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Sunday, May 20, 2012

Life's Endings

Presented by Rev. Diane Teichert with John Sebastian, Worship Associate; Elizabeth Benefiel, Guest Pianist


Life’s Endings

A sermon preached by the Reverend Diane Teichert

Paint Branch Unitarian Universalist Church

May 20, 2012

This sermon is one of the sermons “won” at the 2011 Auction, which gives the highest bidder the opportunity to provide me with a topic for an upcoming sermon. It was won by Ken Montville, who gave me three topics from which to choose. The third he told me was by far the easy way out, and not wanting to seem like a wimp, in his eyes at least, I chose one of the other two.  It’s actually the one I consider to be the most difficult, so of course I’ve had bouts of wishing I’d done otherwise. But I’d already told him and published my first choice in the newsletter, so here we go!

But first let me say something about his first choice. He wanted me to address the topic of our endowment, which is called The Legacy Fund. Ken was instrumental in establishing it, and he wishes more people would 1) provide for the church in their wills through the Legacy Fund and 2) name the Legacy Fund as the recipient of donations in memory or honor of themselves or their loved ones at major life-passages such as births, birthdays, anniversaries, weddings and retirements.

I share Ken’s wish, and not just because the Legacy Fund provides financial stability or that interest from it can be used for special projects that are not funded by our annual budget, which the Legacy Fund Committee determines are in the church’s best interest. 

To me, support for our endowment illustrates long-term commitment to the institution of the church.  It shows that current members understand that we inherited from our predecessors a church we’ve come to know and love which generations to come will know and love too, but only if we are committed to its longevity. What is required to support Paint Branch UU Church’s endowment? Only intention, planning and communication. Not much more.

And, it’s intention, planning and communication that are important in answering the question that IS our topic today:  why do we keep people alive in the first place?

By which I think Ken meant the person whose life does not seem to be worthy of the word “living” and who is on medication that allows them to live or some kind of life support nevertheless – why do we put people on life support in the first place, necessitating a later decision as to whether to remove it or not?

So, perhaps I will re-state it: why do we keep people alive at life’s ending? Why do we extend a person’s life when we are really just prolonging their dying?

[Sigh]. Oh dear. These “end of life decisions” are rarely simple, and many if not most of us have already had some experience with a loved one’s end of life, or perhaps even faced the question of our own death being imminent, and then it wasn’t. 

For myself, I’ve experienced the 1988 death of my father due to cancer at age 61, which now seems to me to have been a very young age, as I turn 60 this fall; the leukemia and death of a best friend in 2003, who at the time was only 45 and five years my junior; and three years ago this July an emergency for my mother, then 80, during which she was in such terrible pain that I wondered if death would be preferable, but she survived and lives today, though blinded by the disease.

Each of these experiences, like any that you may have had, brings back certain feelings, some of them difficult, and reminds me that it’s rarely easy to know what’s right to do. Who am I to preach on this?

And every situation is different, making generalizations difficult, and many are influenced by strained family dynamics, which are painful to revisit.

Perhaps you’ve come to worship this morning in search of hope and this sermon, you are already quite sure, is going to be a downer. Are you thinking you may just slip out, right now? Please don’t! I chose an upbeat final hymn, which means that I plan to bring the sermon up to where we will actually feel like singing “Let it be a dance we do, may I have this dance with you, through the good times and the bad times, let it be a dance we do”… this dance of life.

So, why do we keep people alive at life’s ending, when the dance should have ended?

The simplest answer is fear. The next simplest is regret. And, the third simplest is lack of intention, planning and or communication. Let’s talk about those today.

But, the most complex, and truest, answer may be another question, not why do we keep people alive at life’s ending, but can we know that a person is at life’s ending, at the end of the dance? How can we predict that a person’s life will be worthy of the word “living” if we rescue it from the precipice of death by offering “life support”?

Sometimes more information is needed about the person’s condition than can be had quickly. Other times the care-givers and/or family members disagree, slowing down the decision-making process and in the meantime life-support is provided.  And many times, especially when the apparent ending is unexpected, we feel that death is premature, that there are unmet expectations, lost human potential, and goodbyes that could still be said. 

