SERMON

Voluntarily ending a human life is one of the hardest decisions any of us will ever make. And even after the decision is made, we can be plagued with doubt. ?Did I make the right choice? In the conversational response last week, Phyllis Lincoln powerfully illustrated this struggle speaking from her experience with her son and having to make the decision to withdraw life support. These are decisions we must live with the rest of our lives. We must find ways to make them well.

Last Sunday I proposed that the value of a human life is not constant varying across the course of our individual existence. I proposed three scales to help us value a human life. The first was potentiality. At the time of conception we have probably the most potential and at the end of our lives we probably have the least. The second scale was quality of consciousness. This is our interior subjective experience of being alive and having a functioning brain. The final scale I proposed was independence. I concluded with these words:

Together, potentiality, quality of consciousness, and independence can be used to value human life. An adult human being has close to the maximum in potentiality, independence and quality of consciousness and therefore the highest value. An individual without brain function, intubated on a respirator, with no hope of recovery from a degenerative disease would probably have the lowest value

Human life is therefore valuable and merits protection if it meets at least one of the criteria of potentiality, quality of consciousness and independence. Of the three, quality of consciousness is the most important determinant of value, followed by potentiality and finally by independence. The only times we should be permitted to consider the voluntary ending of human life is if the quality of consciousness is very low or absent, he or she is completely dependent, and be guided in the decision by the potentiality for that life.

This morning I would like to unpack this value system and begin to test it to see how useful it might be to grapple with these profound life and death issues. I want to emphasize again that these scales may or may not be the best ones for valuing human life but that they are useful to help us engage our minds and make peace with our decisions. Each case will always be unique. Ultimately any decision must be found in the heart of what we believe about the meaning of life and death.

First of all, any opening to the morality of voluntarily ending a life does not imply the permission or especially the obligation to end life. This is especially true when we view the worst case. The terminally ill person with no hope of recovery, unable to live on their own and with very low quality of life. Anybody who has visited a nursing home will see these people by the dozen waiting to die. I suspect this is what we all fear about the end of our own lives. Very few would like to slowly fade away while bed ridden, in pain or delirium with a complete loss of dignity.

I assert that this is one of the cases where a person should have the possibility of ending his or her own life. What must guide the decision is the potential for quality of consciousness. A great deal can be done to provide the terminally ill with pain control and medical support to improve their quality of consciousness enough to make living meaningful to the person. This is the great hope and value of the hospice movement. Even at the end of our lives, we still have so much to give and receive. Providing our care can bring a great deal of meaning and value to a son or daughter. Sometimes just being able to share old stories and memories with grandchildren in the last days of life can bring great benefit to them. And sometimes the pain is unmanageable, the mind so confused and the dependence so burdensome and expensive that the ending of a life can be a great blessing to everyone.

Evaluating this potential is very difficult because the future is full of surprises. At one point in my mother's struggle with metastasized breast cancer the doctors told her that she had reached the end of the road for treatment they could offer. The doctors pronounced her terminal and gave her less than six months to live. She made contact with hospice and made her preparations for the end of her life. As part of the hospice program, a social worker came out to visit her every week. They began together to explore my mother's feelings about dying and what was unresolved in her heart. As my mother opened up to the suffering in her past, the progression of the cancer slowed down and her condition began to stabilize. She gained another two or three high quality years of life that she hadn't expected to have as a result of the great work that social worker did with her.

For most of us, the determinant in whether we wish to continue living when facing a terminal diagnosis or a loss of independence is quality of consciousness. When the quality of consciousness is good we have a moral obligation to support that person's continued existence. A good illustration is the case of the great physicist Steven Hawking who is profoundly disabled and has lost the ability to speak. I was able to see him while I was attending U.C. Berkeley. Looking at his frail form up on the stage strapped into a wheelchair, I wondered what he could offer us. Then his synthesized computerized voice began to deliver the lecture and I was amazed at the workings of his mind and the sharpness of his humor. Such uses of technology make me feel proud to have participated in the computer revolution. Even though he has no potential to recover from his illness and has no independence, clearly his quality of consciousness is excellent and deserving of support and protection.

It isn't hard to agree that when there is high quality of consciousness, we should support life rather than end it. Things get more difficult when there is little or no quality of consciousness. The first case I'd like to examine is when the individual still has both potential and independence. When a person is depressed and feels like their life has no value, when a person does not feel as if they have any quality of consciousness we have every obligation to try to assist that person and prevent them from harming themselves. Depression is sort of like temporary insanity. A big life change, a great loss, or a health problem can temporarily cause us to lose our minds. If that person's potential is good for quality of consciousness and ability to function adequately, they should have every expectation to recover. Today depression is one of the most treatable mental illnesses.

Unfortunately other mental illnesses are less treatable and much more debilitating. Schizophrenia in particular can make one's life and all those around one miserable. I remember well the patients I visited at the Delaware State Mental Hospital and the unhappy lives some of these people led tormented by invisible demons planting thoughts in their heads and shouting things in their ears. Even though people suffering from this mental condition can walk around, use the bathroom and feed themselves, their ability to function in society is severely compromised. Yet their potential continues to improve as more and more psychotropic medications come on the market. People who were untreatable even five years ago are finding medications which allow them to function in society again. So even if their quality of consciousness is low today, and their independence compromised but at least self supporting, they still have a strong potential for recovery tomorrow and merit protection.

