Protecting life at every stage

End-of-life seminar explains Church teaching, decisions faced as death nears

By Bill Brewer

As the United States continues confronting the abortion issue, and prayerfully comes up with a pro-life solution, another right-to-life issue on the minds of many Catholics is the end of life— and questions surrounding decisions when confronting death.

Such decisions will impact nearly everyone at some point in their lives, whether regarding their own life or the life of a loved one.

According to recent data, including from the Pew Research Center and the Institute for Healthcare Improvement:

• Only around 22 percent of Americans have documented their end-of-life wishes.
• While most people have considered their end-of-life care preferences, only a small percentage have formally documented them through an advance directive or living will.
• A majority of Americans (around 70 percent) would prefer to die at home if given the choice.
• Although many people understand the importance of end-of-life planning, there is a gap between thinking about their wishes and actually putting them in writing.
• Around 60 percent of adults have discussed their end-of-life wishes with someone, including a health-care professional.
• Despite the preference for death at home, a significant percentage of people still die in hospitals.
• Individuals aged 65 and older are more likely to have considered and documented their end-of-life care preferences.
• 90 percent of people say that talking with their loved ones about end-of-life care is important.
• 27 percent have actually done so.
• 60 percent of people say that making sure their family is not burdened by tough decisions is extremely important.
• 56 percent have not communicated their end-of-life wishes.
• 80 percent of people say that if seriously ill, they would want to talk to their doctor about wishes for medical treatment toward the end of their life.
• Only 7 percent report having had this conversation with their doctor.
• 52 percent say they would ask their doctors to stop treatment if they had an incurable disease and were totally dependent on someone else for their care.
• 35 percent say they would tell their doctors to do everything possible to keep them alive—even in dire circumstances, such as having a disease with no hope of improvement and experiencing a great deal of pain.

Understanding that the need for answers to end-of-life questions is top of mind for many Catholics, Tennessee Right to Life recently partnered with Paul Simoneau of the Diocese of Knoxville to offer a seminar on the topic.

In introducing Mr. Simoneau, Angel Brewer, executive director of the Knox County chapter of Tennessee Right to Life, told the audience of some 70 Catholics from around the diocese that the topic has always been important to people of faith; however, as the health-care industry places greater emphasis on advance directives such as patients’ living wills, medical powers of attorney, and do-not-resuscitate orders, more people need to be armed with information to handle these life-impacting decisions.

Another issue that is challenging Church teaching is euthanasia, which more countries are approving as a form of medical care.

“At Tennessee Right to Life, our goal is to protect the sanctity of life in all of its ages, stages, and conditions, from conception to natural death. We get a lot of airtime for our stand on abortion, but we also protect life at the end of life,” Mrs. Brewer said.

Understanding the mystery of suffering

Mr. Simoneau, vice chancellor of the diocese who also serves as the director of the diocesan Office of Justice and Peace, began the Feb. 11 seminar at the Chancery by exploring the mystery of human suffering.

He explained that Catholics must first understand the impact suffering has on the love of Christ and how Christ suffered intensely to show His love for the faithful.

“Today is the feast of Our Lady of Lourdes. And it also is the day that Pope John Paul II decided to mark World Day of the Sick on an annual basis. You gathering today is very significant in that sense, that this is, on the Church’s official calendar, the World Day of the Sick,” Mr. Simoneau observed. “We know, with Our Lady of Lourdes and the apparitions in Lourdes, France, that hundreds of medically certified miracles have occurred there. And we know that health of spirit is essential to health of body.”

Included in the information Mr. Simoneau shared with those in attendance were a Catholic-approved advance directive or living will that is backed by the National Catholic Bioethics Center; a form for the appointment of a medical proxy, or general power of attorney; and a physician order for life-sustaining treatment (POLST).

“You can tell the health of a nation by the way it treats its weakest and most vulnerable, and also by the way it treats the dead, with a proper Christian burial. That is so very important. But we see so little of that these days,” he said.

