Saturday, August 15, 2009

End of Life as a Spiritual Issue

First, this post is a non-political post. I am writing this not because of the current health care bill but more because of some of the issues it has raised that are spiritual and ethical issues.

Secondly, I write this as a person who does not support euthanasia or physician assisted suicide. I can see the arguments both for and against this. I have seen many people at the end of their lives and have thought that it would be merciful if their lives could end sooner rather than later. Watching people suffer, at the end, is dreadful. But I cannot bring myself to embrace euthanasia of physician assisted suicide. I believe that the risks that go along with these are too great.

Which brings me to where we are right now. Much is being debated about the end of life issues as to what is covered and what is not covered in the health care bills. From what I have read, counseling will be optional for the patient, but required to be paid for to allow the patient and physician to have these conversations. But this is not my issue.

The end of life, natural death, has become an interesting subject of debate. There are several facts that need to be remembered.

Fact number one. All of our senior citizens will die, many of them sooner rather than later. No matter what kind of health care they have, no matter what kind of health care bills get passed or not passed, the mortality rate of our senior citizens will be 100%.

Fact number two. All of the people having the debate right now will also die. Alas, the mortality rate of human beings has always been and remains at 100%.

Fact number three. Many people will have to make decisions as to end of life treatment options. People will potentially need to make them for parents, for spouses and partners, for children, even for themselves.

Medical technology is excellent and has improved a great deal. I have been a minister for over 25 years and have seen several things change in rather dramatic fashion.

When I was a young minister and a person was having by-pass surgery, it seemed like close to half of the people who had the surgery never left the hospital. The surgery was tough and dramatic, and while most survived the surgery, many didn’t survive the recovery. I knew that if a person had the surgery they would be hospitalized for a solid two weeks and would require a great deal of critical care.

Now, most people have the surgery routinely, and most are home within the week.

Years ago if a person had their gall bladder out, a very common surgery, they were hospitalized for a week. Now it is out-patient surgery.

Then, all surgeries were inpatient and often required multiple-day stays; now, many surgeries are out-patient.

People live long and better quality lives. Medicines available are often very effective and in the hands of a skilled physician, people can live well for a longer period of time. Which is, of course, great.

The upside of medical technology is that people can be kept alive and maintained for much longer than they used to. The downside is that often people can be kept alive for quite a long time, but there are issues about quality of life and how much pain and suffering a person is willing to endure.

When is it, for example, appropriate for chemo-therapy to end? This is a hard decision for patients and their loved ones. Cancer is a killer and chemo often prolongs life; but at the expense of quality of life. Many people suffer grievously to the point that they want to stop. It it ethical to stop and allow a person to die? I am not talking about killing them, but allowing nature to take its course.

Often there is discussion of feeding tubes. Sometimes people or their families, are faced with the issue of putting in or removing a feeding tube. Without the feeding tube the person will die----of natural causes---- but because they cannot receive nutrition albeit artificially. Again, there is an ethical question on this.

A person is taken into the emergency room and they are elderly and in bad health. They have had a stroke or a major heart attack. What is the right thing? If they do not have any sort of advanced directives, what does a family and the hospital decide. What happens, however, if the family cannot bring themselves to accept or enforce the advanced directives and the DNR is not followed? What becomes the ethical thing to do?

Part of the dilemma is this. Death is not perceived to be evil. Death is the obscenity we no longer want to discuss. It is almost like we have an ethical belief that we save human life, no matter what we have to do, no matter how much it costs. Everything that can be done, even for a short time, even if there is no quality of life, even if it requires a great deal of pain and suffering, is done.

Perhaps death ought to be looked at, however, from a faith perspective. Maybe the end of life should not be a political football for people to play with but a spiritual issue for people to understand.

Christians believe that when we die we go to be with God. The embrace of Heaven is something Christians believe and share. We debate who goes and how you get there, but there is one constant. Life in this world has to come to an end first, preferably naturally and at an old age.

Increasingly, as the technology improves, people have to decide when to allow nature to takes its course and allow life in this world to come to an end. It strikes me that, as a people of faith, we support people on the journey to a better place at the end of life, than to keep the fight up when all hope and any sort of comfort is no past. This is not, in any way, killing, it is allowing a person to die of natural causes.

This seems to be rational, moral, compassionate, and faithful.

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