Making the Most of the Time that Remains Presenter Simon McLeay
Date: 27 September 2015
I want to have a gentle conversation this morning with you all about when the end comes. You’d think we as Christians, who believe in life after death, would be comfortable talking about death. But actually we often find death just as scary to talk about as anyone else. This morning I want to encourage you to be brave and start to talk more comfortably about dying. Specifically, I want to talk about aging, and coming to terms with our mortality, and I want to talk about how Jesus can help us, our parents and our grandparents have three hard conversations. Jesus loves us, and with God we do not need to live in denial about death.
I want to acknowledge I’ve recently read the bestselling book “Being Mortal” by Atul Gawande which has really made me think about these questions. I also recently heard Dr Peter Sanders, an English expert in Palliative Care, speaking.
The angle I want to take is speaking as a middle generation, and recognising that the scripture talks about my duty of care to my parents. Honour your father and mother. Paul talks about us ‘putting our religion into practice’ by caring for our parents. So, what I’m talking about today is Christian discipleship. I’m talking as a pastor, not a doctor, and not a lawyer. I’m not wanting to put burdens on you but I want to suggest that these three conversations at the right time might help us to fulfil our duty of care.
As Christians we believe in truth telling, that we should be honest with each other. And we also believe in being gracious and kind. These are delicate conversations. But let’s acknowledge that we all age. I played hockey last week, and boy I was sore for a week! There are fascinating conversations we can have about whether God intended human beings to age or not. But that’s not for today. In this world, we all age, and we will all eventually die. And I’m primarily talking about dying of old age today. But actually we will all die of something – cancer, a heart attack, a stroke, pneumonia, or something traumatic. Sometimes we can fight these things so vigorously that it’s as if we haven’t realised that it’s one of these things that will take us.
Why am I starting with this simplest of facts? Because in the west, in the 21st century, most of us live in significant denial. We live as if we will never die. As a believer in Jesus I want to find the courage in Jesus to face my mortality with grace. There’s a time to pray for healing, a time to ask for every medical help, and a time to die. I’m not talking about suicide, but if someone you love has committed suicide you may be able to help gather their legacy for them.
Three conversations:
First Conversation: ‘My Legacy’. How can I die well; what will be my last words; have I got my will up to date; have I made some notes about my funeral; have I thought about what I want to say to my children, grandchildren and my friends before I go.
In this, Jesus provides us with a very brave model, a last meal, last words; looking out for his mother and words of forgiveness. Don’t miss out on leaving a legacy because you are afraid to face death. Jesus can give you strength. God bless the hospice movement. I had my last conversation with my dad in his bedroom, shortly before he died. And the last thing I remember is a hug and a kiss that he gave me, he was saying “I love you son.”
Second Conversation: In making decisions towards the end of life, what are your priorities or what do you value most? What matters to your mum? A number of us have power of attorney in the event that our parents can’t make decisions for themselves. Whether we make that decision, or whether we support our loved ones to make those decisions themselves, it’s good to know what matters to you. Atul writes about Susan Block, a palliative care specialist, and her conversation with her own father. She describes asking him “I need to understand how much you are willing to go through to have shot at being alive and what level of being alive is tolerable to you.” He replied “Well if I’m able to eat chocolate ice cream and watch football on TV, then I’m willing to stay alive. I’m willing to go through a lot of pain if I have a shot at that.” (p.183) Susan would never have guessed that that was what was important to her dad. There’s no formula, but do you know what’s important to your parents or to you? If there are choices to be made, what considerations should guide you?
Thirdly, and this is really towards the end, there comes a time to consider a ‘do not resuscitate’ order. When is it time to know that if someone has a heart attack you ring the hospice nurse rather than the ambulance? Or, if they are in hospital, you don’t try to bring them back. When is it time to stop trying?
Hard conversations, but really important conversations. A time to get right with God, a time to think about letting go into the arms of God, rather than clinging on to the bitter end. When is it time to fight, when is it to time to surrender?