Mr. Simoneau reflected on beautiful ancient expressions that speak of the sacred truth of the individual—a composite of body and soul. Then he explained that the Hippocratic Oath, which physicians pledge, has changed, with the vow to do no harm to patients stricken from the oath by many medical schools.

Quoting Venerable Archbishop Fulton J. Sheen, “Sacrifice without love is pain. Pain with love is sacrifice,” Mr. Simoneau said he believes that quote is a key element in any discussion about the mystery of human suffering.

“To the degree that we lose a sense of the sacred, we lose a sense of sacrifice, and vice versa,” Mr. Simoneau said. “In 1965, Pope Paul VI gave this address and said, ‘You are brothers and sisters of the suffering Christ, and with Him, if you wish, you are saving the world.’”

He continued, saying the mystery of human suffering is the central narrative to redemption, when Christ was made flesh and took on fallen humanity and redeemed His people through His suffering and Passion on the cross.

“Sometimes God’s mysteries are just profound. And the mystery of suffering is one of them,” Mr. Simoneau said.

He cited Gaudium et spes, one of four key documents from the Second Vatican Council, and a quote from that document that stated, “In the face of death, the riddle of human existence grows most acute. Through Christ and in Christ, the riddles of sorrow and death grow meaningful. Apart from His Gospel, they overwhelm us.”

“How so very true. And of course, today, especially with euthanasia and the culture of death, the temptation is to flee the cross, isn’t it? Come down off that cross. Eugenics and euthanasia are Greek words for good birth and good death. Isn’t that what evil does? It calls good evil and evil good. And yet we have proponents out there for abortion, eugenics, selective pregnancies, and designer babies, but also euthanasia and assisted suicide.”

According to Mr. Simoneau, exploring the mystery of human suffering through the guidance of Church teaching greatly helps in better understanding the complexities of end-of-life decisions.

He also cited St. John Paul II, who wrote an apostolic letter on the mystery of human suffering shortly after the 1981 assassination attempt on his life, as well as Pope Benedict XVI before he was elected pope.

“John Paul said in his World Day of the Sick message in 1994, ‘Always look trustingly toward Jesus, the suffering servant, and ask Him for the strength to transform the trial afflicting you into a gift.’ And then Pope Benedict, writing as Cardinal Ratzinger, said, ‘The world is saved, not by the sword of conquerors, but by the sword of those who suffer,’” Mr. Simoneau said. “Our weakness becomes the power of God if we offer it up.”

“Every person has a share in the redemption. Each one of us is called to share in that suffering of Christ. Bringing about redemption through suffering, Christ has raised human suffering to the level of redemption. Thus, each person in their suffering can become a sharer in the redemptive suffering of Christ,” he added.

Mr. Simoneau took issue with ideologies and movements in medical care rooted in evil, such as the increasingly popular ideology that growing older is substandard and senior citizens are a bane on society.

To counter those notions, he cited the wisdom and faith of St. Teresa of Calcutta.

“St. Teresa said, ‘Suffering will never be completely absent from our lives, so don’t be afraid of suffering. Your suffering is a great means of love if you make use of it, especially if you offer it for peace in the world. Suffering in and of itself is useless. But suffering that is shared with the Passion of Christ is a wonderful gift and a sign of love.’ I love that. I get so motivated every time I read that. And it is so true.

“Our sufferings do not make us worthless. Our quality of life does not suffer because of what we can’t do that we used to be able to do. That is the biggest lie that is pushed on us by those who promote euthanasia, making us think that our quality of life depends on whether or not we can jump 3 feet in the air and kick our legs up and put our hands up like you see in some of these advertisements. It is the biggest lie that Satan has introduced into our society, that we are useless as we get older,” Mr. Simoneau said.

He underscored that suffering has purpose.

