With the same energy she might ask for a glass of water, Eileen requested permission to die. She wished for her family, medical professionals and caregivers to allow her disease to progress naturally and take her life. With our commitment to life, advances in medical technology, responsibility for those we love and uncertainty about the future, can we grant permission to let go?
For Eileen, life at 91 years old isn’t what she expected. Curative treatments have caused more pain than hope for a curative outcome. She experiences living as hopeless and dying as a right. She sees herself as a burden to others and seeks the peace of stopping any treatment or attempt and prolonging life as it is.
For Eileen’s daughter Joan, as long as Eileen is alive, a daughter’s job is to provide care and safety for her mother. That means keeping her alive and hopeful. Still, she feels torn by Eileen’s request. Joan realizes that she might wish for the same thing in Eileen’s place. She hopes that time will bring some hope, but also wants to respect her mother’s wishes. Eileen has control over so little in her life and Joan knows how important making her own choices is to her mother.
“Allow Natural Death” (AND) is an order sometimes used in place of DNR (Do Not Resuscitate). On a practical level, AND or DNR may involve the same choices including a refusal of CPR and some other life sustaining measures. On an emotional level, however, allowing natural death may feel more like participating in natural childbirth or eating natural foods.
Giving permission is less intrusive than taking deliberate action. Saying yes to anything we fear or don’t want requires courage. Hearts and minds can be torn when it seems that no good choices remain, time and hope are running thin. Doing the “right thing” is never simple when death can be a result.
Fighting for life is hard work. Eileen is tired. Her wish for peace comes from a commitment she has stated many times through her lifetime, “When God calls me, I’m ready to go”. Now that science is able to do things once ascribed only to God (like continuing a heartbeat or breathing), God’s calling is not so clear. Eileen is still ready, but does following God’s call mean using all God has allowed us to learn about prolonging life, or allowing nature to take its course without assistance?
Several voices participate in the conversation about Eileen’s care. Eileen’s doctor, Joan and other family members and Eileen herself. Should Eileen have the final word, or is her judgment clouded by depression, dementia and feelings of hopelessness? Is her peace of mind more important than the possibility of extending her life? Who is able to know when the burden of living outweighs the benefits.
A request to allow death deserves to be heard with respect. However difficult it is to think about the consequences of allowing death to occur, several elements need to be considered.
Ron has been involved in ministry to people for more than 30 years. As a chaplain with Holy Redeemer Hospice, he hears the life stories of patients daily and faces end-of-life challenges with each one. Along with being a member of the ethics committee, regularly presiding at memorial services and teaching hospice professionals, his primary joy comes in seeing the lessons of life revealed in so many lives rich with memories and questions.
Part of the perspective he brings to the hospice experience is placing this life event in the context of an entire life and generation of family history. As a chaplain, Ron works from a strong belief that the spiritual dynamics create a sacred space for hope and personal growth until the last breath and beyond, for both patients and caregivers. Honoring each individual path toward the end of life, he believes the work caregivers do and the reward they receive is more than physical. As a hospice chaplain, he considers himself a companion on that path.
On his own life’s path, Ron has been the clinical director of a residential addiction center, a community restorative justice organization, and pastoral staff. In addition to his work with hospice patients, Ron is a licensed marriage and family therapist working with families at all stages of the life cycle. This particular practice is enhanced by his own experience of nearly four decades of marriage, two daughters, and four grandchildren.