It is about the healing at the end of life and the difficult decisions we must make in respecting human life at its most vulnerable and exploitable moments that I would like to particularly emphasize in this paper.
For healing at the end of life to occur, even in the midst of the difficult treatment decisions we will all be faced with, it is important that we have an understanding of the primary moral and ethical principles which the Church has given us when making decisions about end of life care. In summary these principles are (O'Rourke, 1994; United States Conference of Catholic Bishops, 2001):
1. Human life is the foundation for all human goods. It has a special value and significance. Life is the first right of the human person and the condition of all the others.2. Life has inherent dignity and worth and is a precious gift from God; we are not the owners of our lives and, hence, do not have absolute power over life.
3. Suffering is a fact of human life, and has special significance for the Christian as an opportunity to share in Christ's redemptive suffering.
4. We have a duty to preserve our life and to use it for the glory of God but this duty is not absolute.
5. In the face of death — for many, a time when hope seems lost — the Church witnesses to her belief that God alone creates each person for eternal life.
6. Because human life is a great good, a presumption exists that human life should be prolonged. However, this presumption ceases if the means to prolong life are ineffective or involve a grave burden for a particular person.
7. No list of human actions or medical procedures can be determined as ordinary or extraordinary from a specific ethical perspective. A general description of means that are usually available, often prolong life, or seldom involve a grave burden is possible, but specific ethical judgments require a consideration of all circumstances.
8. When determining the moral obligation of whether to prolong life, we must know the patient's diagnosis and prognosis, as well as the “circumstances or persons, places, times, and cultures.” Only then may one determine what is morally obligatory and what is morally optional.
9. If possible, every person should be allowed to make decisions for himself or herself. If the person is clearly not competent, however, a surrogate decision maker is needed. The surrogate decision maker proxy determines what is beneficial for the patient, based on what the patient would have wanted, taking into consideration all circumstances that a reasonable person would have considered, including multiple burdens on the family.
10. The decision to choose a good which entails discontinuing the use of a life support system may hasten death. But death is the indirect result and occurs because one chooses another legitimate good.
As stated in the Ethical and Religious Directives for Catholic Health Care Services, 4th Edition (USCCB, 2001):
“reflection on the innate dignity of human life in all its dimensions and on the purpose of health care at the end of life is indispensable for formulating a true moral judgment about the use of technology to maintain life” (p. 30).Specific directives, which guide our decisions on treatment decisions at the end of life, have also been articulated by the National Conference of Catholic Bishops. These directives include the following:
1. 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 (USCCB, N. 56).You can now appreciate that the focus or the ultimate end our of our activities is not to select the appropriate treatment or to withdraw ineffective treatment. These decisions, as difficult as they may seem to be, should enable and empower us to reach the spiritual goal of life to which we have all been called as members of the Christian community.2. A person may forgo extraordinary or disproportionate means of preserving life. Disproportionate means are those that in the person's judgment do not offer a reasonable hope of benefit or entail an excessive burden, or impose excessive expense on the family or the community (N. 57).
3. There should be a presumption in favor of providing nutrition and hydration to all patients, including patients who require medically assisted nutrition and hydration, as long as this is of sufficient benefit to outweigh the burdens involved to the patient (N. 58).
4. The free and informed judgment made by a competent adult patient concerning the use or withdrawal of life-sustaining procedures should always be respected and normally complied with, unless it is contrary to Catholic moral teaching (N. 59).
5. Euthanasia, an action or omission that of itself or by intention causes death in order to alleviate suffering. Catholic health care institutions may never condone or participate in euthanasia or assisted suicide in any way. Dying patients who request euthanasia should receive loving care, psychological and spiritual support, and appropriate remedies for pain and other symptoms so that they can live with dignity until the time of natural death (N. 60).
6. Patients should be kept as free of pain as possible so that they may die comfortably and with dignity, and in the place where they wish to die. Since a person has the right to prepare for his death or her death while fully conscious, he or she should not be deprived of consciousness without a compelling reason. Medicines capable of alleviating or suppressing pain may be given to a dying person, even it this therapy may indirectly shorten the person's life so long as the intent is not to hasten death (N. 61).
Like Jesus, as He cured the sick in His own time, we too can bring healing to the sick and dying in our own time. The blind, the lepers, and the lame were drawn to Jesus, the Healer. So too, the dying in your family, in your parish will be drawn to you. As ministers of healing you are the living endowment of Jesus’ own ministry of healing. For many of the sick, the dying and the abandoned, you are their very best hope; you may well be their only hope, as they attain the ultimate good of life, spiritual union with the Father.
Every time you encounter the person who is sick, each time you enter the room, the home, or the space of the sick, your love for the sick and the dying is implicit. As a member of this faith community, you carry to the lives of the sick the traditions of the healing ministry which has its roots in the healing ministry of Jesus created two thousands years ago.
The dying among you, these special persons, need you to be with them, to care for them, to pray with them. Their lives, their dreams, their suffering, and their pain need the grace of your caring, the wisdom of your ideas, the values in your hearts, and the virtues of your character. These are your people; they are your families, dear friends, colleagues, neighbors, and your community of faith.
As members of this community of faith, our mission of compassion and caring is clear: caring for one another is a challenge to be embraced, never a problem to be endured. It is our first preaching. Through our caring with compassion in the context of the Christian community we bring the healing ministry of Jesus Christ to one another. The ministry of healing is a prophetic witness to and an authenticating sign of what we preach by word of mouth.
As members of the Christian community, we as healers have the power to embrace and overcome any obstacles to the fulfillment of this most noble Promise. The late Joseph Cardinal Bernardin, in his pastoral letter on health care, “A Sign of Hope” (1995), stated:
As Christians, we are called, indeed empowered, to comfort others in the midst of their suffering by giving them reason to hope. We are called to help them experience God's enduring love for them. We are to do for one another what Jesus did: comfort others by inspiring in them hope and confidence in life.The care of the dying, entering the heart of Jesus’ special ministry, the author of all life, is a very special aspect of creation because it is about caring for human beings: nurturing the life that is in them, easing the pain that diminishes them, and accompanying them in their ultimate journey (Casey, 1991).
May God protect each of you in every caring moment as you embrace His sick and fulfill your promise to preach God’s love to them, to care for them with compassion, and to bring hope and healing to those you love.
Amen.
References:
Bernardin, J. (1995). A sign of hope. St. Louis: The Catholic Health Association of the United States.
Casey, J. (1991). Food for the journey: Theological foundations of Catholic health care. St. Louis: The Catholic Health Association of the United States.
O’Rourke, K.D. (1994). Development of Church teaching on prolonging life. St. Louis: The Catholic Health Association of the United States.
United States Conference of Catholic Bishops (2001). Ethical and Religious Directives for Catholic Health Care Services (4th ed.). Washington: United States Conference.
This article is part of NFCM's sponsorship of the Catholic Man channel. Contact NFCM at P.O. Box 86381, Gaithersburg, MD 20886, email them at info@nrccm.org, or call them at 301-519-0646.
