A sermon has religious stuff in it (Sermon prep III).

[rivka]

More of my argument about assisted suicide follows. This part is really long, so I'm putting it behind a cut tag. This is also the part that needs the most work, [N.B.: Michael says no, it's the last section (not posted yet) that needs the most work. So watch for something worse than this.] because I'm not used to making religious arguments - there are so few contexts in which they are appropriate. (Of course, a sermon would be one of them.)

Opinions and argument continue to be welcome.

Why is physical decline considered so different from other negative events that we consider setting it apart as the only acceptable justification for suicide? I have some ideas.

We live in a society that values independence so much that parents of month-old babies are cautioned not to let them get too dependent on their mothers. A society that finds dependence so humiliating a condition that "Depends" is the name of an adult diaper. We live in – we are raised in – we continually breathe the air of a society in which our worth is fundamentally seen as coming from what we do. "What do you do? When are you going to do something with your life? What contributions can you make to society?" Our abilities and our actions are the most important things about us... right?

So that when we cannot do, when our capabilities become disabilities, when we can no longer preserve the rugged independence that is the American ideal… we may not know anymore what we have left.

Or perhaps we don’t put much stock in the abilities of our bodies, but we feel that our primary value lies in our minds, our intellects. I might be able to accept the idea of using a wheelchair, but feel that if I could no longer put together an incisive argument, or read The New York Times, or balance my checkbook, my worth as a person would be degraded.

We may fall into this way of thinking - which some call ablism or disablism – about ourselves. And more gravely: when other people can no longer do, when they are not capable, when they face increasing dependency as they age or become disabled... it may seem to us, through the lens of our independence-and-action-prizing culture, as if it would be perfectly rational for them to conclude that their life is not worth living. A conclusion we would never accept from a physically healthy person.

Where do our UU values lead us, on these issues? That’s a complicated question to answer, and it is clear that where assisted suicide is concerned different members of our congregation have looked within themselves and found very different answers. We may also perceive conflict between different UU values. Our Unitarian forebears were Puritans; from them we may have inherited a sense that our works are what give us value. Unitarians have long prized intellect and rationality; excellent values, but ones which may leave us vulnerable to losing our sense of worth if our intellect fades.

More generally, our Unitarian emphasis on rationality may mean that when someone presents an apparently rational argument that their life is not worth living, it is difficult for us to look deeper beneath the surface of that rational argument, to test the assumptions on which it rests.

And as religious liberals, we may shy away from a position on assisted suicide which would appear to put us on the same side as the right-to-life movement and the Catholic Church. If they’re opposed to assisted suicide on religious grounds, doesn’t that automatically mean that we ought to favor it?

No. I want to call for us to re-examine this issue, approaching it with Universalist hearts as well as Unitarian minds. The First Principle reminds us that we have inherent worth. "We affirm the inherent worth and dignity of all people." Not because of their actions or capabilities, but as an integral part of their very being. Our UU values tell us that we do not have to do to have worth. We simply have to be. Our UU values direct us to honor the lives of people who are disabled, frail, depressed, mentally incapacitated, to the same extent that we value the lives of people who are healthy, vital, confident, intelligent.

To me, the First Principle unequivocally says that when someone tells me that their life is worthless, I cannot agree with them. I must find a way to support and affirm their worth.

The Second Principle guides us toward justice, equity, and compassion in human relations. I want to spend time talking about this, because assisted suicide is often framed as the "compassionate" answer to suffering at the end of life. So let’s consider those problems in greater depth, and the solutions to which the Second Principle may lead us.

So far I’ve focused on the emotional and existential challenges of people facing death or severe disability: a sense of meaninglessness, hopelessness, loss of personal value. We know those are far from the only challenges. People struggle with pain, which is often inadequately controlled. They fear that they will be a care burden for relatives and friends, or that they will have to give up their freedom for the restrictions of a nursing home. They fear that they will be poorly treated when they are helpless. They fear leaving their spouse with tremendous medical debt, or wiping out the estate they hoped to leave to their children. These are not irrational fears. They are often very real. They may seem overwhelming when we, or our loved ones, are facing them.

What, then, is the just, equitable, and compassionate response to someone who says that "the circumstances of my life are intolerable"?