It’s scary to face our own mortality - people fear losing control, people fear pain, people fear losing their dignity. We all do. I can understand why some people talk about euthanasia but I think that it is a false answer to a fair problem. I think that if we have these conversations, and come to understand dying a little better, we will see that there are better alternatives to euthanasia.
I believe that euthanasia robs people of the unexpected discoveries in the final stages of life. Dying is a stage of life. And God does not abandon us in this final stage of life, in fact He is very close.
I believe that we are not our own, and that we do not have the right to take our own lives. However, that is different to choosing which treatments we will adopt, or not adopt; when we will fight and when we will surrender. With good pain management, and wise decision making, we should not fear dying in great pain.
I want to return to this theme of our duty of care as children. I think that we should expect that looking after our parents will be costly. This is what Jesus refers to in Mark when he challenges the Pharisees about something called ‘Corban’ (Mark 7:11). The Pharisees had found a way to avoid looking after their parents by dedicating some of their wealth to the temple, it was clearly a rort and Jesus was scathing about it. My generation and the one before mine have got used to spending more than we make - we have left huge debts for our grandchildren. But looking after our parents may be costly and we need to learn to pay that cost as Christian disciples. That cost might be financial, but more often we need to learn to pay with time and attention, visits and phone calls. This is part of our Christian discipleship. And it is counter cultural. It was normal 50 years ago to expect to look after our parents in their old age but less common now. I don’t mean having to have mum and dad move in, I mean attending to them.
As people age I’ve recently been discovering some facts. The greatest risk factor for older people having to leave independent living is falls. I’m sure many of you fear breaking a hip, and you are right to be weary of that. But here’s something we as kids can do. The three primary risk factors for a fall are poor balance, being on more than four prescription medications and muscle weakness. (p.40). These are the big three to watch out for. Encouraging dad to use that walker could add months or years to his life; letting the man in the taxi help him down the curb. And here’s the big one I learnt from Atul, watch your parents’ feet. Are their feet in good condition, or weak, or infected with painful nails? Wash your parents’ feet. We often talk about following Jesus’ example and washing people’s feet. I’m becoming convinced that if we do that literally we will help our parents.
And you know what, if we can start to care for our elderly, we might start to have those legacy conversations,“What’s important to you mum?” “What are you most proud of?” And in those conversations we can lead a little, “Dad, what do you hope for your grandchildren?” “What would you like to pass on to them?”
Let’s go on to that second conversation, “Mum (or dad) what’s important to you in your later years?” Here’s a question from Atul’s book, “If time becomes short, what is most important to you?” If they are facing disease I’m sure their doctor will have a conversation with them about alternatives, but so often we freeze up at a crisis point. We can help our parents’ prepare for hard conversations, and we can wrap them up with prayer. There might come a time to stop pursuing new treatments. For many people there is a point at which further treatment may actually reduce their life expectancy. Surprisingly, palliative care can sometimes extend our actual lifespan. And I’ve got to say the palliative care nurses I’ve met are really good.
My dad died of oesophageal cancer. When he was diagnosed at 90 there was at least the theoretical possibility of pursuing surgery, but dad chose instead to take a palliative approach. He chose to enjoy the year ahead rather than asking for an operation that would have had minimal chance of success. In a sense, it was an easier decision for dad at 90, facing serious cancer with a major operation that he was unlikely to be offered. If he was forty, of course, we would have done the operation. But here’s the question for your conversation. What are the factors that are important for you and your loved ones? Would losing your speech be devastating for you? Losing mobility? Would you trade a few more months being able to speak and write – and maybe travel to see a friend – would you trade that for another year largely bed bound?
I had a friend my age die of cancer last year. He chose not to fight it at the end so that he could be with his kids and not sick with chemo. What I’m trying to say is that there isn’t just one answer. Values are different for everybody. And if you are the one making the decision, how does your sense of God’s purpose in your life influence that? These are not easy conversations, but important ones – and Jesus can help you have these conversations.
