Events - Upcoming Events
Living and Dying II
- Date:
- Sunday 2 May 2010
- Time:
- 10:00am
LIVING AND DYING II
2 May 2010
The dentist examines your tooth. On the basis of his experience and judgement, he says the tooth should be taken out. He prepares to do so. Perhaps other factors are relevant. He remembers your previous history. He has particular views about trying to save teeth in people your age. He just wants to get on and do the job and get off to his next appointment. None of that is disclosed.
Because you have been seeing your dentist for a long time, you could easily accept his judgement and lose a tooth. But you rush from his dental chair and seek another opinion. The next dentist says - we can save that tooth and does so.
The story highlights the issue of informed consent: you are not able to get all the facts, but a view can be asserted, imposed and carried out. Once the tooth is gone, there is no going back.
There are several comparisons here with our dying. Once you are dead, there is no going back. And the processes of decision-making are also loaded with judgements affected by beliefs, ideologies and emotions. Some declared, some undisclosed.
In recent times, I have been part of the anguish of parents considering whether their pregnancy should go to full term, knowing that the foetus was carrying an identified genetic condition that in the judgement of the doctors, would mean that the infant when born would be catastrophically affected and unable to live an autonomous or socially effective life. Some terminate the pregnancy and cope with the aftermath. Some decide to proceed with the pregnancy. In both cases, the parents make a choice for the unborn who is unable to make a choice. And inevitably the question is asked, did they choose for the unborn or for themselves, or for the other siblings, or for their projection of themselves into a society or a church that asserts and upholds certain values.
Hindsight?
A few days ago, a man stood right here. He was (is) 92 years of age - body and mind in A+ condition, more alert, informed and loaded with such wisdom that we could feel awed by his presence. He looked as if he could live another 20 years, and why not?
Another man died aged 95. His last five years were apparently lost, and probably a few years before that his mind was in process of decline or disintegration. Here was an instance of a person whose aged body was still functioning, and in that regard, clearly part of his brain was still functioning, but the part of his brain pertaining to memory, identity, personality, emotionality was gone.
The family with great appreciation and care waited on him, until at length he died.
He lived a full and good life. And some would say, how sad that after such an active, fun-loving life, he should die a death that deprived him of his independence, his autonomy and his choice, and his dignity.
We all would like to die with dignity. I never hear anyone say, I would like to die a very undignified death. But what is that dignity and indignity, and whose is it?
The issue of living and dying is complicated. People are now living much longer but it can be a very costly way to live - when you count up the hospital costs, the rehabilitation costs, prostheses, medication, ongoing support. They are kept alive and live.
That is only one side of my large two sided page - on the other side there are people who are kept alive but are no longer able to choose their living or their dying. They are kept alive albeit in a state of some suspended living in a kind of survival.
The injured, the damaged, the genetic defect, the Alzheimers and selected conditions. Young and old who will need full care for years. Medically assisted living - dependent on drugs, pace makers and life support machines.
And if you turn onto another page -
you will find a wide and diffuse population who have always lived somewhere out there in a kind of no mans land and it is difficult to know how to care effectively -
we have tried families which may be lost in their own dysfunction
we have tried institutionalised care, and that has its problems, not least in providing the right kind of institutions and the most effective resources for the particular condition.
As we wrestle with issues of dying we need to place that in the context of living. Our goal is to open the pathways for people to live the fullest and most enjoyable life possible - and at the end of their day, die, "feeling" that life had treated them well, and their death was a proper caring death after the life they had lived.
In my first SAGE group, 25 years ago, I had 15 people in it, all over 80 (that in size compares with the SAGE group two Fridays ago when we had 120 in it). In that first group, one session focussed on their dying. Several said they wanted to avoid the indignity of incontinence, loss of mind functioning and mental confusion and physical dilapidation. One member of the group, a retired matron of one of our largest hospitals said - Don't worry. You won't know about it. They'll just hose you down, and dry you off and sit you up and feed you until at last you die.
Her words were so very matter-of-fact: respectful, rational, and right, and on top of those 3 Rs, she relieved them of their anxiety of dying an undignified death.
Anxiety plays a large part in this - in the dying person, in their families and their carers. Some find their anxiety difficult to control. Others are strong steadying influences in what are frequently emotionally unsteady times.
