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I'm going to be preaching at my church on July 11. In fact, with the help of a Worship Associate (who presumably will know what he or she is doing, one hopes - because I don't), I'll be doing the whole service.

I kind of can't believe I got myself into this.

The title of my sermon is "Life Or Death Situations." I'm going to talk about my experiences working with people who are terminally ill and and people who are suicidal. The scary part, for me, is that I am going to talk about why assisted suicide is problematic and why I believe that endorsement of assisted suicide is contrary to UU religious values. I don't think that will be a popular opinion in my church.

I met with our minister yesterday to talk about it. He is very encouraging, and has promised me any support I need. But it's still going to come down to me writing a sermon and then standing up to deliver it, in front of a whole bunch of people who probably don't want to hear what I have to say.

I know there are several ministers and lay religious leaders who read my LJ; any advice you have would be incredibly helpful.

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If you haven't had the opportunity to talk to people who've used physician assisted suicide, I could ask a friend of mine if she could talk to you on the phone. She volunteers with Compassion and Choices of Oregon, which provides "emotional, social and spiritual support to terminally ill Oregonians" who want use our physician assisted suicide law. She's (obviously) convinced that it's a good option to have.

If you haven't had the opportunity to talk to people who've used physician assisted suicide

Um. No, I haven't, because they're dead.

Excellent point. Since I don't believe in an afterlife, it gives me a very large blind-spot in any discussion of mortality. She only know what they think of it up until they become unconscious.

I am curious about whether she's ever had contact with suicidal people in other contexts.

In my line of work I have met many people who clearly expressed their desire and intent to die. Some of them have tried to kill themselves, and have been foiled by an insufficiently lethal method or a rescuer that comes along at precisely the right/wrong time. It doesn't seem unusual or notable to me that a suicidal person would speak positively of suicide, right up until the end.

I think that assisted suicide supporters typically haven't had broad exposure to suicidal people, and so they think that suicidal people who have a profound disability or a terminal illness are somehow different from people who are suicidal for other reasons. But to my knowledge there is no psychological research to back up that claim.

I don't believe that she'd had any contact with suicidal people prior to this volunteer work. The Oregon law on assisted suicide requires anyone using it to be quite close to death, and I believe they must also be evaluated for depression. One person she met had cancer blocking their colon, causing them to vomit feces. They were pretty motivated to die immediately, on purely physical grounds.

When the law was proposed, I was nervous that people would opt for it out of financial worries. The immediate result of the law was that pain management and hospice care improved dramatically in the state, which is a sad commentary on how things were done prior to the law passing. I volunteered at a hospice for 5 years, and have seen that hospice is a great help for many people and their families, but not for all.

There has been much analysis of the Oregon experience over the past decade, and the worry about people choosing suicide for financial reasons hasn't been substantiated. The people who apply are typically financially secure and have good insurance. Most people who apply don't actually use the pills -- it appears that having that option, that control, is what they needed.

Over here, the main pro side of the debate is that some people are annoyed because they have to commit suicide while they are still physically capable of doing it effectively themselves, when actually they'd rather live longer, knowing that someone else would do it for them when they decided it was time even if they weren't physically capable of it themselves.

Here in the UK we're in the aftermath of an election, and the likely future government is a party which seems to want to hugely cut back on the state-funded support for the frail and elderly. An acquaintance, who works in this area of healthcare, thinks that some of the elderly, still with their wits, might think suicide is the only way to have assets left to pass on to the next generation.

It's not just the immediate moral issue, there's so much else it can interact with.

An acquaintance, who works in this area of healthcare, thinks that some of the elderly, still with their wits, might think suicide is the only way to have assets left to pass on to the next generation.

Yes, I think this plays a significant role here in the US as well - probably more so, given that even with Medicare (government health insurance for elderly and disabled people) you are still likely to burden your heirs with substantial medical bills.

