Easing the Rocky Parts

“Journeying: Easing the Rocky Parts,” Rev. Jim Turner

READINGS

Hebrew Scriptures – Ecclesiastes 12:1-8

Christian Scriptures – 2 Corinthians 4:16-18

bibleodyssey.org – Excerpts from article,

“Suicide in the Bible” by Paul Middleton

“Many people assume the Bible condemns taking one’s own life. However, even a careful reader will search in vain for any explicit prohibition of self-killing in the Bible.

In fact, the biblical attitude toward suicide ranges from ambivalence to praise. There are seven unambiguous examples of suicide in the Bible:

Abimelech, mortally wounded by a millstone, ordered his armor-bearer to dispatch him; (Judg 9:52-54);The prophet

Ahithophel hanged himself after betraying David 2Sam 17:23;

Zimri burned down his house around himself after military defeat 1Kgs 16:18); and

The more familiar stories of Saul and his armor-bearer (1Sam 1:1-61Chr 10:1-6), Samson, (Judg 16:28), and, of course, Jesus’ disciple Judas.  (Matt 27:3-5) There is nothing in any of these stories to suggest that the biblical narrators disapprove of the characters’ [actions of killing themselves].”

 REFLECTION
Last Sunday I reflected upon the value of creation and of human beings as put forth in both the Hebrew and the Christian scriptures.  The early part of my reflection was upon the importance of caring for one’s self.   Related to self-care I talked about the importance of making good healthcare decisions. Finally, I exposed the importance of having signed and witnessed advanced directives in place to protect our own medical choices and who will make those decisions for us when we cannot make them for ourselves.  Those documents are the Power of Attorney for Health Care, (POAHC), and The Physician Order for Life Sustaining Treatment, (POLST).  Blank copies of both are on the back table.   If you have questions about either of these, see me after the service.

There was a time when we only spoke of playing God when we talked about ending a life earlier than it was meant to end.  With all the medical knowledge and tools we have today, we need to talk more about playing God when we keep a life going longer than was meant to be.   At some point in our life we may decide we are approaching that point.  We may choose not to be resusciutated if our heart or lungs stop functioning.  At that point we need to update our Physician Order For Life Sustaining Treatment to reflect that decision.  We need to indicate in our POLST that we want no exceptional life sustaining treatment; that we do not want resuscitated.  In addition, if we are hospitalized, we need to ask our physician for a DNR, or Do Not Resuscitate order.  And, every time we are hospitalized, the attending physician must write a DNR order.

There are other choices we need to make as well when we believe we are reaching the end of life.  If hospitalized, do we want treatmentPalliative Care, or Hospice Care.  We may still choose treatment.  Treatment means medical care of injuries, infections, and other medical conditions.  Treatment is care directed at sustaining our life.  We may choose treatment up to the point our heart or lungs stop functioning.

Early in my work as a hospital Chaplain a physician and I were “keeping watch” with an elderly lady.   She had been resuscitated in a nursing home only to end up in our Intensive Care; unconscious and on a ventilator.  She had spiked a temp that evening.  The physician said,

“Jim, I think it’s time to practice a little compassionate neglect.”

“What is that,” I asked.

She said, “You know, in the past, Pneumonia was known as “the old folk’s friend. It was the one thing we couldn’t treat.  They could finally die of pneumonia.  This lady’s fever is probably pneumonia. I could put her on antibiotics and treat the pneumonia, but is that the compassionate thing to do for her?”

Today we call that approach Palliative Care. Palliative care is care in which the goal is not to sustain a person’s life, but to keep the individual comfortable. The value is in the quality of life not the quantity of life.  Palliative care is pain control, and other actions to keep us comfortable.  With Palliative Care, there is no Intubation, (a tube put down your throat, and into your lungs), so we can be put on a ventilator to breath for us.  There is no artificial nutrition or hydration; no IV or stomach tube; to replace normal eating and drinking.

A physician may determine at some point that our life expectancy is six months or less.  This may be due to cancer, heart failure or a number of other Medical issues which will lead to an imminent death.  If we reach this point, another end of life choice we have is Hospice CareHospice Care is Palliative Care but with a cadre of professionals who come to wherever we live to support us.  Hospice care will be led by a physician and will include regular visits by one or more nurses, a Social Worker, a Chaplain and other health care professionals as needed.  In Hospice Care Medicare will pay for medical visits and medications it would not pay for outside of Hospice Care.

