"A GOOD DEATH: END OF LIFE DECISIONS
And UU Ethics"
Reverend Lynn Thomas Strauss
River Road Unitarian Church
Sunday, February 6, 2005

Reading from "Death With Dignity" by Timothy Quill, MD
We must train physicians to balance their drive to extend life with a mandate to listen to and learn from their patients, especially those who are dying. This delicate balance requires a much more judicious use of medical technology, combined with much more time spent informing and learning from patients themselves. Such exchanges are at the heart of humane medical care that serves patients who are ill, rather than treating disease and prolonging life as if the person did not exist.

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. There is no one right way.
Two: Sometimes we have the opportunity to make choices and sometimes we don't.
(Sometimes death comes with the stark finality of a phone call in the middle of the night.)
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 nurses, ministers, spouses, partners, children, grandchildren, friends...you will not be alone. You will have help, you will have companions.

It is a good thing to talk about death and dying. It is important not to be afraid to speak of these difficult things.

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 those who mourn.

My intention is to speak of death and dying and end of life decisions so that you will feel more free to speak of these things as well. So that when you stand in intensive care making decisions for a parent or 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 out place in the order of things.

Unitarian Universalists tend to face death squarely. With reason and candor comes courage.

UU minister of All Souls DC, 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. You will grow old much more cheerfully, if you are willing to die when the time comes."

The words of Dr. Davies remind me to set some things aside...to set some kinds of death aside...For death is not a good thing, when a child dies. Or if it is its harder to see. And death is not a good thing when it comes as a suicide...when it comes as a result of mental illness. And death is not a good thing when it comes as an accident rather than from age or illness. 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,"
"Every day 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.

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've 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 knew 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 cancer advanced chose, with the help of a loving family, to end her life at a time of her own 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 live 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 the 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 we'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 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 that 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. I have found this to be true in Bethesda and in rural Wisconsin ...it is probably true in most places in America today.

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 stand at hospital bedsides 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?

The first principle is, (as I've said) - 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. We do not believe that suffering is wrought by God and is therefore to be borne in silence.

Third, UU's hold autonomy, personal choice and individual conscience as a high value. We believe that autonomy is essential to moral action. For Unitarian Universalists 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 UU's 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 or 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.

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 I want my heart re-started?
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 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 about what they might want or not want in terms of care when they come to die. But experience shows that its often a moving line in the sand. We think we can't tolerate radical surgery, or chemo-therapy, 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 allows by law (in 1997), a hastened death with assistance of a physician is the state of Oregon. People of that state voted for this right. 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 terminal 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.

My younger sister had heart surgery a couple of years ago and is doing great, more than one friend is living cancer free after breast surgery, a friend with brain tumors has survived two surgeries and is still going strong...as fast-paced as medical research and technological innovation is...we must take care not to give up on life, on any life, too soon.

And yet, when all therapies are exhausted we should have the right to make choices. More states are going to consider death with dignity laws, this is the time to think and talk about it.

There are also some guidelines for care-givers:
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.

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.

I must always ask myself, 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, whatever they are and be present with you to the best of my ability. I know that Scott and Ginger pledge the same.

Today in the fellowship hall you will find members of our pastoral care team making available emergency information forms. We would like to have one for every member and friend of RRUC so that in case of emergency we know who to call.

There is also a table in the fellowship hall of representatives of our Life Choices Task Force...they have a sign-up for Advanced Directives; living wills, and power of attorney for health care forms.

The action to take away from my message today is to talk to family members about these matters.Please make sure you have communicated your wishes. And if you have advanced directives take them out and update them.

I believe that death and dying, because it is a part of life that we don't fully understand, is a spiritual path...we are all somewhere on that path, even today.

As I try to understand death and dying....as I attempt to prepare, to think about possible end of life choices...I find myself following one question after another. Questions keep coming. I have no final, all encompassing wisdom.

As a religious humanist, I honor and trust human love and courage, I also trust the mystery and power beyond my understanding.

What is a good death.

I'll leave you with the quote that most touched me this week. From poet Annie Dillard: "I think that the dying pray at the last not "please", but "thank you". Perhaps that's the definition of a good death. That we can say a final "thank you". May blessings be upon you and may you come at the last with the word, "thank you" on your lips. So may it be.

AMEN.