One December night in 2000 as part of our supper conversation, Fr. Ian McRae shared that he visited Fr. John Weisgerber in the hospital earlier that day and that he was concerned. John was facing the prospect of yet more surgery due to his diabetes and a whole host of other medical issues, and Ian wondered out loud if John was ready to die. His wondering sparked something inside me. Was this a veiled hint or suggestion that I was supposed to do something? I decided that I'd visit John the next day.
It's important, as this story unfolds, to understand that Fr. John was a man of very few words. Sometimes you might get a "good evening" at supper and sometimes you might not. That was alright with us as we respected his space and didn't take it personally. That's just the way things were.
In any event, I visited John in the hospital and after the pleasantries and formalities were out of the way. I said to John that I wanted to review with him some moral issues so that he would be clear about his decision-making. So I eased into the subject by talking about medical assisted nutrition and hydration, rather safe ground. From there, I then got down to the main issue, namely, refusing and stopping treatment when the burdens resulting from the treatment are clearly disproportionate to the benefits hoped for or obtained.
John listened attentively, seemed to understand but didn't say anything. I thought that it was now time to move on to the even bigger issue and said: "John, are you ready to die?" Again he didn't say anything and I waited in silence for him to say something. Feeling that the silence was longer and more intense than usual, I began to question myself that I might have misread his need and the whole situation.
Then with a twinkle in his eye, he looked straight up at me and said: "I really don't know, bishop, I've never done it before!" At that point we both laughed.
Sometimes we struggle with decision regarding end of life issues, and to understand how to journey with someone to a 'happy death'.
The Catholic Health Alliance of Canada has recently published its third edition of the Health Ethics Guide and I would like to review a few of the guidelines of Catholic moral teaching.
Sickness, suffering and dying are an inevitable part of human experience and are a reminder of the limits of human existence.
Our Catholic tradition holds that we are stewards but 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 this life is not our final goal and so we recognize that the duty to preserve life is not absolute. Thus we may reject life-prolonging procedures that are insufficiently beneficial or excessively burdensome. However, suicide and euthanasia are never morally acceptable options.
Advances in science and technology are dramatically improving our ability to cure illness, ease suffering and prolong life. These advances also raise ethical questions concerning end-of-life care, particularly around life-sustaining treatment.
Reflection on the inherent dignity of human life and on the purpose and limits of medical treatment is indispensable for formulating a true moral judgment about the use of technology to maintain life. The use of life-sustaining technology is judged by Christians in the light of their understanding of the meaning of life, suffering and death.
In this way, two extremes are avoided: on the one hand, an insistence on the provision of technology that cannot bring about the goal desired or that is considered overly burdensome by the person receiving the care and, on the other hand, the forgoing of technology with the intention of causing death.
Good palliative care, that is, health care that aims to relieve suffering and improve the quality of living and dying, should be a key goal of all facilities that care for those nearing death.
Here are some of the key guidelines for care at the end of life (Health Ethics Guide 2012):
- 65. Dying persons are to be provided with care, compassion and comfort....
- 67. The physical, emotional, psychological and spiritual care that characterizes palliative care should be available to all who have a life limited illness....
- 68. A person receiving care should be given sufficient pain and symptom management .... it is important to note that these medications, if used appropriately, are effective, safe and do not hasten death. The goal is to alleviate pain and suffering while minimizing the potential side effects of medication. Such treatment does not constitute euthanasia but rather good pain management....
- 69. Palliative sedation can be morally permissible within the Catholic tradition. Patients should be kept as free of pain as possible so that they may die comfortably.
- 70. .... the wishes, values and beliefs of the person preceding care should be the primary consideration....
- 71. Persons receiving care are not obligated to seek treatment that will not accomplish the goal for which the treatment is intended or when the burdens (excessive pain, expense or other serious inconvenience) resulting from treatment are clearly disproportionate to the benefits hoped for or obtained.
- 87. Treatment decisions for the person receiving care are never to include actions or omissions that intentionally cause death (euthanasia.