There is one other end of life choice we need to consider.  Its acronym is MAID: Medical Aid In Dying.  Medical Aid in Dying allows a terminally ill adult to request and receive a prescription for a medication which brings about a peaceful death.  It allows us to experience death with dignity when we are experiencing unbearable suffering.  As of last month, ten States have enacted MAID laws.

A MAID law may come before the Illinois Congress sometime this year or next.  MAID is controversial.  Hence, we need to know about it; debate it; consider how we feel about.  As I said last week, these choices are hard to talk about. But if we do not consider them, and make our wishes known, then we have no choices.  So, let’s reflect upon MAID.

If Illinois considers a MAID law, it will probably follow the basic pattern of the ten states that have a MAID law.  If so, then Medical Aid in Dying differs from suicide.  To be eligible for MAID, one must have been determined by a physician to be terminally ill with a life expectancy of six months or less. Suicide is ending one’s life when there is no physical illness.  To receive MAID, an individual must be determined of sound mind and able to make their own decision.  Suicide is an irrational decision made by someone who is not emotionally well. MAID is planned and usually includes one’s own family.  Suicide is an impulsive and secretive act which is done alone.  Maid is asked for by someone who would prefer to live. Suicide is committed by an individual who does not want to live.  With Medical Aid in Dying, death is planned, peaceful and gentle.  With Suicide, death is usually tragic and is often violent.

MAID is also different than euthanasia.  With MAID, an individual must be able to take the medication on their own, without assistance. MAID is not available to those who cannot take the medication on their own or are not aware/alert enough to know what they are doing.  “Old age” is not a terminal illness, (even if sometimes it feels like it is).  Many insurance companies will now pay for the medication for Medical Aid in Dying in those states where MAID is legal.  Even if seen by others as a form of suicide, MAID will not affect life insurance that has been in place for more than a year. And, the death certificate will state the terminal illness as the cause of death.

If Illinois does pass a Medical Aid in Dying law within the next two years, it would be the eleventh state to do so.  Public opinion is shifting toward general acceptance of MAID as a reasonable alternative for those experiencing an excruciating dying. 58% of physicians state they have had patients they wished Medical Aid in Dying had been available to.  67% of US citizens sate that when cure is not possible MAID should be an available choice.  I was surprised what research shows about the attitude of religious people concerning Medical Aid in Dying.  53% of Protestants and 70% of Catholics favor having MAID as a choice when dying gets too difficilt.  59% all Christians and 70% of other religious groups support such a law.

If Medical Aid in Dying becomes law in Illinois, we each will still need to make our own choice.   If faced with a terminal illness would we want MAID as an option?  If Paul Middleton is correct, and I believe he is, there is nothing in either the Hebrew Scriptures nor the Christian Scriptures which  disparages one taking their own life.

Ecclesiastes says of death; the Body returns to dust and the spirit returns to God. (Ecc, 12:7)  The Apostle Paul spoke of dying, observing that as the body wastes away we look beyond what is temporary to that which is eternal.(1stCor. 16:18  Whatever it is that comes after death, there comes a time when some are faced with the choice, live with temporary suffering or look beyond it to eternal rest.  None of us can know what our choice will be until we face it.  It is, however, a choice worth reflecting on before we find ourselves in the situation.

Throughout life we are faced with choices; health care choices.  At some point we may be faced with the choice of quantity of life on the one hand and quality of life on the other. Depending how we answer that choice, we may reach a point where we want treatment, though, perhaps, not extra ordinary actions such as resuscitation, ventilation, and/or artificial nutrition.  If we are suffering with no hope of recovery, we may choose palliative Care; we may choose only to be kept comfortable.  Finally, if we know we are likely to live only six months or less, we may choose Hospice Care.  While it is not currently legal in Illinois, if it becomes Illinois law and we meet the criteria, we may be able to choose Medical Aid in Dying.

Discussion:

  • What do you value about life?
  • Which do you value more, quantity of life or quality of life?
  • Given your current age and health, what kind of care do you want?
  • What is your reaction to the concept of Medial Aid in Dying