Power at the End of Life

A sermon by the Rev. Daniel Charles Davis

for the Unitarian Universalist Fellowship of Winston-Salem

May 22, 2005

Shortly after being a social worker at Hospice, I had to care for someone. It was hard. He was incontinent. He could not chew his food. He slept a lot, but whenever he woke he was in distress. He could only communicate with his helpless eyes and strident cries. Even then, I was guessing most of the time about what he needed.

I sure am glad my son has grown up and can fix his own darn lunch. Someday the situation may be reversed. He may need to care for me. Only he won’t see me as a bundle of hope and potential. I will be a shell of myself, a picture of decline and dying.

Life is powerful. The spirit of life animates our being. The cry of the newborn is the inhalation of power, combined with the fear of powerlessness. There is little else a newborn can do but breathe, suck and sleep. It has little power but is utterly selfish in using it to survive. It also has one more power: It is cute and adorable. No matter how we may have grown up, at one time we were all cute and adorable.

When I am dying, the age of being cute and adorable will be decades past. Perhaps there will be a reservoir of love that attracts my son to me. But he will be powerless to stop the inevitable. And he may be torn between his work and his family. He may live far away. But I can give him the power of knowledge. He will have an idea of what I want. I’ve already have had conversations with him about end-of-life issues. And he is not even grown.

Death is a part of life and it should be discussed naturally and simply, yet people often avoid the topic as if pretending that it will never happen makes us immortal. But we will die. In this world of uncertainty we know one thing: We will die. We do not know when but we will die. We do not know if it will be sudden or slowly but we will die. We do not know the place but we will die. We do not know how but . . . we will die. We do not know the precise circumstances but we will die. There are details that lie beyond our understanding but we will die. We do not know which of our loved ones will survive us but . . . we will die.

I could die right now, for I believed I would die before I heard call-and-response preaching in a UU service.

So many things about death are beyond our control. That is one of the difficult things about this topic. None of us like to feel powerless. But we are not totally without power. We have choices that we can make. Ignoring our own death robs us of the power we yet possess. While we are strong, we can prepare for the time we will be weak. While we are strong, we can prepare for the time we are gone.

Now is the time where we have power over our bodies. Our bodies belong to us. We control the quality of our breathing. Some of us control our breath with yoga breathing, focusing as it goes in and out. Some of us hold our breath underwater. Some of us increase our lung capacity by running. Some decrease their lung function by smoking. Some take medication to control their asthma. One day all of us will stop breathing. Will we want to be resuscitated? It depends. Sometimes during surgery we are put on a ventilator to help us to survive. And then it is removed. In an emergency a machine will need to breathe for us until the trauma is over.

But what happens if our breathing slowly gets worse and worse? When do we decide to start using oxygen? When do we decide to go on a ventilator? How long do we want to stay on a ventilator once it begins. Christopher Reeves lived on a ventilator for years, but there came a time where it needed to be removed. He was an optimist but also a realist. His wife knew when to make the decision because they had talked. When his heart stopped, they removed the ventilator.

Our hearts have the power to pump blood, but if they stop they can be restarted. How many times? Have you thought about this question? Have you talked to anyone about your heart?

Before the advances in technology, death was easier to define: Lack of pulse, no breath. But now that machines can artificially sustain those functions, they look to the brain. Brain death is when they are not able to measure impulses from the brain. But brains also do not die all at once.

Terri Schiavo’s brain still functioned when it came to her heart and lungs and digestion. Yet there was no higher thought processes. What defines being alive? What are the qualities that make life worth living? It ultimately came down to her choice. If she had told her husband she wanted to stay alive at all costs, he should have kept the feeding tube in her. Since she said she did not want that, he respected her wishes. She would have made it easier on the family if she had written down her wishes. Even though her husband had the legal power to make the decision, her family doubted he was acting in her interest.

