Troubling experience -- end-of-life issues

[Langdell]

Today I attended a seminar for lawyers and healthcare professionals on end-of-life issues. Most of the seminar was very informative, but aspects of it were more than a little troubling.

First, in the discussions of living wills (a/k/a advanced medical directives) and medical powers of attorney, issues of religion were barely mentioned. A few of the speakers mentioned religious values in passing as something to be taken into account, but no one took the time to explore the issue or point out that some of the options provided in “standard” living wills are not appropriate for Catholic patients.

Second, while “ethics” and “bioethics” were mentioned often, only one speaker bothered to talk about the source of the ethics she was dealing with. (It wasn’t much of a discussion – she pretty much said that all major religions share the same basic moral values. I doubt that that’s actually the case, but I’m not a comparative theologian.)

Third, the last two speakers were advocating so-called “death with dignity,” IOW, assisted suicide. One person talked about “VSED” – voluntary stopping of eating and drinking. The other one talked about doctors giving patients pills to commit suicide. Both of the speakers thought people should be allowed to do this and claimed that this isn’t really suicide.

Three states already permit assisted suicide (OR, WA, and MT). We’re going to see more of this kind of talk, and be prepared for pro-death folks to try to redefine “suicide.”

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[Fae76]

I definitely understand what you’re worried about. I’m a physician, and I’m just waiting that a law very similar to this will be passed here. Thankfully I’m a psychiatrist, so I can work on discouraging suicide.

What I find very irritating, at least around here, is that if you don’t take the mainstream stance on this (people should be able to die when they want to and how they want to, and doctors should just do as they’re told) you’re seen as a cruel, merciless person who doesn’t care about the suffering of the dying person - while nothing could be further from the truth. Somehow is has become a normal thing that doctors should kill people.

That’s so not in my job-description.

ETA - “here” being Sweden Though I think that things are similar in my homecountry, Germany. It’s apparently the modern thing to do. /sarcasm

 

[Langdell]

Yes, it’s getting that way in the USA, too. A lot of people think you’re just cruel if you don’t want doctors to help people kill themselves.

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[vera_dicere]

I think this is going to snow ball a lot worse before it gets any better. The culture of death has not only made it something that should be a right, (euthanasia and assisted suicide) but also scoffs at religious value, regardless of what faith it comes from, though I have noticed a lot more negative comment is directed towards Christianty.

Currently, there’s a woman in my country who has refused food and only taking sips of water, she’s in her 60s and had a CVA or some such brain injury that has left her with limited physical capacity. She is doing this in a Catholic rest home.

Its a fine line indeed where we stand by and let a patient kill themselves by not eating or drinking, and while I don’t we should force an NGT down their throat, I do believe we should be doing something about the obviously rubbish hospice/continued care they are receiving. The woman I mentioned obviously has reached a point in her life where she feels she is a burden and has nothing to live for, I have to question who is helping her, what her family are doing, if anything, what about her friends? Instead of encouraging her, and getting her to focus on the positive aspects of her life, they are just letting her starve herself!

Advanced directives and power of attorneys, I believe, can be useful, if they are constructed from a well informed conscience. I for example, have drafted something that is legally on par with an advanced directive, that should I, for whatever reason, be injured into a coma, and I happen to be pregnant, that no abortion is to take place. (granted, I’m not married, so its not likely to happen, but I want people to know how much abortion disgusts me).

I’m a nurse, and I’ve seen the mess not having a POA can cause. But I think, they can be used for evil as much as for a good and dignified care for someone. I think religious adherence must be considered. A patient I cared for was a devout Catholic, and went to mass everyday and she had given her son POA. She suffered a serious CVA and the medical team wanted to remove her feeding tube and let her go with just the comfort of IVF. They contacted her son, who, unbeknown to his mother, he was gay and had turned fully against the Church. The woman was starting to show signs of recovery, so they upped the morphine and kept the tube out, as the son said “she wouldn’t want to live like this”. But this woman had told her very devout Catholic daughter that all measures are too be taken to save her if some form of mental recovery is able and if she’s not brain dead. But, the gay son had POA, so that elderly lady was killed with a nice little unquestionable dose of morphine and went with a sunken belly. Its not the only situation like this I’ve seen. I think POA’s need to have a clause where the patient’s religious belief must be respected.

Of course, then you get POA’s where people want to be snuffed if they so much as sneeze in a rest home.

