In-Dignity

In the last article I posted (July 4) I mentioned that I had been working with the archdiocese of Boston on its educational campaign opposing doctor-prescribed suicide, an initiative that will appear on the November ballot here in Massachusetts…this year…for starters. If you think that this concerns only the Bay State, or that it’s a matter of “privacy” with no bearing on public policy, you might want to scroll down to that article before you read another word of this one.

That said, the issue does have its personal, if not exclusively private side. That’s what we explored in our reflection/movie/prayer sessions in seven parishes, where a total of 89 of us gathered to understand its “human” side: its spiritual, psychological, and social aspects.
One day over lunch, I told several sisters I had been thinking of using Scripture and film to do this and asked for their suggestions. Sr. Christina Miriam must have been inspired, because the HBO movie she came up with was perfect: Wit.

Emma Thompson plays Vivian Bearing, an “uncompromising” scholar of John Donne’s poetry. Independent to the point of isolation, Professor Bearing has become self-sufficient and even arrogant. At the age of 48, she is diagnosed with stage four ovarian cancer. She agrees to collaborate with medical research by submitting to eight months of chemotherapy. As she declines physically, she gradually “distinguishes herself in illness,” becomes “the one taught,” and is gradually freed from identifying her person with her professional self-image. She becomes the human being she was meant to be and so—we are led to believe—finds peace in God who never lets go.

The movie never mentions suicide, but every scene pulses with a human value that’s a major motivation both for those who go that route and those who choose life: dignity. Clearly, then, it’s a key dynamic in the current debate.

This past April, the Health Department of Washington State, where doctor-prescribed suicide is legal, issued its “Annual Death With Dignity Report” for 2011. Look at the reasons cited by the 94 people who died last year after opting to end their lives.

End-of-life concerns of those who died in 2011 in Washington State
Loss of the ability to participate in activities that
   make life enjoyable                                                          89 %
Loss of autonomy                                                                 87 %
Loss of dignity                                                                     79 %
Loss of control of bodily functions                                          57%
Burden on family, friends/caregivers                                      54%
Inadequate pain control  or concern about it                           38%
Financial implications of treatment                                          4%

Unlike laws about seat belt use, or allocation of tax revenue, this issue reaches deep within us to the core of how we perceive ourselves as persons and what we understand about our dignity as persons. As we met with people in parishes over Scripture and Wit, we all struggled with this. Morality notwithstanding, if viewers allowed themselves to remain with the surface narrative of the film—Vivian’s journey toward death—they could easily argue a case for taking their lives: Who wants to go through what she did? That narrative, though, offered us a portal for going to a deeper level: What do we deprive ourselves of becoming if we abbreviate the experience, despite the ordeal? What growth? What reconciliations? What relationships, including one with God? Vivian observed that she was “learning how to suffer.” Instead of standing apart from the rest of humanity as she had been doing, she identified with them and so, paradoxically found her true self. Not unlike real people.

Even more: The perception out there is that the Catholic Church insists on using every means available for prolonging life, regardless of expense, suffering, or indignity. So— many people reason—the only option for maintaining any kind of control over our lives is to decide how and when to end them. Nothing could be further from the truth! If Vivian made any mistake in her care, it was her decision to “leave the action to the professionals,” even regarding the management of her pain. She had already requested a Do Not Resuscitate order (DNR). Why not express her will regarding her treatment? As Pope John Paul declared to his physicians pending the course of his care, he was a “subject, not an object” of treatment; he expected to be in the driver’s seat. The movie highlights failure on several levels to provide the patient with adequate palliative care and underscores the need for everyone to have a health care advocate or proxy to ensure respect for his or her personal wishes.

