Poor little Barbara’s cat died and she struggled to understand exactly what it meant.She sat next to her father with his arm around her shoulder and sobbed, “Oh, Daddy, poor old Tom is dead.”

“It’s okay dear,” her father said, “Old Tom has gone to heaven to be with God.”

Barbara stopped crying and looked puzzled.After a moment she asked, “Daddy what does God want with a dead cat?”

Sometimes kids struggle with the fairness of life and death.Henry came home from school very upset saying, “I studied hard day and night and only got a lousy B…and that stuck up Leopold hardly studied and got an A!”

His mother replied, “You may as well get used to it, Henry, life just isn’t fair.But then death doesn’t have a very good track record either.”

We know life has problems associated with it, but we tend to want to forget that oftentimes so does death.

I pulled into a gas station on a Friday afternoon before Labor Day weekend.The lines at the pump were very long at this tiny full serve station I happened upon in the middle of nowhere wanting to get my oil checked.When I got to the pump, the attendant apologized for the long wait.

With exasperation he exclaimed, “I don’t know why it is that people wait until the last second to prepare for a trip they know they are going to take.”

“I know what you mean,” I said, “I have the same problem in my business.”

Death is a trip we are all going to take, hopefully a long time from today.Still, we must prepare for the journey.As we overcome our resistance and chart the territory this morning, let us not forget its okay to laugh a little along the way as we join together in the celebration of life.

Spoken Meditation

Family and friends had been with Moe during his last hours.Both sadness and gladness had been there.A beautiful friend had left us.A long suffering had come to a gentle end…

The days that followed were full of sorrow and joy.Moe was dead, but it seemed as if new life were immediately visible.Telephone calls were made to friends far and wide; letters were written.Most of all, people came together to pray, to eat, to tell stories, to look at pictures—to remember with smiles and tears.Of all the days that I have lived at Daybreak, those after Moe’s death belong to the most intimate, the most uniting, and, in a strange way, the most sacred.A man who, through his fragility and weakness, had helped us create community during his life did so even more through his death.

As we came together in our chapel, visited the funeral home, sang and spoke in gratitude in the Anglican Church of Richmond Hill, and carried the coffin to the grave in King City’s cemetery, we shared a deep sense that not only does life lead to death, but death leads to new life.The spirit of gentleness and kindness that surrounded and pervaded our conversation, the spirit of forgiveness and healing that touched each of us, and most of all the spirit of unity and communion that bound us together in a new way—that spirit was gratefully received as a gift from Moe who was dead and yet very much alive…

I had dinner with Nathan, a friend and longtime member of Daybreak…During the meal Nathan asked me, “Where and how do you want to die?”He raised the question in a gentle way.It was a question that came from our new awareness that, like Moe, we would soon die.Our awareness prompted us to ask ourselves: Are we preparing ourselves for our death, or are we ignoring death by keeping busy?Are we helping each other to die, or do we simply assume we are going to always be here for each other?Will our death give new life, new hope, and new faith to our friends, or will it be no more than another cause for sadness…

Nathan’s question, “Where and how do you want to die?” brought me face-to-face with a great challenge: not only to live well, but also to die well.

Sermon

Imagine, if you are willing, this is your daughter’s story.The event happened the night of April 19^th, 1993:

Brandishing a meat cleaver, Trisha Marshall burst into the apartment of a disabled man in his early sixties.She demanded money but the man, both of his legs had been amputated, had been robbed before.Now he was prepared.He pulled out a gun and shot Marshall in the head.Then he called the police…

Two days later, Marshall, now in the intensive care unit at Highland General Hospital [in North Oakland, California], was declared brain dead.She was twenty-eight years old, and the mother of four children, all of them being cared for by other people.Berkeley police said she was under investigation for several other robberies.She had cocaine and alcohol in her blood.She was also seventeen weeks pregnant[i].

Pretend you are Marshall’s mother or father.Would you want the hospital to do everything possible to help bring the fetus to term and be born or would you let both of them die?