Some people I see close their eyes to that anxiety, they don't want to talk about it; nobody else wants to talk about it, and they either die in that silence, or perhaps they will thrash about, are restrained, and soon everyone's anxiety is relieved. The question is: Could we do any better? In some cases no: in some cases maybe.
The anxiety is a major part of dying - it raises the question, how did we understand and handle our anxiety when we were in the full stream of living? If we were always in denial of anxiety, always on retreat of anxiety, always trying to cushion our anxiety - it should not surprise us that this will continue in our dying.
There is substantial anxiety about the end of life. Being extracted from the world we know to be lost in oblivion.
And the losses are many -
the loss of all we have been,
the loss of all belonging,
the loss of place, and personality,
the loss of enjoyment,
and the letting go.
On top of that there may be the anxiety of unbearable pain, the anxiety of the futility of hanging on when suffering has no other future than death. Then there is the anxiety of loss of the critical choice over their death. They have lived their life, now they want or need to die their death.
The palliative care nurses and doctors will give their important reassurance that they will do all they can to relive the pain, and lessen the indignities.
But if the person knows that no amount of palliative care will relieve them from dying, they want to exercise that choice:
They want to die a natural end to their life.
They want rational assistance to die without pain.
We now know that 85% of people support a rational death assisted by the careful preliminary counselling by their doctors and key people.
We know that when people know effective help will be available to them, their anxiety lessens and many then settle for a comfortable death or their dying program changes.
In my previous address on this topic I pointed to the values of a humanitarian society - of care and compassion. They are basic to all the well-known religions, though the big three are often stronger in their endorsement of cruelty and suffering - especially in many families, in child discipline, and especially in wartime.
Society has many such conflicts. It is only as we incite intelligent informed conversations that we can hope to evolve into a more rational ethical world.
Some churches, and the Roman Catholic Church in particular, oppose the advocacy of medically assisted dying. In recent times the strongest statement of Catholic opposition came from the very conservative Pope John Paul II: a man who blocked the liberation of Catholic doctrine and encouraged many millions to close their minds to intelligent discussion of values necessary to a vastly changing society.
In our view the traditional Roman Catholic view of God is outdated - and let it be said, that many Catholics do not hold to the traditional view.
The traditional view asserted by the Catholic popes is that life is a gift of a loving God and to destroy it is to reject God's dominion over life and death.
Suffering is not a devaluation of life, but it is also part of God's gift. True compassion leads to sharing another's pain.
The Catholic Church does allow the possibility of refusing treatment. To refuse treatment is not considered euthanasia but a proper acceptance of the human condition in the face of death. These arguments will continue, but we do need to consider that the Catholic Church hierarchy or any church group can be permitted to impose their views on the non Catholic population - or to so frighten politicians that they appear to be more ready to watch the Catholic vote or to follow their own personal view then to heed the growing percentage of the population who want to see some rational change. We need to speak TRUTH TO POWER.
The current political turbulence over health care in our society cannot be separated from these specific issues -
1. that people are living longer; 2. that people are better educated and not so blindly committed to religious views that they know are no longer believable; 3. that proper structures can be established to allow people their choice, their autonomy in deciding how they will live and when they will die. 4. that where the person is unable to express their own decision, others in a proper context may rationally decide for them; 5. that our human society will be open to ensure that the values of comparison and moral wisdom will take precedence over the futile suffering and emptiness of those who wish to bring their life and suffering to an end; 6. that whereas human dignity is difficult to define, our human rights regarding the way we live and the way we die are an individual's right as strongly as an imposed right, and both need to be continually argued.
Here, in all of this, we are trying to raise a fundamental concern - a humanitarian concern, a society concern, a church and liberated Christian perspective.
We know this - every day, people in this city take their lives. In a year, the number of people taking their life amounts to several thousand: a large percentage of those COULD have been prevented, and we would hazard - on the basis of those who have been prevented - that a productive enjoyable life was sadly ended too soon.
We also know this - that these figures are high, yet I rarely ever hear anything from the churches. All those suicides take place without comment. Even the governments seem to avoid the discussion.
Yet when we come to a rational, thoughtful resolution of an individual who says enough is enough, we have people ready to oppose their death and dying process.
We look now for the more enlightened process to become widely accepted as a thoughtful compassionate way to meet and manage the inevitable anxieties of our living and dying.