Navigating ethical quandaries of end-of-life care

Bioethics focuses increasingly on end-of-life concerns. The incredible advances in science and medicine help people to live longer lives, but also present many ethical dilemmas as death approaches. There is a dizzying array of medical options at the end of life.

The chief ethical question is not what medicine can do, but what it should do in a concrete case. Fully 40 percent of the individual consultations that come to us at The National Catholic Bioethics Center (NCBC) concern end-of-life decision making. People have genuine and understandable ethical quandaries when it comes to advanced directives or deciding what is ordinary care, and therefore morally obligatory, or morally optional extraordinary treatments.

One of the most popular publications of the NCBC is our Catholic Guide to End-of-Life Decisions. I think it is safe to say that almost everyone will be confronted with end-of-life decision making for themselves or a loved one at some point. This is where some knowledge of bioethics becomes a necessity. This compact document, or others produced by dioceses or other faithful Catholic organizations, can be a great guide through dangerous pitfalls at the end of life.

The NCBC strongly urges individuals to consider appointing a health care proxy as opposed to other kinds of advanced directives. If the person chosen has a strong Catholic faith and understands the wishes of the person they will be serving, this is a morally sound choice.

Why are ’living wills’ or Physician Orders for Life-Sustaining Treatment (POLST forms) not a better option? Space limitations here do not allow for a full treatment of this topic, but here is a summary of our reasons. It is impossible to know in advance what decision should be made in every possible future medical scenario. Furthermore, a person’s views will almost certainly change over time, but unless the living will or POLST form is changed, those directives will remain in place. The best moral medical decision making happens in the moment when the current circumstances are known. This is possible with a health care proxy or agent, but not with other kinds of advanced directives.

There is also a danger with advanced directives that elements contrary to Catholic teaching may be included, for example, improper withdrawal of nutrition and hydration. The Congregation for the Doctrine of the Faith clearly stated that this is ordinary care in the vast majority of cases. The only exceptions that could apply are: if the person’s body can no longer assimilate food or water; it is excessively burdensome; or the dying process has actively begun. The Church does not want anyone to die of dehydration or starvation. This is a passive form of euthanasia and is, sadly, becoming more common. Some people end their days by Voluntary Stopping of Eating and Drinking (VSED). This practice is clearly unethical and condemned by the Church.

The most important moment of our entire existence is the end of our earthly life. Our eternal destiny is determined at death. Up until our last breath we can choose God or turn away from Him. A deathbed conversion can rescue a person from Hell. Final despair can deprive us of God forever. It is therefore vital that we make the right moral decisions as death approaches. The NCBC is a resource for Catholics in this area with our free counseling given by trained ethicists. Go to www.ncbcenter.org to reach our counseling service or to get a copy, for a small charge, of the NCBC end-of-life guide.

DR. JOSEPH MEANEY, president of the National Catholic Bioethics Center, earned a Ph.D. in bioethics from the Catholic University of the Sacred Heart in Rome. Formerly, he was director of international outreach and expansion for Human Life International (HLI). He has travelled to 81 countries on pro-life missions over 25 years. He has been featured internationally via his writings and broadcast appearances.