Saturday, July 25, 2020

Our ride into the sunset


Our ride into the sunset 
by Dr Nihal D Amerasekera

Media vita in morte sumus - In the midst of life, we are in death. This is the first line of a Gregorian chant circa 1300. This rings true now as it did all those years ago. Presently we battle through our lives in the midst of Covid-19. For septuagenarians like myself, in the autumn of our lives, there are many other pitfalls just around the corner.

At any age we all lust for longevity. Although we all will face it someday, our aversion to talk about death is universal. This is partly due to the fear of the unknown and also not wanting to tempt fate. During my childhood, grim legends were abound, and tales were told of death, devils and the darkness of hell. These daunting images continue to colour my thoughts even now. It is true there is little point in talking about death when we are young and healthy. The scene changes irrevocably when we become septuagenarians. This is the time to bite the bullet and face reality while still able to enjoy the good life.

Life expectancy has risen considerably in our lifetime. Perhaps, professionally, we have helped to make this happen. In the United Kingdom, the life expectancy for men is 79 and for Women 82. Living longer has many benefits. It is indeed so wonderful to see our own grandchildren grow-up and perhaps also to see their children too. But there is a price to be paid while the years take their toll on us. The sudden deaths that took away our parents and our grandparents don’t happen anymore. We just live longer. Our bodies continue to wither away as the years pass. A fistful of tablets and an earful of advice keep us going. The joints continue to creak and the backaches as we trundle along. I can feel the gradual decline and the loss of energy as the months' pass. I am not as steady on my feet as I was last year. Gravity is gradually trying to take over when I walk or try to maintain my erect posture for long. These issues that are rather trivial now will only get worse with time. If I live long enough I will need help for walking, feeding and ablutions. This may be with a carer at home or in an institution. This requires careful thought and judicious planning.

Life must have an end. A rapid exit is everyone’s dream. Unlike for the previous generations, the end for us may not be swift. Cancers or degenerative nervous diseases like strokes, dementia and Parkinsonism are some of the common ways to exit this world. Departing this life is never pleasant. Then again, we will need help in the way of a carer or be confined to an institution. These issues need careful planning now when we are compos mentis. Importantly the family should be consulted. They must be aware of our choices that may have significant financial implications. We must remember it is their pain and burden too. They must have the information to discuss with us the feasibility of our plans.

To plan ahead we must make an informed choice. For this, the doctors must provide us with the information with honesty. Thankfully, in the new millennium, the conceit and the patronising pomposity that existed in the medical profession has largely melted away. This has resulted in far better rapport between the doctor and the patient. When confronted with a terminal illness we need to know the prognosis, the positive and negative implications of treatment and also of having no treatment. It is invaluable to weigh up the implications of a range of alternatives, some of which may be “off the menu”, before making a choice.

It is wise to leave written instructions as to our care including treatments we do not want to have. This is legally binding and is called the Advance Decision to Refuse Treatment (A living will). I know some have instructions not to be resuscitated. Some want all treatment stopped including antibiotics. We can also allow someone else to make the decisions for us when we can’t. This is called the Legal Power of Attorney. Some cancer patients do not want any treatment. They do not wish to prolong life not wanting the stress and struggle of radiotherapy and chemotherapy and its many unpleasant side effects. It is imperative the doctor should discuss the quality of life on treatment. Many others show great resilience and courage in continuing and completing the treatment schedule and we respect their choice.

If terminally ill I should have the right to end my life. This issue has come into prominence in the UK in several high-profile cases of Motor Neurone Disease and Multiple Sclerosis that went to the Supreme Court. Adequate safeguards must be built in for this. In the UK there has been a shift in common morality for euthanasia and assisted suicide both of which are illegal under English law. Some go to Dignitas in Switzerland, a place for assisted suicide, to end their lives. Ending one’s life is the last resort. The National Health Service provides good palliative care as well as providing psychological, social and spiritual support.

The answers to the many questions that arise and the solutions to the many problems that surface will vary according to our personal circumstances. It is paramount that the wishes of the patients and their relatives are respected. I am merely raising awareness to a common problem we will all face sooner or later. As I write I know of 90-year-olds, like Queen Elizabeth II and the Duke of Edinburgh, who are still smiling, enjoying life and their families. But they are no doubt in the minority. Some may still have the old fashioned, laid-back and carefree attitude thinking “Que sera sera” Whatever will be will be!! This may just leave our loved ones in the dark about an issue which may be long and protracted and financially draining.