There are many realistic fears/concerns that could lead someone who is terminally ill to think suicide is their best option: fear that pain will go uncontrolled, fear that you will lose your ability to communicate and be subjected to unwanted life-extending procedures, fear of dying alone in the ICU instead of at home surrounded by your loved ones.

It isn't that I think these concerns are not legitimate; I know that they are. It's that I think we need to fix them, not throw up our hands and say "we aren't willing to make our society a better place for you to die in your own time, so the compassionate thing is to help you kill yourself now."

you are still likely to burden your heirs with substantial medical bills.

Only if your next-of-kin is a spouse, I think. Otherwise, creditors get first cut at the estate, but if that doesn't pay the bills, they go begging. (Legally, anyway. They might try and scare money out of folks.)

(FWIW, I'm on the fence on the issue, leaning towards your side of it.)

If I say that you're brave, will that make you think it's scarier than you already did?

Does your church have the custom of having a talkback at the end of the service, where people can ask questions like for a conference paper? (One small UU congregation I attended for a bit had this, but I have no idea if it's typical.)

I have given three sermons in churches, if you count the one that was me and my dad doing a scripted dialogue when I was 10. I did not push the boundaries of their convictions very much, and the parts that felt scary to me to say in public I tried out on a couple of minister-type people beforehand.

I feel like you know a lot more than I do about how to get people to listen to something hard they don't quite agree with, in a way that leaves them open to re-thinking their opinions. And you probably know more than I do about how many new thoughts people can absorb in a sermon format, because you listen to them more often than I do these days. But if you think a handout of annotated bibliography and weblinks would help, use one. And the same goes for PowerPoint or videoclips. For a topic like that, I'd be most inclined to listen to a differing POV from someone who talked about the personal encounters that let her/him to her/his convictions. And if I did have my differing opinion because of some personal encounter (watching the lingering death of a grandparent when I was a child maybe?), I'd want to hear something that acknowledged my situation.

Have you read anything by Harriet McBryde Johnson? She was a disability rights activist who was definitely on your side in this argument.

Her most famous essay was probably "Unspeakable Conversations," about her debate with Peter Singer. My favorite piece she wrote was "The Disability Gulag." Here's a picture of her.

She also wrote two books, one a YA novel and the other a memoir. And, she had a bunch of pieces written about assisted suicide during the Terry Schaivo debate. She has a whole lot of complex reservations about assisted suicide, because of the way our society treats the disabled -- and FTR none of her arguments are religious, as she herself was an atheist.

Also, just to clarify, "Unspeakable Conversations" was partly (largely?) about assisted suicide (although also partly about selective infanticide, something Peter Singer thinks is OK).

I've read Unspeakable Conversations, and I really admired it. And yes, I also come at this issue in part from a disability rights perspective.

I wonder if you would be willing to consider posting some or all of your thoughts on this matter?

I have such mixed feelings about these issues, as a sometimes-disabled person and a longterm pain sufferer. (Mostly I want pain meds FIXED; I don't give a shit if people get addicted to morphine if they're dying, but anyway.)

I'm really concerned about it because my mom, who is uninsured, is convinced it would be the ethical thing to do if she became seriously ill, and I don't agree.

I imagine that I'll be posting quite a bit about it as I work up to writing (and then delivering) the sermon. I'd be interested to hear more about your mixed feelings as I go along.

Here in Maryland, there's a specific box you can check on the living will forms that says "If I am not expected to recover, I want to be fully supplied with pain meds even if it hastens my death." Which I think is an awesome thing to be able to specify.

No advice, but Davidson Loehr's story of a man who had said he didn't want to be kept alive if he had a massive paralyzing stroke, and who then had that stroke, has stuck with me ever since I heard that sermon.
(http://www.austinuu.org/wp/2004/10/on-death-and-dying/ (http://www.austinuu.org/wp/2004/10/on-death-and-dying/) , about 5/6 down the page)

I know you will do an amazing job with this - science based, clearly outlining the morality, thinking through the objections ahead of time.