As for assisted suicide and euthanasia, these are slippery slopes. How many feminists marching for abortion rights in the 60s and 70s thought that within 20 years there’d be 1.2 million abortions a year, and a procedure where the child is pulled feet first out of the womb and stabbed in the back of the head?

Kind of ironic, though, their generation killed ours, and now its our generation that is demanding their deaths through “the right to die”, which really, is a great big crock, how do you have a right to something we’re all going to do? Its like saying you have a right to skin!

 

[flyingfish]

Does the Catholic Church forbid suicide in absolutely all cases? What about extreme hypothetical scenarios like you’re about to be captured on the battlefield and tortured by the enemy?

Why is it anti Catholic for someone who is in the end stages of a very painful disease to shorten their life by a little bit and save a lot of pain?

 

[Jermosh]

I can see your concerns and understand them. My only thing that I would worry about is on the term of “death with dignity,”. I think sometimes we get the message that we must save a life at all costs and in all situations.

Case in point, when my FIL was ill we moved in with him to take care of day to day things, my SIL had him under strict rules with no smoking, drinking, staying up late, etc, etc. He was 78yrs old, so we let him smoke and I took him to a bar once and awhile for a beer, he could watch TV as much as he wanted. He had another stroke though, Drs wanted to do this, that, put him in therapy, he would have mostly stayed in a home for at least another 2 months to a year maybe. He looked at me and told me “Jon, only 2 people in the world wiped my A@#, my mother and me. Take me home”, the Drs fought it, but we signed the papers and brought him home. He died a few weeks later sitting in his chair with a beer watching his beloved Tampa Buceneers winning.

There are some who think I did the worse thing possible, that he could have had years of life left. But I have to ask, what is life then? To me, I think this event was one of the best things that I have done in my life, and I thank God and Berny for allowing me the privilege of helping someone die with dignity.

 

[Langdell]

I can see your concerns and understand them. My only thing that I would worry about is on the term of “death with dignity,”. I think sometimes we get the message that we must save a life at all costs and in all situations.

Case in point, when my FIL was ill we moved in with him to take care of day to day things, my SIL had him under strict rules with no smoking, drinking, staying up late, etc, etc. He was 78yrs old, so we let him smoke and I took him to a bar once and awhile for a beer, he could watch TV as much as he wanted. He had another stroke though, Drs wanted to do this, that, put him in therapy, he would have mostly stayed in a home for at least another 2 months to a year maybe. He looked at me and told me “Jon, only 2 people in the world wiped my A@#, my mother and me. Take me home”, the Drs fought it, but we signed the papers and brought him home. He died a few weeks later sitting in his chair with a beer watching his beloved Tampa Buceneers winning.

There are some who think I did the worse thing possible, that he could have had years of life left. But I have to ask, what is life then? To me, I think this event was one of the best things that I have done in my life, and I thank God and Berny for allowing me the privilege of helping someone die with dignity.

Yes, I don’t think the Church teaches anything opposed to what you and your FIL did. A competent adult is entitled to refuse certain kinds of treatment. He continued living his life “normally,” eating and drinking, and not taking positive action intended to end his life.

“Death with dignity” I had always thought of as a positive thing. It wasn’t until yesterday that I realized that *some *groups are trying to make it a code phrase for “assisted suicide” because the word “suicide” has “negative connotations.”

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[Langdell]

I think this is going to snow ball a lot worse before it gets any better. The culture of death has not only made it something that should be a right, (euthanasia and assisted suicide) but also scoffs at religious value, regardless of what faith it comes from, though I have noticed a lot more negative comment is directed towards Christianty.

Currently, there’s a woman in my country who has refused food and only taking sips of water, she’s in her 60s and had a CVA or some such brain injury that has left her with limited physical capacity. She is doing this in a Catholic rest home.

Its a fine line indeed where we stand by and let a patient kill themselves by not eating or drinking, and while I don’t we should force an NGT down their throat, I do believe we should be doing something about the obviously rubbish hospice/continued care they are receiving. The woman I mentioned obviously has reached a point in her life where she feels she is a burden and has nothing to live for, I have to question who is helping her, what her family are doing, if anything, what about her friends? Instead of encouraging her, and getting her to focus on the positive aspects of her life, they are just letting her starve herself!

Advanced directives and power of attorneys, I believe, can be useful, if they are constructed from a well informed conscience. I for example, have drafted something that is legally on par with an advanced directive, that should I, for whatever reason, be injured into a coma, and I happen to be pregnant, that no abortion is to take place. (granted, I’m not married, so its not likely to happen, but I want people to know how much abortion disgusts me).

