Thursday, September 24, 2009

The Worm in the Apple

Scott and Helen Nearing

Are you familiar with Scott and Helen Nearing? In mid-twentieth century they were pioneers of the back-to-land movement. Their co-authored book Living the Good Life: How to Live Simply and Sanely in a Troubled World (1954) chronicled their 19 year experiment in simple living in rural Vermont.

Scott Nearing was one of the larger than life personages of the 20th Century. His radical views, including socialism and pacificism around the years of World War I, led first to his dismissal as an economics professor at University of Pennsylvania and then Toledo University. After nearly two decades of activism as a socialist and communist in NYC, Scott with wife Helen retreated to Vermont, c. 1935, where they broke their days into three parts: 4 hours of physical work; 4 hours of service related work; and 4 hour of personal work. Born in 1883, Scott Nearing lived one hundred years. The nature of his dying and death is noteworthy. Helen Nearing’s account of her husband’s end of life choice is packaged with much good thought about the art of dying, which she weaves into the fabric of living the good life.

This extended piece, which I will now read, comes from the foreword to a collection of quotes, Light on Aging and Dying, compiled by Helen Nearing in 1995.

Helen Nearing

There is much speculation about life after death.

What about life before death? To learn how to be old is one of life's last lessons. To learn how to die is the very last lesson of all.

When vital powers ebb and we realize we are on the downturn, we can prepare with equanimity or with trepidation. How we approach old age, and finally death, is our own affair and no one else's. We are the ones who must choose our attitudes and behavior.

Our live's experiences, well assimilated, can be our gift to the mainstream. We can take care to pass on in some form what we have learned in living our lives. We have received; now we can confer what we have learned and gained, while we are still around to do it. Up to the last moment of life there are opportunities to make a contributory mark.

The inevitable aging of the body need not cut us off from leading a good life. Even abed or in a wheelchair we can contribute in some slight or great way by little particulars of personal conduct. We can deal with circumstances in nondestructive ways: we can be pleasant and cheerful or we can growl and complain and criticize, demeaning others and their projects. While losing some of our vital powers, we can try to remain healthy and strong in mind and spirit, if not in body.

Psychological aging, melancholic and misanthropic, need not accompany physiological aging. There can be such a thing as successful aging. A sense of wholeness, of integrity, can be the culmination of old age. It can be a time of rich involvement, with a golden glow over the inevitable ending.

The whole of our lives so far has been our message. What now, in the time still available? We can deepen our awareness; we can fulfill ourselves and help others by imparting what we may have learned from the high and low phases of our existence. In that way we can find completion at the end of our lives….

A good old age can be the crown of all of our life's experiences, the masterwork of a lifetime. Behind us are years of actions and thoughts that developed us, changed us—and the world—for the better or the worse. We know in our inner selves which they have been and to what goal they have led.

That is past and gone. Now, or at any age, we can still make adjustments, can still become the best of what was in embryo at our birth. We came with incalculable opportunities ahead, no matter in what circumstances we were born. Some changes for the better we grasped; others we let slip. We sometimes frittered away our time and got nowhere; at other times we made the very most of the situations in which we found ourselves. It is up to us still to become what we are capable of becoming. There is time while we are still in the body.

Just as the last stages of one's life can be a shiningness or shadowed, so the act of dying can be bright or dark. It can be a harrowing ordeal or a hallowed happening. As we can live into our old age with consideration and grace, we can approach death with minimal distress, meeting it with dignity and deference.

There are techniques for dying well, just as there are for living well. There are ways of transition, sane approaches to death. We can make a conscious and worthy exit. Dying can be a natural and desirable process, a happy act, a rendering back to the whole what has been separated for a time-—a willing and glad restitution, almost a celebration of successful aging.

My husband, Scott Nearing, died with deliberation and in full consciousness. He knew exactly what he was doing and planned it in advance. It was a death in keeping with his life— a reasoned process which he wanted to experience and make manifest. Death, to him, was merely the last stage in his growth, a natural organic act. He knew he was near the end and he wanted a death by choice—his own decision. His life had been sane and lived quietly and purposively. He wanted to go the same way—to live right into death.

One day, as we were starting our evening meal at the table, he said, "I think I won't eat any more." He was ninety-nine, approaching his hundredth year. His body was wearing out, his usual vigor ebbing, and he was ready to call it quits. He thought he had lived long enough, and he was interested to know what lay beyond. He believed in some kind of survival of the spirit, some continuity, and was ready to enter into and partake of that phase, as he had learned from and contributed to the physical phases of life.

From that time—a month before his hundredth birthday—he abstained from all solid food, taking only liquids. He waned and lost his strength, but kept his wits and good cheer— and determination. After a month of fasting on vegetable and fruit juices he announced, "Only water, please."

His aim had been to avoid all pills, drugs, doctors, and particularly forced feeding in hospitals or nursing homes. He had wanted to die at home, quietly, and in his own good time. All of which he did, simply and serenely and resolutely. He stepped quietly and consciously into death.

At the very end, alone with me, after a week on water, he breathed his last, detached and yet still aware. He drifted away and off, like an autumn leaf from the parent tree, effortlessly and tranquilly. It was a benign and calm departure—well-timed and appropriate. He breathed low; then he breathed no more. He went somewhere else, with active volition. He had practiced the art of dying well.

