Green Lights Aplenty, Yet I Still Only Hope for Hope

 This morning a friend, who has played basketball at levels higher than I ever dreamed, likened my recent increase in ministry and employment opportunities to the momentum a team experiences when there has been even a brief series of successes on defense and/or offense. A few three-pointers, or a couple of steals in a row, or any number of other combinations can propel one side forward. What had been a close contest moves toward a seemingly inevitable victory. When one player is finding a great deal of that success, it has been said that they have a “green light” to take whatever shot they choose.

Eavesdropping on conversations in the publishing and motion picture production industries, I have also learned what it means to “green light” a project. Here are some of the green lights that have recently begun falling into place for me.

One of those green lights this week was the scheduling of my dissertation defense (also referred to by some as the presentation of my ministry project paper) for April 4. Because this really is a presentation, and not the kind of defense you can “lose,” I now know that I will, in fact, graduate from Multnomah Biblical Seminary in Portland, Oregon on Friday, May 12. Four years of work will have culminated in being a Doctor of Ministry. (I’d use the abbreviation, but some enjoy pronouncing it “demon.” So, well…no.)

Any discussion of green lights has to
eventually get to F. Scott Fitzgerald.
Right?

Another green light, in the sense of getting the go-ahead with other aspects of my ministry, is the invitation I have accepted to serve Multnomah Biblical Seminary as an adjunct professor this fall. I will be teaching one course, being on campus in Reno for just two Friday-Saturday face-to-face sessions with students, and covering the rest of those responsibilities from the internet-connection (which interestingly has failed yet again while I type this) here in my office at the house in Fall River Mills. That means I get to continue being pastor of The Glenburn Community Church, and be a seminary professor as well. Gravy!

Still another green light comes from being part of the faculty for Right On Mission Vocational Seminary. I accepted an invitation this week along with others from the faculty being funded (as in “all-expense-paid”) by Church United. We will be participating in a conference in Washington D.C. entitled “Watchmen on the Wall” late this May. This is a great opportunity to better understand some of the priorities and perspectives of those within our government and from within the Evangelical tradition’s church leadership.

The view from Jay's dock?

Finally, this last “green light” borders on irony, if not the sublimely ridiculous. As some of you may remember, there had been a number of hateful misrepresentations made about me to the faculty and staff of my three-time alma mater,[1] Simpson University, where I was serving at the time as an adjunct professor, preparing to teach “Old Testament: Kings and Prophets.” In short, the President, Provost, and Board Chairman had all suggested, recommended, and requested (though not respectively in that order) to the new dean of the seminary that I be relieved of my responsibilities. To shorten a long story, I did teach my class that following Spring. But I have not had a similar opportunity since. And yet, this past Thursday, I was blessed to guest-lecture in that dean’s Pastoral Care course on what I refer to as “pastoral thanatology”—encouraging and equipping our students to serve our dying and bereaved neighbor. Following that morning’s session, we discussed how we might go about getting similar training into the hands, hearts, and minds of others throughout the Central Pacific District of the Christian and Missionary Alliance (my ordaining denomination).

Neil Hilborn - conveniently attired.

So, I am seeing a lot of green lights.

And that brings two others into view. Some of us who paid more attention in high school’s American Literature class may only need to Google the second reference. Others who are more attuned to social media may only need to Google the first reference. Those of you who immediately recognize both—well, you are doubly blessed, indeed! I do hope, though, that all of you take the time to fully understand what these last two green lights mean to me.

It has been nearly forty years since I first read about Jay Gatsby’s green light, and all the hopes for future success and satisfaction that distant glimmer represented. Gatsby’s green light, of course, never fell fully within his grasp. I have fears about that green light, and the attractive illusion that somehow there is a point of arrival, after which I can say, “I am done.”

Don't blame the fixture.
It's just letting you know it's there.

It has been a much shorter time since I became acquainted with the work of Neil Hilborn. Because the signs at each door of my office’s building glow green, I think of his “exit sign” as another kind of green light. I have fears about that green light as well. It is, for me, no illusion at all that there could be a point of arrival, after which I could say, “I am done,” even though, lately, in the words of Mr. Hilborn, the show has “never been quite bad enough to make me want to leave.”

So, for all those who imagine that all we need is for a few things to go well, to go right, or to go not-quite-so-badly, and we’ll be feeling much better shortly, I’ll tell you this. For all the other green lights I have seen so recently, it is my fear of these two others, Gatsby’s and Hilborn’s, that dominates my thoughts, even now.

---

[1] To refresh your memory: I hold a bachelor’s from Simpson College, a master’s of ministry in pastoral counseling from The Simpson Graduate School of Ministry, and a master’s of divinity from A.W. Tozer Theological Seminary. In total, the four members of my immediate family have earned four bachelor’s, three master’s, and two teaching credentials, and all four of us have been employees of the college/university/seminary, some among us on multiple occasions. 

Unifying Our Fragmenting Society – “Who Cares?”

In his recent blog post, “How Do You Get the U.S. off Life-Support?” (referring to the growing incivility in public discourse that has been exacerbated by the examples set before us during this most recent election cycle), Paul Louis Metzger (disclosure: Dr. Metzger is my faculty mentor in my doctoral program) notes the position taken by Dr. Robert Potter (again, disclosure: Dr. Potter is the other academician reader of my dissertation/ministry project paper). Drawing an analogy to palliative care (seeking to alleviate a patient’s symptoms and pain, separate from addressing curative measures), Dr. Potter seeks a solution to the pressing question, “What needs to be done?” by framing the questions “What am I missing?” and “Who am I missing?” These are essential questions. In pain management and end-of-life care, the holistic approach to the mental, emotional, spiritual, and social dynamics of the patient and their family can often be even more important than the physical processes being treated.

