Last sermon prep.
Jul. 9th, 2010 07:46 am![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
rivkaSo. My service is this Sunday. I drove by the church yesterday and my name was on the sign out front, the one with the slide-in letters. Holy cow.
If you're in or near the Baltimore area and you'd like to attend, the service will be held at 10am (not 11, if you've been to our church before) at the First Unitarian Church of Baltimore. The church is at the corner of Charles and Franklin Streets, and there is free parking on Sunday mornings in the garage across Franklin Street from the church. The service will actually be held in the Parish Hall, which is on Charles Street behind the main church building.
The service will be followed by coffee hour (the only UU sacrament) and then, at 11:45, by a post-sermon discussion moderated by someone who is not me, in which I fully expect to wind up in a fistfight with members of the Final Exit Network.
My minister said very nice things about the sermon draft, but man am I ever terrified.
I've put the last portion of my argument (following this one) under the cut. This is the part where I try to undercut the false dichotomy which says that we either leave people to suffer under the current broken system of care for the dying, or we help them kill themselves.
When faced with the suffering of people who are seriously disabled or dying, we have options beyond reframing "compassion" and "dignity" to mean fatal overdoses for those who lose hope.
Fully describing these options would be a book-length project, not a sermon-length one. But I want to quickly sketch an outline of some of the options we have for changing the circumstances of dying people, to give a sense of the full possibilities beyond the false dichotomy which offers us, on the one hand, a uselessly prolonged life full of pain and aggressive medical treatments, or on the other hand, suicide.
We can advocate for improved pain management. Half of all terminal cancer patients are not given sufficient treatment for pain – because providers are afraid to prescribe sufficient quantities, because patients and their families fear addiction, because the focus on curative treatment options outweighs the focus on symptom management, because controlled substance laws are more responsive to the War on Drugs than the needs of patients. We can advocate for changing laws to protect prescribers and families. We can insist that our own providers and those taking care of our families and friends treat pain as if it matters.
We can fight for better access to hospice services and palliative care. There are medical and psychosocial and pastoral experts in relieving suffering at the end of life, for patients and for their families, but many people are not aware of these experts or cannot access them. We can insist that these benefits not be considered optional, a boutique service for those with the best insurance or the greatest understanding of their options. We can insist that more people have access to therapies like Dr. Kissane’s, designed to relieve demoralization and loss of meaning at the end of life.
We can work to expand health care reform to protect the financial survival of families with critically ill or disabled members, so that no one feels that they should die before they drain their family’s assets.
We can promote systems that care for and support the families of dying people in both concrete and emotional ways, so that no one feels that they ought to die to relieve the suffering of those around them.
We can support the disability rights movement and its push for independent living – giving people more options for personal care services and assistive technology to enable them to preserve maximal independence as their physical abilities decline. A concrete example is the fight to allow Medicare and Medicaid dollars to be spent on in-home care in states where they currently only pay for nursing homes.
We can address ablism wherever it arises in our religious movement, in our communities, in our culture, and in our hearts. We can – and we should, and we must – question assumptions about the lesser value of disabled lives whenever we encounter them.
Finally, we can continue to protect the right to refuse medical care. We can refuse to blur the line between stopping useless and painful medical treatments, and actively procuring or advocating euthanasia. Each person has the right to make their own decisions about when to stop pursuing curative medical treatment and shift their focus to symptom care and pain relief. Each person has the right to expect their families and care providers to honor their decisions about future treatment, if they are no longer able to make decisions themselves.
But no person has the right to ask that society decide when their life no longer has value. And that is what assisted suicide asks us to do: to determine that although for most people suicide is an irrational decision, for others it is acceptable because their lives truly are not worth living. Those judgments will inevitably affect not just the person who lives or dies, but others who live in vulnerable conditions – as well as those of us who are asked to make such judgments, or to stand by in approval or silence.
I’d like to bring us back for a moment to the story of my friend and client Ray, whose profound emotional transformations defied all rational expectation. The end of his story is of course inevitable: Ray died of AIDS. He lived a year longer than his doctors predicted, but in the end an opportunistic infection carried him off. None of us, including Ray, could have predicted what that last year of life would mean to him. He died a changed person. He changed me, too.
What did Ray teach me, and what do I hope to persuade you? That "death with dignity" involves affirming dying people’s worth as human beings – their absolute worth, regardless of the assistance they may need or the actions they can no longer perform. That compassion for the dying involves fighting the conditions which make their lives painful, acting to reduce their suffering and isolation and their often legitimate fears. And that always, when they struggle with demoralization and doubt, we must stand with them on the side of life.
If you're in or near the Baltimore area and you'd like to attend, the service will be held at 10am (not 11, if you've been to our church before) at the First Unitarian Church of Baltimore. The church is at the corner of Charles and Franklin Streets, and there is free parking on Sunday mornings in the garage across Franklin Street from the church. The service will actually be held in the Parish Hall, which is on Charles Street behind the main church building.
The service will be followed by coffee hour (the only UU sacrament) and then, at 11:45, by a post-sermon discussion moderated by someone who is not me, in which I fully expect to wind up in a fistfight with members of the Final Exit Network.
My minister said very nice things about the sermon draft, but man am I ever terrified.
I've put the last portion of my argument (following this one) under the cut. This is the part where I try to undercut the false dichotomy which says that we either leave people to suffer under the current broken system of care for the dying, or we help them kill themselves.
When faced with the suffering of people who are seriously disabled or dying, we have options beyond reframing "compassion" and "dignity" to mean fatal overdoses for those who lose hope.
