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.

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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

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?