Sunday, September 28, 2008

Days of Shock and Awe

When I was a boy growing up in New Jersey, my parents and I attended Congregation Sons of Israel, an orthodox Jewish synagogue in Asbury Park, New Jersey. We would go most every Saturday. I never liked it much—all the good cartoons were on Saturday morning and I couldn't stand wearing a tie. Although we went to an orthodox, very traditional synagogue, my parents varied widely over the years as to how much we adhered to the rules at home. We didn't fulfill al 613 mitzvot or commandments, or pray all the complex daily prayers at home, my father never put on Tefillin, the little boxes that contained written prayers that are bound to the forehead and arm for particular prayers in accordance with an injunction in the Book of Exodus. At home, being Jewish mostly meant bagels and lox and laughing at Jackie Mason. But at Hebrew school I learned all the things we were supposed to do. Learned the blessings to say before eating or drinking anything, learned the rituals for the holidays, learned to read (but not understand) Hebrew. The rabbi who taught our classes was very, very orthodox—adhered to it all—and made it clear he didn't think much of my family for being, well, let's just say, less observant.

The result of these mixed messages was that I never really understood everything going on around me or what was actually expected of me during what the complex service. If you've never been to an orthodox Jewish temple, the morning service is mostly in Hebrew, with many songs and chants and very specific prayers—far closer to a Catholic or Muslim service that most Protestant ones. The service is highly ritualistic and fairly opaque to an outsider, or even someone like me who was, at least theoretically, an insider.
If the average Saturday was a strange combination of bewildering yet familiar, the high holidays were even more so. Rosh Hashanah is the Jewish new year and, for me, mostly associated with the sound of the shofar, the horn made from a ram's actual horn. The blowing of the shofar is not just a interesting musical choice during the Rosh Hashanah service, it is a commandment from God that all Jews older than 13 hear the sound. It serves to remind us of many things—not the least of which is God's judgment. You see on Rosh Hashanah God opens the Sefer HaChaim, the Book of Life, and inscribes a fate for each of us for the coming year—most important is whether we are inscribed at all in the Book of Life or if our name will be blotted out because we are to die.

On Yom Kippur, ten days later, the Book is closed and our fates sealed for the year to come. The days between Rosh Hashanah and Yom Kippur when the book is open and our fates might be revised are known as the Days of Awe. This period is when Jews consider the year that has just passed and the one to come. During this time, we ask forgiveness of each other and God. I remember going every year to temple and saying the prayers, part of which includes pounding one's heart as you list the sins for which you ask forgiveness. The prayer says:

We have transgressed, we have acted perfidiously, we have robbed, we have slandered. We have given evil counsel, we have lied, we have scoffed, we have rebelled, we have provoked, we have been disobedient, we have committed iniquity, we have wantonly transgressed, we have oppressed, we have been obstinate.

You get the picture and it goes on for while in this vein. This was a time of genuine fear for me as a child. I worried if my parents, my brother and I would all have met the bar—we weren't very good Jews, we ate pizza that had meat on it and, living on the Jersey coast, we even had lobster as a rare treat—both decidedly not kosher, as the Rabbi informed me with a scowl when once I asked what the proper blessing for pepperoni was. If I had really thought about or comprehended the full extent to which we failed to meet the exacting standards of orthodox Judaism, I would have been an absolute wreck. It's completely conceivable that the Pope was a better Jew than anyone in my family was. Still I felt deep inside a sense of what was right and wrong. I knew I was a Jew and that certain things were expected of me, even if neither I nor my family completely complied. I remember the deep sense of wrong I felt the first time I had a cheeseburger (mixing meat and milk is a kosher no-no). By the time I was 13 and done with my Bar Mitzvah, this was all starting to unravel as my somewhat high level of teenage rebelliousness took aim at any institution my parents valued. It would be many years before Judaism came to mean anything to me again.

I need to strike a balance here between the sadness I feel when looking back to that little boy who was so scared for his family's safety, so lost in a world that was both familiar and foreign, and the intensity of religious feeling that moved that little boy so. It is both deeply reassuring and yet sometimes concerning that the youth in our own church will likely never feel anything as intense here in this space. I imagine more than a few people might now be thinking, “Good, I would never want one of our kids to feel that kind of fear of God.” Of course, I agree, but there is something important about a sense of deep awe and even a little fear in religion. Those evenings at the temple as a child, with the light of the candles, the musty smell of the prayer books, the men somberly dressed with their white prayer shawls and yarmulkes, the chanting of Hebrew the meaning of which I only vaguely knew was nothing short of magical....and frightening.

But it got me, at the time, to take forgiveness seriously. To have a real sense of deep wrong. I'm not sure if we can muster that intensity for the errors in our own lives. I offer that question very honestly, not as a rhetorical device, do we have any way of connecting with a deep sense of wrong, one that moves us from the internalization of the cultural sense of right that is shame, to the deep grace of forgiving and most importantly to the saving power of profound change. I sometimes see it in the people I minister to. Mostly, a concern for forgiveness comes in the hours before death—but not too much before that, and I don't think I see it much at all in our public figures, in politicians, let alone celebrities who all too often are a substitute for heroes in our culture. When it is just human to human with no active divinity involved how do we find deep forgiveness for others and, just as importantly, how do we find absolution for ourselves? If there is no cosmic keeper of the score, no powerful agent who can really wipe the slate clean, how do we move past the hurts and harms that are done to our souls. How do we relinquish the easy apathy that comes from knowing that quick words and a band-aid is just as good, certainly easier, and more expedient than the painful work of deep reconciliation, forgiveness, and, most importantly, change.

I've been involved with Buddhism for the past eighteen years, and for many years I thought of Enlightenment as the process of getting rid of faults, of the perfection of the individual. Now I see it as the quest to accept and even embrace the faults and flaws—which, not surprisingly also reduces the influence they have. Not that we don't work on getting better and certainly reducing the damage those flaws can inflict, but the more I accept my inherent quirks and flaws, the easier it is to accept them in other people—to extend a bit more grace to my fellow keystone cops as we bumble along doing the best we can in a wacky world.

I've spent a lot of time in recent years wrestling with God, enough so that I think I should change my name to Jacob—and if that reference doesn't mean anything then we need a class on mythic themes in the Bible. Jacob's story is a bizarre one—as many of the Old Testament ones are, but I'm coming to a new appreciation for the old stories as I study and dig deeper into Jungian psychotherapy, theory, and perhaps one could even say Jungian theology.

Anyway, Jacob isn't a real upstanding guy in some ways—not what my parents would have called a “mensch.” And yet this fellow is a great patriarch of the Bible, the father of the 12 tribes of Israel. Some, including myself not so long ago, would point to the immorality and inconsistency of Biblical figures as evidence of their poverty as worthy heroes—Jacob cheated his brother out of his inheritance, Noah was a drunk, even Jesus curses and kills a fig tree cause it didn't have any fruit. I read the stories and wonder why anyone would include them in a book that's supposed to guide and inspire.

The answer, of course, is that they are meant to be deeply flawed individuals because we are deeply flawed individuals. I am coming to prefer my heroes more broken and in need than perfect and powerful because they more closely echo my own struggles. We make mistakes that are profound. And for many of us, there is no absolution to be found out there. And so we must learn the painful imperfect path of forgiving ourselves and others without the benefit of divine justice or intervention. In a paradoxical way, the absence of a judgmental, punishing God makes the work even harder—there is no one else to turn to, to do this work. We have to do the heavy lifting. You've heard me preach enough by now to know that this theme that runs through most of my thought—regardless of what god or gods, forces or powers may or may not exist, we are the ones who need to act for good in this world. No one, no divine power will aid us more than we aid ourselves and this applies to forgiveness just as much as anything else.

