Wrestling with the Angel of Death

JEANNE AUDREY POWERS, 85 years and counting, wanted to stop counting. She felt herself growing more frail, less clear-headed. She was losing her sight. Worst of all, the woman who once spoke on international podiums was losing her words.

However, Jeanne Audrey, as her many friends called her, was technically not terminally ill, despite the waves of mini-strokes stealing her senses. California physicians, gatekeepers under the state’s End of Life Options Act, would not deem her likely to die within six months, an essential qualification for a legal lethal prescription that would let her choose her final hour.

But she was dying to her self as she knew her self to be. And that was a form of suffering she did not believe God required of her, of anyone.

So Rev. Jeanne Audrey Powers—one of the United Methodist Church’s leading voices for ecumenism, a champion for LGBTQ rights within her denomination, and someone who knew the doctrines of her church included one against suicide—bought herself a one-way ticket to Switzerland last September. There she died, at peace with her decision, in a euthanasia facility.

She left two requests. One was that her last letter be included in the memorial service program, says Rev. Barbara Troxell, who officiated at the service. The letter describes a “deeply peaceful and affirming” vision Powers had of a fatherly God who came to her in prayer and tenderly called her “friend ... preparing me to trust the journey ahead.”

The second request was that her tombstone read: “Subversive to the end.”

Bedside manner

Among major U.S. denominations, only the Unitarian Universalists endorse the use of “medical aid in dying”—the terminology used by Compassion and Choices, a national lobby group for physician-assisted dying. Every other denomination is either silent on the topic or opposes it as suicide.

Yet seven U.S. jurisdictions currently allow aid in dying, either by law or by court decision: Washington, Vermont, Montana, California, Colorado, and the District of Columbia. In these places, clergy and chaplains who minister at the bedsides of the sick and dying may find themselves on the moral front lines, caught between the teaching common to most religions—only God sets the moment of someone’s death—and the growing belief held by many Americans that personal autonomy extends to the deathbed. And as some religious leaders admit, it’s a dilemma that pushes them to be clear on how they see the nature of God as well as the value, if any, they see in suffering.

For conservative Evangelical Free Church pastor Bob Burris, how long and how deeply we endure pain and suffering is entirely in the hands of the sovereign God—and he believes it should stay that way. When he sits by the side of fearful families who seek spiritual consolation, he tells them to “be joyful that we are not the creators of our own reality.”

Since California’s End of Life Options law took effect in June 2016, Burris, pastor for 20 years at Taft Avenue Community Church in Orange, says he has not encountered a direct request to provide spiritual comfort for someone who was planning to end their own life through medical intervention.

But he knows what he would say. Trust God, he would tell Christians. And for those without faith, he says, his compassionate role is to open the door to conversion, for the dying and for their surviving loved ones. In his experience, “The real reason that the lost are wanting to die is because they have no hope, they don’t have true relief from suffering.”

That kind of relief, the pastor says, is “only found at the cross. Dying well is dying with your trust in God. Our hope is in the savior who suffered far more than us.” If Burris himself were given a fatal diagnosis, he would live to his natural end, “joyfully,” believing he was accepting God’s will.

A dying perspective

Most Americans, however, don’t see dying this way. According to Gallup’s annual national Values and Beliefs poll conducted last May, “73 percent of U.S. adults say a doctor should be allowed to end a terminally ill patient’s life by painless means if the patient requests it,” and 57 percent find such an action “morally acceptable.”

LifeWay Research, an evangelical polling group, found that an even higher number, 67 percent, agreed that medical aid in dying was “morally acceptable” when “a person is facing a painful terminal disease.” This includes majorities of people in most faith groups including evangelicals, mainline Protestants, Catholics, and people with no religious identity.

Last November, 59 faith leaders, sidestepping the official positions of their denominations, wrote to Congress asking it not to rescind Washington, D.C.’s Death with Dignity Act. Their letter cites Luke 6:36: “Be merciful just as your father in heaven is merciful.”

Many clergy, however, see a divide between mercy and medical aid in dying.

Rev. Ray Allender, SJ, pastor of St. Agnes Church in San Francisco and a veteran of hospital ministry, remembers the day he got a call from a hospice chaplain seeking help. A Catholic patient in hospice care had said “she wanted to choose assisted suicide—and wanted to receive absolution. I told the chaplain I would be happy to speak with her if she wanted me to, that I respect her conscience. I respect her decision. But I am not able to give her absolution,” Allender recalls. But “If she had asked for the sacrament for the sick, I would have been right over.”

He would have anointed her, prayed with her, and consoled her with “the healing presence of God in her suffering” to help her find spiritual peace. “I would have said that while I may not be able to reach out to her with absolution as Catholic priest, it was more important for her to reach out to God. But she never did contact me. I don’t know what happened with her,” says Allender.

All who suffer

Rev. Michael E. Moynahan, SJ, pastor at St. Ignatius Parish in Sacramento, Calif., has yet to face such a morally distressing moment, when someone wants to do “something they know is wrong, an act for which there is no replay button.”

What will guide him, he said, is the church’s teaching that “wisdom and knowledge come through suffering. That is the redemptive aspect of it. We are called to make the life-giving choices.” In Moynahan’s diocese, “We actively tried to discourage legislators from approving the [medical aid in dying] law.”