Making that final journey to exit from this world is something we must all do in the fullness of time. This challenging journey may take from a few days to a few months. Professional medical input is vital during this period to remain free of pain and to receive psychological support. We must leave behind the sadness and regrets of the past, taking with us only those happy and joyful memories. In the lonely waking hours, one may wish to walk with God for comfort and support or focus the mind on meditation and mindfulness. Some receive comfort from the “Mozart effect” of listening to soothing classical music. There is a lot of helpful advice available from professionals, carers and institutions to reach that final destination with dignity.

As much as there is no holding back the night, there is no hope of a second dawn. I feel we leave this earth never to return again. I seek the wisdom of that great Roman Poet Horace "NON OMNIS MORIAR" (Not all of me will die). Our children and grandchildren are shaped by the genes they inherit from us. They smile and laugh like us and even may think like us at times. They will carry our baton into the future.

As septuagenarians, our minds are much calmer now. There is no burning ambition or desire to chase money or position. We have done our caring for our progeny. Once we have made our choices for our parting it is so important we must return to our regular routine. It serves no purpose to dwell on death and dying. We will deal with it when it comes. It is so true we will not pass this way again. So enjoy the beauty of nature, the birds and the bees and the company of family and friends.  It is only then we can sing that famous song “Que sera sera”.

Here are my best wishes for a happy and peaceful journey's end with poise and dignity.

30 comments:

  1. This is the first post since I took over as temporary Blog Administrator and quite appropriately by one of our most prolific contributors. "Keep em coming!"

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  2. Mahen
    It will be patronising of me to say well done for making this happen. You have got your own Blog which you've managed in the most professional manner. So taking this on will be just a breeze!!But anyway I will say well done!!

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  3. Nihal, You have raised some important issues in your inimitable, elegant style, that we all need to confront. Laws may be different in every country, and in the US different in every state. It is wise to be prepared for the inevitable and not leave major headaches for one's children. I went for my annual healthcare interview (prelude to the annual physical) with my doctor and she handed me a document to fill out. It includes naming a Health Care Representative, Living Will instructions, Document of Anatomical Gifts, and designates a Conservator in case I am incapacitated! it is very thorough, more detailed than anything I filled out with my attorney. I plan to fill it out, leaving a copy with her as well as one with each of my daughters. My doctor described a situation with one of her patients who is intubated and unresponsive who did not have health care directives. His two children do not agree on what needs to be done and now the patient lingers on. A sad situation which could have been avoided. Thank you Nihal, for raising our awareness, although some may find it a bit depressing!

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  4. Nihal, Thank you for laying out with your usual clarity and sensitivity, the issues we will encounter and have to deal with as we “ride into the sunset” .
    The complexities and dilemmas will be many- more so for our children/ families than for ourselves, and the best we can do is ease their burden by leaving clear guidelines for them to follow. You’ve presented the many scenarios we need to think of most delicately.
    Thank you.

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  5. For a change, it is nice to watch proceedings from the sidelines. Mind you this is even before reading any content. Thank you Speedy for stepping in. This is indeed a relief.

    Now to enjoy ND's usual gems!

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  6. Srianee and Rohini
    Thank you for your kind comments. I am aware this is written for doctors who have spent a lifetime in healthcare. I have done my best to avoid being patronising. I am also mindful I have entered a no go area and feel so pleased when you say its been done delicately and with sensitivity. Those hard facts and the home truths are never palatable. Writing this it has jogged my mind to get on with things and to update.

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  7. Hi,Speedy,
    Nice to see in the mighty boots of Lucky.
    Give Lucky a temporary respite for a "Speedy" recovery.