I mentioned earlier the people I minister to. While that sometimes includes the members of this congregation, it is mostly with the patients in the Intensive Care Unit at the hospital. Maybe three or four times a year, I meet with someone who expresses profound fear at dying because they don't believe God can forgive them for what they've done. I remember the first man who expressed this level of anxiety over his sins to me. He confessed to me a host of sins, some fairly grievous and even frightening, some so common as to be almost humerous if not for the intensity with which he spoke them. I remember being at a bit of loss as to how to console him and assure him that Love and Mercy are more powerful than Judgment and Punishment. As he talked and I listened, I started to have an intuition about his spiritual distress. When he paused in his litany of sins, I said to him, “I hear that you're worried if God can forgive you for all you've done, but I wonder if you've ever forgiven yourself.” He burst out crying uncontrollably. All the pent up pain and regret that was eating him up as surely as the cancer was came flowing out. We spoke several more times and while I don't want it to sound like a single sentence on my part “cured” him, it helped move him in a different and I hope more helpful direction.

I've spent a lot of time thinking and working on forgiveness in the past few years. My training as a chaplain consists largely of enough self-examination to allow me enough freedom from my own neuroses and anxieties to be reasonably present to people in crisis. I've also coupled that with a lot of work with Jungian psychotherapy. One thing I've learned, although it continues to be a challenge truly putting it into practice, is that forgiveness isn't something you give just to someone else, it is something you give to yourself as well. I don't mean just forgiving oneself for the errors we all make although that is essential to a healthy whole life. What I mean is that when we forgive someone else we drain poison from our own veins. Perhaps this is the deep wisdom of Judaism. Forgiveness can't be too simple. Forgiveness can't be too simple—and maybe that is more the sin of our culture, thinking it's just a matter of saying, “oops, sorry.” If the days between Rosh Hashanah and Yom Kippur involved a ritual that consisted just of some simple gesture, it wouldn't be enough to shake our own thoughts and feelings loose. Chrisitianity believes that it is so difficult to be forgiven that God has to torture and kill his only son. Forgiveness is and may need to be hard. It is through pounding our hearts, going to a body of water and casting our sins into it, praying that we can be forgiven enough and forgive enough to be worthy of the gift of life—it is through these profound, dramatic gestures that we pause enough to consider the depth of what it takes to forgive and be forgiven. A simple sorry doesn't always do it any more than a walk to the mailbox counts as an aerobic workout. We need to get our emotional heart rate up if we're going to connect with inner peace.

We probably can't summon the intensity and sense of terror and awe that I felt as a child or that some of you may have felt in the church or temples or other places where you grew up. I am, overall, glad of it, but there's a bittersweetness to it as well—one that I think many of us feel at times as we've made the transition to being Unitarian Universalists. We make the choice, not always consciously at first, but almost always increasingly so, to trade certainty for freedom, religious clarity for spiritual integrity. And with any trade, we gain something and we give something up. If I am honest, I have to say that there are things I miss of those years being a religious Jew. I've heard other UU's express similar sentiments about what they've left behind to be a part of this free faith—they miss the beauty and mystery of mass, the power of communion, a sense of security that comes with dogmatic belief and I don't use the word negatively here. We are a congregation of what, 150 adults. There is much we agree on, but much that we differ on as well. Most churches don't have to have much discussion on whether there is even a God—let alone what he, she, or it wants us to do. So we take our license to believe as we will, to pursue our individual path, and we leave behind most of the structures that provided clear boundaries and foundational beliefs to our lives. I am not saying we believe nothing or that Unitarian Universalism is not a strong, beautiful tradition upon which to build a life. I am saying that, for the most part, we have dedicated ourselves to a complex journey, an adventure of spirit that comes with a price. Part of that price is having to find the strength within to acknowledge our weakness and to find it within ourselves to forgive and the sometimes far more difficult process of allowing ourselves to be forgiven.

I quoted one prayer of Judaism when I began this morning and I close with a different, very different voice of Judaism, song-writer Leonard Cohen. Cohen, who spent years at a Zen monastery, wrote the amazing lyrics that I should read aloud every morning and which I know were sung quite recently here, and bear repeating.

You can add up the parts
but you won't have the sum
You can strike up the march,
there is no drum
Every heart, every heart
to love will come
but like a refugee.

Ring the bells that still can ring
Forget your perfect offering
There is a crack, a crack in everything
That's how the light gets in.

Ring the bells that still can ring
Forget your perfect offering
There is a crack, a crack in everything
That's how the light gets in.
That's how the light gets in.
That's how the light gets in.

