Advance Directive - A Questionable Solution
Nahman of Bratzlav, a great Chasidic rabbi once proclaimed, "It was difficult for the Angel of Death to kill everybody in the whole world, so he appointed doctors to assist him."
I am finally beginning to understand the rabbi's statement. For years we have been exposed to the ongoing debate of euthanasia. The questions of life and death are no longer in the hands of God or, for that matter, the healing physician. This week a family member was admitted to the hospital and asked to sign an Advance Directive. We, the family and the patient, are the ones responsible for decisions. They will define what reduces the human being from a living, productive person to an unproductive, undignified person. I assume that once the patient is catalogued as "undignified and helpless," death will follow quickly. If needed, they may even be helped along. Hence, we now have the new cliché for a death sentence, "Dying with dignity." We are expected to make monumental decisions about how much suffering there has to be.
True, when a patient is very sick, so sick that he cannot feed nor care for himself, he seems undignified. But, who says that he can make the decision to die? For that matter, he may not really care what you think. All he knows is that he is sick. He doesn't have to look good when he is feeling sick. He may even think that he is looking good!
After 30 years of chaplaincy I have come to the conclusion that almost all patients are just happy to be alive and cared for. Sure, they would like to be without pain or suffering but who doesn't!
This brings me to the on-going saga of modern medicine. As a chaplain, I am meeting more and more physicians who become methodological murderers. They believe that as a learned physician, the healer of flesh, they have the outright permission and God given right to decide who shall live and who shall die. Some actually claim that what they are doing is legal and right. Therefore, nobody should stop them. Well, I know they are dead wrong.
Imagine for one moment the following scenario: A person so sick of life goes to his local mechanic and asks to be killed. He tells his friend, Louis, the mechanic, that he would like his car exhaust pipe to be hooked up to a special hose and placed in his car so that he could kill himself. Would anyone do that? Would it enter anyone's mind that this is not murder? The answer is unequivocally, no! We don't want to be an accomplice to murder. If Louis, or anyone, would assist in this diabolic plan, they would be held as an accessory to murder. That's the law that most of us know.
Why in the world would we think physicians should be above the law? Why should physicians claim that they have the God given right as a skilled physician to not only cure and prevent sickness but also to end sickness by aiding suicide? They claim that the Advance Directive give them that right.
Now don't think we are talking about crazies. The people whom physicians put to death are very normal and decent people. They are distinguished by the fact that they may be depressed, crippled, suffering, and disenchanted about the future. Some claim they dont want their children to suffer caring for them. They welcome death thinking that death is preferable to an undignified life. Well who says so? Has anybody returned and given such a report. I ask, who says death is more dignified?
As a clergyman I have been taught that, in fact, the person who commits suicide is damning his soul. From what I have studied, a soul suffers a lot more by being cast out of the body through suicide than being in the sick body. Once dead, the soul goes to heaven. Most God fearing Americans believe that there is a soul. Perhaps some modern physicians feel that it may not be worth worrying about souls. As a great philosopher once said, "I have dissected thousands of cadavers and still have not found a soul."
The truth is that every physician carries the responsibility for extending life and alleviating the pain and suffering of the patient. Physicians must also remember that abandonment is not part of the physician's right. If healing means to sustain a patient then where does the quality of life come in. The physician should continually help. We, the families, should also learn how to help the dying by giving them a sense a dignity. I dont think people really have a clear understanding of the Advance Directive.
As life begins to fade and the soul prepares itself to return to its Creator, there should be a state of calmness and fulfillment. The dying patient should be infused with the feeling of having fulfilled all that they can in a body. They have accomplished all that is expected from the body and now will return the soul. They should not be made to feel that they are a burden to the family.
I received a phone call late at night. An engineer called about sustaining his old father who was in his late 90's and had suffered from a stroke. The physicians wanted to know what he, the son, felt would be best for his father. Being a religious person he called me and said that he wants a rabbi to help him with the decision.
In establishing that this man already was on a respirator and was connected to life support I told him to have hope, pray and keep on sustaining. For two months the elderly man wavered between life and death. Towards the end he had his respirator removed and then, quite unexplainably, he called his son by his name and then he passed away.
When I asked the engineer after the funeral, "Was it worth it?" He answered, "Definitely! To be able to be close to my Dad and hear him call me before he passed away was worth all the medicines, expense and personal suffering." The two months of dying brought more dignity and love to the father and son than ever before. It is only of late that physicians and health practitioners have become entangled with questions of life and death ultimately forcing families to make unqualified decisions.
When dealing with the sick and hooking them on the life support line, we shouldn't think of it as a cold hold button soon to be disconnected but rather as music on hold, as a time and opportunity for the patient and family to make everlasting peace and make the proper good-byes. Think of it as holding on to one another and, as the time draws near the finish line, all was done with grace and dignity. The physician must realize that God has given him the gift to practice medicine in order to heal the sick. This gift is limited and is to be used for curing and not for terminating.
There is an old expression, "Both the doctor and the Angel of Death kill, but the former charges a fee." Remember, when you visit your doctor, you may have to place your life in his hands. But, it's in God we trust.