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  8. My apologies for the length of this comment.
    • This post is most relevant to us but applies even to younger generations. I won’t deal with the very practical preparations and advice which has been so well set out by Nihal. My response is somewhat philosophical.
    • Life is possible only because it is inexorably linked with death. Although we recognised death from a very early stage in our lives, it was a something that was there in the background and we didn’t pay much attention to it and indeed tended to avoid thinking about it as it was not pleasant to be reminded that you and your loved ones are transient. I use the word transient in a relative sense. What is transient is a matter of perception. Your life is transient compared to the life of the Universe!
    • I am of the opinion that although there are many reasons for the arising of religion, one powerful stimulus was the desire to “extend” your life. Some sort of after-life is part of all religious beliefs. It provides some comfort and a basis for moral laws. We all like to see “good” being rewarded and “bad” being punished. When examining this, It is inevitable that Man sees something extraordinary, something beyond his capacity to understand how this operates. He sees a possible mechanism for this to operate as through God or Gods or some “spiritual law”. This causes problems such as why so much hardship and sadness exists in the presence of a God who is apparently either choosy or if not, hasn’t got the power He is alleged to have and this is overcome by a belief or faith that although it appears so, we are unable as humans to appreciate the true nature of the grand design.
    • Man requires some sort of “immediate” reassurance when in difficulty. The Buddhist concept of Nirvana is too distant and is of little help in these situations and hence the intermingling of mainly Hindu concepts such as worshipping deities and inanimate objects such as statutes throughout the cultural history of Buddhism . They can differ the attainment of Nirvana for a future birth but do enough good to keep their merit score high enough not to stray from the path.
    • What am I leading to? Firstly to accept that death is real and without it paradxocially life is not possible. Secondly, we cannot take our material possessions with us at the end of the journey. Thirdly, if human beings have the capacity to determine what is the absolute “truth”, they have not yet done so. If they had done so conclusively, there would be only one Religion. I think we must recognize the importance of faith (sardha), reverence and the comfort it provides to many. On an intellectual dimension we can debate and form our conclusions but this is separate from aspects of human need.. The final question is whether we have the capacity to understand reality by mere intuition or through rational sifting of evidence through learning. The Buddhist philosophy implies that intuition is possible.
    • All this leads to why I believe that we should be humble, understanding the needs of others, empathetic, non-judgmental and why we should think beyond the material universe. Death is a reminder of our common destiny, the need to live in the present and the need to cultivate our minds more than our physical aspects.

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  9. Mahen
    Thank you for that discourse on philosophy. I agree with the sentiments you have expressed with such clarity. Perhaps it is me being too much of a rustic not being able to appreciate the finer points of philosophy. No religion no real philosophy, I am like that wandering star drifting aimlessly in space only to crash and perish in the fullness of time.

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    1. Mahen, thank you for this stimulating comment. When I saw the length of it, I decided to get a good night's rest before reading it! Most people need to believe in something, a higher being or after life. Religion helps us navigate the trials and tribulations of our present state. I believe, but do I know for certain, of course not! Do I know if heaven and hell exist? All I know is that if I end up in either place, I will have friends and family in both places!
      Your last paragraph says it all: Be humble, understanding, empathetic, non-judgmental and focus on things beyond the materialistic world. If we can achieve all that without expecting the same from others, we will find true happiness.

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    2. Don't worry Nihal, you won't crash and perish!

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  10. ZITA'S reply to Nihal’s thought provoking article:
    Nihal, I hope you don’t mind my repeating: ‘Media vita, in morte’ which means ‘in the midst of life, we are in death’ the phrase with which you graced our Blog with a well written article. Nihal speaks volumes at the time we ageing colleagues read it. No doubt we all had thoughts of the end drawing close. Looking back on our own ancestry, our own countrymen and humans in general, we have had a good innings and we are on our last legs, last journey, journey’s end, to name but a few metaphors to denote this swan song’, this adieu, well there are many more expressions. Life is a mystery and so is death. This word has enough charge and enough force attached to it, even though a second later one is lifeless.
    There is no magic formula about facing it. But
    We can live each day to the full.
    Wish your fellow beings well
    ‘By the horn’ take the bull
    ‘Gonna be just fine’ you yell
    It’s the end of the beginning
    As it begins it also ends
    ‘But there’s nothing worth the wear of winning
    But, laughter and the love of friends’!

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  11. Zita
    Thank you for your comment and thoughts and the lovely poignant poem. My point in writing was to alert those of us who haven't made a plan for the future to some less palatable home truths. It is not a signal to start moaning about the inevitable. Once a plan is in place we can enjoy life hopefully to the very end. I am eminently aware the topic is not everyone's cup of tea but cannot emphasise enough its importance and relevance to us at this present stage of life.