Sunday, August 10, 2008

Finishing the Quilt

Finishing the Quilt

I don't know about you but sometimes it feels to me like the world is incredibly screwed up.
I am aware that may not be the most inspiring first line ever offered in a sermon, but it's where I need to start this morning. I'm not feeling depressed or particularly morose, but when I read the news, listen, against my better judgment to talk radio, read bumper stickers saying “illegal alien hunting permit” or “either stand behind our troops or stand in front of them,” see more reports of humanity's inhumanity---when I see all this I start to feel more than a bit of despair and a fair amount of paralysis. I begin to feel overwhelmed by all the challenges and problems and hatred and ignorance and shortsightedness and deception and greed and destruction and and and I'm back to not being inspiring. I just wonder how one leaves this life feeling like they've accomplished anything given how short our time is and how limited our strength and influence is. It feels like so much gets left undone. I met a patient at the hospital recently, let's call her Sarah, who was reaching end-of-life. We spoke a number of times, at some length. Sarah said at various points how much she regretted that she would never get a chance to finish the quilt she was working on. She brought this up several times across our conversations and at first I just didn't get it, but now I think I might. Anyway, you get the picture. The problems of our lives, let alone the world can seem so overwhelming, so difficult to make any real impact on. I don't think I'm alone here, right. When you read the news, look around the world, it seems dramatically, perhaps irretrievably screwed up, right? Can I get a solid Universalist amen or even a nice quiet Unitarian show of hands?
Several weeks ago we had a really wonderful Sunday service led by Bob Nemanich. The entire service focused on the impact music has upon our lives and the morning was embroidered with wonderful songs. As I sat where you sit now, I listened and sang along to a couple of my favorite songs. The first was Dust in the Wind by Kansas which, as the title implies, speaks to the incredible transience of our lives. “Dust in the wind, all we are is dust in the wind”--so goes the famous rock anthem. I've always loved the song and the quiet, melancholy simplicity of it still appeals to me. It echoes the sentiments of so many of the world's sacred scriptures. Whether it be the Book of Ecclesiastes or the Buddhist idea of Anicca or impermanence, spiritual paths throughout human history have reminded us about our limited nature—limited by strength, resources, distance, and, of course, most powerfully, we are all, paupers and princes alike, limited by time. The author of Ecclesiastes writes “vanity of vanities, all is vanity. The Hebrew word central here is hebel which means transient, insubstantial. That is to say, “all we are is dust in the wind.”
It doesn't take much to remind us how small we are. Carl Sagan's wonderful passage reminds me how very small I am and short my life is. Each of us is the barest piece of dust in the universe. Our lives, indeed dozens upon dozens of generations, flit by in less than a blink of the galaxy's eye. Not that this awareness is without its own gifts. There is a certain peace in remembering that so many of things we worry about, the day to day conflicts and chaos, the spikes and troughs of daily life, mostly smooth out from the perspective of a 100 years out. Sometimes it can help to take a deep breath, relax, and ask what will this really mean a year or 10 or 50 or a 100 years out. But still, it is easy to feel overwhelmed by the weight of history and culture. So few make an actual difference, so many live “lives of quiet desperation.”
But I, we, are not alone in our fears and doubts. Indeed we are in good company, others have gone before us and felt daunted by the enormity of their problems. The feeling of being too small is part of the hero's journey, part of our journey.
Arjuna, the hero of the Hindu epic poem, the Bhagavad-Gita found himself in a such a situation. Just before a huge battle between two sides of his family, Arjuna directs his charioteer, the god Krishna, to drive his chariot onto the battle field between the gathering armies. He looks out and his courage fails, he loses sight of his reason for acting. The rest of the poem is Krishna's instruction, assurance and encouragement to Arjuna to act in the world despite his doubts. Krishna comes to see all his action as an offering to God thus letting go of ego and attachment to outcomes.
Moses also faced such difficulties. Minding his own business, tending his sheep, he sees a burning bush. God speaks to him and calls him to be his emissary in freeing the Jews from bondage in Egypt. Moses takes a lot of convincing—who am I to do this, what if they don't believe me, what if they don't listen to me, I'm a lousy public speaker, what did you say your name was again? God convinces him to speak to pharoah and overall, apart from the plagues and Red Sea business, everything turned out OK.
Although the details of the two stories differ, both point to an individual struggling to act in the face of seemingly insurmountable odds. These stories are too significant to take literally, but once we see them metaphorically, as archetypes for our own lives, then we can truly appreciate their importance. Every heroine or hero in the great myths represents us, each of us in our struggles. There is story after story of prophets and seers, heroes and heroines, all facing the fear that they are not enough, that they do not have the strength, resources, or abilities to carry the message or accomplish the task.
“Dust in the Wind” was only the first of the songs that really sang to me that morning. The other was Melissa Etheridge's “I need to wake up” written for Al Gore's An Inconvenient Truth. The song speaks to the individual awakening to the problems that need work, now. I find the song a powerful and inspiring call to action against an enormous challenge---one that will require us to remake our culture in an effort to avoid remaking the global climate. And even though the song was written specifically for the movie and the threat posed by greenhouse gases, it also simply speaks to an awakening of one's consciousness to the need for action on any front—hunger, justice, equal rights.
The two songs feel so at odds with each other. One reminds me how small I am, a mere mote of dust on a tiny ball floating through an enormous galaxy in an even-larger universe. My years are limited and even I, at 39, may well not have as many years ahead as are behind. While the other seems to cast that off or at least reframe it, to remind us that we not only should act, but must act when we see problems that need our help no matter how small that aid may be.
Some religious traditions might actual confirm me in my fears---I am too small to help, I am too warped by original sin to even know what The Good is, I am powerless in the face of evil. I reject that absolutely.
I have wandered through several spiritual paths as have many of us here. But whether I identified as a Jew, a Christian, or a Unitarian Universalist Buddhist as I am now, there is one belief that has always been a part of my spirituality: what good happens on this earth happens by the hands such as these. Whatever role God or Spirit may play, we can never wait for a transcendental rescue. God may inspire, Spirit may guide, but we must act.
I don't care what you do. I don't care if you are republican or democrat or neither, liberal or conservative or beyond labels. I don't care what you get fired up about: climate change, poverty, illiteracy, gay rights, animal rights, abortion, choice, xeriscaping, supporting the troops, protesting the war, any war, all war, freedom of religion or freedom from religion. All I care is that you care enough to move, to get up, to stand up, to speak out, to find an injustice that causes you pain enough to change your own life. Unitarian Universalists have been called free-thinking mystics with hands—the first part is wonderful, it's great to be free-thinking, great to be mystically inclined, but its all crap without being a presence in the world. Most of our beloved forebears, those we claim with such pride were not thinkers or not merely thinkers. They acted in the world. Even Thoreau, a fairly thoughtful fellow, went to the woods—he just didn't sit in his living room in Concord. Some may say that he didn't go far. Walden Pond is indeed a short distance from town, but that's the point not the problem. You don't have to go far to change yourself or the world around you. It is by small, almost unnoticeable movements that some of the most worthwhile changes happen. Inflate your tires, use fluorescents, plant a garden, email a city council person, skip coffee for one week and give that money to the food bank. One doesn't, as the old saying goes, eat an elephant all at once. You do it one bite at a time.
I doubt anyone came here this morning to secure a place in heaven. I don't think most of you come back to this church week after week, year after year, because you are afraid of hell. I don't believe that you are worried about salvation. But you should be. You should worry about how you will be saved. Not by anything you were told in any church, temple, mosque you've been in before. Not by God, Jesus, Krishna, Shiva, or any of a thousand other divinities. Other faiths will condemn you for your thoughts and feelings, but I say to you it is not in our thoughts and feelings that we are damned no matter if they are the thoughts of a Gandhi or a Hitler, what matters is action. Has anyone in this room never wished harm upon someone else?—I certainly have—everything from a speeding ticket to death. It is not good to hate, but action is what turns emotion into evil. I feel sorry for you if your heart and mind burn with hatred of Jews, Gays, Blacks, Whites, Women, Children, Christians, Muslims, Unitarians, anyone. If that malice is what fills you, I feel sorry for you, but I fear you if you act. That man in Tennessee could have hated liberals like me from today to eternity, but had he not acted, he could have lived his life that way—only wasting his own life and not that of our fellow believers. I know this simplifies the relationship between action and thought. How we think colors all of our actions and who we are at a deep level, our inmost thoughts and feelings, speak in every choice and movement we make. My point however is that no matter our worst or, perhaps more importantly, despite our best intentions, what actually matters is acting on those convictions. It is horrible to see someone starving, but until you transform the inward to the outward, all you offer is pity not help.
But we were talking about salvation. I don't believe that salvation is a simple matter of belief, not that belief is all that simple. I've certainly never mastered it. I think salvation is a matter of action. I say again, you should be worried about the state of your soul, you should be worried about your salvation, but I can offer you no salvation... apart from this—that as you act in the outer world so will you change your inner world. I do not believe that you can give and not receive, offer love and not be loved, change and not be changed, save a life and not be saved. I do not know for sure what kind of eternal reward there may be, if any, but some part of me says that if t here is someone or something that sits in judgment I feel certain that I better have more than a lifetime of good intentions. But again we come back to good humanism and, indeed, good traditional Unitarianism. One of the tensions between the Unitarians and the Universalists was the concern that the Universalist focus on transcendental salvation might take the focus off the Unitarian goal of transforming and perfecting this world, right here right now. But both traditions I believe could share in a sense of the word salvation that has roots that go back to sense of health, and that's what I'm talking about here. Salvation not as a theological proposition but as a measure of the health of our spirits. Action aimed at improving the world is aerobic exercise for the part of us that isn't physical.
It is because we are small that we must act simply because no one is any bigger. Never let the size of our contribution keep us from making it. And isn't that what faith is. The belief that the acorn can grow into the oak, that the trickle of water will cut the grand canyon, that small acts of conscious compassion can feed the hungry, mend the broken, and heal our planet.
Of course action can be subtle. We often act without knowing the effect. Anyone who has ever taught anything has likely had an impact that will never fully be known. Here again we see the deeper more complex relationship between thought, attitude and action. Embrace your highest ideals deeply and fully, wonderful ideals like our principles, and you will touch lives in ways you will never know.
I want to return to the dying patient I mentioned at the beginning. She was so concerned about not finishing the quilt she'd been working on for years. I wasn't quite sure what to say to that and so I did what any good chaplain would do, I kept my mouth shut and just held her hand. Eventually broke the silence and said she never felt she had known what her purpose here on earth was and wasn't sure she had ever made a difference. But then a young student nurse came in. Her shift was over and she would be moving on to a different unit the next day and so would not see the patient again. Sarah took the young nurse's hand and thanked her for the wonderful care and for sitting with her when she had been scared. The nurse and the patient teared up and just held hands for a while, looking into each other's eyes. It was clear that these two human beings had formed a profound bond. I watched the student nurse's face as she said good-bye clearly knowing that she was saying goodbye forever.
When Sarah and I were alone, I suggested that maybe she had just accomplished a part of her purpose. I told her that I could see how profoundly touched that young nurse was and I could tell she would remember Sarah for the rest of her career. Through who she was, even through her disease and death, she had touched this young woman's life forever and inspired her to a life of service and helping others. Then we spoke about how maybe none of us ever “finishes our quilt.” Maybe the quilts of our lives are only finished by those we love and touch and help and heal. Maybe this is the balance and the mystery. We must act despite or even because of how small our lives are, we must know that we will never know all the ways we touch others, we must trust that those connected to us by invisible threads of love are the ones who in turn help us complete our lives, placing them in a deeper wider context that the threescore and twenty years we have, and we must have faith that although little makes sense or perhaps even seems to change from the limited perspective we have, that we are all a part of a greater movement, that we all all contribute to the on-going story of humanity, the each of us is an essential thread in finishing the quilt.
This is one of the great aims of religion. Religion helps us embed ourselves in a quilt of meaning that has threads that runs from the far past, bold threads of figures that are models, archetypes for our own journeys. The old traditional stories often don't work for us, it's one of the reasons many of us found our way to Unitarian Universalism. And yet, when we turn back to those myths, those of Arjuna and Krishna, Moses and Jesus, Coyote and Crow, when we turn back and take them seriously enough not to take them literally they can unlock worlds of meaning, reveal the finely interwoven threads of our lives, and help us to wrap ourselves in a quilt lovingly constructed—not a quilt that hides us from reality, but one that helps us stride forward in brave ways knowing we are connected and have a role to play no matter how brief the scene.
Amen, Namaste, and Blessed be.

