Living with Dying

1. Living with Dying Theological and Practical Aspects of End-of-Life Issues

2. Hittites

3. Introduction “I am leaving the land of the living and will soon be with the dying.” “I am leaving the land of the dying and will soon be with the living.”

4. Theological Aspects of Living with Dying A. The God-given Value of Human Life “What is man that you are mindful of him, the son of man that you care for him?” (Ps. 8:4) “You made him a little lower than the heavenly beings and crowned him with glory and honor.” (Ps. 8:5) “Just a bit of slime on the planet.” Peter Otkins, Oxford “A curious accident in a backwater.” Bertrand Russell “A fortuitous cosmic after thought, a tiny little twig on the enormously obsolescent bush of life.” Stephen Jay Could (Harvard)

5. Theological Aspects of Living with Dying A. The God-given Value of Human Life

6. Theological Aspects of Living with Dying A. The God-given Value of Human Life “There are no gods, no purposes, no goal-directed forces of any kind. There is no life after death. When I die, I am absolutely certain I will be dead. That’s the end of me. There is no ultimate foundation for ethics, no ultimate meaning to life.” William B. Provine, Cornell University

7. Theological Aspects of Living with Dying B. The Christian View of Death “The death of a man is, however, an infinite and eternal misery and wrath.” “We should be happy to die and desire death. Death is only the narrow gate and the small way to life.”

8. Theological Aspects of Living with Dying 1. Death as Law “We are consumed by your anger and terrified by your indignation. You have set our iniquities before you, our secret sins in the light of your presence. All our days pass away under your wrath; we finish our years with a moan.” (Ps. 90:7-9)

9. Theological Aspects of Living with Dying 1. Death as Law “Our death is a more terrible thing than all death not only of other living beings, but also than the troubles and death of other men. What of it when Epicurus dies? He not only does not know that there is a God, but even fails to understand his own misery and recognize the disaster which he is experiencing. Christians, however, and God-fearing men know that their death, together with all the other miseries of this life, is to be equated with God’s wrath.” (Martin Luther LW, 13, 112)

10. Theological Aspects of Living with Dying 1. Death as Law LIFE! • Faced with difficulties, majority of older adults 60-100 – LIFE! • Kidney dialysis – LIFE! • AIDS – • Quadriplegia – LIFE!

11. Theological Aspects of Living with Dying 2. Death as Gospel “Where, O death is your victory? Where, O death, is your sting? The sting of death is sin, and the power of sin is the law. But thanks be to God! He gives us the victory through our Lord Jesus Christ.”(1 Corinthians 15:55-57) “In the midst of life, we are in death. In the midst of death, we are in life.” (Luther LW 13,83)

12. Theological Issues of Advance Directives I am torn between the two: I desire to depart and be with Christ, which is better by far; but it is more necessary for you that I remain in the body. (Philippians 1:23-24)

13. Theological Aspects of Living with Dying C. The Theology of the Cross “God shows that He is God precisely in the fact that He is mighty in weakness, glorious in lowliness, living and life-giving in death.” (Paul Althaus. Theology of Martin Luther p. 34) “The well organized campaign for legalized euthanasia cruelly exploits the fear of suffering and the frustration felt when we cannot restore to health those whom we love. Such fear and frustration is genuine and deeply felt, especially with respect to the aging. But to deal with suffering by eliminating those who suffer is an evasion of moral duty and a great wrong.” (Always to Care, Never to Kill)

14. God’s love is at work even in our suffering. Paul said – “I rejoice in my _____________” Paul said – “I rejoice in my sufferings.” Luther said – “ ___________ is the best book in my library.” Luther said – “Affliction is the best book in my library.” C.H. Spurgeon said – “I venture to say that the greatest earthly blessing that God can give to any of us is health, C.H. Spurgeon said – “I venture to say that the greatest earthly blessing that God can give to any of us is health,with the exception of sickness.”