When I look back at UU history, I see that we have faced that question again and again. Our UU forebears have answered that question with their social action work for abolition, for civil rights, for women’s rights, for immigrants, for lesbian, gay, and transgendered people, for oppressed people all over the world. We have fought to relieve suffering and increase freedom and improve living conditions in the most desperate and hopeless of circumstances.

Only with this issue, as far as I can tell, have UUs been encouraged to come to the conclusion that when the conditions of someone’s life are intolerable, the just and compassionate response is to kill them.

That doesn’t make sense to me. To me that is a profound rejection of our responsibilities under the First and Second Principles, and a profound rejection of our denominational history as agents of transformative social change. I don’t know how we got here, except that – as Aaron Beck warned us – on this issue we’ve gotten sucked into agreeing with helpless, demoralized, and oppressed people that their situation is truly hopeless.

I say to you that it is not. When faced with the suffering of people who are disabled or dying, we have options beyond reframing "compassion" and "dignity" to mean fatal overdoses for those who lose hope.

(Then I have stuff about what we need to do to support people who are dying and transform end-of-life care, which I'll break off into a fourth sermon prep post.)

Comments

[kalmn.livejournal.com]

Only with this issue, as far as I can tell, have UUs been encouraged to come to the conclusion that when the conditions of someone’s life are intolerable, the just and compassionate response is to kill them.

ha!

if people do not fall of their chairs when you say that, it is because they are secretly robots. go, you. this is great.

[ororo.livejournal.com]

This is a fascinating journey you've been on. thank you for sharing it.

[naomikritzer]

I think this is a really good section, actually.

The big open question for me here is, "How can societal change help people who want to die because they are terminally ill?" Which I assume you will address in the next section.

I think the assumption a lot of your audience is making is that the suffering created by terminal illness is solely a medical issue; social change does not fix medical issues, thus letting us off the hook. You're challenging that really vigorously here, but I think you will need to underscore that again in the next section.

[txobserver.livejournal.com]

I have been reading all your posts about this and I see your point of view. But I would like to share a personal story. It relates to the subject of your sermon as follows: I am going to describe the two year horror that my mom experienced and tell you that I believe one of my sisters (at least) will be extremely interested in assisted suicide if she sees herself going down the same path. I myself have decided to try and keep the means for suicide at hand for the same reason. My mom had a right brain stroke taking away her ability to see things on her left side. She had subsequent brain events that might have been some kind of seizure or additional strokes. The most awful part of the stroke was that it left her with psychotic episodes (not all the time, but pretty much every evening and night) in which she was convinced she was away from her (girlhood) home, and her mom was worried sick about her. She would repeatedly try to call her mother (who died 20 years before). She would try to get up and go to the parking lot to transport herself home, sometimes believing she would catch the bus, sometimes thinking she could drive, etc. She also thought people had stolen her furniture and that she was being held captive. Her psychiatrist prescribed anti-psychotics. These would help for a while (days to a couple of weeks) then would build up in her system causing her to be immobile and requiring complete assistance to get to the toilet, get in a wheel chair, everything. Then they would lower the dose or stop the medication. Her mobility would return, but so would her delusions. She was in psychic agony, and despite taking her to multiple doctors, she was never free of this horrific cycle of symptoms. She finally had a heart attack and died.

There was not a time when assisted suicide would have come up in the care of my mom. But for her children who saw this happening and got the nightly calls to come to the nursing home (or 3000 miles away, the daily calls where she told of her plight), unable to help her no matter what we tried, we all were left wanting to be certain this never happens to us. Consequently, I don't think your arguments against assisted suicide apply to, for example, my sister were she to have such a stroke and ask for help committing suicide in a lucid period. Because it was quite evident to us that the medical community has no answer for my mother's type of misery. She had excellent insurance (retired military wife) and an estate that paid for good care. Two of her daughters lived very near and went to see her multiple times a week. I spent a week with her once a quarter during this time, as I live across the country, and so did my brother. I would be interested in your reaction to this situation.

[matthewwdaly.livejournal.com]

Very thoughtful. And well-argued. If this is the second-worst part of your sermon, then it should be a relief to you.