Sunday, April 13, 2008

This Wednesday, April 16th, is National Healthcare Decisions day. I'll be leading a workshop at my church to discuss Advance Directives and having conversations with family and friends about our wishes in the event of life-limiting illness or injury. It is also a time to open up conversation with loved ones who may be facing these issues. Almost all of us will, at some point, need to make or help make these decisions for someone we care about.

Here are ten points about end-of-life decision making. At the bottom of this post are some links to other resources. Email me if you have any questions.

blessings,

Nathan

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Ten Points about End-of-Life and Advance Directives

1.Think about what quality of life means to you.
Is it enough to be biologically alive even if machines are needed? If you needed machines to exist, would you want that long-term?
Do you have to be awake for life to be worth living? How awake?
How aware do you need to be to consider it worth continuing? Does your mind need to be fully intact?
Are there certain activities that define an acceptable quality of life for you? For example, “If I can't talk [or eat, or play golf, or listen to music, or go the bathroom by myself] then I may not want to prolong life any further.” Think about whether there's something without which life would not be worth living.
Everyone's answers are different—there is no right or wrong here. For some, not being able to interact with family might be a threshold. For others not being able to perform basic activities of daily living might cause them to make particular choices regarding health care. These are hard questions to answer because as illness or age take things away from us, we often find life still holds enough to keep us wanting to be here. It's important to understand that, in general, we're talking more about acute and clearly life-limiting illness or injury, not chronic, slow progressive processes—though age also is a factor. Decisions you would make at 62 are different than ones you might make at 92. Finances can also play a role here. Many people express concern about being a financial burden to family. Setting can be a part of the decision-making mix. Some do not want, under any circumstances, to live in a nursing home. There is no way to answer all the questions ahead of time, but we can give some thought to the broad categories of possibility in an effort to be more prepared.

2.Have The Conversation with family and friends.
Talk about what you think and want in the event of catastrophic illness or injury. Few statements are more powerful than a family member or friend saying to hospital staff, “We spoke about this last Thanksgiving. Jane said she would never want to be kept alive like Terri Schiavo.” Be assured that any discomfort felt now will be more than offset by the peace of mind you've helped provide to family and friends when the time comes for these incredibly hard decisions.

3.Have Advance Directives in place.
Encourage other family members—adults of any age—to have these documents in order. Ask older relatives what they want. Give copies of your Directives to family, close friends, and your physician. Revisit your Advance Directives and Financial Will once every decade of life.

4.Have realistic expectations for medical treatment.
CPR survival rates on TV can be as high as 85%, while real life is less than 15% overall and less than 2% for the elderly and/or those with more than one significant medical problem. Those who survive are often worse than they were before and may have brain damage.
Medical technology is such that we can keep bodies alive even when the disease process cannot be stopped and death is inevitable. We often need to make choices about how prolonged the dying process is. Again there are no clear answers. One might, for example, choose to keep someone on life-support until a family member can arrive to say good-bye.

5.Understand that doctors are, for the most part, trained to save lives at any cost. The family often needs to look to themselves for guidance at end-of-life. Doctors will often present all that can be done, but they are not always good at clarifying what should be done. It is reasonable to ask direct questions like, “How likely is this treatment to prolong life with good quality?” Medicine during critical illness is increasingly the role of specialists who sometimes focus on one body system. Ask for the big picture: How is the patient as a whole doing?


6.Artificial ventilation and artificial hydration and nutrition is transitional help for ill people, but often is not appropriate at end-of-life. The natural cycle of death usually includes a decreased need and desire for hydration and nutrition. Providing these items via IV or other non-natural routes at end-of-life can often increase discomfort. If someone wants to eat or drink, they should, if at all possible, be given food and drink. However, for the unconscious person who is in the process of dying, giving these substances by artificial means often creates more suffering. As the body shuts down, it has little need for this material and forcing it in may short-circuit the body's natural way of making us comfortable as we die.

7.All medical treatment has a goal. If the goal isn't being achieved, the treatment can be stopped. The quality-of-life questions discussed in #1 above can help you identify what your goal is, for yourself or for a family member.

8.You, not the doctors, are in control of your health care.


9.In general, there is no reason for a patient to be in pain, anxious, or uncomfortable at end-of-life. As our goal moves from cure to comfort, more options may open up in terms of palliative (symptom management) medicine.

10.Live your life.


-----------------

Here are some links to resources:

http://www.pikespeakforum.org/resources.htm

http://www.caringinfo.org/

http://www.nationalhealthcaredecisionsday.org/

http://www.caregiver.org/caregiver/jsp/content_node.jsp?nodeid=401

Sunday, April 6, 2008

Where the Wild Things Are

Where the Wild Things are

Intro

Well, I was gonna talk on spirituality and mysticism and that stuff, but then I thought, “y'know they liked the last two sermons about death and dying and pain and suffering. Might as well stick with what works.” Well, maybe not. Today I'm going to leave behind the mundane, but important, matters of planning for the death we want and get to the far more complicated issue of planning for the spiritual life we want.