It is sort of a scary topic to take because people are so passionate about it. But I agree with you - your arguments really influenced my thinking on the entire matter.

Speak slowly. Remember to breathe. Those are likely the things you'll have the most difficulty with, come the day.

I've never given a sermon, but have written two (and a half) sermons, what with the plays I've written for my church. Also, I'm very nervous about leading prayer (but have done it once)...

I think I'm dithering, so... I'm a firm believer in "Take Three Deep Breaths And You Can Do Anything", and the importance of speaking the truth as you see/feel/believe it. John F. Kennedy writes about the importance of this in Profiles Of Courage, and taking a look at it -if you have time- might be helpful.

Hope something in here's helpful. And good on ya' for speaking up.

I'd be happy to read it if you need a "ministerial" opinion. I'm not a UU, but have written and delivered probably one hundred sermons. In fact, I think Bill and Paula have heard me deliver a sermon.

Edited 2010-05-11 01:15 (UTC)

Having dealt with the whole pallative care thing - though not necessarily assisted suicide, I'm a big one on preventing cascading medical interventions that keep people alive artifically. Death with dignity. I know something I have held onto very very hard in the last year about my Dad's death was that he died with his dignity intact, no machines, no interventions in a peaceful relaxed environment with just drugs to help his pain levels. I know he would have never ever considered suicide, but wanted peace.
I think you need to highlight that this is "YOUR OPINION" - its not something the UU has to take on board, but its how you, as a person and researcher look at things. I think the wonderful thing about UU is that everyones opinion is valued and accepted.

I believe that people have an absolute right to refuse treatment, including (at the end of life) assisted nutrition and hydration. I agree that the cascade of medical interventions can be horrific. It makes me sad when people (not you, but other people) present the alternatives as "if assisted suicide isn't allowed, then people will be pumped full of toxic, futile treatments and kept away from their loved ones in the ICU. In horrific pain."

I also have had family members who died peacefully at home, surrounded by their loved ones. I'm not saying that isn't hard, because clearly it is. But it feels much more humane.

I can certainly understand that some suicidal people in our society need treatment rather than assisted suicide. HOWEVER I have lived through the death of several very dear relatives, and treatment for the elderly is horrible.

My Dad died of Alzhimers. He knew he had it, hated it, and would have vastly preferred to choose the time of his own death. He was denied this.

My Uncle died of Alzhimers, seemed content up until the end.

My Aunt (partner of above) died of a broken heart. She actively chose destructive health options over more than 2.5 years till she succeeded in dying of heart disease. Why should we prevent a 80+ year old woman the option of joining her beloved?

My Mother had Hemlock Society pamphlets in her dresser when my sister moved her out of her home. Mom specifically talked about wanting to die rather than live as she is now, in a nursing home. She lost her ability to make rational decision with several small strokes that happened some 8 to 10 years ago, however, since then she has asked to die multiple times, under circumstances that I believe should be honored. It is heartbreaking to me to lean over my mother, age 94, a woman who was vitally active her whole life and who is now held captive in a wheelchair, suffering with advanced dementia. Over and over, during a period of 7 years, she has asked to die.

Would my mother ever have actually taken her own life? I have no way of knowing. The act of staying alive for "one more day" is pretty powerful, but I believe she should have the choice.

I think I know what I would do, and I have a plan for my own end of life should I need it. Will I ever use it? Who knows? Perhaps by the time I am ready to use my strategy it will be too late, and I will be in a wheelchair prison, drugged out of my mind.

I'm not sure I count as a religious leader, but then again, aren't *all* UU's supposed to be leaders? Why not?

I'd be interested to hear your take on why assisted suicide is contrary to UU values, starting with *which* value. I agree that it is problematic, but don't feel the case is as simple as "it's either good or bad."

My understanding of how UUs approach values is that if you phase it as "these are MY thoughts and MY conclusions" most UUs are capable of hearing your points and arguing them on their merits. It's only saying "this is THE truth" that gets us up in arms.

best,

Joel

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