I do disagree with it as a liberal person of faith. Or I might; perhaps it is something that you might clarify. I believe that your principles might well convince you that you should persuade me that my life has value. However, if those principles lead you to reject my right to self-determination, then it is a rejection of my identity and is unjust.

I think that the ablism charge is one that we should analyze as a culture. I don't think that it alone stands up as a major factor, but it's fair to suggest that it is in the mix. Conversely, I think that the belief that the greatest priority of one's life should be to preserve one's life is no less an error. This is not a fresh idea; there are causes for which Gandhi was willing to die, and Jesus believed that the greatest love is laying down ones life for one's friends (John 15).

It's a difficult decision that we will more and more be asked to face ourselves as clinical immortality becomes increasingly less fantastic. But to say that the answer is always "no" is to doom us all to the curse of Tithonus. For myself, I'd rather spend my estate endowing a college scholarship than paying hundreds of thousands of dollars to extend my life beyond my body's natural ability to live. My death is mandatory, but being forgotten after my death is something that is worth struggling against. In any event, with all due respect, you are not welcome to make the decision on my behalf.

[acceberskoorb.livejournal.com]

So very good!

[txobserver.livejournal.com]

Oregon publishes a mandated report annually about that year's outcomes under the Death With Dignity Act. Here is the latest one:
http://www.oregon.gov/DHS/ph/pas/docs/year12.pdf

The first page shows a graph of patients who received lethal prescriptions and those that actually took them. What this tells me is that many people wanted to retain the option of suicide, not that all wanted to die. I completely agree that the society should provide better palliative care and this article suggests that the DWD Act has increased doctors' awareness and use of that in Oregon. http://jama.ama-assn.org/cgi/content/full/285/18/2363

But fundamentally, and after full efforts have been made to invest a dying person's life with comfort and meaning, it is up to the person. For the reasons I described above, I would want access to the option of ending my life. Then I might or might not exercise it.

[johnpalmer.livejournal.com]

Why is physical decline considered so different from other negative events that we consider setting it apart as the only acceptable justification for suicide? I have some ideas.

Speaking for me only - I've never considered it an acceptable *justification* for suicide.

However, I do grant that in most cases, suicide is not rational. People are extremely resilient, and even in awful circumstances, tend not to want to die. Argumentum ad populum is tricky in some cases, but, if enough people desire something, it's safe to say that there's something desirable about it.

However, at end of life, some of that breaks down. "Don't kill yourself because of X; you might have a long and happy life after X gets better, or even in spite of X staying as bad, or getting worse," doesn't apply.

Of course, you might have a *happy* life, even if not a long one, with a fatal disease. And only those who refuse to accept an earlier death as an answer will look for the ways to make those last days happy, no matter how great the challenge.

In that sense, assisted suicide might be compassion, but it's the cheap compassion. It's the "Are there no prisons, no workhouses?" answer. There's *an* answer - so, don't bother me trying to find a better, more compassionate one!

[juthwara.livejournal.com]

I see several people bringing up the issue of Alzheimer's disease/dementia, and before my father died of Alzheimer's, it was definitely on my list of reasons for assisted suicide. But the more I think about it, the more problems I have with it.

My biggest is that we can't truly know what's going on in the head of someone who isn't mentally competent to tell us. And so I have grave reservations about allowing society to walk down the road of allowing people to actively kill someone who isn't mentally competent to make that decision, even with an advance directive. It might start with the elderly who are going to die soon, but how soon would it extend to the mentally ill who don't respond to treatment, or people who are medically stable, but too brain damaged to have real awareness? What sort of test can we possibly come up with to determine the life quality of someone who can't communicate? When would caregivers exhausted by the demands of taking care of an Alzheimer's patient start choosing to end their loved one's life because they can't afford a good nursing home?

When my father was first diagnosed, I kept fantasizing about his having a sudden fatal heart attack, because all I could see is that he was going to die. And I think that's what happens when we talk about assisted suicide - all we can focus on is the death that is coming. But, and I say this while emphasizing this is just my experience and opinion, while he clearly wasn't very happy in his last six months and it was clear he wasn't going to live out the year, it would have felt like murder to take him to the doctor to end his life prematurely, because of how helpless and dependent he was.