So why not keep a person alive and see if their life is still worth living? We cannot predict the future… so sometimes, Ken, we keep people alive because we do not know if it’s the rightful end or not. Sometimes it’s only in retrospect that we can see that a certain point in time was actually the best ending and we didn’t let it happen.

Modern medicine has put an awesome power into our hands and we have not developed the ability to handle that power proficiently, yet.  At the same time, in our culture, we have little direct experience with either birth or death, leaving us feeling ill prepared for both the beginning and the ending of life. In agricultural cultures, the birth and death of other animals, especially mammals, is a part of life. But rarely so in ours.

So, that’s one reason why we fear death, our lack of everyday experience with it.

This was strikingly evident to me in the Table of Contents page of the New York Times Magazine a few weeks ago. Perhaps you saw the April 22nd Special Issue About Health called “All in Our Minds.” The descriptive teaser about one of the issue’s most fascinating articles ended with a sentence that referred to death as “the most dire time of life.”

An inarticulate protestation escaped my lips when I read that – death does not have to be regarded as the most dire time of life! For a long time, I’ve felt it to be simply a part of life, namely the end of it, not it’s opposite, and not a topic to be avoided, kept from children, or discussed in hushed voices behind closed doors. It doesn’t have to be ominous.  Even if it is wrought with sorrow, it doesn’t have to be what dire is:  terrible, awful, calamitous, ominous, dreadful, and so on…  Sad, yes, but dire? No!

Even my best friend Susan’s death, at such a young age, 45, still capable of so much more good to do in the world, was not dire. As her husband said in an email on the day of her death to those who had been supporting her for the three months since her diagnosis, through the rigors of chemotherapy,  “we mourn, for Susan’s loss of life and our loss of Susan.”

Losses, yes. Huge. She put all the energy and hope she had into beating that cancer into remission. Losses, yes. But, I refuse the idea that her death was the most dire time of her life. Her death was a necessity, her organs were dying, killed by the chemotherapy treatment that was offered to save her… her death was a relief and a release from suffering.  How is that dire? Even her illness was not unremittingly dire.  There were very dire times, but there were beautiful times, too: of tender love, of hope, friendship, and sharing.

Let us know death to be a part of, not the opposite of, life. Let us not fear death.

The article with the descriptive teaser that made me angry, “A Kaleidoscope at the End of the Tunnel,” is about new research into the use of a drug to reduce fear of death in cancer patients.  The drug is psilocybin, an active component of magic mushrooms. I read the article with fascination, all the while thinking that religious communities can do for us, without the use of a drug, exactly what these researchers are doing with their subjects. It seems to me to be no accident, in this secular era, when fewer and fewer people participate in the life of a religious community, that we are turning to psilocybin to help us feel okay about dying.

For example, when the subjects come in for their drug treatment sessions, they are encouraged to bring personal objects from home that have special significance to place around the room because they may stimulate memories, promote introspection, or provide grounding. Well, when ministers are trained in pastoral care, but any caring visitor might think of this, one of the suggestions for making a home visit with someone who is terminally ill is to inquire about the meaning of photographs or objects on display, for these same reasons.

Another example, the subjects are provided with hours of research assistants’ time to help them process what happens their feelings during the drug treatments.  When religious communities rally around someone whose death is thought to be impending, and people sit with the person, gently giving them time and space to explore their innermost reality, the same results can be obtained, without the drug.

Also, each of the subjects interviewed for the article mentioned that the transformative moment in their treatment involved intense emotion welling up, long deep crying, the sorrow dissipating, and then a different, more accepting feeling about death replacing their earlier fears. I contend that all of us feel better after a good cry and we don’t need psilocybin to do it for us. We just need time, permission and caring company.

So many losses are experienced during serious illness and its treatment, but many people repress their awareness of their losses in an effort to appear, or be, cheerful or strong. What if people had that kind of support and permission from their religious community, would they need the drug?

