End of life issues

By Mary Grieco
Catholic Herald correspondent

End-of-life issues topic of discussion in Rhinelander

RHINELANDER -- "There are concrete moral norms that we know, but when we try to apply them to real situations, people of good will can come to different conclusions." Beginning with that comment, Fr. John Gerritts, pastor of Nativity of our Lord Parish, led a discussion concerning end of life decisions.

He cited the Terri Schiavo case and the war in Iraq as instances in which people guided by the same moral principles may still hold different views. Some issues, however, are absolute according to church teachings, Gerritts said. Euthanasia and assisted suicide, for example, are not options for Catholics, since they involve actions or omissions with the intention of bringing about a quick death. "But sometimes it is difficult to determine what is euthanasia," Gerritts said.

Among the factors to consider are providing ordinary care versus extraordinary care, and weighing the benefits of specific care versus the burdens involved for the patient as well as family members. There are many gray areas.

"Everyone has a right to ordinary (basic) care, which includes food, water, comfort and spiritual and emotional support. Extraordinary care can be refused or withheld," Gerritts noted, "but there is difficulty determining what is ordinary and what is extraordinary. With medical advancements, this is changing very fast. For example, five years ago a Flight for Life would have been considered extraordinary; now it is a daily occurrence. Location also influences what is ordinary and extraordinary.

Perhaps the most difficult decision involves when to withhold hydration and nutrition.

The following statement is found in the Ethical and Religious Directives for Catholic Health Care Services (part 5) written by the U.S. Conference of Catholic Bishops: "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 ... 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."

"There can be a time in life when some treatments that are a great benefit may also be a burden and may increase or prolong suffering," Gerritts noted. "But again, it is often difficult to apply moral norms, and you need to take each case individually. Among the things that come into play in weighing the benefits versus burdens are how long the person has been sick and the prognosis, and the cost involved, both monetary and emotional, primarily to the patient, but also to the family and caregiver."

To avoid placing the burden of making end of life decisions on family members, all adults are encouraged to have an advance directive which spells out their wishes should they become incapable of making health care decisions. "Both the Living Will and Durable Power of Attorney for Health Care are entirely accepted by the Catholic Church," Gerritts pointed out. Since a Living Will is used only when a person has a terminal illness or is determined to be in a persistent vegetative state, many people are now opting for the Durable Power of Attorney, which designates someone to make health care decisions should they be unable.

"Be sure to discuss these issues with your family," Gerritts emphasized. "When you have these discussions, also talk about things like organ donation and which long-term care facility you would prefer, if that becomes necessary. And talk about spiritual care."

Gerritts recalled how one family decided not to call him to anoint their dying mother. "I know she would have wanted it," he said, "but they had never discussed it, and they told me later, 'We didn't want you to scare her!'

"As Christians, we should never view death as a failure," Gerritts added. "God is the author of life. He is also the one who calls us home to heaven."

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