Understanding the end of life

Mr. Simoneau, who has certification in Catholic bioethics to complement his master’s degree in theology, then segued into the medical and legal aspects of end-of-life decisions.

“To really approach the decisions that we must make, especially as we’re nearing the end of life, if we don’t have a good appreciation of the mystery of human suffering, we can be tempted to make some very terrible decisions,” he said.

He explained that many people are comfortable and satisfied when they get a living will that spells out their wishes on withdrawing nutrition and hydration. And he noted there are options that can lead someone to believe they don’t want to suffer unnecessarily and prolong the dying process, which can prompt choices that are spiritually problematic.

Mr. Simoneau reminded the group that Catholics, based on Church teaching, are stewards of their lives, which means the faithful do not have absolute dominion over their lives.

He said it’s important to emphasize that food and water for the seriously ill and those who are dying are not considered medical treatment but are part of ordinary care, as is keeping a person clean and dry.

“The duty to preserve life is not absolute. We do have options. We can decline extraordinary and disproportionate means of preserving life,” he said. “Quality of life is not the decisive factor in determining use or non-use of medical means to sustain life. High technology focused strictly on the body offers limited hope for healing the whole person.”

He stressed that people should always be asking Mary, the mother of God, for the gifts of the Holy Spirit: wisdom, understanding, knowledge, counsel, fortitude, fear of the Lord, and piety.

“But we should also be asking for prudence, to really have that wisdom and understanding to discern things. To do so, we need to call upon the Holy Spirit. Come Holy Spirit,” Mr. Simoneau shared.

He pointed out that euthanasia, which means “good death,” is a message that increasingly is being forced upon the public. He said it equates a patient’s dignity with the ability to live a life of value and quality.

“It sounds good, but when you start drilling down into it, the message is being forced upon you more and more with some of these medical decisions,” he said. “Pope Francis, from his World Day of the Sick message 10 years ago, said, ‘How great a lie lurks behind certain phrases, which so insist on the importance of quality of life that they make people think that their lives affected by grave illness are not worth living.”

To treat or not to treat

Mr. Simoneau said no doctor in the world can provide a foolproof, one-size-fits-all list of qualifications for treating or not treating a patient.

“Potential benefits and burdens change according to time and a patient’s condition. It requires an honest, prayerful discernment. Again, invoke the Holy Spirit. Benefits are health benefits and the hope they offer. Burdens are to the patient primarily, but they do extend to the family as well,” he observed.

Burdens can include pain, psychological factors, and expense.

Mr. Simoneau was quick to point out that benefits and burdens only apply to treatment, not the decision whether to continue life with the illness. “Burdensome treatment does not equate to a burdensome life.”

Ethical religious directives offer patients and their families a faith-based guide to advance directives, such as identifying ahead of time someone to make health-care decisions as a surrogate. That individual should be someone who shares an understanding of the Catholic faith and Church teaching.

Obligatory versus optional treatment

Mr. Simoneau said it is important to look at medical science and how it has progressed.

“That which defines ordinary means is always going to be in the judgment of the patient, not the doctor or anyone else. In the judgment of the patient, the ordinary means is one that offers reasonable hope of benefit,” he pointed out. “It does not entail excessive burden to a patient or a patient’s family, and it does not impose excessive expense to the family or community.”

An important point that he singled out is that extraordinary and disproportionate treatment is optional if the foreseen burdens exceed the benefits that can reasonably be expected.

“Looking at assisted nutrition and hydration, the Gospel mandate to give drink to the thirsty and food to the hungry exists even in health care. It is not medical treatment. Even though it may be administered in a medical way, it is considered ordinary care, which is differentiated from treatment,” Mr. Simoneau explained.

He observed that some people unknowingly sign a living will by checking the box that says remove nutrition and hydration. Starvation, in most cases, is not considered appropriate care. An exception to nutrition and hydration for a patient is if the patient can’t assimilate the nourishment.