As I have written elsewhere, addressing these multiple areas of concern is difficult, requiring in hospice care an interdisciplinary team that (by law) must at least include a physician, a medical social worker, and a pastoral counselor/chaplain in addition to the hospice manager. The intensive and extensive level of care provided through hospice during the final weeks and months of life is nearly impossible to provide elsewhere. Likewise, it often may seem as though the answers to “What am I missing?” and “Who am I missing?” are not only daunting in the depths of their complexity, they may be endless in breadth. It may seem impossible to determine, much less include all that is missing, and all who are missing from the equation. In such cases, we may be tempted to take license to disengage from the process, allowing ourselves the escape clause: “We’ve done all that we can do.”

Why would I demand of us that we try any harder than that—either in treating a dying patient or in seeking to bring unity to a fragmenting society? Because I believe that beneath the questions “What am I missing?” and “Who am I missing?” lies a motivation that is, in my experience, so often unclear in both discussions. The question “Why is this pursuit so terribly important to you?” might be boiled down cynically to “Who cares?” But whether conservative or liberal, whether focused more exclusively on any few or encompassing all the “moral intuitions” that Dr. Potter cites (care, fairness, liberty, loyalty, authority, and sanctity), the answer is simply this: “You care.” For different reasons, at different levels, and from sometimes vastly divergent perspectives, it is impossible to deny that we have clear and passionate positions on most of the issues being discussed.

If you doubt whether you have such passions, simply put yourself in the place of those who are adversely affected by any of the issues. Start by asking yourself what levels of pain relief and symptom management (think uncontrollable nausea, for example) you would be willing to forego if your hospice team needed to cut back on their agency’s overtime. Questions of healthcare rationing may bore you. But faced with a decision on whether to pursue expensive treatments that have only the most miniscule chance of curing your disease? You may find yourself paying closer attention to the discussion.

The unifying issue for many participating in hospice care, as providers as well as for patients and their families, is that we generally acknowledge the reality of mortality. We not only provide care to the dying and bereaved, we number ourselves among them. Even when we are not among the most imminently dying, we willingly bereave ourselves, intentionally forming close personal friendships with people we know are going to die soon. The unity we find in that mutual mortality and shared grief allows us to discuss matters that nearly all others in our circles of influence work hard to avoid. (Most of them wish that we would avoid those topics, too.) But in caring about the issues, despite divergent positions, relative to hospice care, we are unified by our commitment to solidarity with and around the patient and their soon-to-be-bereaved family, knowing that we eventually will be one or the other or both.

So next, in the broader conversation about our national priorities, I would ask that you think about liberties you particularly enjoy. Would you care if they were being as maligned and restricted as those of others? Try considering your economic well-being threatened by those who would re-zone their neighborhoods to eradicate “your kind.” Imagine your religious affiliation (or lack thereof) as a reason to discredit and persecute you. And visualize yourself amidst the confrontation that would occur if armed authorities denied you your right to express your position on these or any other matters. You do care…if it’s your ox that’s being gored.

We all care. We merely subvert our engagement of these issues behind a pretense of apathy. Apathy, the lack of caring, is not what I find to be the cause of inaction. Instead, we choose not to engage on the basis of what I would call the economy of futility. We do not invest in solutions because we believe the problems to be insoluble. Therefore, we fail to recognize the undeniable unity of our concerns. At their core, our conflicts are universally compelling, if only we would admit how much we care about our own positions on the issues.

Will we agree on these positions? If you demand that I agree with your position, or I demand that you agree with mine, probably not. But we must agree, if we will admit that these are issues on which we each cannot help but have positions. Then, and perhaps only then, we might be willing to listen, understand, and collaborate in ways that resolve our conflicting positions on the issues themselves. Only then can we claim that “we’ve done all that we can do.”

Life-and-Death Differences: How do I know whether I need Hospice, Palliative Care, Terminal Sedation, or Physician-Assisted Suicide?

Doesn't it seem like there should be
at least one more option than this?

Those of us who discuss dying on a regular basis sometimes forget that terms we use very specifically can have a much broader range of meaning for most other (i.e., “normal”) people. For example, grieving, mourning, and being bereaved are often used interchangeably as synonyms (i.e., words with essentially the same meaning). Is it helpful to identify the particular definition of each one? I believe it is, especially for those who are experiencing all three simultaneously, and trying to find a safe course to navigate through them. Technically, then, but briefly: Bereavement = the condition of having experienced a significant loss. Grief = the involuntary reaction we experience when we are bereaved. Mourning = the voluntary actions we take that help to process our grief.

Vocabulary for the Dying

If the terms describing the experience of loss and its aftermath are important to distinguish from one another, then it is even more important to do so when the terms apply to our own experience as an imminently dying patient. Most of us would like to know only what it means to have symptoms, receive a diagnosis, follow a course of curative treatments, and be restored to health. And yet, the reality is that most of us, either in our own life or the lives of those closest to us, will hear some form of that dreaded sentence from our doctors: “I’m sorry. There’s nothing more we can do to make you well.” What are we supposed to do when “there’s nothing more we can do?”

The important distinction, even when you are diagnosed with a terminal disease, is that while there is nothing else to be done that will cure you, there is far more that can be done to ensure that you continue to live the best possible life until that terminal disease (or some other cause) ends your life. The next step, especially for those whose terminal or chronic illness is likely to end their lives within six months or so, is usually a referral to “Hospice.”

