Making end-of-Life decisions through Catholic teaching

Photo credit Matthias Zomer

By Marty Denzer
Catholic Key Associate Editor

KANSAS CITY — As we age, advance directives, living wills and how we want to be treated or not at the end of life are subjects of conversations more and more. What exactly are advance directives, living wills and Church teaching about these and other issues relating to end-of-life care?

A conference, “Ethical Challenges in End of Life Care,” held at St. Joseph’s Medical Center Sept. 12 for priests, chaplains, medical professionals, hospital and hospice care administrators, was facilitated by Joe Zalot, Ph.D., Staff Ethicist at The National Catholic Bioethics Center in Philadelphia. He explained several challenging issues of end-of-life care and medical treatment. Attendees had opportunities for questions and discussions about the issues.

The four issues discussed included Advance Directives: Durable Health Care Power of Attorney and Living Will; Physician Orders for Life Sustaining Care; Making the Decision to Withhold or Withdraw Life Sustaining Care; and Catholic Teaching on Nutrition and Hydration, natural and medically assisted.

Dr. Zalot explained that advance directives are legal documents that allow an adult to remain in charge of his/her health care, communicating preferences for future care and treatment, especially end-of-life care. They are tools to help families and medical professionals through the end-of-life process. And they remain in force even if they lose the ability to make their own decisions. They allow the patient to design his/her treatment plan/strategy in the event of a sudden devastating injury or trauma or a serious illness.

The benefits of advance directives are four-fold: they serve as a means for you to communicate your choices for end-of-life treatments that are consistent with your beliefs, values and goals; they allow you to designate another person to make health care decisions for you if/when you are unable to make them for yourself; they ensure your right to accept or refuse specific medical care, and can spare your loved ones from having to make difficult decisions for you, especially when they don’t know your wishes, and from conflict with other family members. The last can be a real gift to your loved ones.

In order to complete an advance directive, you must be age 18 or older; you must freely express a desire to both request and complete an Advance directive, in other words, you mustn’t be coerced or unduly pressured by others; you must possess decision-making capacity, including a full understanding of what you are doing; the ability to exercise critical thinking, in other words “Why should I do this?” and have the ability to clearly communicate your preferences to others.

Depending on where you live, you may need either an attorney or a notary to complete an advance directive. In Missouri, no attorney is needed, but a Healthcare Power of Attorney requires notarization. A living will requires two witnesses only. In Kansas, no attorney is needed, but the completed form must be signed in the presence of two witnesses or notarized. These actions ensure that the documents are legal and binding. Health care professionals are duty-bound to comply with them and they cannot easily be changed without your consent. And they only take effect when you, the patient, no longer has the capacity to make decisions; in other words, if you can make decisions, you direct your care.

Keep in mind that circumstances can change between the writing of an advance directive and its implementation, which limits it and can hinder those acting on the patient’s behalf from making the best possible decisions. So, when you draw up an advance directive the focus should be on general goals and concerns rather than on specific treatments and procedures.
It might be preferable to assign someone you know and trust to act as your proxy/agent as they can be more sensitive and responsive to your case’s particulars. The proxy should be someone known to make good decisions in times of stress, should know the Church’s teachings and have the practical wisdom to apply those teachings to changing circumstances. And, they must survive the patient, or you can appoint an alternate.

Dr. Zalot said that it’s important to note that the completion of an advance directive does not mean “Do Not Treat.” You will continue to receive any treatments you indicate, avoid any you don’t want, and always receive comfort care. And, make sure you let your loved ones know you have an advance directive(s) and that your proxy, the person you have authorized to serve as primary medical care decision maker for you, as well as loved ones, knows where the directive(s) are kept, to be easily accessed when needed.

There is a difference between obligatory/ordinary care and optional/extraordinary care. Think of it this way: what is morally obligatory (ordinary) must be performed; what is optional (extraordinary) we may include or omit at our discretion. There are several criteria for determining what is ordinary and what is extraordinary.

Ordinary Care
A. Treatments or means of care whose perceived benefits outweigh any burdens associated with them.
B. Means of care that assume a primary function until the body can resume the function on its own (e.g.: a ventilator for breathing).
C. Treatments that offer reasonable hope of benefit to the patient.

Extraordinary Care
a. Treatments of means of care whose perceived burdens outweigh any benefits.
b. Treatments that offers no reasonable hope of benefit to the patient.
c. Other factors:
1. Experimental or risky nature
2. Bad side effects and/or consequences
3. Treatment or side effects that interfere with activities desired in time left to live.
4. Morally objectionable to patient (e.g. Derived from embryonic stem cells).
5. Treatment involves excessive cost.
6. Poses severe demands on others.
7. Treatment is psychologically repugnant to patient (e.g. organ transplants from animals).

In general terms, a medical procedure that carries little hope or benefit to the patient and is unduly burdensome, including its cost, is considered extraordinary, and thus not obligatory. Nutrition and hydration should be presumed as ordinary and obligatory, even in a comatose state, until they provide no benefit to the patient, at which time they may be withdrawn. A feeding tube is considered ordinary if the patient cannot swallow or has similar eating difficulties, but, for example, if they are agitated due to advanced dementia they may yank it out repeatedly which can lead to infections, frequent aspiration and constant throat suctioning. Then a feeding tube may be extraordinary and should be reevaluated.

Some related terms you may hear when considering ethical end-of-life care include:

Anointing of the Sick: a sacrament which usually includes confession of sins, administered to a person in a seriously weakened state of health due to grave illness or infirmity of advanced age. This sacrament can bring the consolation of interior healing and a sense of God’s loving presence. This is not confined to the “deathbed visit,” and is repeatable if a person’s condition worsens.

Double-Effect: this is a moral principle that provides guidance when an act or omission will have two consequences, one that is moral and intended, the other immoral but not intended, even though it may be foreseen. In palliative care for example, a treatment that seeks to alleviate pain and suffering, but which also has the foreseen but unintended effect of shortening life, would be considered morally permissible, because what is chosen is pain relief.

Informed Consent: a decision freely made by a person in full possession of his/her mental faculties and with adequate knowledge of the all the relevant moral and medical consequences.

Morally obligatory and optional means of prolonging life (also ethically moral and extraordinary means): the moral difference between what one must do or omit to preserve life and what one may do or omit to preserve life; not to be confused with ordinary and extraordinary procedures.

Physician Orders for Life -Sustaining Treatment: actionable orders signed by a health care professional that instructs others on treatment to provide or withhold from a patient.

Redemptive Suffering: The comforting belief that by joining our suffering with that of Christ on the Cross, we believe he is with us during our illnesses and shares in our suffering as we share in his through Baptism. Catholics with faith in Christ may not understand suffering but know they can “offer it up” as a powerful source of grace for themselves or others.

Viaticum: the final reception of the Eucharist (during Mass if possible) in the face of death, as a pledge of our resurrection in Christ.

The Church also encourages organ donation. When we direct organ and tissue donation to the personal good of others, we share the gift of life.

For more information on end of life issues, contact The Diocesan Respect Life office: (816) 756-1850 or visit www.diocesekcsj.org, or see the Catholic Medical Association (Sts. Cosmos and Damian Guild) at www.catholicmedkc.org.

Tags: 

Tuesday
October 16, 2018
Newspaper of the Diocese of Kansas City ~ St. Joseph