End of Life Issues

The health care reform brouhaha has shone light on one of the crucial social issues looming on the western horizon: end-of-life.

Three factors converge: 1) American lives are being extended by extraordinary health care—longevity generally, but also palliative care when it is clear that a person is dying. So, lives are generally longer and the decline into death is often relatively slow and long. 2) There is a demographic bulge, the much-ballyhooed Baby Boom generation, who are entering elder years, some 85 million Americans born between 1946 and 1964—a little more than a quarter of the current population. It is anticipated that Baby Boom men will live into their early 80s and women into their mid 80s. 3) Currently 27% of Medicare’s budget is expended during a patient’s final year of life; and as we have learned, resources of health care providers, facilities, and dollars are limited.

Some of the loudest voices against health care reform, ironically, are from seniors already receiving Medicare, ironically a form of socialized medicine, who fear a diminishing of services/care.

There are also fears, and for elders it might be more visceral, regarding a coming triage, when rationing of health resources favors the younger and the healthier, relative to the older, ill, and even dying.

In mid-August opponents to the Obama Administration’s progress toward health care reform raised the specter of bureaucratic death panels who would have the power to “pull the plug on grandma.”

How this perception came to be has a torturous path of insinuation and misinformation against liberal health care reform as imposing (through government funding) abortion and euthanasia. Shortly after Mr. Obama’s election a November Washington Times editorial, according to a NY Times article, reminded its readers “…of the Aktion T4 program of Nazi Germany in which ‘children and adults with disabilities, and anyone anywhere in the Third Reich was subject to execution who was blind, deaf, senile, retarded, or had any significant neurological condition.’

“Noting the ‘administrative predilections’ of the new team at the White House, The Washington Times urged ‘anyone who sees the current climate as a budding T4 program to win the hearts and minds of deniers.” (I editorialize that this is a very clever bit of propaganda—blending so-called Obama “predilections” toward socialism with Nazism with Holocaust deniers.)

Conservative talk radio personalities furthered such innuendo and misinformation that misinterpreted a possible provision regarding end of life counseling. And most famously, former Vice President candidate Sarah Palin in an August Face Book posting declared: The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s ‘death panel’ so his bureaucrats can decide, based on a subjective judgment of their ‘level of productivity in society,’ whether they are worthy of health care. Such a system is downright evil.”

The furor caused Senator Charles Grassley of Iowa, one of the 3 swing Republicans, to declare: “There is some fear because in the House bill, there is counseling for end-of-life. And from that standpoint, you have every right to fear. You shouldn't have counseling at the end of life. You ought to have counseling 20 years before you're going to die. You ought to plan these things out. And I don't have any problem with things like living wills. But they ought to be done within the family. We should not have a government program that determines if you're going to pull the plug on grandma.”

Though patently false, accusations of Mr. Obama promoting death panels, touched raw nerves. Some of those raw nerves, maybe the most, concerned animosity toward Mr. Obama. And this week there has been plenty of back and forth regarding the nature/source of that animosity against him.

However much animosity for Mr. Obama plays in the debate, I don’t want to discount very real end of life issues. We have a large and aging population, living longer than ever before, using a significant percentage of health resources especially in the last year of life.

I’ve offered you two aspects of moral reasoning that I consider when it comes to ethical reasoning generally, by this morning specifically to end of life concerns. The first is Schweitzer’s Ethic of Reverence of Life. The second involves the notion of Choice, as lived out by Scott Nearing who chose to gently end his life in his 100th year.

With Schweitzer I maintain that it is good to sustain life and it is evil to destroy life. Our personal and collective humanity is significantly defined by how we treat those most vulnerable among us--the young, the infirm/ill, and the aged. The hospice movement, especially with the viable option of spending final days at home, has proven how we can care for one another, humanely and lovingly, at life’s end.

And Scott Nearing’s example reminds me of what I’ve witnessed before and affirm, the right of a person to choose to die. This is especially true when it comes to one facing an exceptionally debilitating illness such as ALS. I’ve long believed that freewill—the right to choose one’s outlook in any stage of life—is essential to be fully human. The right-to-die is a tricky area and fraught with dangers. Still, in this regard I lean toward carefully framed means for Physician Assisted Suicide as in Oregon and Washington. At the very least, though it may never be acted upon, a right to die gives a patient a sense of control, even in the depths of the worst circumstances imaginable.

Scott Nearing’s life along with Helen Nearing’s commentary reminds us of 2 important considerations: 1) “the good life” is, in part, preparation for a life’s final days; 2) and that the final days themselves can be incorporated into the greater scheme of living meaningfully and well. How shall we care for one another at life’s end?

The most intelligent sentences spoken in the “death panel” brouhaha was by Senator Grassley: “You shouldn't have counseling at the end of life. You ought to have counseling 20 years before you're going to die. You ought to plan these things out.”

My friends, these two conclusions relate directly to what religion is all about. My colleague Forest Church has put it quite simply and I agree: “Religion is our human response to the dual reality of being alive and having to die.”

In this Church of the Human Spirit we do this pondering of he dual realities of “being alive and having to die” extraordinarily well—that is realistically, seeking the fullest meanings possible inherent in the human condition.