Well, this is a third option, but it's not exactly
what hospice care is all about.

Hospice: What it is, and why.

The best definition of hospice says more about what it is not than what it is. “Hospice exists not to prolong your life, nor to hasten its end, but to help you live until you die.” When curative measures are no longer possible, or desirable (since some patients find the treatments more difficult, debilitating, or even deadly than the disease), hospice can provide patients with symptom-management and pain relief throughout the natural, physical process of dying. But just as importantly, and sometimes more so, hospice provides support for the mental, emotional, social, and spiritual needs of the patient, their family, friends, caregivers, and others. The focus on a patient’s personal preferences includes determining how best to provide service in either the patient’s home or in a medical facility. The support for the many peripheral needs can include discussions with insurance providers, referrals to funeral planners, and coordination with the appropriate faith communities for spiritual support as well.

Why am I so concerned that you understand what hospice is and does? First, you or someone you know will likely need hospice services someday. Second, there are other alternatives becoming more popular, primarily because people are unaware that hospice care is available to them. And third, I want you to understand what hospice is and does because I hear too often, “If we’d only known everything hospice could do, we would have called you in much earlier.” Sadly, I also have to hear people say, “I wish we’d known about hospice when our loved one was dying.”

At least when it's prescribed in California,
it still has to be suicide, not homicide (so far).

“Turn Out the Lights; the Party’s Over”

To fully understand what hospice is and does (and isn’t and doesn’t), there is another pair of terms that are often confused (Palliative/Terminal Sedation and Physician-Assisted Suicide), and a third (the Dual Effect) that needs to be clarified as well.

These distinctions are very important, especially for those exposed to recent references in popular Christian books. In Rob Moll’s The Art of Dying, he quotes from Dallas Willard’s The Divine Conspiracy (before repeating the phrase as his own perspective) to portray hospice as employing “the widespread use of heavy sedation.” No wonder, then, that some patients, friends, and family members imagine that once hospice service begins the patient’s conscious existence becomes a thing of the past. But in actual practice, even what is called the “dual effect” of a patient becoming unconscious (or dying) as a side-effect of sufficient doses of pain medication is rare. When it does occur, it results from attempts to relieve distressing symptoms and/or unbearable pain. Further, it is almost exclusively occurring at the very end of a terminal illness’s progression. And yet, even when diseases have done nearly all they can do to us, hospices routinely accommodate the preferences of patients who, willing to endure higher levels of pain than others might, want to stay as awake and alert as possible. This is sometimes a temporary preference that allows, for example, one last visit with distant relatives or friends, and sometimes a distinct desire to experience as much as possible of the life remaining to them.

But there are, occasionally, physical symptoms that are “intractable.” Sometimes the extraordinary panoply of medications and techniques available are unable to provide the level of symptom management and/or pain relief that the patient desires. Palliative/Terminal Sedation (usually referred to as either Palliative Sedation or Terminal Sedation) is necessary for those patients who can only be made comfortable by rendering them unconscious. This is “palliative” in that it is a means of relieving pain and/or other symptoms. It is “terminal” because, unless there are measures to provide nutrition and hydration (food and water) artificially, the patient does not regain consciousness. Death occurs within a matter of days once there is no further fluid intake.

Is Palliative/Terminal Sedation, then, a form of Physician-Assisted Suicide? Some would see any claim to a difference between them as merely splitting hairs. In practice, however, there is a vast difference between the prescription of pain relief that may result in diminished or lack of consciousness (as can be a side-effect of effective Palliative Care), the prescription of unconsciousness as the only means of relieving pain (Palliative/Terminal Sedation) and the proactive ending of one’s life in order to preemptively avoid whatever symptoms may or may not accompany the progression of a terminal disease (Physician-Assisted Suicide).

So, we have made some progress.
(In grammar, punctuation and spelling, too, it seems.)

One Last, Unfortunate Distinction

While all hospices provide palliative care (relieving pain and symptoms), not all palliative care should be confined to hospice. There are patients for whom symptom-management and pain-relief should be provided, even as they pursue curative care. This is not currently the case for most patients. There are hopes for change, and some signs of progress. But currently both public and private insurers are hesitant to cover palliative measures for non-terminal patients. Still, palliative specialization in the medical community continues to be developed in anticipation of one day overcoming the legislative and regulatory roadblocks to a more enlightened public policy.

This bears careful attention as the push toward suicide continues to grow (as with California’s recent passage of the End of Life Options Act). If our society continues to advocate for hastening the deaths of the terminally ill, we are morally obligated to allow all patients the option of pursuing a cure for their disease and the restoration of their health. Unfortunately, patients too often abandon that curative care due to the debilitating side-effects or devastatingly difficult life-adjustments necessitated by otherwise effective treatments. As the proponents of Physician-Assisted Suicide disregard hospice, offering instead a “get well or die” paradigm, every opportunity should be provided to those patients who would seek to get well, were they not asked to endure torturous treatments unmitigated by palliative care.

On Attending an Intentional Death: Some things to consider before you invite me to join your friends and family for your premature send-off

If all you can see is death,
then I would suggest you look more closely.

I was recently honored to consult on a blog post by my friend, Paul Louis Metzger, entitled “Lights Out: Shining a Light on Caring for the Dying in a Multi-Faith World.” (It can be found here.) He begins by asking, “What would you do if you were a chaplain or pastor or trusted friend given the honor of caring for someone of another faith tradition who is approaching death?” For some, there would be some complications, or obstacles that might prevent them from doing so. For me? Well, I have cared for many outside my faith community, including some whose beliefs differ greatly from my own. But recently, a similar question has been asked, and I now am the one facing the complications and obstacles.