What if you had just given birth to Baby Doe on April 9^th, 1982, in Bloomington Hospital in Indiana.As soon as the baby was born, it was apparent he had Down Syndrome, which involves some physical abnormalities and intellectual disability.Typical IQ’s range from 35 to 70.Some can live on their own when they grow up but many can’t[ii].

Baby Doe also had a related birth defect.His esophagus was not connected to his stomach.Without surgery the baby would starve to death.The defect could be corrected back then.The operation would be major surgery but the chances of success were good.Do you do the surgery or do you let Baby Doe die?

Finally, consider Sharon Sasso’s story.

At about 1 a.m. on March 20, 1999, Sasso slipped from a fire escape falling three stories, causing massive head injuries. She was rushed to San Francisco General Hospital where doctors determined she would die within a day. 

Her mother, Colleen Sasso, arrived at the emergency room about 4 a.m.The doctors told her they did not expect her daughter to survive. Although they had performed surgery to try to relieve the pressure on Sharon's brain, too much damage had already been done, and her brain was continuing to swell.

Less than an hour later, a transplant coordinator approached Colleen, asking if she would be willing to donate Sharon's organs[iii].

These decisions are far from easy.Seeing that person warm, pink and breathing doesn’t register emotionally with the reality of “brain death” or a “permanent vegetative state.”On occasion, people do wake up from comas.I sat with a member of my congregation in Florida watching her husband who unexpectedly didn’t come out of the anesthesia after surgery.He was leading member of our Hemlock Society and vociferous advocate for refusing to be put on a respirator.His wife, a nurse, agreed to hook him up to one anyway.While we were sitting together waiting, he suddenly woke up.Had he not been on a respirator, he probably would have died.Instead, he fully recovered and outlived his wife.

These decisions are difficult because of the uncertainties involved.Would Marshall’s fetus be damaged by bringing it to term in a brain dead body?Would Baby Doe have a life that would be worth living?Would “harvesting” Sasso’s organs and saving up to seven other lives ethically counterbalance shortening her life and eliminating even a remote chance for her recovery?What kind of ethical guidance can help us make these decisions?

With their many hospitals, the Catholics were one of the early entrants into this new field of bio-ethics.They stepped forward with solutions based on their theology of the sanctity of human life from conception to death and the healing ministry of Jesus.The National Conference of Catholic Bishops declared:

Catholic health care ministry bears witness to the truth that, for those who are in Christ, suffering and death are the birth pangs of the new creation. “God himself will always be with them[iv]”. 

Catholics believe God is in charge and gives us life.Thus we are not free to bring it to an end artificially since it isn’t ours but God’s.Imitating Jesus, they work to heal the sick and to assist those conceived to be born.We must not, however, prolong life that God has chosen to end, allowing nature to take its course as we die.

The Catholic ethic is very reasonable if you believe in an actively engaged God determining whether each person will be born or die.What if you are a Deist, or an Atheist?Can an ethic be constructed that is independent of belief or non-belief in God?

Moral philosopher Professor Peter Singer of Princeton University strongly believes we can and must build such an ethic for our pluralistic society.To be able to make these tough decisions free of religious bias, we must construct a non-theistic framework.The foundation of his thinking is based on the concept of personhood.

The concept of personhood was first used to describe the persona or mask worn by an actor in an ancient Greek drama.The bishops attending the Council of Nicea in 325, adopted the concept of personhood to explain the Trinity, one substance in three persons.Thus, the concept of person is not directly linked to a human body.It is sometimes referred to as the spirit, the animating principle that resides in a body.

Singer argues that that animating principle is not exclusively the domain of human beings.Great apes, dogs, cats, birds, and other creatures also have personhood by this definition.Anyone who has had pets knows they have personalities.The challenge is deciding when a life form gains or loses personhood status.

What are the requirements of personhood?Singer believes the two criteria are self-awareness and quality of life.Rather than viewing every life as having equal worth, he believes that worth varies.Being in a permanent vegetative state removes the personhood from the body.Without consciousness or self-awareness, the body has lost its animating principle, its spirit, its soul, if you will.