15. Practical Aspects of Living with Dying Educate About the Value of Life

16. Practical Aspects of Living with Dying Educate About the Theology of the Cross About Pain Control About the “Right to Die” Movement

17. Practical Aspects of Living with Dying A Look at the Past: The Euthanasia Society of America (1938) hoped to “eventually legalize the putting to death of non-volunteers beyond the help of medical science.” Original Intent of the Movement “It started with the acceptance of the attitude, basic in the euthanasia movement, that there is such a thing as a life not worthy of life.” (Dr. Leo Alexander, Psychiatrist and Chief American Counsel at the Nurmberg Tribunal) Nazi Germany

18. Verbal Engineering “Verbal engineering must precede social engineering.” (Rita Marker) “Americans against Human Suffering” “Death with Dignity” “Aid in Dying” “Compassion in Dying” “Compassionate Relief of Suffering” “Assisted Suicide Act” “Death with Dignity Act” “Compassion and Choices” “Hemlock Society”

19. Practical Aspects of Living with Dying Educate About the Theology of the Cross About Pain Control About Right to Kill Movement About “Advance Directives”

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21. Advance Directive An instrument in writing whereby the person signing the instrument, the principal, provided direction in the document for future health care decisions should that person become unable to make their own health care decisions. Black’s Law Dictionary Sixth Edition

22. Living Will A document which governs the withholding or withdrawal of life-sustaining treatment from an individual in the event of an incurable or irreversible condition that will cause death within a relatively short time, and when such person is no longer able to make decisions regarding his or her medical treatment. Living wills are permitted by statute in most states. Black’s Law Dictionary Sixth Edition

23. Health Care Power of Attorney An instrument in writing whereby one person, as principal, appoints another as his agent and confers authority to perform certain specified acts or kinds of acts on behalf of the principal regarding his health care only. Black’s Law Dictionary Sixth Edition

24. Living Wills “Living Wills are deceptively named—they have little to do with living and everything to do with dying. It is not wise to sign a document which specifies conditions under which one would rather be dead.” (Mary Senader, Human Life Alliance) “If we can get people to accept the removal of all treatment and care, especially the removal of food and fluids, they will see what a painful way this is to die, and then, in the patient’s best interest, they will accept the lethal injection.” (Dr. Helga Kuhse at a world conference of Right to Die Societies)

25. Living Wills Example 1 • “If I should have an incurable or irreversible condition that will cause my death in a relatively short time…” arthritis mental illness days, weeks, months, or years

26. Living Wills Example 2 • “I direct my attending physician…” whoever happens to be near… Removes medical decisions from your family

27. Living Wills Example 3 • “Withhold or withdraw medical treatment that only prolongs the dying process…” food and fluids

28. South Dakota Living Will LIVING WILL DECLARATION TO MY FAMILY, PHYSICIANS, AND ALL THOSE CONCERNED WITH MY CARE: I, _________, willfully and voluntarily make this declaration as a directive to be followed if I am in a terminal condition and become unable to participate in decisions regarding my medical care.

29. With respect to any life-sustaining treatment, I direct the following: (Initial only one of the following optional directives if you agree. If you do not agree with any of the following directives, space is provided below for you to write your own directives).

30. NO LIFE-SUSTAINING TREATMENT. I direct that no life-sustaining treatment be provided. If life-sustaining treatment is begun, terminate it. TREATMENT FOR RESTORATION. Provide life- sustaining treatment only if and for so long as you believe treatment offers a reasonable possibility of restoring to me the ability to think and act for myself.

31. TREAT UNLESS PERMANENTLY UNCONSCIOUS. If you believe that I am permanently unconscious and are satisfied that this condition is irreversible, then do not provide me with life-sustaining treatment, and if life-sustaining treatment is being provided to me, terminate it. If and so long as you believe that treatment has a reasonable possibility of restoring consciousness to me, then provide life-sustaining treatment.

32. MAXIMUM TREATMENT. Preserve my life as long as possible, but do not provide treatment that is not in accordance with accepted medical standards as then in effect.