The question is deceptively simple. Would you attend the patient’s death? The answer should not be all that complicated, either.

Can you make death out of life?
Certainly. But why would you?

After all, I have attended myriad deaths, from a variety of causes, in many different venues. As a hospice chaplain, most of the deaths have been serenely accommodated with a gathering of loved-ones clearly aware of the impending last breath. As a police chaplain and as a pastor, however, I have been present when life ended traumatically, amidst the valiant efforts of emergency medical professionals. In a hospital waiting room, I have notified next-of-kin of their loved-one’s death when it was our own law-enforcement officers who fired the fatal shots. I have left the bedside of the woman wounded by her suicidal son, just long enough to confirm that her husband, in the emergency suite next to hers, had not yet succumbed to his wounds. When he died a short time later, I was there to tell her so. I have participated as a first responder and in critical-incident stress debriefings with witnesses to horrific carnage literally on the front porch of police headquarters. There are more and more scenes that come to mind even as I write this, so before I lose track of my point, let me hope that I have clearly illustrated it. There are very few kinds of death that I have not already witnessed.

So, to my ears, the subtext of the deceptively simple question above is this: “Given that I have attended all these deaths under so many and widely-varied circumstances, why would there be any death from which I would choose to be absent? Especially if it is a patient or parishioner with whom I have an ongoing relationship?”

The complications and obstacles I face occur in the specific context of this simple question. My struggle arises primarily from the fact that I have attended some spectacularly overwhelming non-deaths. Those have included SWAT-calls, hostage rescues, and other interventions where the survival of those involved was far less than guaranteed. I have been present when lives were saved by extraordinary medical interventions. And I have been called to the scene when we simply needed someone to argue in favor of life with someone who was intent on ending their own. And that brings me to the reasons you do not want to invite me to your suicide, physician-assisted or otherwise.

I will try to stop you.

Sometimes what we see is not really life.
So, definitely not a time to choose death.

I was one of the founding members of the board of directors and executive committee of The Suicide Task Force of Larimer County. It later became The Suicide Resource Center. Now, since October, 2011 it has a new name. In order to differentiate themselves from other organizations that want to provide you with the resources by which you may commit suicide, the team is called the Alliance for Suicide Prevention. Due to excellent training, and whatever it is about God’s will that passes for “luck,” as both a police chaplain and as a pastor I have yet to lose the argument on behalf of life. Do not mistake me, though. I have friends and colleagues who have lost that argument, though. They were in attendance at a completed suicide and, had I continued in that field, it would only be a matter of time before I was, too. But in each case, we say and do all we know to prevent that suicide from being completed.

That is what I have done in the past; it is what I will continue to do in the future.

So, imagine for a moment that you are not the dear friend invited to attend, but the patient preparing to implement your legally-protected, physician-prescribed, self-administered, and invariably-lethal solution to an unacceptable life. Try to visualize yourself terminally ill, told that your life retains far too much quantity for the declining level of quality—and that the logical decision is to proactively and preemptively end your life? Do you have that picture of a life-not-worth-living firmly in your mind? Good. Now, consider whether you want me to be there.

Please understand, I would be very honored to receive your invitation to be present in that very special moment. But I would also hope to bring your breakfast in the morning, and to be present with you for many more days, weeks, or months.

Don't fear the reaper, but don't rush the hourglass.
What do you need with all that extra sand?

No matter how convincing the arguments in favor of death may be, I will argue in favor of life. No matter how others seek to terrorize you with wild fantasies of unmitigated agony, I can testify to you that it is only the rarest of patients who choose to experience higher levels of pain as a trade-off against greater awareness of the dying process (or simply being as mentally acute as possible for the visit of one more friend or family member). As a hospice chaplain I have seen the life-enhancement that is possible through palliative care (including psycho-socio-spiritual assistance far beyond what most would imagine could ever be made available in our cost-benefit-ration-driven healthcare system) even when the experience surpasses the worst physical deterioration that suicide advocates promise you. You have the option to accept care that neither prolongs your life nor hastens its end, but helps you to live until you die.

So, yes, please, do invite me to attend your going-away party. Just understand that I will still want to win the argument. I will plan to visit with you some more on the morning after. I will never stop encouraging you to give life one more try.

Toward Building a Better Human Race: Two Key Prerequisites to Effective Eugenics

In a recent post to his blog, “Uncommon God, Common Good,” Paul Louis Metzger asks in the title “Should Ethics Be ‘Biologicized’? What Might that Mean for Eugenics?” It’s a good question. But even for those of us who understand that ethics involves determining what is good or bad and what our moral obligations are, grasping the idea that they could be “biologicized” would require a careful reading of Dr. Metzger’s post (which I recommend, and it can be found here). For now, I hope only to discuss, as briefly as possible, the challenges posed by eugenics, especially with regard to my particular ministry context.

“Eugenics” is a term coined in 1883 to describe (according to Merriam-Webster’s Collegiate Dictionary—Eleventh Edition) the “science that deals with the improvement (as by control of human mating) of hereditary qualities of a race or breed.” In some instances, as with Germany in the late-1930s and early-1940s, eugenics sought to improve the human race as noted in Webster’s definition: by controlling who was allowed to procreate with whom. This selective breeding was enforced by prohibiting intermarriage between various groups in order to maintain purity in the traits identified as belonging to the Aryan race.