The third conversation is when is it time to stop fighting? To say, if my heart stops, or I appear to be going, don’t try to resuscitate me? Because CPR on a frail person might break several ribs and damage their back. If you’re in reasonable health, and have strong bones sure – go for it. But there’s that truth you have to die of something. They call this a DNR order in hospital. I know people who have been asked in hospital if they wish to be resuscitated. My friend found this very confronting – much better to have thought about it beforehand. It’s a difficult thing to think about but, if you are unwell and your heart stops, maybe it’s time to go? If you are waiting for a sign from God that your time is up, maybe your heart stopping is that sign. About 20% of older people die in ICU or CCU, that may not be the way you want to go and if you have a hard conversation at the right time, you may avoid dying with tubes everywhere and surrounded by machines.
Or when is it time to say, increase the morphine a little more to reduce the pain? Now there is a confusion that the media perpetuate. Palliative care increases pain control medication to a level that might be a little above normal, but it is still the disease that kills you. Your breathing might reduce but it is still the disease that kills you. Your doctor might give you a small dose of medication to ease your anxiety at the end of life. In Holland, with physician assisted suicide, they give you a massive dose of a barbiturate, 50 times more, with the intention of killing you. These two things are very different; they involve different drugs, dosage and intention. I don’t think we should be giving anyone permission to kill people, doctor or not. However, we all need to face the question, when is it time to stop fighting and let nature and disease take their course?
I believe that, as believers, we should be able to have these discussions, knowing that we have a loving God who will take us home, knowing that final healing is in the next world. All healing in this world is temporary, all healing in the next world is permanent. I believe in prayer, and I believe that God has given us great medicine. But there is also a time to die. I think looking after our elderly parents’ is part of our discipleship. I think we all need to be honest about our mortality. Today I’ve named three hard conversations that we can have. They are best if initiated by the parent, but are important conversations whoever brings them up. The only time I remember dad getting upset was when we started to talk about his funeral, rather than talk with him about his funeral. Let’s be gentle. But let’s talk about the values that matter. Let’s write our Wills and organise Power of Attorney, but more importantly let’s make our peace with God and understand our values, so that we can make decisions for each other if we need to. Let’s learn to put our religion into practice by caring for our parents and grandparents.
Gawande, Atul. Being Mortal. Profile Books, London, 2015.Sermon Notes Simon McLeay 27 September 2015
MAKING THE MOST OF THE TIME THAT REMAINS
1 Timothy 5:1-4
I want to have a gentle conversation this morning with you all about when the end comes. You’d think we as Christians, who believe in life after death, would be comfortable talking about death. But actually we often find death just as scary to talk about as anyone else. This morning I want to encourage you to be brave and start to talk more comfortably about dying. Specifically, I want to talk about aging, and coming to terms with our mortality, and I want to talk about how Jesus can help us, our parents and our grandparents have three hard conversations. Jesus loves us, and with God we do not need to live in denial about death.
I want to acknowledge I’ve recently read the bestselling book “Being Mortal” by Atul Gawande which has really made me think about these questions. I also recently heard Dr Peter Sanders, an English expert in Palliative Care, speaking.
The angle I want to take is speaking as a middle generation, and recognising that the scripture talks about my duty of care to my parents. Honour your father and mother. Paul talks about us ‘putting our religion into practice’ by caring for our parents. So, what I’m talking about today is Christian discipleship. I’m talking as a pastor, not a doctor, and not a lawyer. I’m not wanting to put burdens on you but I want to suggest that these three conversations at the right time might help us to fulfil our duty of care.
As Christians we believe in truth telling, that we should be honest with each other. And we also believe in being gracious and kind. These are delicate conversations. But let’s acknowledge that we all age. I played hockey last week, and boy I was sore for a week! There are fascinating conversations we can have about whether God intended human beings to age or not. But that’s not for today. In this world, we all age, and we will all eventually die. And I’m primarily talking about dying of old age today. But actually we will all die of something – cancer, a heart attack, a stroke, pneumonia, or something traumatic. Sometimes we can fight these things so vigorously that it’s as if we haven’t realised that it’s one of these things that will take us.
Why am I starting with this simplest of facts? Because in the west, in the 21st century, most of us live in significant denial. We live as if we will never die. As a believer in Jesus I want to find the courage in Jesus to face my mortality with grace. There’s a time to pray for healing, a time to ask for every medical help, and a time to die. I’m not talking about suicide, but if someone you love has committed suicide you may be able to help gather their legacy for them.
