumbore, All Rights Reserved