33. With respect to artificial nutrition and hydration, I wish to make clear that (Initial only one) _________ I intend to include this treatment among the "life-sustaining treatment" that may be withheld or withdrawn. _________ I do not intend to include this treatment among the "life-sustaining treatment" that may be withheld or withdrawn.

34. (If you do not agree with any of the printed directives and want to write your own, or if you want to write directives in addition to the printed provisions, or if you want to express some of your other thoughts, you can do so here.)

35. What If I Have a Living Will? • Do you know what it says? • Contact your attorney • They are revocable • Start over

36. Health Care Power of Attorney • Designate someone you trust • More than one person • Share values about the sanctity of life • Discuss your wishes • Do not be too specific

37. Refusing Medical Treatment • Right to refuse treatment • Does not sustain life, but prolongs the dying process • Discuss if treatment is a burden • “Right to die” – patient is a burden

38. “Once we have transgressed and blurred the line between killing and allowing to die, it will be exceedingly difficult— in logic, law, and practice—to limit the license to kill. Once the judgment is not about the worth of specific treatments but about the worth of specific lives, our nursing homes and other institutions will present us with countless candidates for elimination who would ‘be better off dead.’” Always to Care, Never to Kill: A Declaration on Euthanasia by the Ramsey Colloquium as published in First Things February 1992:45-47 Terri Schiavo

39. Dr. Gilbert Meilaender – member of the President’s Council on Bioethics and Professor of ethics at Valparaiso University. “If she is a living human being, albeit a severely disabled one, then our responsibility was to ask what we can do to benefit the life she had. It’s not within the scope of our authority to ask whether it’s a benefit to have her life.” We can and should allow the dying to die. We must never intend for the death of the living. Terri Schiavo was not dying. Removing her feeding tube did not allow her to die. It caused her to die.

40. Focus on the treatment • Is it useless? • Is it excessively burdensome? Focus on the person • Is he/she useless? Is he/she dying? • Is he/she burdensome?

41. The Slippery Slope Right to refuse treatment “Right to die” Right to assisted death (physician-assisted suicide) “Duty to die” Euthanasia (“Right to kill”)

42. A Glimpse of the Future: “The Netherlands has moved from assisted suicide to euthanasia, from euthanasia for people who are terminally ill to euthanasia for those who are chronically ill, from euthanasia for physical illness to euthanasia for psychological distress, and from voluntary euthanasia to involuntary euthanasia (called ‘termination of the patient without explicit request.’) There is no way to stop the slide once a society steps onto the slippery slope by legalizing physician-assisted suicide.” (Dr. Herbert Hendin, 1996 report to Judiciary Committee of House)

43. Practical Aspects of Living with Dying Caring for and about “I have participated in the intensely human drama that surrounds dying. I’ve witnessed the difficulties, I’ve smelled the odors, I’ve seen the unpleasant liquids which assisted suicide advocates claim make life at the end inherently undignified, horrific, and hence worthy of a death sentence. Yet, such conditions need not diminish the inherent value of human life. Dying people remain people, and when properly treated, they usually transcend the limitations of their physical conditions—especially if they know they are cared for and about.” (Hospice Worker)

44. Concluding Parable There was an old woman who lived in the woods.

45. Great Theology Makes Great Practical Care • We know the root cause of pain and suffering. • We know the cure for that root cause. • We know that pain and suffering will be part of this life. • We know about God’s presence in suffering. • We know where we are going.

46. Questions ? ? ? ? ?

47. Recommend Resources • Protective Medical Decisions Document • International Task Force on Assisted Suicide and Euthanasia • Will to Live • National Right to Life Committee • Durable Power of Attorney: Christian Version • Christian Life Resources

48. Brochures from LFL Basics on Advance Directives

49. Brochures from LFL • God’s Love in Human Suffering • Euthanasia and the Christian • A Guide for Christians in Ethical Decision-Making at the End of Life

50. Brochures from LFL • God’s Love in Human Suffering • Euthanasia and the Christian • A Guide for Christians in Ethical Decision-Making at the End of Life • The Right to Die: Rhetoric, Reality, Response