Catholic and evangelical lobbyists have brought that same message to one statehouse after another, usually prompting lawmakers to defeat medical aid in dying bills before they ever leave committee. Disability rights activists joined in. They see such laws as demeaning the quality of their lives and subjecting them and their families to financial, social, and emotional pressures to cut off costly care. Such coalitions have blocked passage of similar laws in New York and Maryland. Then-Gov. Chris Christie, a Catholic, threatened to veto such a bill in New Jersey.

Still, Compassion and Choices’ national constituency director, Brandi Alexander, says that individual clergy of most major faiths, the men and women who meet believers at the bedside, are “much more empathetic” to changing the laws.

So was the governor of California, former Jesuit seminarian Jerry Brown. When he signed the state’s End of Life Options Act, he said, “I do not know what I would do if I were dying in prolonged and excruciating pain. I am certain, however, that it would be a comfort to be able to consider the options afforded by this bill. And I wouldn’t deny that right to others.”

“Comfort” is a term that goes beyond a sense of physical pain being eased. It touches on the very subjective idea of “suffering.”

Suffering can be rooted in fear, despair, anger for the life past or present, or the unknown to come. It can be born of relationships with other people or with God. It afflicts both the dying and those living at their side, says San Francisco Rabbi Michael Goldberg in Raising Spirits: Stories of Suffering and Comfort at Death’s Door, his book about his years as a hospice chaplain. Goldberg opposed assisted dying which, he wrote, leaves suffering unresolved for the dead and for the survivors.

Others see suffering differently. They view it as psychological, cultural—and optional. One can choose not to suffer.

What pills can’t fix

Diane Kwasman of Riverside, Calif., and her mother, Roslyn Mellman, age 90, saw no redemptive value in Mellman suffering, in deep pain from a cascade of medical issues. Mellman was firm and clear: She wanted the option to die her own way.

Kwasman struggled to face the imminent death of her mother, no matter how that death came about. So even as she stepped forward to help Mellman connect with physicians willing to participate under the End of Life Options Act, Kwasman also sought support from her friend, Rabbi Suzanne Singer. They spoke both before and after Mellman swallowed the lethal pills and died in November.

Singer was “very caring and very interested. She’s like the mother rabbi. If anything is wrong, she’s on it,” says Kwasman, who now says she feels “spiritually at peace” with her mother’s decision. Singer had lobbied publicly for the law, in part, the rabbi says, because she was aware that already, in the shadows, “people have helped their loved ones ‘under the table.’” Singer acknowledges that palliative care is deeply valuable, “but I am not sure there is enough medication, enough palliative care, for some kinds of pain and suffering. People fear losing their dignity and their autonomy.”

In some ways, Singer is right: In Pew Research Center’s 2013 study on end of life choices, people were asked about the “measures of a good life.” Living without severe pain did not head the list. It was number four, behind the ability to communicate, to enjoy life, and to feed oneself.

But Dr. Christina Puchalski disagrees with the idea that palliative care is not sufficient to address suffering beyond physical pain. As a physician and founding director of the George Washington Institute for Spirituality and Health in Washington, D.C., she takes a more expansive view of palliative care—one that insists existential or spiritual distress is worthy of treatment. The institute educates clergy, chaplains, and health professionals on how to address such terrors.

Her “prescription” for this isn’t a cup of crushed pills and a glass of water. “You can’t fix existential distress for someone,” Puchalski says. “But you can accompany them. You can be a compassionate presence who listens in a nonjudgmental way. When this happens, I have witnessed people come to a place of immense peace.”

‘Go down, Death’

Rev. Paul Smith, 82, has his own spin on Puchalski’s advice for counseling those nearing death, medically assisted or otherwise: Yes, accompany people. Yes, listen compassionately. Yes, let peace come to the restless dying. But recognize, says Smith, that people who choose the day they die may find peace, and God’s embrace, on that road as well.

Smith—a retired Presbyterian Church USA pastor, civil rights activist, and author of books and studies about views of dying in the African-American community—takes a public stand at odds with many black Americans who oppose medical aid in dying.

It’s all about trust, Smith says. Many distrust the health-care system that has failed, even harmed, them in the past. They distrust the safeguards against misuse and coercion that end-of-life law advocates say will prevent abuse. But as fervent Christians, they trust God. They remind him, Smith says, of his great grandmother, who believed that “to choose death is not up to her, it’s up to God.”

Smith agrees—with a twist. To him, God is always in charge because “God knows and acts when we give our consent to the Angel of Death.”

In his study, in Gaithersburg, Md., he keeps a photo of a rural cabin where a poor black woman might have lived her last hours because it reminds him of the poem “Go Down, Death,” by James Weldon Johnson, the composer of “Lift Every Voice and Sing.”

In the poem, the Almighty’s heart is touched by “Sister Caroline” on her bed of pain:

And God said: Go down, Death, go down,
Go down to Savannah, Georgia,
Down in Yamacraw,
And find Sister Caroline.
She’s borne the burden and heat of the day,
She’s labored long in my vineyard,
And she’s tired —
She’s weary —
Go down, Death, and bring her to me .