Also, if the drug is found to be effective, once it is legal and prescribed, will that kind of time and care be included in the prescription too? I doubt it. It would be far too costly to provide in our current health care system. But, we can offer it to each other in our religious community. If death was accepted as a part of life in our culture, the drug would not be necessary.

Let us know death to be a part of, not the opposite of, life. Let us not fear death.

As one of the researchers, Roland Griffiths at Johns Hopkins Bayview Medical Center, says in the article, “When people are helped to feel less afraid to die… they become more interested in the quality of their remaining life as well as the quality of their death.”

So, why do we keep people alive at life’s ending? The simplest answer was fear. The next simplest is regret.

When anyone involved in end of life decisions regrets his or her prior choices, I think “letting go” is more difficult. Whoever has the regrets - the dying person, their family members or other caregivers – it seems to me that regrets impede our ability to read the signs that life’s ending is near. We want to prolong it to give us time to make things right.

This is understandable, of course, but it just points to the necessity to right them sooner than later, like starting now, either directly, or by forgiving others and ourselves.  It might be hard, but wouldn’t it be easier than having to stop a medication or remove a feeding tube or ventilator, because we couldn’t face saying goodbye when we should have?

So, why do we keep people alive at life’s ending?  The simplest answer was fear. The next simplest was regret. And, the third is lack of intention, planning and/or communication.

I believe that intention, planning and communication are the keys to a good death, as good a death as you or your loved one can have, given past medical history. And what is a “good” death?

I may have told you about the extremely helpful book My Mother, Your Mother:  Embracing “Slow Medicine,” the Compassionate Approach to Caring for your Aging Loved Ones, by Dennis McCullough, MD, a geriatrician [and professor in the Department of Community and Family Medicine at Dartmouth Medical School in New Hampshire]. He defines a “good” death as an “expected, supported, well-attended death in a location of choice.” (p. 197). 

McCullough has identified five fundamental principles, of what he calls Slow

Medicine, which “should guide families, health professionals, caregivers and other caring people in their efforts to enrich and support an elder’s life to the end:

  1. We must endeavor to understand our elders deeply, in all their personal complexity, acknowledging both the losses and the newly revealed strengths that come with aging.
  2. We must accept the need for interdependence, while at the same time promoting mutual trust.
  3. We must learn to communicate well and with patience.
  4. We need to make a covenant for steadfast advocacy [in regard to the care of our loved one, especially if we are far away].
  5. We must maintain an attitude of kindness no matter what.” (Pp. 3-13].

Three years ago, the original health care reform proposal provided funding for intention, planning and communication by a patient, his or her physician, and family members about the patient’s options and preferences when death draws near. Outrageously, the opposition called these necessary conversations “death panels” and succeeded in striking them from the reform bill! Considering the high cost of end of life care, these conversations would have saved money, yet the opposition cruelly deleted the provision, for what reason? to cut costs? Fear of death?

I know a family that wanted such a conversation when the loved one was not able to travel to the doctor’s office, so the children made an appointment, but showed up without the patient. The doctor understood, kindly talked with them about end of life options, and sent them out the back door without mention of charge for the visit, because it wasn’t billable.

In the short time I have been your minister, I have witnessed these fundamental principles for achieving a good death in action among you. Some of you have experienced, or are experiencing, the aging process with, and in some cases deaths of, dear friends, spouses and parents, and I’ve been deeply moved and impressed by your persistence and love, even in once or still-fractured relationships.

Intention, planning and communication are so important in every aspect of life, of course, not just what we do as life’s ending nears.  In congregational life, too, I love you for the intention, planning and communication that I witness here. So many examples come to mind of such excellence, too many to list, but they will create a good life here for us, and for those yet to come, whether they visitors or babies.  And by “good life” I mean a welcoming, caring, creative, energizing, justice-making Beloved Community.

Rather like a dance, wouldn’t you say?

Please join me in singing “Let It Be a Dance” by the late Reverend Ric Masten, Unitarian Universalist troubadour, who sang, composed, and wrote poetry through his nine year struggle with prostate cancer, from which he died in 2008 at age 78.

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