I’m a nurse, and I’ve seen the mess not having a POA can cause. But I think, they can be used for evil as much as for a good and dignified care for someone. I think religious adherence must be considered. A patient I cared for was a devout Catholic, and went to mass everyday and she had given her son POA. She suffered a serious CVA and the medical team wanted to remove her feeding tube and let her go with just the comfort of IVF. They contacted her son, who, unbeknown to his mother, he was gay and had turned fully against the Church. The woman was starting to show signs of recovery, so they upped the morphine and kept the tube out, as the son said “she wouldn’t want to live like this”. But this woman had told her very devout Catholic daughter that all measures are too be taken to save her if some form of mental recovery is able and if she’s not brain dead. But, the gay son had POA, so that elderly lady was killed with a nice little unquestionable dose of morphine and went with a sunken belly. Its not the only situation like this I’ve seen. I think POA’s need to have a clause where the patient’s religious belief must be respected.

Of course, then you get POA’s where people want to be snuffed if they so much as sneeze in a rest home.

As for assisted suicide and euthanasia, these are slippery slopes. How many feminists marching for abortion rights in the 60s and 70s thought that within 20 years there’d be 1.2 million abortions a year, and a procedure where the child is pulled feet first out of the womb and stabbed in the back of the head?

Kind of ironic, though, their generation killed ours, and now its our generation that is demanding their deaths through “the right to die”, which really, is a great big crock, how do you have a right to something we’re all going to do? Its like saying you have a right to skin!

Thanks for sharing your experience! What patients and advisors need to be aware of is that there are *Catholic *advanced directives and POAs out there, approved by bishops. Fortunately, they’re easy to find on the Internet. (I have one that my mother signed.) But I fear that a lot of Catholics (and their advisors) may not realize that “standard” advanced directives and POAs include options that are opposed to Church teaching.

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[Jermosh]

Yes, I don’t think the Church teaches anything opposed to what you and your FIL did. A competent adult is entitled to refuse certain kinds of treatment. He continued living his life “normally,” eating and drinking, and not taking positive action intended to end his life.

“Death with dignity” I had always thought of as a positive thing. It wasn’t until yesterday that I realized that *some *groups are trying to make it a code phrase for “assisted suicide” because the word “suicide” has “negative connotations.”

.

I totally agree, I just think as we attempt to address this, we still need to communicate what our definition is. Sometimes it gets lost and people forget that its even there. Stem Cells is one that comes to mind, we fought against Embryonic SCs so hard that people started to think that SCs in general were inmoral.

 

[Langdell]

Does the Catholic Church forbid suicide in absolutely all cases? What about extreme hypothetical scenarios like you’re about to be captured on the battlefield and tortured by the enemy?

Here’s what the Catechism says:

Suicide

2280 Everyone is responsible for his life before God who has given it to him. It is God who remains the sovereign Master of life. We are obliged to accept life gratefully and preserve it for his honor and the salvation of our souls. We are stewards, not owners, of the life God has entrusted to us. It is not ours to dispose of.

2281 Suicide contradicts the natural inclination of the human being to preserve and perpetuate his life. It is gravely contrary to the just love of self. It likewise offends love of neighbor because it unjustly breaks the ties of solidarity with family, nation, and other human societies to which we continue to have obligations. Suicide is contrary to love for the living God.

2282 If suicide is committed with the intention of setting an example, especially to the young, it also takes on the gravity of scandal. Voluntary co-operation in suicide is contrary to the moral law.

Grave psychological disturbances, anguish, or grave fear of hardship, suffering, or torture can diminish the responsibility of the one committing suicide.

2283 We should not despair of the eternal salvation of persons who have taken their own lives. By ways known to him alone, God can provide the opportunity for salutary repentance. The Church prays for persons who have taken their own lives.

Why is it anti Catholic for someone who is in the end stages of a very painful disease to shorten their life by a little bit and save a lot of pain?

Because our lives are not ours to dispose of. However, there may be mitigating circumstances, as the Catechism explains above.

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[kage_ar]

Why is it anti Catholic for someone who is in the end stages of a very painful disease to shorten their life by a little bit and save a lot of pain?

Because life belongs to God.

 

[Ron_Conte]

Does the Catholic Church forbid suicide in absolutely all cases? What about extreme hypothetical scenarios like you’re about to be captured on the battlefield and tortured by the enemy?