Others more recently have identified as eugenics a practice of unnatural selection subsequent to mating, but prior to the birth of a child. It is becoming more common to abort pregnancies when particular traits are identified as potentially diminishing the quality of the child’s (or parent’s) life. The range of factors seen as being sufficient to warrant these actions include not only what some call “birth defects,” but also the selective elimination intended to provide a couple with either a male or female child as they prefer.

In my ministry context, however, what is more often discussed is not the question of significantly improving the quality of life in the coming generations. Among hospice personnel, we face challenges from those who would define what constitutes an insufficient quality of life in members of the current generation. We do not tend to identify this as eugenics, though, even though the proponents of pre-emptively ended the lives of human persons intend to elevate us to a “good race” (with eu = Greek for good, and genea = Greek for race or generation), at least for those of us with sufficient “quality of life” to survive. Instead, those promoting the removal of living human persons claim to be motivated by a vision for euthanasia: ensuring a good death for those adjudged to be living a bad life.

Whether ostensibly prohibiting procreation by outlawing certain marriages, or preempting pregnancy’s natural outcome by killing unborn human persons, or prematurely ending the lives of the infirm, ill, injured, or otherwise disenfranchised, there are two key prerequisites to enacting effective eugenics outside the ethical considerations that constrain science to be practiced for the common good.

First, we would have to accept the dangerous optimism of democratically-governed science. We would have to believe that the majority of voting citizens were well-informed enough to look beyond the corporately-sponsored marketing messages and exercise some control over otherwise unabated experimentation. Only then could we do as Metzger’s subject, Dr. Edward O. Wilson recommends and remove ethics “temporarily from the hands of philosophers” to be “biologicized.” Eugenics necessitates that we allow those who can (or are willing to try) to do as they wish, without interference from society’s professional thinkers, but still under the influence of our nation’s diminishing ranks of voters.

"They told us to just sit back and watch what happens."

Second, for eugenics to be enacted effectively, we would have to continue to promote the fantasy that love and hate are merely emotional conditions and thus uncontrollable responses for which we bear no personal responsibility or obligation. That way, when we find that we do not have a fond sense of affection toward total strangers who would be eliminated from society, we can excuse our hateful acts of willful indifference as having just as little effect as our sentimentality would. Somehow we would have to allow our hatred to still remain an action, while our love became an even greater illusion. But we have managed it so far.

What would be the results of this unrestrained experimentation and willful indifference toward others? Eugenics seeks the elimination of those unfit to reproduce, or whose mothers are unwilling to nurture them until birth, or all of us who will eventually be in a position to continue usurping resources from the healthier members of the population. If more effectively pursued than is currently the case, then we would be left with an ever-increasing percentage of society for whom anything less than robust health, strength, wealth, and youth would put them at risk. But since that last category ebbs-away from each of us even now, perhaps we might want to steer a better course while there are still enough of us to object to eugenics.

To Darwinians, Dawkins, Humphry, et al. – May the Quality of Your Life Be Not So Strained As Your Mercy

The quality of mercy is not strain’d, It droppeth as the gentle rain from heaven Upon the place beneath: it is twice bless’d; It blesseth him that gives and him that takes.

—William Shakespeare, “The Merchant of Venice,” IV.1.184-187.

Maggie Smith as Portia in
William Shakespeare's
"The Merchant of Venice"

In Shakespeare’s “The Merchant of Venice,” the judge, Portia, pleads for the plaintiff to temper his legal claim to justice with mercy for the defendant. In a recent post, “Abortion & Down Syndrome: An Apology for Letting Slip the Dogs of Twitterwar,” Richard Dawkins begs mercy from “the haters,” those “who go out of their way to find such tweets” as he posted publicly, despite his intention to share only with “the minority of people who follow both her [a woman who had expressed her uncertainties about aborting her child if she were to learn it would be affected by Down Syndrome] and me.” (You can find his full post here.)

In response to her uncertainties, Dawkins had Tweeted™, “Abort it and try again. It would be immoral to bring it into the world if you have the choice.” In seeking to quench the fiery response to his Twitterpations (limited as they are to 140 characters), he offered a 255-word explanation. It suffers from certain anachronisms and additions which would understandably be seen as belated revisions or even second-thought afterthoughts in the eyes of even his most ardent supporters.

Most importantly to my friend and mentor, Paul Louis Metzger, is Dawkins’ rebuttal of the accusation that he was advocating eugenics. Eugenics can be narrowly defined the process of selecting preferable traits, especially within human persons, and seeking to enhance those traits within a population by encouraging procreation by those who possess those traits. Most, however, consider the eugenics that has been practiced to be a clearer indicator of the process: removing from the procreating gene pool those deemed to possess less desirable traits, either through forced sterilization (as has occurred among the developmentally disabled in the United States) or outright genocide (as is the more frequently employed means).

Richard Dawkins

To be clear, neither definition would apply to the decision to advocate aborting the lives of children found to be affected by Down Syndrome. Dr. Metzger is correct to point out that Dawkins’ position is not one of eugenics, but of mere utilitarianism. Guided, as Dawkins claims to be, by “a desire to increase the sum of happiness and reduce suffering,” he holds that “the decision to deliberately give birth to a Down baby, when you have the choice to abort it early in the pregnancy, might actually be immoral from the point of view of the child’s own welfare.”

Dr. Metzger is careful and correct in admonishing us “to practice the Golden Rule (Matthew 7:12) and do to others what we would want them to do to us. We should try and interpret their claims in keeping with their intended aims rather than with how we might wish to interpret them for partisan purposes, just like we would want others to interpret our positions as we intend them.” (Dr. Metzger’s full post can be found here.) I whole-heartedly agree with Dr. Metzger, and am often indebted to those who are willing to engage in dialogue with me, especially when they request clarification when my points are vague or muddled—or even when they are not unclear, but merely objectionable to those dear friends.