As anyone who has spent a night in the hospital can tell you, you are definitely at the mercy of schedules, policies, and your disease itself—plenty to relinquish control over, plenty of indignities to endure. Why add to them unnecessarily? I’ve been touched by the dark faith of one of our senior sisters who lives with dementia. When it came to choosing Scripture passages to pray with at these movie nights, I ended up pairing the film with the Word she’s been quoting to us recently:

“Jesus said to Simon Peter,… ‘Amen, amen, I say to you, when you were younger, you used to dress yourself and go where you wanted; but when you grow old, you will stretch out your hands, and someone else will dress you and lead you where you do not want to go.’ He said this signifying by what kind of death he would glorify God. And when he had said this, he said to him, ‘Follow me’” (Jn. 21:15, 18-19).

Sr. Sean Mayer, FSP, and participants, Peabody, MA

The people I met with easily connected this text to Vivian Bearing’s experience and their own. It gives a fresh perspective to our common experience, as St. Paul understood well: “In all this we are more than conquerors because of [Christ] who has loved us” (Rom. 8:37). It takes trust and discernment all along the way. “Lord, grant me serenity to accept the things I cannot change, courage to change the things I can, and wisdom to know the difference.”

As I mentioned before, most participants took the booklet To Life! Life and Death With Dignity Through Scripture and Screen, to use at home. It allows them to repeat the encounter through additional films and apply the educational experience to children, teens, and other adults. The idea was to extend the benefits of the group session among family and friends. The beauty is that no one has to be a media “expert” to profit from it. It’s a simple way to connect faith with media culture.*

Wit cleverly exploits the poetry of John Donne to shed light on Vivian Bearing’s inner journey and struggle for dignity. At the forefront is his sonnet “Death, Be Not Proud.” It’s short enough and relevant enough to include here in its entirety:

Death, be not proud, though some have called thee
Mighty and dreadful, for thou art not so;
For those whom thou think’st thou dost overthrow
Die not, poor death, nor yet canst thou kill me.
From rest and sleep, which but thy pictures be,
Much pleasure; then from thee much more must flow,
And soonest our best men with thee do go,
Rest of their bones, and soul’s delivery.
Thou art slave to fate, chance, kings, and desperate men,
And dost with poison, war, and sickness dwell,
And poppy or charms can make us sleep as well
And better than thy stroke; why swell’st thou then?
One short sleep past, we wake eternally,
And death shall be no more, death, thou shalt die.

In a flashback moment, Professor Bearing admiringly recalls how her own teacher and mentor, Eve M. Ashford, upbraided her for having referenced an inferior version of the poem and so, missed its point.

Ashford: Nothing but a breath—a comma—separates life from life everlasting. It is very simple really. With the original punctuation restored, death is no longer something to act out on a stage, with exclamation points. It’s a comma, a pause. This way, the uncompromising way, one learns something from this poem, wouldn’t you say? Life, death. Soul, God. Past, present. Not insuperable barriers, not semicolons, just a comma.
Vivian: Life, death...I see. It’s a metaphysical conceit. It’s wit! I’ll go back to the library and rewrite the paper—
Ashford: It is not wit, Miss Bearing. It is truth….

Our postulants had their own workshop/movie session.

Like Paul who taunted, “Death, where is your victory? Oh death, where is your sting?” Donne chops death down to size by reminding it of its transitory nature and of the company it keeps. Instead, in suicide it takes on a mistaken identity. If we think that death rescues us from fear and pain—a fate worse than death?—we give it a power it does not have, a prestige it does not merit. In effect we say, “Yes, Death (“capital D”), be proud! You have saved me!”

Really, what does it mean to die with dignity? A question I sometimes asked participants was, “Did Jesus die with dignity?” The initial response was a resounding “No!” Then as they reconsidered, they weren’t so sure. Is it the circumstances surrounding death that determine a dignified passing, or the way it’s faced? When we look at the passion narrative in the Gospel according to John especially, Jesus is clearly in charge. He unflinchingly carries his kingship and control, sure of his Father’s love even when he no longer feels it. Go through chapters 18 and 19; you’ll see what I mean. His dignity in death is ours for the asking.