City and Forest

In any religion there exists a tension between what I'm going to call the City and the Forest. You see on one side we have the tradition holders, those individuals who ensure the continuity and structure of the faith. On the other side we have those who push the boundaries and rattle the hierarchy. The City side creates ritual and hierarchy, establishes the law, and formalizes the original story that inspired them and those who came before. They put that story into a cleaner format, make it more understandable, appealing, and more streamlined. The Forest folk tap into the power of wilderness or wildness. These are the mystics---who push those boundaries, often break the laws, create new stories, embrace the messy and rough edges of their faith. Both elements are needed. A religion that is all mysticism and no structure—in my metaphor all forest and no city--- will almost always fade away as the first generation of enthusiastic practitioners fail to find ways of passing on their passion. And of course a faith with all structure and nothing left of the wild is flat, inert, and stuck forever in convoluted justifications for self-serving hierarchical power.
We need to have a balance, just like in the physical world. A place to live that is all “city” with no trace of the wild “forest” would be a sterile environment—all hard angles and rigid structures. All city and no forest is inherently, indeed intuitively, unhealthy. We know we need a connection to the untamed aspects of the earth if we are to remain sane. Thoreau once said, “in Wildness is the preservation of the World. Every tree sends its fibers forth in search of the Wild. The cities import it at any price. Men plow and sail for it. From the forest and wilderness come the tonics and barks which brace mankind.”
Contrariwise, living in a place that was all wilderness and no city wouldn't be a picnic either. You would have to constantly struggle for existence. Even the most rudimentary structures—a tent or tepee, would sort of be part of the “city” and need to go away as soon as it was built. Almost all that we depend on to live is the product of organized labor even if it is only our own. We are structured and quite social animals You can start to see that humans never live in a pure state of wildness, we need structure. Even if it is the barest trace, we need a little bit of “city-ness” around us to orient ourselves and allow us to function in the world.
As with a lot of spiritual metaphors we can see them at work in many places and on different levels. The balance between these two forces reflect physical and spiritual truths that apply to all of us.
This morning, I mainly want to focus on the forest side of the equation, the place the mystics and shamans go to find new wisdom, where the young hero or heroine goes to face the monsters and find the treasure. The city is, in many ways, has more obvious ways of taking care of it. Human beings tend toward organization, though you would never guess that by looking at my desk. That said, we uphold our tradition, our city obligations if you will, by being here Sunday mornings, volunteering on committees, giving money, reading UU World magazine, and by supporting parish ministers like Matthew and maintaining connection to community ministers like myself—by doing these things and more you participate in the structures of Unitarian Universalism. By having a wonderful RE program we nurture the next generation, telling them our story and helping them make it their own. By buying this building and tending to it we have contributed to Unitarian Universalism having a lasting home here in this place.
That said, the mystics and the wilderness tend to be what fires our imagination and seem to call to us, especially to us, who have frequently left the more structured faiths of our past seeking a more direct connection with others, with ourselves, and with the Sacred however we conceive it. The mystics ensure the vitality of the tradition over time by going out beyond the known border—and I don't simply mean north of Woodmen. By going into the wilderness and bringing back new truths, having new experiences and interactions with the dangerous, uncontrolled divine we feed ourselves and our community. Between the stones in the foundation we stand upon there are spaces, gaps if you will, that open up into the unknown and unexpected.

Gaps

I've always been interested in the “gaps.” Perhaps what I love best about Unitarian Universalism as we practice it today is the unprecedented, exhilarating freedom we enjoy to reach out to wisdom wherever we can find it. You have few limits as to what traditions and practices you can draw on as you form your own spiritual life. There are two main limits. The first is that whatever practice or philosophy you adopt should feed the good and be based in love and reason and stand the scrutiny of your fellow travelers. The second limit is far more challenging for most of us—it is the limit we place upon ourselves as we hold ourselves back.
I adore writer Annie Dillard and her book Pilgrim at Tinker Creek is one that I go back to over and over—and she addresses this issue. She refers to these “gaps” and quotes the brilliant, insightful Trappist monk Thomas Merton when he says:
There is always an enormous temptation in all of life to diddle around making itsy-bitsy friends and meals and journeys for itsy-bitsy years on end. It is so self-conscious, so apparently moral, simply to step aside from the gaps where the creeks and winds pour down, saying, I never merited this grace, quite rightly, and then to sulk along the rest of your days on the edge of rage. I won't have it. The world is wilder than that in all directions, more dangerous and bitter, more extravagant and bright. We are making hay when we should be making whoopee; we are raising tomatoes when we should be raising Cain or Lazarus.
And then Annie continues in her own wonderful voice...
Ezekiel excoriates false prophets as those who have "not gone up into the gaps." The gaps are the thing. The gaps are the spirit's one home, the altitudes and latitudes so dazzlingly spare and clean that the spirit can discover itself for the first time like a once-blind man unbound. The gaps are the clefts in the rock where you cower to see the back parts of God; they are the fissures between mountains and cells the wind lances through, the icy narrowing fiords splitting the cliffs of mystery. Go up into the gaps. If you can find them; they shift and vanish too. Stalk the gaps. Squeak into a gap in the soil, turn, and unlock -- more than a maple -- a universe. This is how you spend the afternoon, and tomorrow morning, and tomorrow afternoon. Spend the afternoon. You can't take it with you.

These are the dark places, our normal senses weaken in the presence of these mysteries and we are forced to rely on other ways of knowing. In the gaps we must learn to see with other eyes and hear with other ears. We must turn inward.

Three Practices

I want to invite everyone here, and I include myself, to begin to explore the wild within through three practices: love, simplicity, and challenge.

Love

First, let us begin with love. Our relationships with those closest to us are potential sources of profound wildness simply because of the complexity involved being in deep relationship. In our life partners and closest friends we see reflections of our needs, fears, strengths, and wisdom. For our deepest relationships to be part of our spiritual practice however requires a deep honesty, courage, and openness to the other. The poet Rilke said it well when he wrote:
It is ... good to love: because love is difficult. For one human being to love another human being: that is perhaps the most difficult task that has been entrusted to us, the ultimate task, the final test and proof, the work for which all other work is merely preparation. ... it is a high inducement for the individual to ripen, to become something in himself, to become world, to become world in himself for the sake of another person; it is a great, demanding claim on him, something that chooses him and calls him to vast distances.
Or as author John Wellwood put it, “intimate relationships are ideally suited as a [spiritual] path because they inspire our hearts to open while at the same time activating all the pain and confusion of our karmic entanglements.” Being committed in relationship implies work over time. It takes work and awareness to be intimate and engaged with another. And yet the potential rewards and growth are so great, precisely because the stakes are so high. Nothing I have tried, be it mountaineering or 12 hours of Zen meditation day after day in a Japanese temple is as challenging as trying to be in a conscious relationship with someone as wonderful, complex as my wife. And if she would simply always be how I expect her to be, life would be easier. Conscious relationship is certainly not something I always succeed at. We bring each other in touch with the deepest challenges of our past, present, and future as we struggle together through good times and bad. One of the greatest challenges in deep relationship with a spouse or close friend is to work at seeing them as they are, and not as projections of our own needs and desires. To see them as themselves takes clarity, courage and patience and is a spiritual practice that has been noted and encouraged on across the world's religions.