Why is it anti Catholic for someone who is in the end stages of a very painful disease to shorten their life by a little bit and save a lot of pain?

Certain kinds of acts are inherently contrary to the love of God and neighbor. Such acts are called intrinsically evil. Murder is intrinsically evil and always gravely immoral. Types of murder include abortion, abortifacient contraception, infanticide, homicide, suicide, etc. All such acts are inherently contrary to the moral law, and never justified by intention or circumstances.

Whenever the subject of any intrinsically evil act is discussed, inevitably someone will claim that in a certain dire circumstance, or with a certain good intention, the act is no longer intrinsically evil, or is somehow justifiable, or that it is really a different kind of act. Such is never the case.

“Consequently, circumstances or intentions can never transform an act, intrinsically evil by virtue of its object, into an act ‘subjectively’ good or defensible as a choice.” (Pope John Paul II, Veritatis Splendor, n. 81.)

“No circumstance, no purpose, no law whatsoever can ever make licit an act which is intrinsically illicit, since it is contrary to the Law of God which is written in every human heart, knowable by reason itself, and proclaimed by the Church.” (Pope John Paul II, Evangelium Vitae, n. 62.)

 

[Doc_Keele]

I’m not sure why you’d expect issues of religion to come up in a discussion of advance directives/proxies?

The beliefs of the person are what will be expressed by the advance directive or proxy, unless the particular jurisdiction expects “best interests” rather than “substituted judgment”.

 

[Langdell]

I’m not sure why you’d expect issues of religion to come up in a discussion of advance directives/proxies?

The beliefs of the person are what will be expressed by the advance directive or proxy, unless the particular jurisdiction expects “best interests” rather than “substituted judgment”.

At a minimum, I think practitioners should be made aware of it, because most people use boilerplate advance directives/POAs where they just check the boxes. They may be Catholics who aren’t aware that some of the choices on the form their lawyer/doctor/whoever presents them with are contrary to Church teaching.

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[Doc_Keele]

At a minimum, I think practitioners should be made aware of it, because most people use boilerplate advance directives/POAs where they just check the boxes. They may be Catholics who aren’t aware that some of the choices on the form their lawyer/doctor/whoever presents them with are contrary to Church teaching

So why should the lawyers or doctors be directing people as to Catholic teaching?
Can you see the problem here?
Professionally speaking, the lawyer or doctor should be prepared to be instructed by the client/patient or else bow out on grounds of conscientious objection.
Do you have any evidence that this actually happens very often (that Catholics sign things they haven’t read properly and/or without knowing church teaching)?

 

[Langdell]

So why should the lawyers or doctors be directing people as to Catholic teaching?
Can you see the problem here?
Professionally speaking, the lawyer or doctor should be prepared to be instructed by the client/patient or else bow out on grounds of conscientious objection.
Do you have any evidence that this actually happens very often (that Catholics sign things they haven’t read properly and/or without knowing church teaching)?

I think if one is a doctor (or in my case a lawyer), s/he should let patients/clients who are thinking about these types of documents know that there are different options available for different religious traditions. In addition to Catholic ones, there are also Jewish and Jehovah’s Witnesses ones. There are probably others.

As far as evidence goes, my only experience is in dealing with my mother and my in-laws. My mother knew enough to ask whether what she was choosing was consistent with Church teaching, but my in-laws had no clue.

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[Doc_Keele]

So you don’t think it’s the responsibility of the patient/client to bring up all relevant factors in drawing up advance directives?
If the client/patient is Catholic, can the lawyer/doctor make presumptions about the person’s position of end of life issues?
Doctors and lawyers aren’t meant to be spiritual advisers.

 

[Langdell]

What I’m saying is that the doctor/lawyer should be aware of the options that exist and should make the patient aware of those options. If the patient then says, I’m an atheist, or I don’t care, or whatever, then fine. But as part of his/her professional responsibility, I think any lawyer (I can’t speak for doctors) should know the options and make the client aware of them. I almost never do the first thing that a client tells me s/he wants to do.

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[Doc_Keele]

I don’t think it is part of the professional responsibility of a doctor or lawyer to give spiritual advice - and I could see crossing the boundary getting you in trouble. You’re there to give medical or legal advice. The client or patient informs YOU of their beliefs.

 

[kage_ar]

Lawyers and doctors may not violate natural law, moral law is written on the hearts of all men and applies to every human.