Reading from The Joy of Living and dying in Peace, Chapter 2: “Dying in Peace,” by the Dalai Lama SanFrancisco: HarperCollins, 1996.

         Something that preoccupies us all is how to live and die peacefully. Death is a form of suffering. It is an experience we would rather avoid, and yet it is something that will definitely befall each and every one of us. Nevertheless, it is possible to adopt a course of action so that we can face this unwelcome event without fear. One of the principle factors that will help us to remain calm and undisturbed at the time of death is the way we have lived our lives. The more we have made our lives meaningful, the less we will regret at the time of death. The way we feel when we come to die is thus very much dependent on the way we have lived. . . .

Sermon

         I am not certain of very much in life, but this week, as April 15th approaches, I am certain of taxes and I am also certain that one day I will die. And I think that you are also certain of these things as well. So now that we have established all this certainty, we might as well go home……unless we want to consider when and how we might depart!

         The title of the Dalai Lama’s book from which this morning’s reading was taken is The Joy of Living and Dying in Peace. Joy in living, the Dalai Lama tells us, is attained by practicing the ten virtuous actions of Buddhism, which are: sustaining life, giving gifts, maintaining sexual ethics, speaking truthfully, speaking harmoniously, speaking kindly, speaking sensibly, generosity, helpful intent, and [thinking that benefits others]. (p. 3) He says that when we are kind and bring benefit to the world, we are naturally happy. No one would argue with this for in this way, we live with dignity.

         All religious systems, including our seven principles, urge us to ways of behaving that bring dignity to life but how can we bring dignity to dying? The Dalai Lama says that if we have lived a good life, then we can look forward to a good death and rebirth. Tibetan Buddhists are taught how to accept suffering and dying from an early age. The dying person or a family member or priest will chant Buddhist prayers until the end to ease the consciousness of the person into the afterlife. Perhaps their firm belief in what happens when they die actually does help them bear death better, both as a person dying and for the family and friends. In our western world, what would be considered a “good death” I have heard some of you say is a quick one!

         Each month I receive a monthly journal from my spiritual teacher, Jose Stevens. There is always a feature article. Last month, the feature was called “The Right Way to Die.” That intrigued me! Almost the entire journal was a conversation between Jose and his mother, Margarita Espana, who was dying of terminal cancer of the spine. The article consisted entirely of the conversation between Jose and Margarita upon her dying. Margarita greeted her son with, “I’m so ready. I want to go soon. I’m tired. It’s enough already. They are all waiting for me, your dad, my friends, my mother, my father, my brothers. I want to see them. You are such a good son. I love you and I am very proud of you. I am finished with everything. There is nothing more to do. I’m just trouble now.”

         Jose said, “Mom, you have a right to be trouble. You’ve helped so many people…” and he went on to enumerate the ways she had spent her life caring for others and that dying is a process we all have to go through, even though it is “a mystery and no one knows for sure when you will pass over.” Margarita drifted off into a morphine-induced sleep. In the days that followed, she told her son that war is a terrible thing and she related in great detail her family’s experience and suffering in the Mexican revolution. She detailed her life of helping to raise all her brothers. One day she awoke and said, “Oh, I’m still here.” She detailed the fantastic places she had been to in her mind where pink flamingos roamed. But Margarita wanted to know about her son and his life and what he found to be true. Margarita had been a devoted catholic all her life. She talked also of her sins and there were periods of fear where Margarita would talk of seeing demons. Jose assured her that these w ere fears she had been taught to believe but they were not real and she nodded her head.

         Their conversation ranged far and wide over Margarita’s life and what she had learned. Finally, after five days, Jose told her that he had to go home to Santa Fe in the morning so if she wanted to pass, she could do it at any time. Margarita never spoke again and died 36 hours after Jose left. Clearly Jose considered this a “good death” perhaps even a death with much joy and dignity. His mother had reviewed her life and her understanding of it and the two had had a wonderful conscious exchange, leaving one another with great love. In my opinion this was indeed a good death, a death with dignity, and if I could choose, I would wish this kind of death for myself—not necessarily a quick one, but a conscious one. But we can rarely choose how we will die.

         The Terri Schiavo case has brought us face to face not with a “good death” by anyone’s standards but a complicated and distressing situation that can arise when we are unable to make decisions for ourselves. Perhaps you already know Terri Schindler’s story. Terri had always been a chubby girl who desperately tried to become thin. When she met her dream man in college, Michael Schiavo, she had a great incentive to lose weight, which she did very quickly. Terri and Michael married in 1984. Terri was 20 years old. Her weight went up and down, up and down, and it might have been that she had an eating disorder because one day in 1990, when Terri was 26, she suffered a cardiac arrest due to a potassium deficiency and the result was massive brain damage.

