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How to make end-of-life decisions with faith

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From the Ten Commandments to Jesus’ Sermon on the Mount, God has always explained to His people what is good and what is evil in His sight. Throughout history, the Catholic Church through the Holy Spirit has discerned how God’s law can be applied to different situations. While the moral principles remain clear, life and death can be messy. Deciding the best moral choice at the end of one’s life is not always easy. 

To assist local Catholics, the Virginia Catholic dioceses released an advanced medical directive form and explanatory primer that reviews church opposition to physician-assisted suicide, and the difference between necessary, ordinary means of preserving life, and means that are considered extraordinary. It allows Catholics to appoint a health care agent to make medical decisions if they become incapacitated.

Understanding church teaching and discussing your wishes with loved ones is an important way to prepare for death. Just as critical, said Joe Stuart — an estate, trust and elder lawyer, is to review those decisions and your medical directive every few years as your situation changes and as treatment advances are made. 

Take DNRs, or do not resuscitate orders, as an example, said Stuart, a parishioner of St. Andrew the Apostle Church in Clifton. If you’re in a car accident at age 25, they’ll try to revive you and in the process may break a few ribs. But your otherwise healthy body can heal from that, and you may go on to live decades more. If you’re 92 years old, “It’s quite a different thing,” he said. Sometimes, it’s ok to let go.

“People think the church wants people to suffer or demands we do every medical procedure (to preserve life) and that’s very erroneous,” said Franciscan Sister Clare Hunter, diocesan director of the Respect Life Office. “Nothing is black and white (because) every situation is different.”

In some cases, Catholics may need to fight doctors to receive care that they consider to be simple, ordinary means of preserving life, such as receiving food and water. But doctors overwhelmingly want to protect life, said Father Stefan Starzynski, chaplain at Inova Fairfax Hospital, and they usually understand Catholic teaching. “I find most doctors and nurses to be people of faith,” he said. “It's not by accident that hospitals came from our Catholic tradition.”

In his ministry, Father Starzynski counsels men and women who are dying, as well as their loved ones. Those in charge of making end-of-life decisions for their parent, spouse or child often agonize over the medical choices. When the time comes to take someone off artificial ventilation or another such treatment, they may feel like they are ending a life. But Father Starzinski reminds them that letting nature take its course is completely different. 

“It’s heartbreaking when you're in a room and they’re taking the extraordinary means off of a baby,” he said. “(These mothers are) dying inside and they need to be encouraged and supported that this is the farthest thing from killing their baby.” 

Over the years, Stuart has served as the guardian of several people, usually those with some form of dementia who have no one to be their health care advocate. Sometimes, he instructs doctors to provide simple medical care to elderly patients. Other times, he realizes that their body and immune system is failing, and that more medicine will not be effective.

He advises all those making end-of-life decisions to stay calm and look at the situation in front of them. “The one thing that helped me is to focus on the medical situation and talk with the physician so that you understand it well, and you’ll be alright,” he said.

Recent medical advances in palliative care have reduced end-of-life suffering. As Father Starzynski said, when he sees patients die, “it looks as though they’re truly going to sleep.” Still, dying or watching a loved one die is tremendously sad. In that moment of death, people need to hear that you will suffer with them and that God is there, said Sister Clare. 

“We have to look at the grace God gives us to go through the difficulties,” she said. “Each of us should reflect on the theology of suffering. Of all the ways to be redeemed, it was through the suffering of Jesus Christ, and we can know God in suffering.”

Dr. Pamela Alexander, an internist and a parishioner of St. John the Beloved Church in McLean, often has to tell patients they have a terminal illness. As a Catholic physician, she prays for all her patients’ good health, but also for an acceptance of their diagnosis, whatever it may be. “If you can help (the patient or their) family understand that all suffering is not bad, that it has value, I think that provides comfort,” she said.

Having faith in God and in the resurrection changes one’s whole perspective on death, said Father Starzynski. “If you have a fear of the nothingness out there, you’re not going to want to go gently into that good night. If you really have a simple faith — ‘death where is your sting?’ ” he said. “I’m not dying, I’m simply entering into heaven, right?”

Learn more

To create an advanced medical directive, go here.

The National Catholic Bioethics Center has a 24/7 hotline where Catholics can reach an ethicist in emergency situations. Call 215/877-2660 or go to ncbcenter.org

Quick Catholic guidelines for end-of-life issues

—     When a person is facing the end of his or her life, Catholics believe ordinary means should be employed to preserve life, including adequate pain relief, nutrition, personal cleanliness, a comfortable, safe environment, the presence of loved ones and basic medical care. 

—     Actions that are not morally obligatory include means that offer no reasonable hope of benefit, are disproportionately burdensome or useless, or later become so, or are extraordinary, such as mechanical ventilation. A person is not killed when nature is allowed to take its course. 

—     Powerful drugs such as morphine may be used if the intent is to alleviate pain, but not if the aim is to hasten death. 

—     Providing food and water, even via feeding tube, would be considered ordinary means to those who are conscious or in a persistent vegetative state. If artificial hydration becomes ineffective or offers no hope of recovery, it can be removed. 

This guide was compiled from documents created by the Arlington and Richmond Dioceses. 


© Arlington Catholic Herald 2017