Fully describing these options would be a book-length project, not a sermon-length one. But I want to quickly sketch an outline of some of the options we have for changing the circumstances of dying people, to give a sense of the full possibilities beyond the false dichotomy which offers us, on the one hand, a uselessly prolonged life full of pain and aggressive medical treatments, or on the other hand, suicide.
We can advocate for improved pain management. Half of all terminal cancer patients are not given sufficient treatment for pain – because providers are afraid to prescribe sufficient quantities, because patients and their families fear addiction, because the focus on curative treatment options outweighs the focus on symptom management, because controlled substance laws are more responsive to the War on Drugs than the needs of patients. We can advocate for changing laws to protect prescribers and families. We can insist that our own providers and those taking care of our families and friends treat pain as if it matters.
We can fight for better access to hospice services and palliative care. There are medical and psychosocial and pastoral experts in relieving suffering at the end of life, for patients and for their families, but many people are not aware of these experts or cannot access them. We can insist that these benefits not be considered optional, a boutique service for those with the best insurance or the greatest understanding of their options. We can insist that more people have access to therapies like Dr. Kissane’s, designed to relieve demoralization and loss of meaning at the end of life.
We can work to expand health care reform to protect the financial survival of families with critically ill or disabled members, so that no one feels that they should die before they drain their family’s assets.
We can promote systems that care for and support the families of dying people in both concrete and emotional ways, so that no one feels that they ought to die to relieve the suffering of those around them.
We can support the disability rights movement and its push for independent living – giving people more options for personal care services and assistive technology to enable them to preserve maximal independence as their physical abilities decline. A concrete example is the fight to allow Medicare and Medicaid dollars to be spent on in-home care in states where they currently only pay for nursing homes.
We can address ablism wherever it arises in our religious movement, in our communities, in our culture, and in our hearts. We can – and we should, and we must – question assumptions about the lesser value of disabled lives whenever we encounter them.
Finally, we can continue to protect the right to refuse medical care. We can refuse to blur the line between stopping useless and painful medical treatments, and actively procuring or advocating euthanasia. Each person has the right to make their own decisions about when to stop pursuing curative medical treatment and shift their focus to symptom care and pain relief. Each person has the right to expect their families and care providers to honor their decisions about future treatment, if they are no longer able to make decisions themselves.
But no person has the right to ask that society decide when their life no longer has value. And that is what assisted suicide asks us to do: to determine that although for most people suicide is an irrational decision, for others it is acceptable because their lives truly are not worth living. Those judgments will inevitably affect not just the person who lives or dies, but others who live in vulnerable conditions – as well as those of us who are asked to make such judgments, or to stand by in approval or silence.
I’d like to bring us back for a moment to the story of my friend and client Ray, whose profound emotional transformations defied all rational expectation. The end of his story is of course inevitable: Ray died of AIDS. He lived a year longer than his doctors predicted, but in the end an opportunistic infection carried him off. None of us, including Ray, could have predicted what that last year of life would mean to him. He died a changed person. He changed me, too.
What did Ray teach me, and what do I hope to persuade you? That "death with dignity" involves affirming dying people’s worth as human beings – their absolute worth, regardless of the assistance they may need or the actions they can no longer perform. That compassion for the dying involves fighting the conditions which make their lives painful, acting to reduce their suffering and isolation and their often legitimate fears. And that always, when they struggle with demoralization and doubt, we must stand with them on the side of life.
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no subject
Date: 2010-07-09 12:14 pm (UTC)no subject
Date: 2010-07-09 12:29 pm (UTC)no subject
Date: 2010-07-09 01:55 pm (UTC)no subject
Date: 2010-07-09 01:08 pm (UTC)no subject
Date: 2010-07-09 01:25 pm (UTC)You rock, Rivka.
I'm going to have both kids myself this weekend, and I expect Spud is going to be in full "where's my daddy, WHERE'S MY DADDY" meltdown, but if he seems like he can handle church at all, I'll try to make it.
no subject
Date: 2010-07-10 11:46 am (UTC)no subject
Date: 2010-07-09 01:37 pm (UTC)1. He was an ordained Anglican minister whose father was an ex bishop.
2. He was himself disabled.
Good luck, and I hope that the discussion afterwards is as thoughtful and thought provoking as your sermon...(and I hope the Final Exit people dont become rabid).
no subject
Date: 2010-07-09 02:02 pm (UTC)no subject
Date: 2010-07-09 02:21 pm (UTC)I think you will give a lot of people the kind of food for thought that means they will go and talk about it with other people afterwards. I hope Michael is able to be with you in the talkback and is not needed for some kid crisis.
I'll be thinking of you Sunday.
no subject
Date: 2010-07-10 11:48 am (UTC)A member of the congregation who is a retired minister is going to be there to moderate the discussion, so that should help. And I won't be without friends.
no subject
Date: 2010-07-09 02:40 pm (UTC)Overall, I think that's a much more healthy approach to illness and death, and one I wish more people would take.
no subject
Date: 2010-07-09 02:56 pm (UTC)no subject
Date: 2010-07-09 07:35 pm (UTC)no subject
Date: 2010-07-09 09:10 pm (UTC)I just read this and thought of you: http://www2.macleans.ca/2010/07/08/thankful-to-the-very-end/
It seemed weirdly timely.
Best of luck on Sunday.
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Date: 2010-07-09 09:19 pm (UTC)no subject
Date: 2010-07-09 11:24 pm (UTC)no subject
Date: 2010-07-10 02:43 am (UTC)no subject
Date: 2010-07-10 03:51 am (UTC)no subject
Date: 2010-07-10 11:48 am (UTC)no subject
Date: 2010-07-10 09:29 pm (UTC)no subject
Date: 2010-07-11 01:39 pm (UTC)