Derek Humphry

Among the conversation partners with whom I am currently engaged, though, are those who are seeking to navigate the very difficult and narrowing channel between hospice care and physician-assisted suicide (PAS). With the recent passage of California’s End-Of-Life Options Act, there is an assumption that hospice providers will become what we are already often mistaken to be: “the black-pill people,” aka “the death-squad.” Hospices have traditionally followed the pattern set by Dame Cicely Saunders (more about the founder of the modern hospice movement here). We seek neither to hasten nor postpone a patient’s natural death. Why? Because, in the words of Dame Saunders, “You matter because you are you, and you matter to the end of your life. We will do all we can not only to help you die peacefully, but also to live until you die.”

This basic philosophy is being attacked by those who want hospice to “evolve” in order to cooperate in accommodating and referring, if not actively providing, physician-assisted suicide. Now legalized in six of the United States, and moving toward legalization in fifteen more, PAS is advocated strongly by an organization now known as “Compassion & Choices.” (Their website can be found here; I have addressed my concerns with what was previously called “The Hemlock Society” in a post you can find here.)

I find a striking similarity between the position that Dawkins takes, and the one taken by the organization founded by Derek Humphry. In both cases, they advocate that there are human persons who would be better off dead than alive. For Humphry, the choice is presumably in the hands of the human person who experiences a life-threatening diagnosis and chooses, like Brittany Maynard (Compassion & Choices’ fundraiser, “The Brittany Maynard Fund,” eulogizes her here), to proactively end her life by committing suicide (to express it in terms most of us would use). Dawkins, however, prescribes death as the moral choice “from the point of view of the child’s own welfare.” In short, others should decide on behalf of the child that she would be better off dead than alive.

Brittany Maynard

Some would see a difference between these two decisions. On the one hand, there is the exemplary suicide of Brittany Maynard, intended to preclude her own suffering by choosing to die while she was still able to increase the sum of her happiness by doing so. On the other hand, Dawkins recommends the homicide of a child in order to preserve someone else’s happiness by preventing what he would presume to be their suffering, caused by failing to end the life of their child.

But there is less difference here than you might imagine. Dawkins has backtracked from his earlier statement. He claims that while the woman in question could end the life of her child, he was not deciding for her that she should “Abort it and try again.” Those claiming to offer Compassion & Choices would say they merely want others to know they could end their life. But if I read Dawkins’ intent correctly, what he meant to say privately has changed, now that it has been heard publicly. If what Humphry’s progeny are saying publicly is any indication, then it should not surprise us that some whose lives are considered to lack a sufficient level of quality…well, the message we are hearing is that we should end our lives.

Shakespeare’s Portia wanted mercy to temper justice. Dawkins wants mercy to temper reactions to his inadvertently public position on aborting lives of insufficient quality. And where do we find the mercy of Humphry & Company? “Compassion” would seem to include Choices that foster mercy toward the terminally ill, but not what amounts to mercy-killing—even if, as the current PAS laws require, you make the patient administer their own hemlock.

What’s in a Name: Learning Advocacy from the Opposition

During the most recent conference of the California Hospice and Palliative Care Association (CHAPCA), much of the discussion centered on the recent success of a group now called “Compassion and Choices.” They were repeatedly referred to as “the most effective advocacy organization ever seen.”

They are advocates. They are effective. And they don’t mind making it clear that they are opposed to the current options available: either curative (seeking to restore the patient to health) or palliative (seeking to relieve the dying patient’s symptoms).

How effective are they? So much so that in a presentation on how to construct policy relative to California’s new law facilitating physician-assisted suicide, the spectrum of attitudes was described at one end as “embracing” the practice of self-administered euthanasia, while the other end of the spectrum was labeled “denial.” Now, most of us can imagine that “embracing” is a good thing. And even outside the ranks of those who work most closely with the dying and bereaved, you may be aware that “denial” is considered inevitable, but only as a temporary measure to buffer the sudden realities of crisis, trauma, or loss.

"The Death of Socrates"
by Jacques-Louis David

How opposed is Compassion and Choices to the status quo? Their six objectives (found here) include pursuing legislative innovations, exerting influence over medical professions, and establishing a litmus test for elected officials in making “aid in dying…a prime motivator in voter decision-making.”

But the most telling of their objectives is to “Normalize accurate, unbiased language throughout the end-of-life discussion (‘aid in dying’ instead of ‘assisted suicide’).” Taking them at their word, the intent here is insidious. While California has become the sixth state to legalize physician-assisted suicide (with legislation pending in at least fifteen others among these United States), the eventual goal is to allow active euthanasia—the proactive intervention by doctors and other in ending the lives of others, which under European health-care practitioners often occurs without the patient’s consent (noted here).

The word “semantics” signifies the art of choosing proper terminology to convey specific meaning. The term also gets used to describe those same talents when being used to obscure and mislead as well. With Compassion and Choices, however, the only word-games of which they could be accused involve being so clear as to be incredible. That is, thinking “I must be reading this wrong” would be a reasonable response to their desire for “accurate, unbiased language.”

A close-up view of Socrates.

You see, part of the argument against physician-assisted suicide is that of “the slippery-slope.” Some worry that if we allow patients to use physician-prescribed medications to end their own lives, it is only a matter of time before we move from describing “who could die, if their life is no longer of sufficient value to them” to prescribing “who should die, if their life is no longer of value to us.” The safeguard written into each state’s laws, so far, is that the patient must self-administer their own death. This is the essence of “assisted suicide,” that the means may be made available, but the final act to end a life should be taken only by the one whose life would be ended.