Simplicity

The second practice is that of simplicity. Simplicity contains gifts for us as we try to connect with what is most important to us. It is no surprise to anyone here that we live in a society that has raised acquisition to the level of high art. And I don't use the comparison lightly. I think about the amount of talent and energy put into advertising, an art form that intends to move us, not toward self-reflection or inspiration or to appreciation but has the purpose of seducing us into purchasing items or services for which we usually have little need or space.
Some of you may have heard of the new holiday named Discardia. A woman named Dinah Sanders pondering consumerism and the amount of junk that had acquired in her life decided that the world needed a holiday that is not associated with conspicuous consumption and indeed is aimed at the exact opposite. Julia and I celebrated it for the first time this year though we are trying to be more careful consumers throughout the year. Still there was something pleasantly festive about going through closets, bookshelves, and boxes looking for stuff to give away or throw out.
It might seem unusual to include discarding material goods when talking about bringing the wildness of mysticism into our lives, but to me it is very much of a piece. Our friend Thoreau's experiment next to Walden Pond was largely one of leaving behind the “city” and some of what he learned at Walden was the art and value of simplicity. There tends to be an inverse relationship between the amount of stuff we surround ourselves with and our ability to engage our lives in an actively spiritual manner. When we streamline our lives we create more space literally and figuratively. Being in a simple environment allows our thoughts and feelings to expand in a way that is more complicated when we are awash in a sea of things.

Challenge

The last practice I want to speak about is challenge. Here I am thinking of the benefits of engaging in some activity that requires practice, allows the practitioner to lose herself or himself in the practice and is a goal in and of itself. Martial artists know this state of mind as mu-shin, no-mind, sociologists call it “Flow.” It comes when you have enough skill in your chosen art to escape self-consciousness and ascend into a form of profound self-awareness even as you lose yourself. I have heard musicians speak of this, and artists, and hunters, and puzzle-solvers and writers and runners and knitters and and and. All you need is a practice you enjoy in and of itself and enough patience to hone your skill into the practice of freedom. For it is in that strange place where we lose and find ourselves automatically that we discover the wild and touch the mystic. You don't have to be a Tiger Woods or Bruce Lee or Pablo Picasso—you just have to let go of the rigid conscious city mind and lose yourself in your own forest.
These practices can be profound and to be found in the world's great spiritual paths. And while they have tremendous potential, they don't have to be tremendously difficult. Start small. Love the ones you love a little more openly, let go of something you don't need to make space for the space you do need, and find a way to lose yourself a little on the way to finding yourself. Don't say inside your head or heart that these are too difficult or abstract or whatever. Practices such as these and many others are just some of the ways that you ensure a life filled with life and inject vitality into this community. These practices encourage us to let go of the great impediment, that which keeps us from growing and loving---the shadow that hold us back from being who we dearly want to be—fear. Fear is the root of all evil, money has gotten a bad rap. The quest for money only points to the fear of lack. Fear keeps us from loving as strongly as we might, fear keeps us from letting go of the accumulated detritus of the years, and fear keeps us from letting go of our small selves long enough to touch the greater self within us.

Daemon & Conclusion

As I wrote this sermon, read in different books, what started coming up again and again was the concept of the Daemon—the inner guide and wisdom that we all possess but often get disconnected from. If you are visiting this morning, I ask that you not confuse the term I am using that comes from the Greek and means “filled with wisdom” with the more common word demon meaning an evil spirit. The words sound alike but diverged centuries ago to mean very different things. God help us all if you go away this morning thinking, “Those crazy Unitarians told me to find my inner demon.” No, what I'm talking about is closer to the “still, small voice” the prophet Elijah heard, it is the voice of the “better angels of our nature,” it is the voice of our deepest and often unconscious wisdom. It is a voice that leads us to the knowledge of the Good and it is a voice we need to learn to hear because when we are out of tune with our Daemon we tend to be less happy, more lost, feel more empty and try to fill that space in the wrong way. When we start to integrate the wisdom of the Unconscious, the Daemon, we tap into the deep centered wisdom we have that helps us fill the spaces inside with love, challenge, simplicity and the rest. The framework of religion, any religion, can set you up for this connection but can't make it for you. For that you need spirituality, you need to seek out those experiences and ways of being that will honor what you know in your soul, your Buddha-nature, you inner Taoist Sage, the god that lies inside you. Part of our faith as Unitarian Universalists is that we do not believe there is one right way, each of us finds our own path, faces our own monsters, finds our own rewards. We come together to compare notes along the way, to share in the victories and the setbacks. But ultimately it is up to each of us to find ways of quieting the noise of the city sufficiently, we have to find ways of leaving it far enough behind to hear the small still voice within that calls to us, loves us, and guides us on the path.
Amen, Blessed be, Namaste

The readings for the day:
From Annie Dillard's Pilgrim at Tinker Creek
Thomas Merton wrote, "There is always a temptation to diddle around in the contemplative life, making itsy-bitsy statues." There is always an enormous temptation in all of life to diddle around making itsy-bitsy friends and meals and journeys for itsy-bitsy years on end. It is so self-conscious , so apparently moral, simply to step aside from the gaps where the creeks and winds pour down, saying, I never merited this grace, quite rightly, and then to sulk along the rest of your days on the edge of rage. I won't have it. The world is wilder than that in all directions, more dangerous and bitter, more extravagant and bright. We are making hay when we should be making whoopee; we are raising tomatoes when we should be raising Cain or Lazarus.
Ezekiel excoriates false prophets as those who have "not gone up into the gaps." The gaps are the thing. The gaps are the spirit's one home, the altitudes and latitudes so dazzlingly spare and clean that the spirit can discover itself for the first time like a once-blind man unbound. The gaps are the clefts in the rock where you cower to see the back parts of God; they are the fissures between mountains and cells the wind lances through, the icy narrowing fiords splitting the cliffs of mystery. Go up into the gaps. If you can find them; they shift and vanish too. Stalk the gaps. Squeak into a gap in the soil, turn, and unlock -- more than a maple -- a universe. This is how you spend the afternoon, and tomorrow morning, and tomorrow afternoon. Spend the afternoon. You can't take it with you.
The Summer Day Mary Oliver
Who made the world?
Who made the swan, and the black bear?
Who made the grasshopper?
This grasshopper, I mean-
the one who has flung herself out of the grass,
the one who is eating sugar out of my hand,
who is moving her jaws back and forth instead of up and down-
who is gazing around with her enormous and complicated eyes.
Now she lifts her pale forearms and thoroughly washes her face.
Now she snaps her wings open, and floats away.
I don't know exactly what a prayer is.
I do know how to pay attention, how to fall down
into the grass, how to kneel down in the grass,
how to be idle and blessed, how to stroll through the fields,
which is what I have been doing all day.
Tell me, what else should I have done?
Doesn't everything die at last, and too soon?
Tell me, what is it you plan to do
with your one wild and precious life?

