GREEN BAY — Today’s medical technology has the capacity to prolong human life. For Catholics who want to follow the church’s teachings on end-of-life decisions, this technology can blur those decisions.
But if people spend time reviewing directives issued by the church, the process becomes easier, according to a Catholic bioethics expert.
Fr. Tad Pacholczyk, director of education at the National Catholic Bioethics Center in Philadelphia, presented, “Care and Treatment Decisions for Patients at the End of Life,” to about 75 people at St. Bernard Church March 11. The priest, who holds a doctorate degree in neuroscience from Yale University, was invited to Green Bay by Fr. Mark Vander Steeg, pastor of St. Bernard Parish. The priests were classmates while studying theology in Rome.
The church’s teachings on the sacredness of life, even at the end of life, help people maneuver through “some of the more complicated questions that arise because of technology,” said Fr. Pacholczyk, such as, “What am I required to do?” “What can I decline?”
Understanding the moral guidelines will help Catholics see “how important it is to die well,” said Fr. Pacholczyk.
“It’s such a beautiful grace and a stepping stone into our next life, our eternal life,” he said. “So to die well enriches all of us and it’s something we should all work assiduously to bring about.”
The speaker based his presentation on a document issued by the U.S. Conference of Catholic Bishops titled, “Ethical and Religious Directives for Catholic Health Care Services.”
The document’s fifth chapter focuses on issues related to caring for the seriously ill and dying.
Weighing benefits, burdens
Fr. Pacholczyk said a key passage in the bishops’ document states that Catholics “have a duty to preserve our life and to use it for the glory of God.” But this duty is “not absolute.”
Life-prolonging procedures can be rejected if they are “insufficiently beneficial or excessively burdensome.”
When faced with using procedures such as feeding tubes, dialysis, blood transfusions or other interventions, Fr. Pacholczyk said families need to weigh the benefit and the burden. “There is a lot of misunderstanding, even within some Catholic quarters, in terms of what our obligations and duties are.”
Fr. Pacholczyk said there are two fears most people have when discussing end-of-life care.
- Entering a hospital, being hooked up to wires and tubes and not being allowed to remove them.
- Checking into a long-term care facility that may pull the plug before death is imminent.
“So I would suggest that the right course of action is … right down the middle of those two fears,” he said. “The key criterion that we need to reflect on is this idea of ordinary means, also called proportionate means.”
Proportionate means of preserving life
The bishops’ document states that a person has “a moral obligation to use ordinary or proportionate means of preserving his or her life.” It adds that 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 an excessive expense on the family or community.”
“If something is proportionate, it is required. That’s what it means to be good stewards of our own lives and our own bodies, that we take care of ourselves, and we use proportionate means,” said Fr. Pacholczyk.
However, if something is disproportionate, it is optional. “It can be declined and that is morally acceptable,” he noted.
For some people, the use of feeding tubes invokes a “revulsion factor,” said Fr. Pacholczyk. “But I often say, ‘Think about it in a slightly different way. Think about it like a long spoon that you are using to feed somebody who maybe has a blockage in their throat. They can’t swallow on their own. You are going to go beyond the blockage and feed them.’ It’s a way you take care of them.”
He quoted Pope John Paul II, who in 2004 addressed the issue of caring for patients in a vegetative state.
“Administration of water and food, even when provided by artificial means, like a tube, always represents a natural means of preserving life, not a medical act,” said Pope John Paul.
But the use of a feeding tube needs to be weighed by benefit and burden, reminded Fr. Pacholczyk.
“If a loved one is dying of advanced dementia and you want to put this tube in and death is maybe not far away, if there is not going to be much benefit from it, then this may be a case where that tube is now disproportionate and not required,” he said. “The judgments always need to be made case by case.”
Living wills and advanced directives
Fr. Pacholczyk said that living wills, advanced directives and similar documents outlining a person’s medical preferences are acceptable, as long as the language “is not overly broad.”
“If you have one, use very carefully crafted language and don’t try to manage things in minute detail 10 to 20 years in the future,” he said.
He said people should choose a surrogate, sometimes called a health care proxy or durable power of attorney. “A surrogate is someone who cares deeply about the patient and is reasonably able to make decisions in accord with the known wishes of the patient,” he said.
Fr. Pacholczyk warned his audience to avoid wills or directives that contain a check-box approach. “There is one called the five wishes. This basically sets up all of your end-of-life planning in the course of a few pages. I discourage people strongly from using the five wishes.”
In Wisconsin, patients need to avoid the use of POLST (Physician Orders for Life Sustaining Treats) forms, said Fr. Pacholczyk. “The orders have been written in such a way that, believe it or not, the patient doesn’t have to sign the form. … The bishops of Wisconsin have issued a very strong statement against POLST forms.”
Dying is a sacred act
The speaker reminded his audience that the process of dying is a sacred act. “We have this journey that we are invited to enter into with our loved ones as they experience sickness and it will change us. We are changed when a loved one goes through their difficult times and we also suffer with them. We should realize that this is part of our own journey in life.”
He encouraged Catholics to discuss their wishes with loved ones.
“You want a lot of cross talk between all of these different parties so that you have enough information and the ability to make good moral discernments,” he said. “You’ve got a complex blend of factors that need to be considered when making a good, prudential judgment.
“I often say to people, your mom or dad is dying and you are struggling to make good judgments all of the way through, when they die, they can die in peace and you will be in peace as well,” he said.
In responding to a question about suicide, Fr. Pacholczyk said that people who have advanced diseases may experience depression and turn to suicide.
“Can they be fully responsible for this? The answer is probably not,” he said. “My suspicion is (that) many, if not most suicides do involve elements of depression. What this means is, clearly there is a diminished moral culpability.
“We have to leave all ultimate judgment to the Lord. He’s the one who knows the circumstances,” added Fr. Pacholczyk. “But what we don’t want is in our society to set up situations where we encourage people to think about (committing) suicide when the going gets rough, offering it to them as an option. What we need to say is, ‘Look, we will be at your side. We will give you pain management. We will have good hospice. People who love you all the way to the end will take care of you.’”