Tag Archives: End-of-life

Coaching Catholics through ethical dilemmas

The National Catholic Bioethics Center has an active consultation line. The vast majority of calls taken by the ethicists concern end-of-life decision-making. The principal analytical tool used in these cases is the distinction between ordinary and extraordinary means of treatment.

The Catholic Church holds that we have an obligation to use ordinary means of treatment, but that we may forgo those that are extraordinary. Typically what is meant by ordinary is any procedure that is easy to carry out, not painful, and whose benefits clearly outweigh the burdens. The extraordinary include procedures that are very difficult, very painful, too expensive, or cause some measure of deep psychological distress. Some of these criteria are more objective than others. 

We often receive questions about medical treatments for those who are elderly. On analysis, many qualify as extraordinary and may be forgone. The line between ordinary and extraordinary is not a stable one but rather varies according to the age and condition of the patient. A procedure that might easily be performed on a young person, and that would be clearly beneficial, may turn out to be much more difficult for someone who is in a fragile state of health. Burdensome treatments are not necessary, though we are always free to try extraordinary measures if we wish.

We also receive many calls from concerned loved ones who are upset by decisions made by others that do not conform to Catholic teaching. If one is not the designated proxy, and does not have the authority to make decisions, it can be very difficult to watch others make errors, but there is little that can be done about it. The only power one has in these cases is that of moral persuasion.

Thus it may be that an elderly person has requested in writing that he or she be provided with no food and water if unconscious for any prolonged period of time. Generally, we should die from some underlying condition, not from dehydration or starvation, though there are some unavoidable exceptions. Ideally, one would override this bad decision. At the other extreme, no one should be placed on a feeding tube when still able to swallow, even if he or she is unable to meet his or her full daily nutritional requirements. 

We have begun to receive calls on gender dysphoria. A father recently recounted how his autistic son had been convinced by a psychologist to undergo sex-reassignment surgery. The young man was living at home, had no job, and was over 21. The father had no legal authority to prevent him from following through on this decision. Obviously, this was not the right course of action. All he and his wife could do was to try to dissuade their son and express their strong objections to the psychologist.

In another call, a wife described the decision of her husband to transition to a female. She and their adult children were devastated. In words that I will never forget, she said that he had lied to her at the altar when he had promised that he would love her until death. He said had made this promise as a man, she rightly insisted. The NCBC opposes all gender transitioning and holds that psychological counseling is the best course of action for those suffering gender dysphoria.

Then there are the calls from physicians or family members concerning problem pregnancies. These are the most difficult of all, coming at any time of the day or night and often requiring a moral judgment under a time constraint. These are the decisions that keep an ethicist awake at night.

EDWARD J. FURTON, PH.D., is director of publications for the National Catholic Bioethics Center in Philadelphia and among its team of seven ethicists. He’s editor-in-chief of NCBC’s award-winning National Catholic Bioethics Quarterly and Ethics & Medics.

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.

Seeing stealth euthanasia for what it is

Most of us are aware of the horror of abortion, of parents paying a doctor to kill their child, even if it goes by a sugar-coated name such as “choice” or “planned parenthood.” Too few are aware that at the other end of life, children, in an ironic turnabout, can pay a doctor to legally kill their own parents; the sugar-coated names for this are “hospice” or “palliative care.”

I learned this from the case of my own mother, who recently fell victim to “palliative care” and was killed at the hands of doctors and nurses, on the orders of one of her own children. She had imprudently chosen the wrong child to be her “health care proxy,” who then immediately had her physician sign a bland, one-sentence statement that she was legally incompetent. It is true that my mother was somewhat confused, particularly about time, but she recognized and cared about people, ran her own life, and knew what she wanted. Although she should not have made a major financial decision at that point, she certainly knew whether she wanted to live or die.

Unfortunately, a few months later she fell and fractured her pelvis, requiring a move to a nursing home while the bone healed. The nurses attending her were charmed by her kindness and her stories, and said that with physical therapy she should soon be able to walk again. However, her proxy decided instead that it was time for her to die. My mother was removed from medical care, and placed in hospice, or palliative care. As much as I and my mother fought for medical care, there was nothing we could do. No medical aid, including nutritional supplements or physical therapy, were to be provided – just morphine, ostensibly to relieve pain, but as later made clear, actually to hasten death.

The doctor ordered large doses of morphine at six-hour intervals, whether my mother was in pain or not. Morphine is known to depress appetite; it is used, illegally, by runway models to lose weight. When she weighed little more than 70 pounds and was losing about a pound a day, I asked that she be given a nutritional supplement, such as “Ensure.” I was told it was forbidden, under doctor’s orders. When I asked that the morphine be given only when in pain, I was told it had to be given by the clock. When I confronted the director of nursing, saying “You are allowed to give morphine to relieve pain, but not to hasten death” her reply was, point blank, “Not true – it depends on the quality of  life.” When I asked what the terminal condition was that justified her being put in hospice, the answer was “she is 96 years old and has a broken pelvis.” A broken bone is not a terminal condition. What they were saying is it was time for her to die.

Although her weight dropped to about 60 pounds, she ended up dying not of starvation, but of thirst. When she became too weak to lift a glass to her lips, the nurses were forbidden to syringe any water into her mouth – under doctor’s orders, at the behest of the proxy. My mother’s will to live kept her alive far longer than the “authorities” wished, but she eventually died after an excruciating last few weeks.

The irony is that as a young Jewish woman in Germany in the 1930s, she was slated to be exterminated at Auschwitz, but miraculously escaped from the train en route. Ironically, 75 years later she died a 60-pound skeleton, looking for all the world like an Auschwitz victim, killed not by that Holocaust but by our own Holocaust, that of our “culture of Death.”

 

ROY SCHOEMAN  is a Jewish entrant into the Catholic Church, best known for his writing and speaking on the Jewish roots of the Church, particularly in his bestseller, Salvation Is from the Jews. He has taught theology at Ave Maria University and Holy Apostles Seminary, and currently hosts a weekly radio show on Radio Maria.

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.