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    1. Dear Nihal from Zita. I totally agree with all you say in your comprehensive article on 'Our ride into the Sunset' and in my first comment I could hardly add anything sensible to your wonderful assessment of this most important journey. Your discussion of any subject makes us think in the best way whatever the subject you discuss. In fact in my family you are well known for your excellent writing. Joe always gets me to print them out so he can read and 'digest' at leisure. Thank you for opening our eyes on facts relating to the time we close our eyes for good.

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  12. Mahen, You have summarized well in your last para how we should conduct ourselves.
    At the end of it, Nihal’s idea of “ crash and perish” appeals to me as there will be be no lingering . To top it all, Srianees ray of hope that whether we end up in heaven or hell we’ll “find friends and family in both places” might be something to look forward to !! Hope we dont miss each other like ships passing at night between heaven and hell- depending on which way we are travelling ! From hell to heaven as in Dante”s ‘Divine Comedy’ or from heaven to hell like Goethe”s Faust !

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    1. Rohini, somehow I think we'll end up in the same place!

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  13. Just a word of explanation about my comment.I feel that this topic cannot be fully discussed without reference to our belief systems which has a large role to play in our attitude to death and how we deal with it. Let me give you an anecdote which is a true story and it happened in my Ward. I had a terminally ill but alert patient who was unsure as to why he was so ill. His daughter told me that I shouldn't tell him that he was dying of cancer. I had a meeting with her and allowed her to talk and unburden herself. Very gently, I reminded her that would she not want to show how much she cared for him and support him in his hour of need. I then told her that as a matter of principle, I always give my patients the opportunity to question me and that I shall always give and honest answer. The tearful daughter agreed and I had a word with my patient and explained what was wrong and how we will manage him. He went quiet and then thanked me for being honest. The next morning, when I saw him in his side room, he was all smiles. I was puzzled and asked him how a man who knows he is dying can be smiling. He told me as follows. "Doctor, I just can't wait till it happens as I know my dear Ethel is waiting for me. She passed away 5 years ago and I know she is waiting for me". The moral of the story is that it doesn't matter if the helicopter in the sky waiting to come to your rescue is there are not; what matters is that you believe it is there.

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    1. Mahen
      I admire your philosophy. It is the final sentence that speaks volumes. Unlike in the last century and the centuries before people are less religious now. The new generation - they do have ethics and values. Many of them lead good clean lives. Although I am an agnostic, a drifting star, my way of life is guided by my past association with Christianity learnt at home and school and the Buddhist philosophy which I have acquired by my association with Sanath de Tissera, who has a fine understanding way beyond the rituals of Buddhism.
      The corollary of what you've said about the helicopter is also true - one doesn't have to prove its there. There are many Christians who have faith in God - for them no proof is needed. Although it seems a far cry from reality the mere thought of meeting my parents again would give me the greatest pleasure if it were true.

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    2. Absolutely true. Religions appeal to so many people as faith is such a powerful force. The academic curiosity of the Scientist seeking answers is very different to the needs of the religious follower who does not need verifiable answers but just comforting answers which make sense to them. I have total sympathy with them and my one and only reservation on religion is with those who emphatically believe their religion is the "truth" and the rest is heresy. This is the kind of belief that promotes unspeakable inhuman behavior. Incidentally, when you read the history of missionary activities in Ceylon, it was quite interesting that the Christian missionaries were quite taken aback by the acceptance and respect accorded to Christianity. The Buddhists saw Christians as good people with sound moral values and regarded Jesus Christ with reverence. Even belief in a God was not a major problem because they too believed in deities. But the Buddhists did not want to embrace Christianity because they were happy with their own religion. The missionaries then had to change tact and start attacking Buddhists as heretics who believed in idolatry worship and superstition. This in time led to a backlash against them. What worked best for conversion was the favours granted to converts in obtaining employment! The point I am attempting to make is how these missionaries were driven to highly objectionable and unethical behaviour because they were convinced that they were doing the right thing and guiding these unfortunate natives to a path leading to Heavenly bliss. You see the same kind of fervour today in Islamic fundamentalists. If only people looked at Religions as possible different ways of organising human society to live harmoniously and happily and not as "The TRUTH", the world would be a better and more peaceful place.

