Guidance for Catholics on Prudent End-of-Life Decision Making

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The last few weeks have been filled with numerous news stories of end of life issues and interesting online dialogues have taken place.

It is not my goal here to rehash some of the earlier conversations. I want to use the momentum of these discussions to introduce you to (or remind you of) some helpful documents that American Catholics need to be familiar with.

We as Catholics have a huge advantage over other traditions when it comes to understanding something as complex as end-of-life ethics. We have the luxury of centuries of some if the greatest minds in human history committed to understanding and communicating Truth added to some of the greatest minds of today who can help us apply theoretical teaching to real life situations.

It is our task, however to understand how to apply the teachings, writings, traditions and directives so that in the moment we can make prudent decisions for ourselves and those we are tasked with making decisions for.

Prudent end-of-life decision making is so important when deciding levels of intervention. Not agressive enough treatment may mean lost time the person could have lived and too-aggressive treatment may result in painful and futile procedures that are of no benefit to the sick person.

Please notice I don\’t say \”withdraw care.\” Care is an attitude of helpfulness; interventions are treatments and procedures. It is a misnomer to ever say that medical professionals \”withdraw care\” even if they withdraw aggressive treatments and procedures.

It is a common misconception that Catholics are directed to preserve life at all costs. The Bishops have addressed many circumstances and made the Directives easily available for us to review:

http://www.usccb.org/issues-and-action/human-life-and-dignity/health-care/upload/Ethical-Religious-Directives-Catholic-Health-Care-Services-fifth-edition-2009.pdf

This is a wonderfully helpful document that every Catholic adult should familiarize themselves with. If you choose not to read it now, please save the link to have as a reference in case you are called upon to make healthcare decisions for yourself or others. I specifically want to point out two items from section 5:

56. A person has a moral obligation to use ordinary or proportionate means of preserving his or her life. Proportionate means are those that in the judgment of the patient offer a reasonable hope of benefit and do not entail an excessive burden or impose excessive expense on the family or the community.

57. A person may forgo extraordinary or disproportionate means of preserving life. Disproportionate means are those that in the patient’s judgment do not offer a reasonable hope of benefit or entail an excessive burden, or impose excessive expense on the family or the community.

In addition, I suggest people visit the website of the National Catholic Bioethics Center. They have excellent resources and offerings plus the availability of well educated Ethicists for consultation.

Part of the reasons to know of these resources is that some (even well intentioned) Catholics involved in media and social media may misunderstand situations and/or expound based on opinion rather than teaching. I don\’t believe there is a conspiracy to intentionally deceive and misinform the lay faithful, but I have seen circumstances where misinformation is passed and shared and perpetuated.

These two sources I mention (along with encyclicals from Rome) are the closest we have in our society to a final word on complex bioethical issues. Again, we are blessed to have a \”final word\” resource for some of life\’s hardest challenges; I can\’t imagine being in a faith tradition where my only resource is the opinion of a local pastor.

I am interested in the questions / comments that this might spark.  I especially invite experts who may know more than I do about other excellent resources.

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8 thoughts on “Guidance for Catholics on Prudent End-of-Life Decision Making”

  1. Pingback: Crashed Ice Leads Many to Nat'l Shrine of Apostle Paul - BigPulpit.com

  2. i have a question about end-of-life issues. Basically, how do you safely determine that you are AT the end of life? We had a difficult discussion on this before my father died last month. We had understood that artificial nutrition and hydration were never to be considered extraordinary. It turns out we were mistaken on that. If death is imminent, then forcing a patient to take food and water, either naturally or artificially, is not required. As we were told by the hospice nurse, who also happened to be a deacon in the Catholic Church, people who are about to die do not need and cannot use food and water. He said that in the past, people who were dying would often just stop eating of their own accord. They were just no longer hungry because their bodies were basically shutting down. Such people would not have been offered artificial nutrition and hydration because those resources were not available. These people were not starving to death, they were just dying.