But the semantics are clear, and Compassion and Choices wants us to stop pretending that they mean anything other than what they say. They seek that we “normalize accurate, unbiased language” to communicate that their goal is something beyond what the current laws allow. Patients should receive “‘aid in dying’ instead of ‘assisted suicide.’”

Not Socrates. But you should still
take a close-up view.

Perhaps, though, the more accurate, unbiased name by which “Compassion and Choices” was previously known might help us understand their origins and intentions. When Derek Humphry, author of the infamous Final Exit (1984) which explored the field made more popular through the exploits of Dr. Jack Kevorkian, founded the organization, it was called “The Hemlock Society.” (The debate and decision to abandon the historic name is described here.)

Referencing as it does the story of Socrates, it might be good to remind ourselves of the Greek philosopher who was condemned to death and forced to drink hemlock, the deadly poison. Thus, as we face the continued efforts of “the most effective advocacy organization ever seen,” the chilling question we must face is this: “who will be making whom drink what?”

Where does this leave the student of effective advocacy? The mixed messages of what was until relatively recently The Hemlock Society, and has since become Compassion and Choices, make it difficult to adopt their strategies, even before issues of integrity, authenticity, and transparency eliminate them from consideration. An organization that promotes as a goal “to mean what they say” would, ironically, need to “say what they mean” just little more clearly, and certainly far more fully.

Otherwise, the only ones likely to drink their poison are those who fail to listen to them as carefully as we should.

Being Moments from Eternity, Please Take a Moment To Consider Eternity

A dear friend shared this illustration with me. Her comment? “Why is it that something about this makes me sooooo uncomfortable?”

Some might suggest that the discomfort she feels should be identified as conviction. The intent of the illustration, then, would be to suggest that perhaps she is not so eternally secure as she should be. In that case, her discomfort is a sign that she should…what? Re-accept Jesus as her Lord and Savior today?

Two things lead me to reject that explanation. First, I am as convinced of her relationship with Christ as I am of anyone’s beside my own. Second, there’s “sooooo” much more here to be uncomfortable about. Let me first note one issue in particular, then explain why it’s a far bigger problem than you might initially recognize, and finally offer an alternative.

The Point Being Made

We accept that “two wrongs don’t make a right.” But here, I would suggest that two rights do make a wrong. Of course, as with any bumper-sticker and/or t-shirt theology, I realize that the eight words in the second statement imply a great deal beyond what they say. And I do think it would be a very good thing to “Accept Jesus as your Lord and Savior today.” (Accepting, of course, that “accept” suggests believing and following Jesus as His disciple.)

The first statement is also true, mostly. I would object that eternity, arguably, encompasses the time-space continuum—so we are already living eternal life here and now. Still, I think the meaning is clear enough. And being who I am (Death Pastor, after all), I heartily recommend that you live with the constant possibility of your imminent death. Further, I believe that part of the advance planning for that inevitability (in addition to communicating your health-care directives, outlining your funerary preferences, and writing your will) should be the consideration of where you spend eternity. (Of course, that’s another problem with this illustration. You are going to live forever. It’s just a matter of where and how. But I want to keep my promise to focus on just one of the many issues raised by this illustration.)

So, in the illustration, the point being made is this: You should accept Jesus as your Lord and Savior today, because today might be the last day you get.

The Problem with That Point

Here is my problem with the logic being presented. Christ’s gospel is too often reduced to a simplistic consumer transaction. “You get what you pay for,” and “you deserve what you earn,” are just two ways of expressing what most North Americans believe about life in general. Thus, we tend to think of the gospel as a contract in which we “accept Jesus” as the price of admission to heaven (as envisioned by the pearly gates in the illustration).

As presented, the logic of this illustration is simple and easy to follow. Since your next breath could be your last, you need to make sure you have that admission ticket in your hand, or have added your name to the guest list, or gotten the code for the push-button remote that opens those unmanned gates in the illustration. The emphasis of all this: “sign your contract with Jesus today.”

If that logic makes sense to you, though, I am deeply concerned for your soul.

All that many know of Jesus is that He did something in the past (sinless life, atoning death, validating resurrection, etc.) in order to provide something for us in the future (heaven, eternal life, kingdom reign, etc.). But far from that limited view of God’s obligation to honor a contract, even if sincerely accepted, there is so much more that Jesus is intending to do in and through your life.

If you accepted Jesus, and are looking forward to heaven, are you engaged in conversation with Him through His word and prayer? Do you recognize the ways in which He is transforming your life to reflect His? Do you experience the deepening compassion for others, and passion for Christ that result from getting to know Him better each day? In short, beyond having “signed a contract,” do you have a living, breathing relationship with God through Christ?

If not, you might still be saved. You might sincerely have obligated God to admit you into heaven on the basis of having once prayed “the sinner’s prayer.” But if that were all you had experienced of Jesus Christ, there would be so much more you would be missing.

The Alternative to Eternal Fire Insurance

The concept of “salvation as fire insurance” is at the heart of many gospel presentations. Even great philosophers can tend to replace the idea of a relationship with God through Christ with something resembling a convenience store purchase, or a brief trip to the casino. What is called “Pascal’s Wager” (after Blaise Pascal, 17th Century French philosopher, mathematician, and physicist) is simplified to portray our “bet” that God exists. As our wager, we give up certain aspects of our finite existence (sins, usually) in anticipation of infinite gains. “If we are wrong, then we have lost little. If we are right, we have gained immeasurably.”

But it is not just our sins that Jesus calls us to surrender. And it is not merely heaven that He promises in return.