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    3. The behaviour of some of the Missionaries 150 years ago is inexcusable. Sadly we haven't learnt from our errors. The tragedies of the World Wars in the last century and the atrocities in Myanmar in the 21st Century are inexcusable too. Perhaps these are reasons why people are moving away from religion as they have failed to address these issues. Human intolerance causes untold misery and the troubles in our homeland are good examples as any.

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  15. People who read the history will know the amount of massacres done in the name of Religion in the fast and at this very moment.
    Spaniards destroyed several advanced Red Indian civilizations.Portuguese converted people into Catholicism where they went.Islam ramified like wild fire in Africa and the far East.
    Only religion that I can think of,never resorted to conversion are the Jews.I was told that one has to be born a Jew to be a Jew,and not by conversion.
    Karl Marx was correct by his statement that Religion is opium of man.Man's brasined is poisoned by religion as well as by opium.

    AHTS.

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    1. Sumathi, I know people who have converted to Judaism, usually after marriage, so one doesn't have to be born a Jew. However, I don't think Jews go around proselytizing the way Mormons and Jehovah's Witnesses do.

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  16. Hi friends, I have read all your comments and feel that I need to add my 'two cents!' As I wrote in my previous comment most people need some belief to bring meaning into their present life.
    When colonists arrived in new lands they brought along their culture, cuisine and religious beliefs. Some were ruthless and decimated the native populations as in North and South America. The Spanish built their cathedrals on the sites of Inca temples. You can see that in Mexico City today. I'm sure similar actions were taken by colonists in other countries as well. Perhaps converting the native population to the religion of the colonists was one way for the colonists to control the natives.
    At least the British missionaries in Sri Lanka made major contributions to education in the country, and most of us have benefitted from that; after all we are communicating in English aren't we? We even quote from English literature and poetry on this Blog!
    The prophets and teachers who established the philosophies and various religions that we follow preached simple truths, which at their roots are very similar. Unfortunately, in our modern world, to be 'religious' has taken on a negative connotation, because radical elements in all religions have hijacked and politicized these long held beliefs and twisted them for their own benefit. It is no surprise that many young people prefer to be agnostic.

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  17. Srianee, I have no problems with what you have stated and agree with you on the contributions made by missionaries. The only point I was attempting to illustrate, maybe not very well!! is this.

    I must make my point clear. I have nothing against a person of any religion expounding his faith. What matters to me is the motive. If it is driven by compassion and the desire to share a good message there may not be a problem although linked with it, there could be a potential danger. This may sound simple but it is not. Compassion is not a good force if it is guided by a dogmatic and unshakable belief in what they consider as the “truth” because it opens the methods used for conversion to unfair means. The driving force then becomes “the end justifies the means”.

    Some of the missionaries had absolute contempt for Buddhism and for example the well known Wesleyan Minister Robert Spence Hardy described the battle for supremacy between Christianity and Buddhism thus. “There can be no doubt as to the result of the contest now carried on; for although it may be prolonged and severe, it must end in the total discomfiture of those who have arisen against the Lord and his Christ, and in the renunciation of the atheistic creed that now mars the happiness, and stays the enlightenment, of so many of the dwellers of Lanka”. If you believe what he says, and why not? all he wanted was the happiness of the people of Lanka.

    There are numerous references in the colonial literature to the heathenistic, idolatry worship full of superstition which is in the way of the happiness of natives of Lanka.

    Let me emphasise again- If a person who truly cares for his fellow humans believes that any human being who does not accept the creed is doomed, then you can understand him for doing his utmost to “save” him. This to me is the danger of absolute acceptance of the “truth” and not being humble enough to say “this is what I believe, but I grant that I may be wrong or that others who follow a different path may also reach the same destination”. I grant that Colonial powers have done good things as well as bad things. I am not anti-English or anti-Portuguese or anti-Dutch, and my sole reason for suggesting that absolute belief in fundamental “truths” is to point out that it runs the risk of harming people and society. We usually couch them with the term “Fundamentalist”.

    The British were taken aback in the early days when “the natives” treated them well and showed their admiration for Jesus Christ. But the “natives” were happy with their religion and found no conflict in basic moral behaviour. They then changed tactics and began to attack Buddhism as an evil and superstitious belief. They also promoted conversion by offering material benefits such as employment and land. Most probably, all this was done because they genuinely believed that by converting them, they were saving them from disaster, just like the suicide bomber who gives his life for the “cause”, driven by the “truth”.