The most difficult cases come when the quality of consciousness is practically non existent and there is no independence at all. All that exists is the potential for life. Jim Whiton's case is an excellent one to get us thinking about the situation. Jim had surgery for a congested carotid artery. It is a widely used procedure to increase blood flow to the brain. Those of us who saw Jim before the operation and then afterward can attest to its value in increasing quality of consciousness. The first operation to clear the right one went without a hitch. The second one though did not go as expected and Jim didn't wake up after the surgery. His vital signs were depressed so the decision was made to put him on a respirator. When I joined Missie the evening after the surgery we were gravely concerned for his condition. We knew that Jim had very negative feelings about artificial life support technology and here it was being used to keep him alive. Fortunately, as we watched him he suddenly stirred and woke up which surprised even the nurse.

When we considered whether he should have been put on the respirator during a session of Conversation Among Friends, I thought Bob Hansman, as he often does, had an insightful comment. Of course he should have been put on because his potential for recovery was very high. Perhaps he had just had too large a dose of anesthesia or some temporary abnormality had cropped up. Only after several days when the situation had been medically assessed could any other choice be made.

Jim's case and in the case say of a mother of two preschool children who arrives unconscious at the hospital are the reasons we greatly appreciate all of this medical technology in the first place. In these situations we should pull out all the stops to actualize the person's potential for recovery. Any other decision would be highly immoral. Age and ability to pay should not be a criterion to prohibit use of heroic measures if the individual has good potential for quality of life.

Now let's get to the hardest test case. What about the case of the fertilized egg which also has great potential? ?Does it not also deserve the same protection and opportunity for continued existence? As I was working out my system last week, I was greatly troubled by this conclusion, this corner my reasoning was forcing me into. I do believe women have the moral right to terminate a pregnancy. I think society has the moral right to limit reproduction to prevent overpopulation. The problem and its resolution can be found in opening up and understanding the dimensions of potentiality.

Not all potentials are the same. I have both the potential to finish this sermon and listen to your responses and win the lottery. These events may be in my potential but have vastly different probability and likelihood of actually happening. The chance I finish this sermon is 99.99% unless I am struck down by lightning right now. The chance I win the lottery is extremely low since I do not believe in playing it and have never bought a ticket. But I may change my mind someday and almost did at the card party when Fred Lienhardt suggested the idea of buying tickets and donating them to the Fellowship.

Not only are the probabilities different, the consequential results within the social whole are quite different. As I mentioned last week when discussing potentiality, we must consider the social ramifications. If Jim had died or the mother of two preschoolers had died, it would cause major disruption and suffering in the lives of other people. If a pregnancy is secretly terminated in the first couple of months, the only lives affected are the woman's, the father's and to a much lesser degree the fetus as it has little or no quality of consciousness. If it is a pregnancy as the result of rape or incest or the woman is barely a teenager, both the potentiality and quality of consciousness of the woman are likely to be greatly enhanced. If the woman is addicted to crack, our society is protected from the inclusion of a potentially dangerous and disruptive addition.

The complicating factor about the beginning of life is the fast acceleration of a fetus' experience of consciousness which mitigates against the morality of terminating a life. After the fetus passes the point where it can survive outside the womb, the woman begins to have a greater and greater moral obligation to carry the child to term. And certainly every effort should be made to bring desired fetuses to birth even if its potential is compromised by birth defects.

I hesitate to try to define too much moral obligation here as I think there needs to be much room for choice and responsibility. The circumstances are always so important in making these agonizing decisions. Certainly abortion in the last trimester should be very rare and unusual. Even abortion in the second trimester should be carefully weighed. History, I believe, will smile on the wisdom of the Roe v. Wade decision and the wise moral guidance to be found there by viewing each trimester differently. What is important I think here is the scales of potentiality, independence, and quality of consciousness change over the course of a pregnancy and should influence the decision.

So from the beginning of life to the end, the scales of potentiality, independence and quality of consciousness can be used to guide a decision to voluntarily bring a life to an end. And these scales are not just useful for determining the end of life. These scales can also reveal how much value we have no matter where we are in the course of our lives and perhaps even suggest a direction for improving our self-valuation by increasing our potential, our independence and our quality of consciousness. Increasing education, learning new skills for self-reliance and communication and freeing our minds by finding and releasing our hidden inner mental limitations can do much to improve our quality of life.

My system of potentiality, quality of consciousness and independence may be useful but it is not and never can be authoritative. As I have repeated several times, each case is unique and must be treated uniquely. My system should be only one of a combination of different mental tools which can help make the final decision. There is no escape from the magnitude of such a decision which requires a little something beyond reason. There will always be the cases of the people given up for lost who miraculously come back seemingly from the dead, like a modern Lazarus. After all is said and done, only in the inner sanctum of our own hearts can this decision be made.

Whatever the decision, may we be comforted that no matter what happens to an individual fact of life, the stream of life rushes on with or without us. We are still part of a wondrous evolutionary process which didn't begin with us and shall not end with us. Nor shall it end with the extinction of the human race or even life on this planet. We are part of the cosmos and shall remain so till the last moment of existence. Life has no beginning or end.

What an honor, what an honor, we have today, yes, today, just to witness and participate!

Copyright (c) 1997 by Rev. Samuel A. Trumbore. All rights reserved.