Sunday, January 27, 2008

Im going to live forever: So far, so good--thoughts on life and end-of-life

After the service a number of people came up to me with stories of their own , opinions they wanted to share. One thing I may not have emphasized enough was that the true heart of my message is choice. If you want everything done--placed on a ventilator, all the drugs available--at end-of-life, that is your choice. If you want to die at home without all of that--that is your choice. If a nursing home or hospital or hospice is the appropriate for you or your family, that too is a choice. Most of all, I want people to think about what they want and make conscious decisions and not have their loved ones struggling when you are no longer able to voice your opinions. If you have questions about Advance Directives or end-of-life concerns, please do get in touch. Thanks and blessings. -N

Jerry Seinfeld once noted that, “according to most studies, people's number one fear is public speaking. Number two is death. Death is number two. Does that sound right? This means to the average person, if you go to a funeral, you're better off in the casket than doing the eulogy.”
I've gotten over whatever fear of public speaking I used to have and, having read a number of eulogies at this point, I feel pretty clear about preferring to think outside the box, so to speak. As a hospital chaplain however, I spend a lot of time with death or, to be more accurate, with people at the end of life.
End-of-life issues are not all that popular—not easy cocktail party or family dinner conversation, well not unless you hang out with chaplains, ICU nurses, or hospice workers. People tend to be naturally uncomfortable with death. I doubt it's ever been much different. Since the first proto-humans buried their dead with jewelry and tools--a tradition that goes back to at least 60,000 BCE, we have sought to calm our fears about death. Whether you believe in a traditional afterlife, reincarnation, or simple extinction, the fact still remains, the person that you are, that I am, will cease to be in a way that is immediately meaningful for those who survive. The topic of death can be difficult and frightening, and yet, as we know, it is the destination to which we are all walking.
I think there remains within us a sort of superstitious attitude—if I talk about death I somehow invite it in. I grew up with a deeply superstitious mother so, despite my agnostic stance on most everything and a firm commitment to rational discourse, I can appreciate the primordial fear that by naming something we somehow also invoke it. Not unlike speaking of “he who must not be named” in the Harry Potter series, but just as Harry learned, to understand something, to name something, is to reduce its power to induce fear in us.
Shakespeare famously wrote “All the world's a stage, And all the men and women merely players: They have their exits and their entrances” This morning I want us to give some thought and perhaps even some planning to our parting number.
Before I started at Memorial Hospital one of my chaplain internships was at a local hospice. I was glad for the experience, but I thought I was leaving the constant association with death mostly behind when I went to work at the hospital—not so much. Just out of curiosity I kept track for several weeks in December, I was involved with 15 deaths in as many days at work. Now, I feel quite certain this isn't a reflection of the quality of care at Memorial, but rather a fact that I spend most of my day in the Intensive Care Unit and with the patients and families in the worst situations. Sometimes I feel like a mid-wife for the other end of the journey.
We've become so distant from death in this country. A short 100 years ago, the average life expectancy in Colorado was roughly 40 years old—by the time you were 15 you had been to any number of funerals. You had probably stayed up all night with the body in the parlor as was the custom. Not so long ago, we mostly died at home, cared for by our families. Funerals were family experiences and indeed you didn't attend a funeral without an invitation. The process of death was familiar—we were more likely to live near, if not with, aging relatives. We would see them, as their time grew near, turn away from the trappings of this existence. When people get close to death their appetites diminish, they may drift in and out of awareness, but often still have enough clarity to have a chance to say what needs to be said. Children saw death, learned the natural way a body shuts down, and accepted that it was part of life, inevitable.
Today the situation is quite different. Death has become a stranger and a process handled by people we hire. Death, like war and other dramatic events, is something we mostly experience through television and movies. Somewhere around 80% of Americans say we want to die at home, but most of us, almost 80% in fact, die in hospitals or nursing homes. Families are often ill-prepared for the reality. I think most people aren't aware of how far medical technology has come in terms of keeping bodies alive. These technologies are in many cases less than 30 years old. Our grandparents never had to decide if our great-grandparents wanted to be on a ventilator for a month or if they wanted a feeding tube placed in their abdomen. Hospice has been an option in this country only since 1974. The questions we face today as individuals and as a society have changed dramatically.
I'm not going to talk much about the details of Advance Directives, the legal documents that allow us to specify what we want in terms of treatment at end-of-life and who will make decisions for us if we are not able. I'm happy to answer questions during coffee hour if folks want specifics or if there is interest we can set up a workshop for a later date. There is also much more to be said about the actual process of dying, but that too can be discussed in detail elsewhere. There will be a links at my blog to websites that more information including free downloadable forms—you don't need an attorney to draw these documents up for you.
A study done in 2005 showed that roughly 25% of Americans have a Living Will, but of those, less than 16% are actually in the medical chart when the time comes. That means that around 4% of patients have the document where it needs to be.i More problematically a survey of physicians showed that 65% of them would ignore a Living Will if the decisions in it conflicted with the doctor's own beliefs. While Living Wills are important documents they are in some ways quite limited documents. A person intimately familiar with your wishes and empowered by Medical Power of Attorney is far more effective in ensuring that your choices and values are upheld rather than a physician who has never met you before or a random relative.
Yes, random relative—that is not simply artful language. It might surprise you to know that Colorado law doesn't specify a particular order of precedence in terms of who makes medical decisions when there is family conflict—indeed it isn't even limited to family members. So if your estranged sister from Kalamazoo shows up at the eleventh hour to dispute your spouse's choice, your family could well wind up in court. Some states have gone as far as creating “black sheep” clauses where you can specify an individual you specifically don't want having a say in the process. But to have the documents in place is only one step in the process—you also have to know what it is you actually want.
Most people don't want to live hooked up to machines for any significant duration, unable to interact with family and friends--and yet it happens more and more. In fact roughly one in five Americans die in an ICU and of them somewhere between 70-90% people who die in modern ICU die because the decision is made to withdraw care or limit care. That an amazing number to me, and one that I think will continue to rise---up to 90% of people who die in an ICU die because someone makes the decision to let them die. So what is the obstacle between the death we want and the one we so often get—lack of communication with our loved ones is usually the detour that sets us on a path most of us don't want.
No conversation of end-of-life choices can be complete without mentioning hospice. Hospice is not necessarily a place, though it often is, it is more a system and philosophy of end-of-life care. I think hospice is fantastic and I've had several relatives die in hospice care and I fully intend to be there myself someday. One aspect of hospice that I love is the tendency to care for the family as the patient, not just the person in the bed. Unfortunately, most families don't access hospice care until fairly late in the process. Physicians are often reluctant to suggest hospice—they all too often see it as a failure or fear their patients will feel abandoned. Some people see hospice as giving up. Some fear losing the time that might be gained by aggressive treatments, but a study just done in March of last year found that patients in hospice lived an average of 29 days longer than their hospitalized peersii—and I can pretty much guarantee that they had better pain and symptom management and that their families had better bereavement support after the death.
The discussion isn't just about the comfort and dignity with which we die, it's also becomes a dollars and cents issue and aggressive treatment in an ICU is very expensive. Now I'm Generation X, but a bunch of you out there are Baby Boomers—let me see a show of hands. Well, y'all are getting old at an astonishing rate and the number of American over 85 will quadruple between now and 2050. Currently roughly 22% of our lifetime medical costs happen in the last year of life—and that is likely to increase. With fewer and fewer of us dying of what used to kill us, more and more of us die of old age, and increasingly after a period of chronic illness and decline.
One of the reasons for the increase in costs is the increase in technology available to prolong life, or as is often unfortunately more accurate, prolong death. Now I can imagine some looking up here and thinking, “easy for you to say, you're pretty young, in good health, handsome.” And you'd be right, but it's not just about you. When this happens to you, me, anybody—it isn't usually the individual that bears the burden. It's usually a spouse or adult child who has to navigate these difficult waters. I am not, of course, saying that we shouldn't use the wonderful interventions modern medicine can offer, but we need to learn how to really press our healthcare providers about the likelihood that treatment will provide the quality of life we want. Prolonging life should always be our hope, but we should also be aware when we cannot prolong life, we should be careful not to prolong death.
These discussions are hard, but the circumstances that bring them on are not any easier. I've spoken about various gifts that I've learned I can offer to my patients and the people in my life. I hope they are gifts we can all learn to share with each other in this community—of being present to each other, of not being afraid to ask the questions that frighten us, and of acceptance even in the absence of understanding. Another gift we can offer our friends and families is the gift of helping them understand what we value about life and what are the terms on which we wish to stay or to go.
These conversations need to happen in our families, our congregation, our cities and our country. Some places are getting a start. Oregon has the only physician-assisted suicide law in the country. Right or wrong, the political battles and legal challenges about the law led to an unprecedented amount of discussion about end-of-life decisions in Oregon. It was a topic of conversation everywhere and aside from the law being in place, more Oregonians are dying on their own terms—at home, often with hospice care, with friends and family, comfortable.
The proper care of those who are dying is a topic that is well placed within our spiritual communities and also is, in many ways, a social justice issue. If you have any doubts about this then think back to the debacle surrounding Terry Schiavo’s death and the unwarranted intrusion of the state and federal governments into that process—a story that wouldn’t have been a story I might add had Terry had a Living Will and Medical Power of Attorney. Many of us here are advocates for reproductive freedom and choice. We embrace the belief that among the highest of goods is the right of the individual to self-determination. And yet to the matter of how we die, many of us give little thought and sometimes even less voice.
But I can't simply stand here and speak to you about death. To speak only of death is to speak to only one side of the coin. We must talk about life whenever we we talk about death because there is, of course, no separation. How we live is, quite often in my experience, indicative of how we die.
Rarely do Unitarians quote the New Testament, but I am thinking right now of John chapter 10 verse 10—when Jesus says “The thief cometh not, but for to steal, and to kill, and to destroy: I am come that they might have life, and that they might have it more abundantly.” If I were only to speak on death, I would be the thief; instead I want to preach to you the Gospel. Now, don't get nervous. This isn't the gospel being preached across the city this morning. This is the good news of our Unitarian Universalist faith. The gospel as written by Jefferson, Emerson, Thoreau, and the other prophets we call our own. The gospel I'm speaking of is what we find together every Sunday, the truth we create together, the freely chosen path that is so central to our enterprise here. We are a very here and now kind of faith. We believe in the value of this world, the protection of its people and the planet itself. We are not a faith much focused on the world to come, we don't look to paradise that we may be rewarded with later, we choose to build the world we want, again here and now. One way we do that is by affirming our first principle—in which we celebrate and vow to protect the inherent worth and dignity of all people. I want however to start with ourselves. I want us to do what is often far more difficult that caring for the other, I want us to care for ourselves. Affirm our own worth and dignity and one way we do this is to live as we choose, follow the spiritual path we chose, love whom we choose, and, hopefully ultimately, die as we choose.
I want you all to write a living will, not only the legal document put down on paper, but I want you to write a living will in your hearts. I want you to have a LIVING WILL, an affirmation of the values, a set of choices so that to paraphrase our beloved Thoreau, “when it comes to die” you find that you have truly lived as you wish to have.
One of the great lessons of Zen, and Buddhism in general, is in encouraging us to find a sense of urgency, an awareness of the fleeting time that is ours. The last words of the Buddha were “This I tell you: decay is inherent in all conditioned things. Work out your own salvation, with diligence.” Many of us have had brushes with disaster and, for better or worse, the air is changed, the sunrise more brilliant, the world sharpens and comes into a different focus. Buddhism and especially Zen with its practice of constant mindfulness strives to move us into that place more fully every day.
It is one of the blessings of my work: every day I walk with people experiencing tragedy and loss and it frequently makes me aware of the fragility of the world I've constructed and profoundly grateful even in that terrifying fragility. I would like to share with you this sensation, this poignancy, this bittersweetness—share it with you in sufficient quantity that you talk with your spouses, children, friends, and even your ministers. You may think that everyone already knows what you want, and you may be right, but I want you to consider the gift you give to those who in the future may need to make a terrible choice. These decisions are rarely clear—there is often some chance of recovery, some glimmer of hope and physicians are not inclined in my experience to present families with black and whites. Think forward to this time and to your loved ones gathered round a table. Think of the peace they might be able to have as they remember a series of conversations in which you said what you want. More than any document, those conversations are what help ease the mind and hearts of those you love. And I can assure you that these choices are only going to become more complicated as technology advances.
Please be clear that I am not speaking of euthanasia, indeed I feel I am speaking, in some sense, to its opposite. What I am advocating is a fully conscious engagement of the issue so that you and your loved ones can make choices that are in concert with your highest values.
I want you to think about your death, certainly to prepare for it in a way that eases both your and your loved one's pain, but more importantly, we should consider death for the reason people have contemplated death as a spiritual practice throughout history. People think about death to help them define their lives and the time they have. People ask me if it is hard to be around tragedy and death so much. It can be draining and sad, but as I said, it also makes me aware of what a blessing life is, what a blessing love is, and quite often, what a blessing death is.
Now is the time to choose not only your life, but also your death, to write your own eulogy—not the few words spoken to your coffin but the eulogy that will be written and spoken in the hearts and minds of those you love. I appreciate comedian Steven Wright's optimism when he quips, “I'm going to live forever, so far so good” but even so the mortality rate for Americans remains very high at 100%. Time always adds speed to life—there is, for better or worse, no standing still. Let us prepare for what will come to us all with, as the Buddha said, diligence. Amen and Blessed be.

