First Parish Unitarian UniversalistLife Decisions
A sermon preached by the Reverend Diane Teichert
First Parish Unitarian Universalist - Canton, MA
April 17, 2005
You know how it feels when you are sure the other person is thinking “of all people, you should know better”???
When I brought our ailing parishioner Ruth for admission at Norwood Hospital five weeks ago this past Friday, the admitting nurse asked her if she had a health care proxy. Ruth shook her head “no.” Then the nurse turned to me, who she knew to be Ruth’s minister, “Do you?” “No-o-o-.” There was a brief pause—and this is when I knew what she was thinking and it was… “of all people, you should know better.” :-)
“Well,” she responds,”you should have one, both of you.”
Ruth may have been too ill to have been following the news, but I knew the reason for the nurse’s tone of voice: on the previous day, the feeding tube of a Florida woman, Terri Shiavo, had been removed at the request of her husband, after fifteen years of being in what the courts had ruled, based on medical evidence, a “persistent vegetative state with no hope of recovery.”
As you probably remember, the tragic private conflict within Terri Shiavo’s family regarding her life support had by then been writ large and public, loudly amplified in the media. Many conservative political leaders including many in Congress, President Bush and Florida governor Jeb Bush, and conservative, predominantly Christian, religious leaders plus Jesse Jackson interceded in support of Ms. Shiavo’s parents who wanted to retain the feeding tube, while the courts repeatedly upheld the husband’s request to remove it. The problem was: Ms Shiavo did not leave a written record of her wishes in an event such as this. Absent a written record, family members differed on what she would have wanted.
Had Ms Shiavo identified in writing someone to make health care decisions for her in the event she was unable to do so herself (that’s what a health care proxy is), and had she been explicit about whether or not she wanted to be kept alive if there was no hope of returning to a conscious state, this conflict would not have emerged as it did.
Do you have a health care proxy? Does your proxy know what you would want?
Do you know what you would want?
If anything good came of Ms. Shiavo’s sad life and even sadder death, it was that the rest of us have been aroused to think about these difficult questions and to discuss them with our loved ones. Also, to me there’s good news from polls taken since Ms. Shiavo’s death: that the majority of Americans don’t want the government to answer for us this last question, about our wishes at the end of life.
A week after the hospital admissions nurse told me that I should have a health care proxy, I went to see the Academy Award winning film “Million Dollar Baby.” I was reminded of the admitting nurse’s question again that night.
Maybe you’ve seen it. It’s the story of Maggie Fitzgerald, played by Hilary Swank, who never had much in life but the desire to become a champion female boxer and makes it to the pros because of her unfailing persistence, the confident support of Morgan Freeman’s kindly ex-boxer character and his friend, Frankie, the demanding trainer she finally wins over, played by Clint Eastwood. It’s a double love story—Frankie loves Maggie like a surrogate daughter, while he and Freeman’s character are like a long-married couple, sometimes hurting and sometimes helping each other, always squabbling.
In a championship fight, Maggie is cruelly, illegally thrown across the boxing ring. Her tough landing breaks her back and her promising career breaks with it. She loses use of her hands and legs, but not her will to live. Frankie does everything he can for her. Caring for her becomes his life. But, eventually, after one leg has to be amputated, Maggie decides that this is no life to live and asks him to help her end it. She tells him that she’d already accomplished her life dream of becoming a champion boxer.
“I can’t,” he says, “I just can’t do it.” But he knows it’s what she wants. She attempts it herself, the only way left to a quadriplegic. Nursing home staff people restrain and drug her. Finally, Frankie wrestles long and hard with himself, his religion, and his devotion to Maggie, and in the end decides to honor her wishes.
Which is, of course, against the law in the United States, everywhere except in Oregon, where (since 1997) a doctor may be consulted and under carefully prescribed circumstances make it possible.
Million Dollar Baby , in the end, asks questions much the same as the admissions nurse: Do you have a health care proxy? Does your proxy know what you would want? Do you know what you would want? In addition, the movie asks, should a hopelessly ill person have the right to choose a death with dignity?
At this point in time, we Americans have a lawful right to choose palliative, so-called “comfort care,“ over improbable curative attempts or treatments that prolong our life artificially. But, except in Oregon, we do not have the right to an assisted suicide such as what Maggie wanted. Let it be known, however, that the same politicians who pushed to keep Ms Shiavo alive, and will no doubt try again with a similar case, have been challenging the Oregon law in federal courts and want to take away a woman’s right to choose abortion as well.
Like with a woman’s right to choose abortion at the beginning of a life based on her beliefs about quality of life, I believe that no person or government should decide for another what constitutes quality of life at the end of life.
But, it is hard to think about. Few of us want to anticipate our own deaths, the less so the younger we are, perhaps. But Terri Shiavo was only 26 when heart failure caused her severe brain damage. The film character Maggie Fitzgerald was in her early thirties. In this age of medical miracles, maybe we’re never too young to prepare for our deaths.
So, to demystify the topic, I have pulled together some resources for you.
First, the Massachusetts Health Care Proxy form. We tried to give all adults a copy along with your Order of Worship, but if you did not receive one, there are extras on the side pew to my right.