         At first Terri’s parents and Michael worked together to care for Terri, even trying to care for her themselves at the Schindler’s home, which they found they couldn’t do and Terri was moved to a nursing home. In 1992, Michael won a settlement of $750,000 for Terri’s care and $300,000 for himself. Michael’s unwillingness to share the $300,000 with the Schindler’s spoiled their relationship and in 1993 the Schindlers petitioned the court to have Michael removed as Terri’s guardian. They were denied because Florida state law designates the spouse as the first priority decision-maker.

         Most of the doctors Michael consulted said that Terri was in a “persistent vegetative state” which means that though a person can breathe on their own, he or she is unaware of themselves or their surroundings. Eight years after her collapse, Michael petitioned a court for the removal of Terri’s feeding tube.

         If a feeding tube is removed, a person essentially starves to death. If hydration is removed, the organs of a person eventually fail and death results, usually in two weeks. An organized group of disabled people called Not Dead Yet became strange bedfellows with the religious right and many politicians, including the President of the United State and they all sought to have Terri’s feeding tube reinserted. Not much of Terri’s brain functioned but just enough to allow the apparently wide-eyed, semi-smiling face that we have all come to know so well. Over the last four years, her feeding tube has been withdrawn and reinserted three times. What disturbed the “Not Dead Yet!” people was that they considered that Terri should not have been in a hospice. They considered that she was profoundly disabled and should have been cared for elsewhere. The term “profoundly disabled” was in conflict with the prognosis of “persistent vegetative state.”

         In their six years of marriage, Michael Schiavo said that in conversations with his wife, she had expressed her desire not to live if she were ever in a state where she could not recover. The Schindlers deny that Terri could have said that because she was a devout catholic and it would have been against her religion. Young people rarely put these end of life wishes down on paper so there was only Michael Schaivo’s word about Terri’s wish. My experience is that young people in their 20’s are often not much influenced by their religious upbringing.

         Conversations with our significant others and significant friends range far and wide, don’t they? It is likely that the young couple discussed such a topic but this we cannot verify since nothing was in writing. If Terri had made out an end of life directive or a living will, Michael Schiavo, might not have had to spend 10 years in court.

         What do we want for ourselves when we can no longer make decisions? How can we help our loved ones make decisions for us? Very few people make out the few simple documents we can fill in to make our wishes known. The first and foremost is a “Health Care Proxy.” This is the document where we identify one person who can make our health care decisions if we are unable and an alternate person in case the first one is not available. These are called our Health Care Agents. Then the most important thing is to sign and date the Proxy in the presence of two witnesses (who are not the health care agents). The witnesses sign to witness your signature. Then, you make at least four copies of the proxy. Keep the original for yourself and have it in an easy to find place (not in a safe deposit box!).One copy should go to your doctor for your medical file, one copy to each of your health care agents. Give additional copies to your clergy and/or lawyer and anyone else who you want to be inv olved in your health care.

         You can also fill in other forms such as a Living Will and a directive of what to do in certain circumstances. However, in this state, it is the Massachusetts Health Care Proxy that is the most important. Having taken all these precautions, what is the most likely situation?

         Many people have a major health event where Emergency Room or hospital physicians do everything possible to save your life, no matter what Proxy form you wave in their faces. They will sweep the form and everyone aside except you and they’ll try to save you. Now, this is actually good because you might recover and live a few more years of enjoyable life. On the other hand, perhaps your life will be at an end and in the balance, in which case all your family members will gather around. It is an intense, distressing, and memorable time for them that is likely to stretch over many days. I have been part of many of these waiting room vigils. Sometimes, family members go and visit friends you were close to and get their input. I do so hope you will do this for yourself and your loved ones. The chances are that you will have been very frank with people of your own age who are friends. All of this makes it easier to make the decisions we want.

         The most important thing we must do is to talk to people we know about our wishes—many people who are close to us. This way, when the difficult decisions have to be made, at least they will all know your views and your wishes. If you, the patient, are able to be consulted, the doctor, and also your family, should listen to your wishes, even though they may be opposite to what your proxy said! It can happen. You can change your mind!

         When you have written and said all that you have to say about how you want to end your life, trust your loved ones to do your wishes. If you haven’t made out a Health Care Proxy, I hope you will take home today one or more of the forms from the table in the Parish House as well as a Living Will and End of Life Directive forms. (Dear Reader, These forms are attached. We also have three attorneys in our congregation if you wish to have a referral.)

         All of these things are an effort for us to end our lives with dignity. But what we are really doing is to ensure that we live with dignity to the end. So let us do it in our Beloved Community.

References

The following has inspired and informed this sermon:

Article, “The Right Way to Die by Jose Luis Stevens from the journal “The Power Path,” Volume 14, Number Three, March 2005.

Article, “Lessons of the Schiavo Battle” by Daniel Eisenberg, Time Magazine, April 4, 2005.

Many background articles from the Standard Times (New Bedford, MA) and the Boston Globe.

The many wonderful people who I have come to know before and during the dying process of themselves and their loved ones.