Making tough end-of-life decisions

John Haas writes that Catholics should be equipped to address end-of-life questions . . .

Dr. John Haas

The National Catholic Bioethics Center provides over 1,400 consultations in a given year. Without a doubt, the issue most often raised with our ethicists has to do with making difficult, sometimes heart-wrenching, decisions at the end of life.

Catholics, however, should be the best equipped to address these challenges calmly. After all, we know that our final destiny lies not here but in the life beyond the grave. Also, how many times a day do we bring up our own death when we pray the Hail Mary? And then there’s the wonderful Catholic devotion of praying to St. Joseph for a holy death.

Nonetheless, when we face the challenge of making decisions for our loved ones, it can be very difficult. We don’t want them to suffer on the one hand, and we don’t want to lose them on the other. We’re also sometimes conflicted because we don’t know exactly what the Church would have us do.

Because of our love for life, many Catholics think the Church insists that we use every means available to keep someone alive as long as possible. This is not the case. The U.S. bishops have issued a guide known as The Ethical and Religious Directives for Catholic Health Care Services. This useful document, however, cannot tell Catholics exactly what must be done in every situation. Decisions must be taken in each individual case — and there are countless details that can enter into each situation.

For this reason, the Church generally discourages the use of a “living will” or “advance medical directive” which presume to state what one wants at the end of life (for example, “I do not want tubes”). However, one cannot know ahead of time whether the “tube” will alleviate suffering or assist in significantly extending one’s life. This is why we at the Center encourage people to designate a “health care proxy,” someone to make decisions on their behalf when they’re no longer able to do so.

One time I received a “living will” from a parish priest who asked me to read through it to see if it was ethically sound. He had written 27 pages, single-spaced, about what medical interventions ought to be taken if this or that happened. I wrote him back and said, “Father, I have one criticism of your living will: It’s not long enough!” It was not long enough because we simply cannot anticipate all the problems that could arise. That’s why it’s better to designate a trusted friend or family member who can make such decisions when you can’t.

But what about some specific advice our tradition can give us? Directive 56 of the Directives reads: “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.” This is a very helpful guideline for Catholics, and it’s obvious that the facts of the case can vary with each individual.

It’s important to note that the judgment with respect to what would constitute an excessive burden or an excessive expense rests with the patient. It might be that the patient simply doesn’t believe that an experimental cancer treatment which has terrible side-effects and which might extend his or her life for two months offers a “reasonable hope of benefit.”

Or the patient might prefer that family resources be used to send his last child to college rather than be used on an experimental treatment. This ought to be a judgment made by the patient, not by an insurance company or a governmental agency!

And one step we should certainly take near the end of our earthly pilgrimage is to call a priest to bring the comfort and joy of the sacraments of Reconciliation and Anointing.

The bishops’ Directives remind us that we must ultimately be prepared for eternity. “The dignity of human life flows from creation in the image of God, from redemption by Jesus Christ, and from our common destiny to share a life with God beyond all corruption.” The only thing that could risk the loss of that shared destiny is sin.

The bishops’ Directives are available at the USCCB website or through The National Catholic Bioethics Center. The Center also provides the simple and easy to understand Catholic Guide to End of Life Decisions, which includes a form for an “advance medical directive” or the designation of a “health care proxy” which conforms to Catholic moral teaching.

John M. Haas, PH.D., is president of the National Catholic Bioethics Center and founding president of the International Institute for Culture. He is a member of the Pontifical Academy for Life.