Dignity is not what we give each other, but is something human beings possess inherently within themselves. The respectful way we treat others acknowledges that dignity and can go a long way in helping them to recognize their worth, but nothing we do can add to that dignity or take away from it. In addition, a person’s dignity is eroded not by what is done to him or her, but by the choices she or he makes (cf. Mt. 15:11). While it is championed by believers, this is a principle that those of other faiths or of no faith can agree on. In fact, society has an obligation to ensure that its structures affirm each person’s dignity, too, so that people can live in keeping with it.

Regardless of how the November vote turns out, “death with dignity” will not be a one-time issue, soon to be replaced by other ethical dilemmas. How we respond to society in general will be shaped by how we respond to family, neighbors, colleagues, and friends as we share with them our vision of human dignity. For some of us that will come at the “comma” between life and life everlasting—ours or someone else’s. What insight faith can give at that point! What life!

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*Interested in a digital copy of the family/friend booklet, To Life! as well as the guide for our conversation on Wit? E-mail me your request at pearlmjo@gmail.com.

PAS—Coming Soon to a State Near You

For the past two months I had the privilege of working with Boston’s archdiocesan Pro-Life Office and the Office of Faith Formation and Evangelization on a challenging project. This November, voters in Massachusetts will be asked to legalize physician-assisted suicide (PAS), more grimly called “doctor-prescribed suicide,” which if passed, would make the Commonwealth the third state, after Oregon and Washington, to do so.

Need I say that the Massachusetts Episcopal (Bishops) Conference takes a dim view of the idea? (See www.SuicideIsAlwaysATragedy.org). The Church in Boston has officially concluded its workshop campaign and plans to inaugurate a media blitz this fall. I helped promote the informational workshops on the legal and medical aspects of the issue in several parishes and led a reflection session as a follow-up, using Scripture, the movie Wit, and group discussion to highlight the “human side” of the issue: its spiritual, psychological, and social aspects.

We had time for workshops in only twelve strategic locations. Attendance was minimal. We knew it would be, considering the topic and the current lack of media attention on the referendum. About 300 people attended the informational workshops and 89, the reflection sessions, half of whom had not attended the workshops. The upside is that the archdiocese is keeping in touch with those who offered their services to assist in defeating the Act at the polls. In addition, many of those at the movie sessions took the booklet I had prepared for home use, so that they could replicate the experience for families and friends. Stories about people, as in Scripture or on the screen, can be great indicators of what is truly human. Some suggestions in the booklet use simplified Scripture passages and kids’ movies to educate young people in reverence for life, human autonomy, compassion and dignity, and interpersonal dynamics surrounding end-of-life issues. Only 17% of Catholics in the Boston archdiocese attend Mass regularly, so churches are not the place where most people, young or old, will get their information and values formation.*

No doubt the lack of publicity will change somewhat come the fall, but even then, it will be overshadowed by the hype around the presidential election and local elections. This is a “blue” state, and a Democrat, fairly popular with Bay State voters, sits in the White House. Compassion and Choices (the former Hemlock Society) wagered on all that when it targeted Massachusetts as the next state to include its Death With Dignity Act on the ballot. With this state as an international leader in health care, a win in Massachusetts would set the stage for legalized suicide in one state after another. Last December, the Massachusetts Medical Association voted 178 to 56 against what it views as a “bad bill,” because of its lack of safeguards for the terminally ill and its disregard for palliative care. One doctor I spoke with said that although it was not part of the debate, the prospect of malpractice suits in the aftermath of misdiagnoses and wrong prognoses may well have been in the back of some doctors’ minds as they voted. Not surprisingly, disability rights activists are alarmed. In addition, various churches and both Christian and non-Christian organizations have stood up to be counted and some are planning their own educational events, including one that I know of that intends to use the movie as well. It's definitely not just a Catholic issue.

A useful online site is www.SuicideIsAlwaysATragedy.org. It includes Cardinal Seán O’Malley’s video and lists a number of digital and print media resources.