“That’s why it is dangerous to select in a living will the removal of nutrition and hydration. All they are going to do is give you lots of palliative care because you are going to be so uncomfortable and in pain, not to mention what it does to you psychologically and mentally. It’s going to be brutal,” Mr. Simoneau said.

He underscored the importance of maintaining a good relationship with the physicians treating the patient, and he stressed the importance of all family members being in agreement about treatment.

He shared that the National Catholic Bioethics Center (ncbcenter.org) can be invaluable in navigating end-of-life questions.

Uncertainty, confusion, and guilt are common factors in dealing with an end-of-life decision, which is why accurate information and agreement are critical.

“When it becomes clear that life support is no longer providing any benefit to the patient, or that the burdens exceed the few benefits to the patient, a decision can be made to withdraw life support,” Mr. Simoneau said. “That should come as consolation to all of us that if you have been intubated and there is a point where you are in the end stage of dying, and it’s providing no benefit, just prolonging the process, you can withdraw life support.”

He noted that the Ethical Religious Directive states that the terminally ill have a right to die in total serenity with Christian dignity.

The faith-based, spiritual part of an end-of-life decision is key to making the wise, accurate choice. And as part of that decision, it is critical to notify a priest, who can administer viaticum and anoint the patient to prepare them for the journey toward heaven.

He said the Church teaches that a patient should be kept as free of pain as possible so they can die comfortably, with dignity, at a place of their choosing. But he cautioned against depriving a patient of consciousness using pain medication.

He stressed the importance of patients’ family members recognizing the balance needed in managing pain but not over-medicating, which can deprive patients of consciousness. He said a patient should be encouraged to request pain medication, and family members or health-care proxies should be aware of a patient’s propensity to flee from pain.

Conversely, he pointed out, if an illness results in excessive pain, it is morally permissible to provide a patient more pain medication than standard dosages may recommend “to help that person get to a point where the pain isn’t overwhelming.”

He said the Church prescribes that even if there is an unintended consequence of shortening the life of someone who is gravely ill, it is permissible to relieve the pain.

Deacon Bob Hunt, who serves at All Saints and Holy Ghost parishes in Knoxville and also is a registered nurse, answered a question on whether advance directives can be amended or updated, saying directives can always be changed, even at the moment of death.

He said a patient’s will always overrides previously stated advance directives.

“If you can express them (your wishes) yourself, or your surrogate can express them, that overrides any POLST. I don’t know of a doctor in the world who is going to follow a POLST when a patient or a surrogate says, ‘I’ve changed my mind. Don’t do that,’” Deacon Hunt said, citing legal concerns.

Mr. Simoneau related a personal experience where he was managing the care of his elderly father, who was in the hospital toward the end of his life.

Mr. Simoneau explained that hospital representatives placed a POLST form pertaining to his father in front of him and told him he needed to sign it. Mr. Simoneau had never seen such a form and was unfamiliar with its contents.

The POLST form is akin to a living will and expresses end-of-life care. It is signed by a physician and transfers with the patient. Another physician would have to abide by it.

“Looking at it, I couldn’t translate what I was looking at, so I wrote in big letters along the margin because there was no place to write anything ‘Presume in favor of artificial nutrition and hydration.’ I want to at least have that in there,” he recalled.

One attendee shared that people caring for loved ones tend not to think well and are stressed out in these emotionally charged situations involving end-of-life questions and decisions.

Mr. Simoneau urged seminar attendees and everyone to be prepared with proper documentation that is well thought out and hopefully conforms to Church teaching to serve as an advance directive.

“We can’t predict where we’re going to be. But at least our fallback is on these documents and the teachings of the Church,” Mr. Simoneau said. “They state that the patient just wants to be treated the way the Church teaches, treated the way the Church tells us we should be treated in medical situations.”

 

Find resources on end-of-life decisions and care, including funeral planning resources, at dioknox.org/catholic-bioethics