DECISIONS AT THE END OF LIFE

NOVEMBER 10, 2006

It used to be that preparing for death meant taking care of one’s Last Will and Testament, and calling the priest for the Last Rites. Not so today. Because of steady medical advances over the years, a number of options regarding treatment and care are now available, requiring that decisions be made. These can be morally confusing and emotionally wrenching.

The sanctity of human life binds us to do everything we can to foster and protect the dignity and life of every person. Indeed, has not the whole purpose of medicine always been just that: to serve the cause of life?

Rightly do we recognize medical science and technology as immense blessings, and we are indebted to those who advance medicine and care for the sick and dying. Yet, we must recognize that medical science has placed into our hands vast powers which are susceptible to unethical use, in spite of good intentions. So, it is important to think ahead and plan for the end of life, by making now the decisions we would lose the ability to make if we should lapse into unconsciousness. Doing so will spare family members the burden of having to make decisions on our behalf without certain knowledge of our will. Medical personnel, too, need direction.

Here are a few general ethical principles of healthcare, and some end-of-life issues.

Everyone has a right to informed consent in medical treatment, and everyone’s choices should be respected, but this does not allow cooperation with immoral choices. For example, suicide and assisting another’s suicide are gravely morally wrong.

We must do what is morally obligatory: provide the care necessary for life and health for ourselves and others. This includes taking care of our health by doing such things as getting an occasional physical examination and taking a prescription the doctor gives us. However, we are not morally bound to do what is extraordinary in virtue of its cost or burden. For example, if a medical procedure would provide little benefit, and is very costly or burdensome, it is considered extraordinary by the Church, and is not morally required. An example of an optional treatment would be submitting to an experimental drug or procedure whose effects have not yet been established. We are free to accept or refuse such treatment. .

When death is imminent one may forego all treatment, if it would only serve to provide a burdensome and precarious prolongation of life. This does not include discontinuing ordinary care or depriving the patient of food and water. In the very rare occasions when food and water no longer serve any benefit to the patient, they may be withdrawn.

In the case of someone who is not at death’s door, giving food or water is ordinary care and is morally obligatory. Persons in a persistent state of unconsciousness or paralysis who are not near death, have a right to the sustenance of their lives by means of food and drink, and we have the obligation to provide it.

How should we prepare for life’s end? We should prepare written directions that family and medical personnel can follow when the time comes. I am speaking of a Health Care Proxy document (also known as a Durable Power of Attorney for Health Care) and an Advance Medical Directive. These documents have legal power and take effect whenever a person can no longer make his or her own health care decisions.

Catholics should prohibit any action contrary to their Catholic faith (e.g. physician-assisted suicide, or the discontinuation of food and water if they fall into a state of unconsciousness like Terry Schiavo). They should also indicate they want a priest to administer the Sacraments of Penance and Annointing of the Sick and offer them Viaticum (Holy Communion for the journey).

Everyone should carefully read any papers a hospital or other health care institution asks patients to sign before treatment, to ensure that they conform to what they stated in their Advance Medical Directive and Health Care Proxy. It is good to consult with one’s pastor when difficult moral decisions must be made regarding one’s health and life.

Christ, by his death and resurrection, has opened for us the hope of salvation and eternal life. For us who have faith, death has lost its sting, and has been swallowed up in the joy of the resurrection.

+Bishop Raymundo J. Peña

last updated 05-Jun-2008 9:48 sitemap