PASTOR’S NOTES

This week we conclude our examination of the Bishops’ Conference Ethical and Religious Directives for Catholic Health Care.  In reflecting upon the issues faced at times of serious and, perhaps, terminal illness they state: “Christ’s redemption and saving grace embrace the whole person, especially in his or her illness, suffering, and death. The Catholic health care system faces the reality of death with the confidence of faith. In the face of death – for many, a time when hope seems lost – the Church witnesses to her belief that God has created each person for eternal life. Above all, as a witness to its faith, a Catholic health care institution will be a community of respect, love, and support to patients or residents and their families as they face the reality of death. What is hardest to face is the process of dying itself, especially the dependency, the helplessness, and the pain that so often accompany terminal illness. One of primary purposes of medicine in caring for the dying is the relief of pain and the suffering caused by it. Effective management of pain in all its forms is critical in the appropriate care of the dying. The truth that life is a precious gift from God has profound implications for the question of stewardship over human life. We are not the owners of our lives and, hence, do not have absolute power over

life. We have a duty to preserve our life and to use it for the
glory of God, but the duty to preserve life is not absolute, for we may reject life-prolonging procedures that are insufficiently beneficial or excessively burdensome. Suicide and euthanasia are never morally acceptable options. The task of medicine is to care even when it cannot cure. Physicians and their patients must evaluate the use of technology at their disposal. Reflection on the innate dignity of human life in all its dimensions and on the purpose of medical care is indispensable for formulating a true moral judgment about the use of technology to maintain life. The use of life-sustaining technology is judged in light of the Christian meaning of life, suffering, and death. In this way two extremes are avoided: on the one hand, an insistence on useless or burdensome technology even when a patient may legitimately wish to forgo it, and, on the other hand, the withdrawal of technology with the intention of causing death. The Church’s teaching authority has addressed the moral issues concerning medically assisted nutrition and hydration. We are guided on this issue by Catholic teaching against euthanasia, which is ‘an action or an omission which of itself or by intention causes death, in order that all suffering may in this way be eliminated.’ While medically assisted nutrition and hydration are not morally obligatory in certain cases, these forms of basic care should in principle be provided to all patients who need them, including patients diagnosed as being in a ‘persistent vegetative state’ (PVS), because even the most debilitated and helpless patient retains the full dignity of a human person and must receive ordinary and proportionate care.”

These principles are embodied in the specific directives about an area in which all of us will one day make decisions concerning our own care or that of a loved one. It should be noted from an earlier part of the document that every Catholic institution should have an ethics committee in place to assist both the professional community and the patient and their caregivers. The individual who is ill deserves respect as our shepherds state repeatedly and fundamentally that requires that they be aware of their condition and/or their health proxy. “They should…be offered the appropriate medical information that would make it possible to address the morally legitimate choices available to them. They should be provided the spiritual support as well as the opportunity to receive the sacraments in order to prepare well for death.” (55) Once again, in this regard, the distinction between ordinary and extraordinary care is made. “A person has a moral obligation to use ordinary and 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. A person may forego extraordinary or disproportionate means of preserving life. Disproportionate means are those that in the patient’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.” (56-57) When you see the word “patient” you can read the word “health proxy” as well. An example of the latter directives might be whether or not to amputate an extremity of a diabetic who is over eighty and is suffering from dementia.
As previously stated in most cases nutrition and hydration are perceived as ordinary means of preserving life and therefore required. However, “medically assisted nutrition and hydration become morally optional when they cannot reasonably be expected to live indefinitely if given such care…For instance, as a patient draws close to inevitable death from an underlying progressive and fatal condition, certain measures to provide nutrition and hydration may become excessively burdensome and therefore not obligatory in light of their very limited ability to prolong life or provide comfort.” (58)

In terms of the above and all life-sustaining procedures we must comply with Catholic moral teaching. “Do not resuscitate” orders are permitted under the conditions we have already discussed. Not to give ordinary care is euthanasia. Doctor Kevorkian, its patron saint, has tried to convince, to a degree successfully, society that he is preserving people from unbearable pain. His hubris is expressed in the face of the fact that pain management is more successful today than in anytime in history. The Church herself desires that no one suffer unnecessarily. “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 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 if this therapy may indirectly shorten the person’s life as long as the intent is not to hasten death. Patients experiencing suffering that cannot be alleviated should be helped to appreciate the Christian understanding of redemptive suffering.” (61)

The Bishops conclude their work with the affirmation that the church must always identify with the ministry of Jesus. “Sickness speaks to us of our limitations and human frailty. It can take the form of infirmity resulting from the simple passing of years or injury from the exuberance of youthful energy. It can be temporary or chronic, debilitating, and even terminal. Yet the follower of Jesus faces illness and the consequences of the human condition aware that our Lord always shows compassion toward the infirm.

Jesus not only taught his disciples to be compassionate, but he also told them who should be the special object of their compassion. The parable of the feast with its humble guests was preceded by the instruction: “When you hold a banquet, invite the poor, the crippled, the lame, the blind” (Lk 14:13). These were people whom Jesus healed and loved.

Catholic health care is a response to the challenge of Jesus to go and do likewise. Catholic health care services rejoice in the challenge to be Christ’s healing compassion in the world and see their ministry not only as an effort to restore and preserve health but also as a spiritual service and a sign of that final healing that will one day bring about the new creation that is the ultimate fruit of Jesus’ ministry and God’s love for us.”

Let us remember the preciousness of all life as we beseech God’s grace upon the people of Haiti.

Vivat Jesus,

Fr. Brian