    I am not against Religion, but I have a problem with Organised religion and their evangelistic tendencies. I also have a problem with religions who require you to totally accept their Lord, Prophet or Leader, in order to be saved. This is the most potent force in compelling followers to take drastic action of questionable means to convert people. All of us have a right to examine the alternatives on offer and accept what appeals to us but no one has the right to embark on crusades of conversion, without regard for the methods used.

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  18. Speedy and Srianne,
    I read your comments.Conversion by marriage was a very common thing in the past and the present.To become a Muslim or a Jew,one has to follow the rituals,such as circumcision.Arabs and Orthodox Jews do not consider converts as pure Muslims and Jews,respectively.Arabs use a name for the converts that I have forgotten.
    .
    As for Srianne,I fully agree that European invader did a lot of things to improve the Island.
    Portuguese introduced the registration of names of people and I am sure the old fashioned Surnames came into existence during that period.Famous Alagiyawanna Mohottala was given the responsibility of registering the names.There is legend that a low caste man game his son the name Alagiya and Alagiyawanna was so infuriated that he ordered the poor villager to have his two lower limbs tied to two areca nut trees,and release the two trees.Poor man was split into two and died.You just imagine how so called low cast people were treated.That is still happening in Sri lanka.
    Dutch build canals for transport purposes,when I infrastructure was so poor.They were interested in trade and the East India company spread across the whole of South East Asia.British acquired the Company,later.
    English were more interested in running the administration in the Colonies and they wanted petty clerks,and not civil servants in the hierarchy.Civil servants were all Oxbridge products and the Administration was of a high quality.People embraced Christianity,in order to get privileges.
    All Religions have moral codes and forceful conversion should be condemned.
    I,am sure,the educated masses find it difficult to believe in after birth,hell and heaven.We do not know whether those places exist in the Universe.
    My Philosophy is that one should serve humanity within his capabilities.Exploitation of man by man is a disgrace and I can not understand why the unseen Good Lord does not punish them,before they end up in Hell.Some believers think that God is most merciful and same time can be harsh in punishment.Is Covid 19 God sent,in order to kill non believers.

    AHTS.

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    1. Sumathi, well said my friend -"My Philosophy is that one should serve humanity within his capabilities.Exploitation of man by man is a disgrace" . Your other genera points also have been well made.

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  19. I was educated in a Methodist School established by the Missionaries in 1874. When I was at school in the 1950's there were more non-Christian students than Christians. The non Christians were treated with kindness and respect and were provided facilities to observe their own religions. The British Chaplains are some of the kindest people I have met. Despite all that I am not a Christian but have the greatest respect for the religion and its teaching.

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  20. ND,You will know very well,about the Methodist church.
    It is a breakaway from the Protestant Church and is tolerant to other denominations.I am not sure whether conversion of pupils of other faiths were their hidden motives.There is a saying in Koran that "you follow your religion,I follow mine".I have a feeling that was a statement of Prophet Mohammad(Nabi)I have forgotten the Arabic words of that statement.Majority of present day Muslims have forgotten all about it.

    AHTS

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  21. Dear Mahen, Sumathi and Nihal, you all make valid points and have a better knowledge of history than I do (I often found the history lessons boring and fell asleep; I think it was the teacher!) I'm sure the early missionaries in Sri Lanka had ulterior motives and needed to convert the native population forcefully in order to control them. The missionaries with whom I had contact were educators and a few Anglican Priests. By then, we had obtained our independence, and like Nihal I had a positive experience under their guidance. My Buddhist, Muslim and Hindu friends were NEVER pressured to convert to Christianity. While we attended Chapel every morning they had interesting talks and lectures on Ethics. They have only good things to say about the education they received. I just didn't want all of you to overlook the contributions made to education by the missionaries, which benefitted us all. As for those fundamentalists in all religions who pressure people who are not of their faith to convert, I do not agree with their line of thinking.
    The fundamentalist Churches that are proliferating all over the world are a new phenomenon and definitely make me uncomfortable, especially when non-Christians think that they represent Christianity. True Christians respect all other religions. I guess we have generated a lively discussion on this topic!

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