Linda Lewis, a chaplain at our local Hospice, had an interesting take on the Schiavo case. She writes:

    The tragic circumstances surrounding Terri Schiavo have produced much conversation about the sanctity of life. Politicians, protestors, and legislators used religious language in their arguments to save Terri. In spite of the fact that the tubes and fluids were providing “artificial” life for her, the removal of this artificial sustenance was denounced as a sinful act of disregard for the value of human life.

    Where in all the religious rhetoric is the reasoned voice of spiritual wisdom to remind us that “there is a time for all things…a time to be born and a time to die” (Eccl 3:1-2). Is it possible to value the sanctity of life and also recognize that when it is “time to die,” there is sacredness in life’s ending?

    Certainly, the sanctity of life is a principle that both religion and law should uphold. Life is valuable. A society needs safeguards in place to protect human life, especially the most vulnerable: children, those who are physically or mentally challenged, the elderly.

    But in our zeal to exalt the sanctity of life to a place of ultimate value, let us not forget that physical life, by its very nature, is fragile and temporary. Life is precious because it is limited. The very thing that makes life sacred is the unexplainable mystery that separates living from dying.

    http://www.ethicsdaily.com/article_detail.cfm?AID=5728

    Copyright © 2002-2005 EthicsDaily.com

How do we make the end of life sacred? One way is to recognize all of it as valuable. Our death is too important to be ignored. What happens after death is speculation. So many sages are so sure about their particular belief. The contradictions are not subject to scientific scrutiny. We cannot know and we do not have control after life. But we do have some power before we die – if we tell people what we want done with our body.

First, we need to think about what we want. How much intervention do you want? There is no wrong answer. Only you can decide what is right for you. Only I can decide what is right for me.

Once we make our decision, we should let others know. Have a conversation. Put it in writing. One such document is a living will. This can help, but it often does not have legal standing. A doctor standing with a piece of paper in his hand, facing a relative who threatens to sue, is likely to side with the relative. Of course, you could tattoo “Do not resuscitate” across your chest, along with the telephone number of your lawyer.

Another problem with a written document is that we cannot predict all the circumstances that may happen. If I get electrocuted, I may want to be resuscitated and placed on a ventilator. If I am dying of multiple sclerosis, I might make a different choice. If I just write “Do not bring me back from the dead,” my true wishes might not be granted.

It is best to designate a person with durable power of attorney for health care. Choose someone you trust, someone who understands your wishes, someone who will carry them through. This might not be a family member. Sometimes there may be conflict among your family. After you choose someone, put it in writing, and tell everybody. If you let your wishes be known, you give a gift to those you love: You save them from speculation and guilt; you save your power of attorney from having to convince others that they are doing what you wish.

The stakes are even higher if you are gay or lesbian. The power of attorney may be the only thing that allows you to see your loved one while they are in the hospital. When working with the AIDS project in Wisconsin, we saw love negated by next of kin. With new privacy laws, your right to know what’s going on needs to be well documented.

After service today we can help you document your desire. And you can exert your power over the future of your body.

But life is more than the physical. Besides a living will there is one’s last will and testament. Money is a way to preserve your power. I do not mean in a crass way by threatening to cut people out of your will; I mean that money is something we receive for exerting our energy. Our energy manifests itself in many ways. How we spend our money is a spiritual discipline. It is one way we determine what we value – the type of house that is our home, our car, our clothes, the food we eat. All have a ripple effect on the world. And those ripples extend even after our life.

We continue to help people and institutions with our wealth. It is a way to fund our ideas and hope. But money is a fickle thing. It often does not last. It comes in slow and moves out fast, depending on how we define necessities.

But our ideas and our affections are our true wealth. When we are having our conversations about death, we should also share our ideas about life. I knew a 29-year-old woman with terminal cancer who made a video tape for her 3-year-old-daughter. The daughter must be around 20 now. I bet that $2 tape is more precious than any insurance money she may have received.

Why wait until our deathbeds to tell others we love them? Why wait until we are declining to share what we value? Our immortality is gained when we seek out eternal principles. Our immortality is passed on to future generations when we share our principles with others.

Let us find what we value most – and live and die accordingly.