http://www.npr.org/programs/death/readings/spiritual/index.html
a variety of literature, poetry, and reflections on death and dying.
http://www.npr.org/programs/death/971208.death.html
Information on do-it-yourself funerals

http://www.caringinfo.org/AdvanceDirectives
Free, downloadable, easy to follow forms for Living Wills and Medical Powers of Attorney, also good information on end-of-life

http://www.hospicenet.org/
varied information on hospice and palliative care

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When Death Comes by Mary Oliver
When death comes
like the hungry bear in autumn;
when death comes and takes all the bright coins from his purse

to buy me, and snaps the purse shut;
when death comes
like the measle-pox

when death comes
like an iceberg between the shoulder blades,

I want to step through the door full of curiosity, wondering:
what is it going to be like, that cottage of darkness?

And therefore I look upon everything
as a brotherhood and a sisterhood,
and I look upon time as no more than an idea,
and I consider eternity as another possibility,

and I think of each life as a flower, as common
as a field daisy, and as singular,

and each name a comfortable music in the mouth,
tending, as all music does, toward silence,

and each body a lion of courage, and something
precious to the earth.

When it's over, I want to say all my life
I was a bride married to amazement.
I was the bridegroom, taking the world into my arms.

When it's over, I don't want to wonder
if I have made of my life something particular, and real.

I don't want to find myself sighing and frightened,
or full of argument.

I don't want to end up simply having visited this world.

Mary Oliver
To One Shortly to Die by Walt Whitman
FROM all the rest I single out you, having a message for you,
You are to die - let others tell you what they please, I cannot
prevaricate,
I am exact and merciless, but I love you - there is no escape for
you.

Softly I lay my right hand upon you, you just feel it,
I do not argue, I bend my head close and half envelop it,
I sit quietly by, I remain faithful,
I am more than nurse, more than parent or neighbor,
I absolve you from all except yourself spiritual bodily, that is
eternal, you yourself will surely escape,
The corpse you will leave will be but excrementitious.

The sun bursts through in unlooked-for directions,
Strong thoughts fill you and confidence, you smile,
You forget you are sick, as I forget you are sick,
You do not see the medicines, you do not mind the weeping friends,
I am with you,
I exclude others from you, there is nothing to be commiserated,
I do not commiserate, I congratulate you.


iWilliam Colby Unplugged: Reclaiming our right to die in America
iiNational Hopsice and Palliative Care Organization study: Comparing Hospice and Nonhospice Patient Survival Among Patients Who Die Within a Three-Year Window