In short, as human persons we were created to bear the image and likeness of our Creator—one God eternally existing in a community of three persons. The vital experience of that image in us was broken through our decision to sin. We decided to do something other than what God designed us to do, which was to enjoy life in His presence. Through Christ, however, there is the means of restoring and repairing our relationship with God, and thus with other human persons as well. Our relationships with one another can better reflect the relationships of Father, Son, and Holy Spirit—relationships of intimate fellowship, harmony, and cooperation.

So, why should you choose to follow Jesus Christ as your Savior and Lord today? Because today is the soonest you can begin to cooperate in the process of repairing and restoring (and representing to others) the life you were always intended to have. And today is also the soonest you can begin to cooperate in the process of repairing and restoring the relationships among other human persons that we were all intended to enjoy in His presence.

If you’re waiting for that to begin in heaven, then you’re at least missing out on what Jesus wants you to be, and have, and live today. So, yes—do not wait to “sign the contract.” But instead, enter into the conversation with Him. Today.

A Cure Worse Than Death: The Failures Leading to Physician-Assisted Suicide

Do you want to die? Most reading this will, on most days, say no. But why? The reasons vary for each of us, but the strongest tendency is to imagine waking again tomorrow morning. How do I know? I’ve done it over twenty thousand times now. Maybe you’re only halfway or less to that number, but you have to admit, it’s habit-forming. So it is almost impossible for most of us to imagine, on most days, how someone might choose to break with such a long-standing pattern and to proactively end their lives.

But there are enough who do that our culture now embraces what was, until very recently, pushed to the margins, into the dark corners, out of polite conversation, and certainly against public policy. What had become an illegal cottage-industry leading up to the publication of Final Exit by The Hemlock Society and the media-celebrity of Dr. Jack Kevorkian, has now gained not only broader acceptance, but legal sanction in several states. The number of states establishing a “right-to-die” through Physician-Assisted Suicide (PAS) seems destined to grow until, eventually, some case or other prompts the U.S. Supreme Court to decree it as a constitutionally-protected right (as in 1954 – Brown v. Board of Educaction “legalizing” public school integration; 1973 – Roe v. Wade “legalizing” abortion; or 2015 – Obergefell v. Hodges “legalizing” same-sex marriage).

Understandably, some physicians see a patient’s decision to proactively hasten their end-of-life as representing a failure. So do I. But there are two different failures in view here. One of them is unavoidable. At some point, the tools, techniques, and therapies of modern medical practice fall short of restoring a patient’s health, or even of preventing that patient’s death. But while, in my life, there is still hope of the process accomplishing its stated goals, I am thrilled to have a primary-care physician who clearly states what steps are required to prolong and improve my life. I have known physicians, though, whose patients have died, despite efforts that should have prolonged or enhanced their lives. Sometimes, the medical system fails to keep a human’s physiological system functioning.

But there is a second failure in view when a patient chooses to proactively hasten the end of their life. Not that I am unsympathetic to the decision. In more than three decades of pastoral ministry, I have sat with enough patients and families to know how dreadfully difficult life can become, even with vitally-supportive faith communities being as attentive to their needs as possible. Still, even when the medical system announces “there’s nothing more we can do” (by which we mean “there’s nothing more we can do to cure you”), I do not support suicide, even if legally sanctioned and popularly recommended.

My belief in the sanctity of life extends from conception (and even prior to physical conception—given Jeremiah 1:4-5) to natural death. So, is the legislation sanctioning Physician-Assisted Suicide a failure of the Church’s emphasis on the sanctity of life. Perhaps to some extent. But only because we have failed to offer a viable alternative to torturous procedures. For some patients, we propose what they interpret as senseless dissection (surgery), systemic poisoning (many pharmaceuticals, including chemotherapy), and selective incineration (usually through radiation). We accept the cost-benefit ratio when there is an expectation of recovery, restoration, or at least slowing the dying process. But what about those patients for whom there is no longer any hope of cure, who see our role as merely prolonging a life of intensifying misery? The dichotomy routinely being presented to such patients is a false one, but it proves a compelling argument for many: “When the cures we offer are no longer effective, you deserve the right to have us kill you.”

The dichotomy (a choice between only two options) is a false one. But it is a pervasive one, nonetheless. Modern medicine routinely lives up to our expectation: “Cure me.” When we are beyond its best efforts, what do we then ask our doctor to do for us? If we imagine that we have no other options than to die painfully and protractedly, in a downward spiral of ever-decreasing self-determination and dignity, it may make sense to many to choose the only other option being so popularly promoted: Physician-Assisted Suicide.

So, the patient asks the medical community: “When you can no longer prolong mu life, are you willing to hasten its end?” The legal answer in a number of states is now, “Yes, we are. And yes, we will.” But before you or a loved one finds yourself facing that binary decision, the false dichotomy of choosing either “painful life or peaceful death,” consider that there may be other answers.

A small, and apparently invisible part of the medical community exists to serve a third purpose. Our goal is neither to prolong your life nor hasten its end. Providing pain-relief, symptom-control, and as much improvement in your quality of life as possible, the goal of hospice care is nothing more or less than to help you live until you die. Amidst a culture that will continue to gravitate toward offering just two options to dying patients, my hope is that you will at least discuss with us what we might be able to do for you, when you’ve been told “there’s nothing more we can do.”

"You matter because you are you, and you matter to the end of your life. 

We will do all we can not only to help you die peacefully, but also to live until you die."

— Dame Cicely Saunders, nurse, physician and writer, and founder of hospice movement (1918 - 2005)