    But here is my question. My father was put in a hospice room in the hospital where he did die in about 12 hours. But what about people like him who live for two weeks or more? Can we really believe that such people should not be given food or water? If someone is so close to dying that they can’t use either food or water, why would it take two weeks to die? Or to put it another way, if you think death is imminent so you do not insert an NG or OG tube or a PEG, are you required at some point to use those resources if the patient continues to live? To put it another way, what, really qualifies as “imminent” death? Death that is expected to occur within hours or at most a few days? Or death that might take two weeks or more even without artificial nutrition and hydration?

    1. I agree with your Hospice Nurse/Deacon that while we never withhold water and nutrition for anyone who can use it, there is a time in the natural dying process when they lose all desire for it and to force it upon them does no good, extends suffering and interferes with the natural shut down that God programed into us. (Isn’t it interesting that newborns who hadn’t eaten by mouth for 9 months in-utero are born and are suddenly hungry? Its that process in reverse).

      How to tell? The physical urge of thirst and hunger themselves are good indicators, but additionally, people like your Hospice Nurse are well versed in reading peoples cues even if they are non verbal. In reality, you really cant live for 2 weeks without drinking so they either continue the dying process as your father-in-law did or they rally and again desire food and water in which case it should be given.

      A Hospice Nurse/Deacon…that person sounds worth their weight in gold…I wish every community had one of them.

      Your question of “what is ‘imminent’ death?” is really quite a good one. It is my perception (having now been a nurse for 29 years) that long ago, that term was used more widely…I have heard stories of a person being considered “dying” while they were awake, alert and taking visitors. I have been out of the adult hospice world for a while, so I cant really speak to how that is commonly used now, but in the hospital, i perceive that it is not acceptable to use the term “dying” until the person is ACTIVELY dying – possibly with just a few moments to live. I think our reluctance (even fear) of using this word is probably a disservice to families who might be better served if we were more willing to use it.

      Lastly, I very much appreciate your question and this dialogue because if we don’t discuss this stuff, people can become and remain very misinformed. I was at a local event a number of years ago and some gal piped up with “I didnt realize until now that ____ hospital was engaged in euthanasia!!” WHAT? Euthanasia is STILL wrong and illegal and she just publicly accused my coworkers of murder. I asked her why she said that and she responded “I was visiting the sick on Palliative Care and they said they had stopped feeding a certain patient”. I asked her if she knew anything of the person’s case or care. “no” I asked her about her understanding of the dying process and she really had none.

      Honestly, I was livid with her playing the “I’m more pro life than you and can prove it by the outlandish accusations I choose to make about things I have no clue about” game at the expense of my decent, kind, hardworking, and ethical coworkers. I managed to pull myself off the ceiling long enough to calmly and respectfully explain some of these things to her and in the process I told her about the Bishops Directives above.

      Bearing false witness against ones neighbor is still a huge sin and I would include uncharitable and untrue accusations against innocent healthcare workers falls into that category. I believe if we are well informed, we are less apt to fall into that error.

  3. 56. A person has a moral obligation to use ordinary or proportionate means of preserving his or her life …
    As a hospice volunteer I have run the course on end of life scenarios; spending up
    to two months and as little as two hours comforting those who choose ( elegibility
    by medicare is 6 months or less to live ) to let a condition end their lives without
    proactive medical treatment. I take it the above excerpt does not apply.

    1. The above excerpt is a directive to Catholics…so it would apply to them if they are endeavoring to follow Church teaching.

      Whether it would “apply” to non Catholics is a fascinating question …to what degree do we believe that everyone in our pluralistic society needs to adhere to Catholic teaching? That could be a wild and lively discussion.

      I applaud you for being a Hospice Volunteer (I have been one too) and I really believe that you brought something important into the mix by being a Catholic helping in the care of the dying. Corporeal works of mercy in action.

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