Three conversations:
First Conversation: ‘My Legacy’. How can I die well; what will be my last words; have I got my will up to date; have I made some notes about my funeral; have I thought about what I want to say to my children, grandchildren and my friends before I go.
In this, Jesus provides us with a very brave model, a last meal, last words; looking out for his mother and words of forgiveness. Don’t miss out on leaving a legacy because you are afraid to face death. Jesus can give you strength. God bless the hospice movement. I had my last conversation with my dad in his bedroom, shortly before he died. And the last thing I remember is a hug and a kiss that he gave me, he was saying “I love you son.”
Second Conversation: In making decisions towards the end of life, what are your priorities or what do you value most? What matters to your mum? A number of us have power of attorney in the event that our parents can’t make decisions for themselves. Whether we make that decision, or whether we support our loved ones to make those decisions themselves, it’s good to know what matters to you. Atul writes about Susan Block, a palliative care specialist, and her conversation with her own father. She describes asking him “I need to understand how much you are willing to go through to have shot at being alive and what level of being alive is tolerable to you.” He replied “Well if I’m able to eat chocolate ice cream and watch football on TV, then I’m willing to stay alive. I’m willing to go through a lot of pain if I have a shot at that.” (p.183) Susan would never have guessed that that was what was important to her dad. There’s no formula, but do you know what’s important to your parents or to you? If there are choices to be made, what considerations should guide you?
Thirdly, and this is really towards the end, there comes a time to consider a ‘do not resuscitate’ order. When is it time to know that if someone has a heart attack you ring the hospice nurse rather than the ambulance? Or, if they are in hospital, you don’t try to bring them back. When is it time to stop trying?
Hard conversations, but really important conversations. A time to get right with God, a time to think about letting go into the arms of God, rather than clinging on to the bitter end. When is it time to fight, when is it to time to surrender?
It’s scary to face our own mortality - people fear losing control, people fear pain, people fear losing their dignity. We all do. I can understand why some people talk about euthanasia but I think that it is a false answer to a fair problem. I think that if we have these conversations, and come to understand dying a little better, we will see that there are better alternatives to euthanasia.
I believe that euthanasia robs people of the unexpected discoveries in the final stages of life. Dying is a stage of life. And God does not abandon us in this final stage of life, in fact He is very close.
I believe that we are not our own, and that we do not have the right to take our own lives. However, that is different to choosing which treatments we will adopt, or not adopt; when we will fight and when we will surrender. With good pain management, and wise decision making, we should not fear dying in great pain.
I want to return to this theme of our duty of care as children. I think that we should expect that looking after our parents will be costly. This is what Jesus refers to in Mark when he challenges the Pharisees about something called ‘Corban’ (Mark 7:11). The Pharisees had found a way to avoid looking after their parents by dedicating some of their wealth to the temple, it was clearly a rort and Jesus was scathing about it. My generation and the one before mine have got used to spending more than we make - we have left huge debts for our grandchildren. But looking after our parents may be costly and we need to learn to pay that cost as Christian disciples. That cost might be financial, but more often we need to learn to pay with time and attention, visits and phone calls. This is part of our Christian discipleship. And it is counter cultural. It was normal 50 years ago to expect to look after our parents in their old age but less common now. I don’t mean having to have mum and dad move in, I mean attending to them.
As people age I’ve recently been discovering some facts. The greatest risk factor for older people having to leave independent living is falls. I’m sure many of you fear breaking a hip, and you are right to be weary of that. But here’s something we as kids can do. The three primary risk factors for a fall are poor balance, being on more than four prescription medications and muscle weakness. (p.40). These are the big three to watch out for. Encouraging dad to use that walker could add months or years to his life; letting the man in the taxi help him down the curb. And here’s the big one I learnt from Atul, watch your parents’ feet. Are their feet in good condition, or weak, or infected with painful nails? Wash your parents’ feet. We often talk about following Jesus’ example and washing people’s feet. I’m becoming convinced that if we do that literally we will help our parents.