Being a former member of the Hemlock Society that advocated euthanasia, I found Singer’s ideas very reasonable and acceptable.I’ve preached similar ideas in the past and gotten a positive response from Unitarian Universalists.But that attitude changed on February 18^th, 2003 when I opened my Sunday New York Times to the magazine section and saw the picture of Harriet McBryde Johnson on the cover.She is a profoundly disabled disability rights lawyer suffering from a muscle wasting disease that confines her to a wheel chair.The headline stunned me: “Should I Have Been Killed at Birth?”

Disability rights advocates, like Johnson, who are part of the organization “Not Dead Yet” put Singer in the category of Nazi genocidal apologists.They believe his attempt to define personhood as conditioned on physical or mental capabilities put their lives at risk.They were particularly appalled by the refusal by Baby Doe’s parents to consent to corrective surgery due to their evaluation that Baby Doe’s quality of life would be unacceptable.They believe that kind of "able-ist" thinking could quickly move toward putting disabled people “out of their misery.”

Fifty years ago Johnson would have died in early childhood.Antibiotics prevented the inevitable infections related to her condition.She is not alone.She is not the only one whose life has been extended by medical technology.Think of all the insulin-dependent diabetics who would die without their daily injections.Think of people with kidney or congestive heart failure kept alive through medications and machines.They are dead men and women walking with a little help from technology.

Johnson argues that quality of life decisions are next to impossible for one person to make for another.We may look at her deformed shape strapped into a wheelchair and decide her life isn’t worth living.But Johnson believes her quality of life is quite high.She is an actively practicing lawyer with a sharp mind who greatly enjoys being alive.Profoundly mentally impaired people can live happy and productive lives even though they might need around-the-clock care.

The political argument Johnson makes is of utmost importance.The parents of Baby Doe didn’t want the burden of raising a disabled child.Some terminally ill people wish to hasten the end of their lives so as not to be a burden on their children.Johnson argues that we should not be forced to make these choices.In a society as wealthy as ours, everyone should have the right to a level of care that would allow good quality of life for both the disabled, the family and the caregiver.If a parent may not wish to raise a disabled child, allow another to do it who would.We should not force children to impoverish themselves to allow their parents to die with dignity.

Not Dead Yet’s argument against using personhood highlights a weakness in Singer’s theory.Singer believes in the ethical imperative to “Respect a person’s desire to live or die.”But if the body loses its personhood, however defined, that may negate self-determination.It also negates a potential person from having a say in their future such as the Down syndrome infant.If Baby Doe doesn’t have the surgery, he will never have the chance to develop personhood, which would allow him to choose life or death.

The guiding principle here should be self-determination either by the individuals themselves or by those nearest and dearest to them who understand their philosophy of life and death.Up until the fetus is viable, I’m not willing to grant it self-determination.But once the fetus can survive on its own outside the womb, it gains the standing of potential person and deserves an opportunity to continue to exist.Only if it has no potential to develop personhood, would I feel that withdrawal of life support could be justified.

As a person’s life comes to an end, we must follow the wishes of that person in determining how her or his life will end.But to do that, we must know what those wishes are.Far too many people never engage in a detailed discussion of their philosophy of living and dying with their family.I’ve witnessed the pain of husbands and wives not knowing whether to put the feeding tube in or not, not knowing what their beloved wanted in this or that situation.The balance between life extension and prolonging suffering can change day by day.

Have you had this conversation?If not, and even if you have, I strongly encourage you to attend the three week “End of Life Issues” class Bill Batt, Sarah Birn, Julie Lomoe and I are offering starting tomorrow night.We’ll cover developing an end of life philosophy, how to record that information effectively and the state of the law that outlines the range of choices and who can make them.

Life is uncertain but your intentions need not be.Any one of us could have a debilitating injury or anatomical malfunction tomorrow that limits our ability to communicate our wishes.Making those decisions now is a great act of love and kindness for those you leave behind--and for those who receive new life through the gift of your organ donations.

Benediction

Copyright © 2004 by Rev. Samuel A. Trumbore.All rights reserved.