At Holy Family Parish in Duxbury

I especially like a clear, no-frills article I read in the Boston Pilot in January and which is available online: “Purpose, Palliative Care, and Respect for Human Life,” by Adam MacLeod. If you’re like most people and you’re touched by a good story, you’ll appreciate the article posted in March on the death of Sr. Annette Margaret Boccabello, one of our younger sisters. The resources that helped her to make her decisions regarding her care and treatment might also help you or someone you know.

If you like something a little more intricate, check out this fascinating report sent by the Catholic Health Association to the Supreme Court in 1997—Physician-Assisted Suicide: CHA Amicus Brief. A Pauline Cooperator who works for a law firm here in Boston sent me the link to the ten-page report, that includes a letter by Cardinal Joseph Bernardin of Chicago written the week before he died. It seems that the controversial Ninth Circuit Court had raised a question as to whether a person has a right, not “to be assisted in ‘killing oneself intentionally,’ but whether there is a liberty interest in ‘determining the time and manner of’ or ‘hastening one’s death.’”

That’s sobering. Among other issues, it erases the distinction, for instance, between deliberately causing one’s death (suicide) and withholding or withdrawing disproportionate means to sustain life, or managing pain with medication, even if as a side-effect, it hastens death.

It also sets society on what is being called “the slippery slope.” The CHA observes that if law is grounded in choice rather than in moral right, “there is no coherent way to limit a purported right to ‘assisted suicide’ to terminally ill people or to competent people who can communicate,” since not even incompetent people “lose their constitutional freedoms simply due to their incompetence.” The non-communicative or incompetent person’s health care proxy would be authorized to make that decision. Euthanasia, or physician-administered poison would be the next step, since as the Court declared, it considers it “less important who administers the medication than who determines whether the terminally ill person's life shall end.” The CHA report’s argument concludes, “At this point, assisted suicide is no longer a clinical event occurring in a health care setting; it is nothing more than state-sanctioned killing by private agreement.”

The voice of the people is not, of itself, the voice of God. Personal choice or public consensus as a basis for law are as arbitrary as the “divine right of kings,” when exercised apart either from natural law, which rests on the purpose for which things exist, or divine positive law, such as the Ten Commandments. For instance, my lungs are made for inhaling oxygen that my blood needs to sustain life throughout my body. If I go into the garage, close the door, turn on the car, and begin to breathe carbon monoxide instead, I’m using my lungs for something other than what they were intended for. My “choice,” regardless of how it’s condoned by the public, is immoral according to natural law. Notice that the basis for this morality, or natural law, has nothing to do with religion; it’s common to all human beings.

This may seem all very theoretical, but it provides the foundation of what we’re witnessing: 
•    When a terminally ill person can request a lethal prescription and have that written request witnessed by an heir and a total stranger;
•    when neither the psychologist administering the psychological test nor the prescribing physician need to know the person;
•    and when death certificates are falsified to reflect the underlying disease and not suicide as the cause of death (life insurance policy concerns?),
we have to ask ourselves some very hard questions about how superficial our moral reasoning has become and not turn our eyes from its consequences. What can our response be?

My two-month interaction with a broad range of Catholic attitudes toward life and dignity was an education for me as much as it was for the people I served. It was a privilege to reach out among them with the Pauline mission, using media in connection with God’s Word, to address an issue that I’ve made my own since my sister and I cared for our parents. We faced many of the same questions and agonies as those I talked with. People were deeply touched by the session. One parish secretary sent us a note that she was thankful for the “human face” the media experience put on the issue.

What kind of world do we want to leave to the next generation? One, I would think, which offers creative alternatives to suicide in facing life’s challenges, one in which we freely take charge of our own lives within an increasingly dizzying array of technological choices. Next week, we’ll look at the movie Wit, see how, practically speaking we can live and die with real dignity, and “grow” our imagination to envision courses of action worthy of our humanness in its best sense, alternatives to the cheapest way out, economically and humanly. May we discover hope.

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*Interested in a digital copy of the family/friend booklet, “To Life!” and the guide for our conversation on Wit? E-mail me your request at pearlmjo@gmail.com.