In her second installment, Rev. Jacobs discusses her advocacy for families to discuss end of life wishes and issues that might arise. As we see below, while she stresses the need to be open, she doesn’t present a good how-to guide at this point. I hope as her series continues she does address some practical aspects of this sensitive subject matter. I want to stress again that while she is clearly writing to a Christian audience that has a specific theological view of the world, her primary theses are adaptable to other religions as well (though as I have been following her posts, it seems clear that Huffington Post could use someone to provide other cultural perspectives on death and dying. Stay tuned for my response to a comment she makes about this issue in a subsequent post).
When there have not been conversations about what someone’s wishes are, it is more painful for everyone. It seems especially tension-filled for adult children when a parent is dying. Sibling rivalry rears its ugly head when children have to try to figure out what their dying parent might have wanted … and each sibling has their own, different take on this. These situations, unfortunately, engender arguments and fights at the very time the family should be there to support and comfort each other and their dying parent. Letting your family know your wishes mitigates much of this pain and tension.
Now, let me point out that I did say “wishes” — because that is what one can hope for — that their wishes be followed. That doesn’t always happen for a number of reasons, including loved ones not being able to let go of the person (most people don’t want their loved one to die), and medical personnel not always following what a person has requested in an advance directive. But, if you don’t have an advance directive and/or told those who love you what your wishes are, they can’t be followed!
As she makes clear, the goal of communication doesn’t guarantee that what a person wants will be fulfilled. The real purpose is to have a base line to work. Having said that, even the communication of wishes doesn’t always create a “good” death situation. Sibling rivalry and arguments over interpretation can still happen frequently, especially when the person being affected physically by the wish is no longer capable of making decisions. This is a place were having hospice care can be valuable, for now the hospice psychosocial staff can be a resource for the family and support the family in a way to hopefully find the common ground.
So, the first step in this process is beginning to have “those” conversations with the people you love and are closest to you. I am not talking about “death panel” conversations; I am talking about honest conversations about how you want your body treated as you near death. You have the right to have everything done in order to stay alive as long as possible. You also have the right to not have everything done; to choose quality of life over quantity of life. But you need to let people know which one of those (or another scenario) you want.
As I wrote in my first posting, the greatest gift you can give to those you love is to let them know what your wishes are as to how you want your body treated as you near the end of life. It is also important to let them know what your bottom line is in terms of what you would want or need to be able to do in order for your life to have meaning for you. The bottom line will be different for each person and depending on your age, it may change. For example, I completed my first advance directive in 1991. I was in my early 30’s and at the time thought that if I could not do everything by and for myself and be able to resume all of the activities I had done prior to something happening to me, I didn’t want to live. Well, I am now 57 and my priorities have changed.
In this part of her post, Rev. Jacobs reveals the secret behind advanced planning. Our thoughts change over time, and as I mentioned in my previous post, this is why families must confront these issues every so often. It is not enough to have one conversation and be done with it. Recognizing that, the idea of advanced planning becomes that much more challenging.
As Christians we have a responsibility to ensure that our bodies are taken care of and we know that we do not have infinite life in our physical bodies, which are meant to break down (“from dust you have come and to dust you shall return” — Eccl 3:20). Adam and Eve did not eat from the tree of life, but from the tree of the knowledge of good and evil. (Genesis 3:22) So, we will one day die. And for us, as Christians, that is not the worst thing that can happen to us! We worship one who died and know that there is something greater awaiting us beyond this life. And that is where faith comes into the picture. Faith in God that God will not desert us as we are dying. As St. Paul wrote, whether we live or whether we die we belong to God. (Romans 14:8) Death is not the absence of God’s love, it is the fullness of God’s love. Jesus is with us in our dying and in our living. God’s love will never die, even as our human bodies fade away.
For patients and families of other religions, especially Judaism and Islam, the first part of this last paragraph is very poignant. We all will die one day as a result of the sin in the Garden of Eden. If we can grapple with that idea and accept that idea, then we can begin to focus on what it means to die.
For Christians, additional belief in resurrection learned from the life of Jesus has its own sense of comfort as well as teaching. This doesn’t mean that Rev. Jacob’s idea of death being another means of G-d showing love is unique to Christian thinking. Rather, for Christians, the idea of love is recognized through Jesus.
In general, religion has much to say about death and dying, though one doesn’t always encounter that in day to day religious life. If we reflect on the general theme of our mortality, we should then be able to be freer in our conversing about it. Until then, advocating for advanced planning of any sort, regardless of the politics, is almost mute.
(crossposted at the Stein Hospice blog).