And you know what, if we can start to care for our elderly, we might start to have those legacy conversations,“What’s important to you mum?” “What are you most proud of?” And in those conversations we can lead a little, “Dad, what do you hope for your grandchildren?” “What would you like to pass on to them?”
Let’s go on to that second conversation, “Mum (or dad) what’s important to you in your later years?” Here’s a question from Atul’s book, “If time becomes short, what is most important to you?” If they are facing disease I’m sure their doctor will have a conversation with them about alternatives, but so often we freeze up at a crisis point. We can help our parents’ prepare for hard conversations, and we can wrap them up with prayer. There might come a time to stop pursuing new treatments. For many people there is a point at which further treatment may actually reduce their life expectancy. Surprisingly, palliative care can sometimes extend our actual lifespan. And I’ve got to say the palliative care nurses I’ve met are really good.
My dad died of oesophageal cancer. When he was diagnosed at 90 there was at least the theoretical possibility of pursuing surgery, but dad chose instead to take a palliative approach. He chose to enjoy the year ahead rather than asking for an operation that would have had minimal chance of success. In a sense, it was an easier decision for dad at 90, facing serious cancer with a major operation that he was unlikely to be offered. If he was forty, of course, we would have done the operation. But here’s the question for your conversation. What are the factors that are important for you and your loved ones? Would losing your speech be devastating for you? Losing mobility? Would you trade a few more months being able to speak and write – and maybe travel to see a friend – would you trade that for another year largely bed bound?
I had a friend my age die of cancer last year. He chose not to fight it at the end so that he could be with his kids and not sick with chemo. What I’m trying to say is that there isn’t just one answer. Values are different for everybody. And if you are the one making the decision, how does your sense of God’s purpose in your life influence that? These are not easy conversations, but important ones – and Jesus can help you have these conversations.
The third conversation is when is it time to stop fighting? To say, if my heart stops, or I appear to be going, don’t try to resuscitate me? Because CPR on a frail person might break several ribs and damage their back. If you’re in reasonable health, and have strong bones sure – go for it. But there’s that truth you have to die of something. They call this a DNR order in hospital. I know people who have been asked in hospital if they wish to be resuscitated. My friend found this very confronting – much better to have thought about it beforehand. It’s a difficult thing to think about but, if you are unwell and your heart stops, maybe it’s time to go? If you are waiting for a sign from God that your time is up, maybe your heart stopping is that sign. About 20% of older people die in ICU or CCU, that may not be the way you want to go and if you have a hard conversation at the right time, you may avoid dying with tubes everywhere and surrounded by machines.
Or when is it time to say, increase the morphine a little more to reduce the pain? Now there is a confusion that the media perpetuate. Palliative care increases pain control medication to a level that might be a little above normal, but it is still the disease that kills you. Your breathing might reduce but it is still the disease that kills you. Your doctor might give you a small dose of medication to ease your anxiety at the end of life. In Holland, with physician assisted suicide, they give you a massive dose of a barbiturate, 50 times more, with the intention of killing you. These two things are very different; they involve different drugs, dosage and intention. I don’t think we should be giving anyone permission to kill people, doctor or not. However, we all need to face the question, when is it time to stop fighting and let nature and disease take their course?
I believe that, as believers, we should be able to have these discussions, knowing that we have a loving God who will take us home, knowing that final healing is in the next world. All healing in this world is temporary, all healing in the next world is permanent. I believe in prayer, and I believe that God has given us great medicine. But there is also a time to die. I think looking after our elderly parents’ is part of our discipleship. I think we all need to be honest about our mortality. Today I’ve named three hard conversations that we can have. They are best if initiated by the parent, but are important conversations whoever brings them up. The only time I remember dad getting upset was when we started to talk about his funeral, rather than talk with him about his funeral. Let’s be gentle. But let’s talk about the values that matter. Let’s write our Wills and organise Power of Attorney, but more importantly let’s make our peace with God and understand our values, so that we can make decisions for each other if we need to. Let’s learn to put our religion into practice by caring for our parents and grandparents.
Gawande, Atul. Being Mortal. Profile Books, London, 2015.