[I’ll tell you a story about how I got them. I intended to just make multiple copies of the version I had when I noted that was dated 1991. So I called the folks listed at the bottom, to get a current version, and told the man who answered that I intended to hand them out in our service on Sunday. “Good for you, that’s terrific, I wish more clergy would do that.” He was a bit profuse. I was a bit surprised, as the idea seems so obvious. He asked me what religion I was and after I answered, I heard him chuckle. “Why are you laughing?” I asked. “Well, I’m a Unitarian Universalist minister too,” he said.
I asked him about his work. The day after the Health Care Proxy law was passed in MA, he explained, “we started this business to promote its use and since then we’ve moved into consulting in many areas of medical ethics.” I was then informed that the form was copyrighted, so—being in conversation with an ethicist, a UU one at that—I did the ethical thing and paid for 100 copies!]*
Second, after the service, there will also be an opportunity for conversation about end-of-life decisions with me and First Parish members Ruth, who is the medical director and founder of Old Colony Hospice, and Myrtle who is a lawyer, Milton Hospital Ethics Committee member and advocate for health care proxies. In fact, because of Myrtle, Ruth now has one.
Thirdly, you will see in the written announcements, that I am recommending a resource on the website of the American Bar Association (abanet.org/aging/toolkit/ home.html). For those who don’t have internet access, I will make available my print-out for copying. Just ask me, or you may be able to call and request one be sent to you. The ABA offers a helpful “tool kit,” they call it, of worksheets to help us think through the many aspects of this issue. Such as:
How to evaluate who among your family and friends would make a good health care proxy for you.
How to reflect on which, if any, conditions of deteriorated independence or ability would cause you to not want medical treatments that could prolong your life.
How to weight odds of survival against the risks and side-effects of treatment.
What are your personal priorities and spiritual values that may effect not only medical decisions at the end of life but also how you would want to use your time if your death is anticipated.
And, finally, a really great guide for how to be someone’s health care proxy, including a set of questions to ask of the person’s doctors that many of us would find useful in getting the best medical care for ourselves.
I wish I could tell you that I’ve already completed all these worksheets, but I only found the website on Thursday. I haven’t filled out a Health Care Proxy form, either. That nurse would be so disappointed!
But I have taken the first steps of thinking for myself and of talking to loved ones.
With my mother who I visited two weeks ago, a simple, “what did you think of the Terri Shiavo situation, Mom?” was a good way to start. The first time, we got side-tracked into discussing the politics of the situation, which upset her as much as me.
But, the second time, I pressed on, “what would you want, if it was you?” “Well, now,” she said, “that’s the question, isn’t it?” She paused and then she answered. She’d obviously already given it some thought. I hope she was glad I asked, but we didn’t dwell on it for very long.
With my spouse, we acknowledged it was something to discuss more fully. Then we found ourselves looking back on the deaths of important people in our lives: my father, his mother, and my best friend Susan. We began to explore our respective responses to each of their illnesses and the decisions regarding treatment for each, what we learned from our responses in hindsight, and what we might want for ourselves if faced with those same situations.
Those three deaths were quite different from each other. This is instructive to me. It says to me that no matter how many worksheets we fill out and how many eventualities we consider, nobody can anticipate them all. Which means, to me, that I won’t write down lots of specific instructions as to my wishes—no list of treatments that I’d want or not want, because it’s impossible to predict the circumstances or what will be possible in medical care by then (hopefully a long time from now!).
Rather, I want to get clear on my guiding principles.
I’ve been wondering about this as the guiding principle for determining my quality of life: can love be given and received? If the answer was no, then such a life would not be enough of a life for me. Would that be enough guidance to give my health care proxy? I like living and I would want whatever treatments are available if they could save my life, but in the end I want to be responsive, and to give and receive love.
A Health Care Proxy itself is only a tool. It gets the communication going and it puts decisions in the hands of the person of your choice. It doesn’t prevent conflict between your ex and your parents, like in Terri Shiavo’s family, but it does make clear who among them should make decisions for you in the event you are unable.
A Health Care Proxy is only as good as the relationships between the people involved and the preparations they have made together. The people you may want to involve in making the difficult decisions near life’s end may or may not be your biological family members, but whoever they are, if you feel recent or longstanding tensions prevent you from discussing your death with them now, don’t think it will be any easier for them later, after you are no longer able to participate. Of all people, you should know better. :-)
Now is the time to end any impasse. To get in touch. To get professional help, if needed. To silently resolve to love and accept them, and yourself, as they—and you—are. And then to take a chance on trust. To say, “let’s talk.”
No family is perfect. Everybody’s family or web of friendships has some dysfunction somewhere. To think that only a perfect family can discuss the meaning of life and death, and make difficult choices in regard to those meanings, is to exempt yours from the richness that life has to offer.
Life is a gift, as we said in the Opening Words. It doesn’t last forever. If it did, there would be no need for this sermon! :-)
[In closing let us recall the words of George Odell, from a familiar reading found in our hymnal, to which I’ve added a line about the beginning of life:
We need one another.
We need one another when we mourn and would be comforted.
We need one another when we are in trouble and afraid.
We need one another when we are in despair, in temptation, and need to be recalled to our best selves again.
We need one another when we would accomplish some great purpose, and cannot do it alone.
We need one another in the hour of success, when we look for someone to share our triumphs.
We need one another in the hour of defeat, when with encouragement we might endure, and stand again.
[We need one another when a child is to be raised in a community of love and justice.]
We need one another when we came to die, and would have gentle hands prepare us for the journey.
All our lives we are in need, and others are in need of us. Amen.]
*Deleted in delivery due to time constraints.