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Let My People Go!
According to the Wednesday San Jose Mercury News, Louis and Evelyn Baer rented a furnished apartment, wrote a letter to their lawyer explaining their action, took pills, and died in each other's arms. She had cancer and he had suffered a stroke. Dr. Baer was a retired Stanford University medical professor. A few days earlier, I had taken out books from Mitchell Park Library in preparation for this sermon. Among the books was Dr. Baer's 1978 book, Let the Patient Decide, A Doctor's Advice to Older Persons. The purpose of the book was "to attempt to show you how to minimize your chances of ending your life in a nursing home and how you can prevent the medical prolongation of your act of dying." Some of the chapter titles are revealing:
When You Neither Live Nor Die
It's Difficult to Die in America
Doctors Don't Always Know Best
Treatment May Be Worse than Disease
How Much is Enough?
The Patient Gives the Orders
What about the Baers' double suicide? Was it cowardly or courageous? Was it sacrilegious? Does it establish a dangerous precedent? Do people have the right to die? Do people have the right to decline medical treatment? As individuals, and certainly, as families, you need to ask and answer these questions.
My thesis this morning, my bias and my conviction, is that we need to change the current climate of medical care, and the relationship we each have to medical care, so that when God calls people home, we let them go! I believe God has called countless persons "home" who are now on machines, or in nursing homes. Medical care, family instructions, and the law prevented God's will from being accomplished. I believe God looks on countless persons in misery and cries, "Let my people go!" When do we cross the line from providing medical care to playing God? B. D. Colen, in his book, Hard Choices, Mixed Blessings in Modern Medical Technology, asks, "Who, after all, is playing God, the physician who turns off a respirator and allows the natural process of dying to conclude, or the physician who turns on the respirator and interferes in that natural process?" (p. 246)
Sometimes it is right to "let my people go" because death is not necessarily the worst of the alternatives. The January 7 issue of The New England Journal of Medicine includes a special article released by The Stanford University Medical Center Committee on Ethics, called "Initiating and Withdrawing Life Support." The article begins with this paragraph,
During the past century, dramatic changes have occurred in physicians' ability to prolong life. A hundred years ago, little more than rudimentary supportive care could be offered to most critically ill patients. Doctors now choose from a vast array of interventions that...often greatly prolong survival. Unfortunately, the quality of the additional life so skillfully sought can range from marginally tolerable to positively miserable.
Death is not necessarily the worst option. A woman in one of my former churches traveled frequently to Oregon to help her sister care for their aged father. At the age of 99, he had prostate surgery. In the weeks following the surgery, complications developed and he had another surgery. When the daughter was anxiously telling us about her father, Ellie innocently asked, "What would have happened if you hadn't allowed the surgery?" Like a light bulb turning on, realization hit her and she exclaimed, "Why, he would have died." Then, she realized that surgery at the age of 99 was not necessarily preferable to death. Her father is now 104 years old, and has been a "vegetable" since the surgery.
The problem most patients, families, and even doctors have is their lack of experience to understand or predict the after-effects of surgery. The Stanford Ethics article included,
Few patients who have not received intensive care can comprehend the general unpleasantness of even the most humane intensive care unit--the invasive monitoring and treatment, the noise and activity around the clock, and the necessary restrictions on visitors. In particular, mechanical ventilators virtually preclude communication with family members at times when emotional support is most needed.
The question needs to be seriously asked: which is worse, the treatment or the illness?
Death is not necessarily the worst alternative. In my experience over the years, I have found that Christians often die peacefully. A person of faith, surrounded by a family of faith, can accept death because we believe in eternal life. For most of us, however, we need permission in this day of advanced medical technology to make a choice between undue prolongation of life and death. We need to establish the climate where it is all right to face the options squarely, and where it is all right to choose to die. As children of God, we each have the right to choose to die. Because of advanced medical technology, this is a right that increasingly needs to be underlined. It is not necessarily God's will to do everything possible to prolong life.
