It is often said that Americans live in a death-denying culture. Others around the world have observed that we live as though we think death is optional, as though it happens only to an unfortunate few. And yet, spiritual self-care would call us to periodically and intentionally take the long view across our lifetimes; looking back across our years of living and ahead toward death as a culmination of our earthly spiritual journeys. What might it be like to look toward our dying process with intention about decision-making we might encounter; actively engaging those choices medicine gives us about the way we move through the interim of a life-limiting diagnosis and ultimately to the time of our transition? Then in balance with those choices, our intentionality would also remind us to embrace what continues to be unknown; making peace with what remains veiled in the Great Mystery. Does looking ahead, taking the long view, change the way I join with the Creator in living into the completion of my journey?

If we think about death and dying from this vantage point, how does it change the stories of our sojourns here? Is my passage through this journey different as a Christian when I view my lifetime as a narrative with a beginning and an ending? What do I want to be intentional about as I write this story? Is the way I face death a part of the spiritual legacy I leave with my family? What will my children and my children’s children learn about the way to approach death by watching me?

One of the ways we can begin to address these wonderings is through an active consideration of advance care planning as a spiritual exercise. We often think of these conversations as far afield from a pondering of our spiritual journeys; as though what happens to the body as death approaches is somehow separate from the spiritual life.  If we proceed from the notion that we are a “nephesh,” a living being into whom the breath of life has been breathed, then anything that affects the body surely affects the spirit. Even those utilizing more secular language in end-of-life care settings have reiterated this basic truth by saying, “we are spiritual beings having a physical experience.” 

So what exactly would advance care planning as a spiritual exercise look like, and what would it involve? 

It would mean:
•    approaching end-of-life care issues consciously, engaging them as part of your “reasonable, spiritual service.”
•    becoming informed about choices that might be before you at end-of-life.
•    honestly and prayerfully working through what your values are—what feels important to you—about healthcare  
     choices in the dying process. Where do you draw lines between heroic measures and comfort measures as   
     disease processes progress?
•    communicating your decisions, values and preferences to your family and to your physicians/healthcare providers.
•    putting these decisions into writing in advance directives, until such time as they are needed, in this way caring for
     your loved ones so they will not have to agonize over what you would want if you could communicate with them.

While conversations about these issues are always challenging, recent concerns have been raised over charged political rhetoric pairing hospice care and completion of advance directives with distressing language about “death panels” and “suicide education.” One politician, referring to a proposed benefit that would provide opportunities to talk in an informed way about advance care planning options with health care providers, characterized them as “counseling sessions that will tell them how to end their life sooner, how to decline nutrition, how to decline being hydrated, how to go into hospice care” (Julie Rovner/reporting,  NPR August 12, 2009, http://www.npr.org/templates/story/story.php?storyId=111729363).

Even though such assertions may be demonstrably erroneous, they still succeed in preying on the fears of elders and others at vulnerable places in their health journeys, and thus fuel that fear. More balanced reflections on these issues from reliable sources, while available, find it hard to compete with the rapid fire dissemination of rumors around such rhetoric through the use of current technology such as e-mail, texting, facebook and twitter. So our challenge as people of faith is to find ways to traverse this rocky political terrain while holding onto spiritual visioning for our life journeys.

It is important to remind ourselves and others that any advance directives we make are ours to change at any time, if as we live into the journey, we receive a deeper wisdom or more profound guidance. There are also many resources available to us that can serve as important tools to help with our discernments.  The National Hospice and Palliative Care Organization provides an excellent guide for surveying this landscape at http://www.caringinfo.org/planningahead. There you will find links to help with the different aspects of advance care planning.

A recent experience provided a powerful framework for me to place my own inner ponderings about these questions. At the end of June, I stayed with the Sisters of Mercy in their retreat center just minutes from the San Francisco airport. Mercy Center has become one of my very favorite places for intentional pauses that allow for quiet reflection. The grounds of the center are sprawling and can best be experienced on a wonderful walking trail through a woodland terrain overlooking the bay. As the trail doubles back around to the motherhouse, it comes right into the gardens. I was walking this trail in the very early morning after our very late night flight, and had been enjoying the walk through old growth groves, stopping to place my hands in homage on several ancient juniper trees. I knew the trail was taking me back in the general direction of the gardens, and yet was surprised when just ahead of me on the trail was a small path leading to a gate. One could choose to continue walking on the trail, or to pause and explore what was behind the gate.  

My body, seemingly of its own volition, turned onto the path, leading me to a worn, rough-hewn, wooden gate, with old-fashioned wrought-iron trim and latch. My hand touched the latch in reverence as I lifted it, somehow already knowing what I would find when I entered. I opened the gate, and still gasped at the beauty of the garden before me, gently holding space for the wonderful labyrinth at its center. I closed the gate behind me and stopped in stillness at several small meditation sites surrounding the labyrinth, feeling that I had entered non-ordinary time as the breathtaking colors of abundant flowers and blooming trees seemed sharper and more brilliant than any hues encountered in ordinary consciousness. My hands dipped into a stone basin filled with rainwater, Creator-blessed, dripping it onto the top of my head, allowing the droplets to trickle from my fingers all the way to my feet. And then I walked the labyrinth. 

Along the way I was acutely aware of chirping song, dawn light, and hummingbird flight all around me. At the center of the labyrinth was a beautiful, black standing stone, cool to the touch.  The stone called me into an intense awareness of the Rock of my Salvation. And there I prayed about many things, asked many questions, until I reached the end of words, and finally there was only my breath in the stillness. And in the stillness there was the Presence…

In many ways this story is a metaphor for the spiritual life, as we seek as Christians to “walk as He walked.” As our journey on the earth ends, there are choices in the paths before us. In this story, one could return by way of the trail, or one could choose to come by way of the garden.  Both paths led back to the motherhouse. 

Similarly, there is no one “right choice” in the paths we choose concerning decisions related to end-of-life care. But, there are definitely choices to make, and this is the work truly before us to do. Let us make these decisions consistent with our spiritual walks. Place advance care planning into the framework of your spiritual journey, and in the fullness of your wisdom, keep watch for the garden gate. Know that The Holy One is in the habit of creating surprising moments of communion that sweep away the mist befogging our minds, to give us clarity and direction beyond all our imaginings.

Additional Resources:
For Help in Checking Accuracy of Political Rhetorical Claims go to Annenberg Public Policy Center and www.FactCheck.org

For Help in Navigating Ethical Questions Related to Healthcare go to The Association of Bioethics Program Directors (representing the leadership  of 60 North American academic bioethics.) http://www.bioethicsdirectors.org/