As patients and families, we do have rights. The Stanford ethics article stated, "the actual authority over the patient never resides with the physician. Patients alone, or their legal surrogates, have the right to control what happens to them." Ellen Haffner's father (Ellen is a member of our church) was resuscitated 15 times after heart attacks. He kept pleading, "Let me go, let me go!" Finally, the family convinced the physicians to use no extraordinary means to prolong his life. When my father's cancer proceeded to the point of no return, and the pain increased, after his children and grandchildren made the trek to Arizona to say goodbye, he calmly declared, "Now I will stop eating." He died peacefully in a few days. We have the right to choose to die. We have the right to refuse hospital care. My grandfather had cancer, knew he had cancer in advanced stages, and refused to go to the hospital. Only in the last days, when the pain was unbearable, did he allow himself to be taken to the hospital, where he died in a few days.
A difficult moral question to ask is, to what extent may a person go to choose to die? My uncle was terminally ill with cancer. In considerable pain, he refused to go to the hospital, took a gun, propped it up in a chair and shot himself. Dr. Louis and Evelyn Baer rented a furnished apartment, took pills and committed suicide. Perhaps in the light of advanced medical technology, our society has come to a point where we need to establish the climate and the means to assist people to die, when the other options are pain, suffering, misery, or even loss of consciousness or memory.
Suicide is too strong a word here. We are talking about persons terminally ill who are forced by society to a painful prolongation of life. Suicide has been considered a sin in Christianity for centuries, Roman Catholics have called suicide an unforgivable sin. Suicide is also against the law, but a little difficult to enforce! The Bible, however, does not deal directly with suicide. The commandment, "You shall not kill," is a commandment against murder, not humane suicide. When King Saul saw his three sons killed by the Philistines, and was himself badly wounded, he asked his armor-bearer to draw his sword and thrust it through him. The armor-bearer refused so Saul took his own sword, and fell upon it. The armor-bearer then also committed suicide. Does not a person have the right to choose death?
When the options are worse than death, does not a person have the right not only to choose death, but to be assisted through a merciful form of euthanasia? Derek Humphry and Ann Wickett in their book, The Right to Die, Understanding Euthanasia, point out, "In more primitive societies, death...was treated more realistically than it is today. It was treated as a natural part of life. Aiding death was often done out of respect for all ill person." (p. 2) We need to change the laws of our land to make them more humane, to allow for merciful euthanasia.
We need to establish a climate where people are supported in their right to choose death. This decision should not be made alone. If the person is capable of making the choice, he/she should have the benefit of a group consultation, consisting of family members, good friends, physicians, and their pastor, if they have one. When the patient is incapable of making the decision, a caring physician with prior knowledge of the patient's wishes, either oral or written, may recommend to the family that it is time to let the patient die. I have participated in such consultations and they are difficult, but very helpful. The family feels supported and is able to concur with the physician with less guilt and second-thoughts.
Now, what can be done? If you basically agree with me this morning, that the climate should be changed so when God calls people "home," we let them go, I have three suggestions for action. First, regardless of your age for you might find yourself incapacitated by an accident at a young age, tell your physician how you feel about using extraordinary means of life support when your body is essentially dead. If your physician does not agree with your view, and you feel he/she may not do what you wish, then change doctors and find one who is sympathetic to the view of this sermon.
Secondly, obtain a "durable power of attorney for health care" for yourself. The living will is no longer enforceable in California. The "durable power of attorney for health care" creates a simple procedure whereby you can indicate your treatment preferences and designate an "attorney in fact"--usually your spouse or child--who is empowered to make medical decisions should you become unable to decide for yourself. The "durable power of attorney for health care" legally protects the physician, as well as provides clear instruction for the physician to follow. The Thursday Times Tribune reported the case of William Drabick who has been in an irreversible coma since 1983. The doctors refuse to abide by the family's wishes to let him die because there is nothing in writing from the patient, and the patient had no prior discussion with his physician. A panel of judges will now make the decision. To secure this document, "the durable power of attorney for health care," consult an attorney who understands and specializes in this document. I understand El Camino Hospital has samples available.
Thirdly, to help create a climate more favorable to free-choice, send copies of this sermon to our legislators--state and federal, to your physician, and to your family members. Copies will be available next week.
The topic of this sermon is very serious, but needed to be addressed within the context of a worship service, because we have a realistic, helpful, hopeful attitude towards death. We believe death is not the end. Through death, God calls us "home." Jesus has prepared a place for each of us, a place in God's mansion, filled with the glory, wonder, and love of God, where we are reunited with loved ones. That is the promise. Because of the promise, we face death courageously and hopefully, not with fear and apprehension, but even with joy and expectation. Therefore, when God calls his people "home," let them go.
© 1988 Douglas I. Norris