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| “For Christians, death has been defeated,” remarked one of the speakers at the end-of-life issues conference, held Oct. 31 and Nov. 1 at the UIW Skyroom.
Jordan McMorrough | Today's Catholic |
SAN ANTONIO • Important end of life issues that affect many people at critical and emotional moments in their lives were examined at a two-day “End of Life Conference” held at the University of the Incarnate Word Rosenberg Skyroom Oct. 31 and Nov. 1.
In 2007, Archbishop José H. Gomez published a booklet, A Will to Live: Clear Answers on End of Life Issues, that, in a simple to understand question and answer format, provided much sought after information on the difficult issues that face families at the end of life, for themselves and the people they love. The book is now published in English and Spanish.
This is the second year that Archbishop Gomez has hosted an event dealing with end-of-life issues, and the presenters featured there are considered among the best experts in the country on bioethics and end-of-life issues.
The gathering began with a Mass celebrated by the archbishop Oct. 31 at the Chapel of the Incarnate Word.
“This is an important issue in our society and a special ministry for the church. The culture of life is a foundational issue of our society,” Archbishop Gomez said. “It is not just a religious matter. It is an essential aspect for the human race and part of the foundation of our nation and western society.”
A passage of the Gospel from the Mass contained the essence of the ministry of healing. Jesus challenged the scholars of the law and the Pharisees with a question about curing on the Sabbath. The question was about the particulars of the law, but also about the spirit of caring for others.
“It is so important that it’s not contained by time or human preferences or financial considerations,” said the archbishop. “Love for others becomes more real as we help each other in difficult situations and health is probably one of the most immediate needs in our lives.”
Archbishop Gomez cited numerous instances in the Bible where Jesus’ ministry is presented in terms of preaching the good news and healing, such as a passage from St. Matthew which states: “[Jesus] went about . . .preaching the Gospel of the kingdom and healing.” (Mt 4:23; 9:35; Lk 9:6-11)
“As followers of Jesus Christ, we are also called to be instruments of healing for people,” the archbishop said. “All of us are called to practice the works of mercy and care for the physical and spiritual needs of our brothers and sisters.”
In the first reading from the Mass St. Paul prayed: “That your love may increase ever more and more in knowledge and every kind or perception, to discern what is of value, so that you may be pure and blameless for the day of Christ, filled with the fruit of righteousness that comes through Jesus Christ for the glory and praise of God.”
Said Archbishop Gomez, “The great truth that we must proclaim as Catholics is that life is not simply biological. Our life is also theological. Our life is conceived and lived in dialogue, in a relationship with God.”
This dialogue with God, he continued, is not interrupted by illness, disability, or disease. “Suffering and sickness can never diminish the dignity of our lives, the great mystery of our lives in the plan of God,” the archbishop said. “A person who is diseased, who suffers cognitive disabilities, or who is in a persistent vegetative state, remains a person in relationship with God.”
He quoted the words of Pope John Paul II from an address to an international congress in 2004 that, “The loving gaze of God the Father still falls upon them, acknowledging them as his sons and daughters, especially in need of help.”
End-of-life issues, like the issue of the beginning of life, aren’t simply “Catholic” issues or matters of faith, explained Archbishop Gomez, but ones which concern the most fundamental questions in any human civilization. “Who gets to live and who doesn’t — and who gets to decide this question?” he asked. “Can one’s rights or freedoms include the right and freedom to extinguish the life of one who is weaker?”
The archbishop concluded with the words of the day’s responsorial psalm: “How great are the works of the Lord! … He has made known to his people the power of his work, giving them the inheritance of the nations.”
Dr. John Haas
A return presenter from the previous conference was Dr. John Haas, Ph.D., president of the National Catholic Bioethics Center. He gave the more than 100 attendees an overview of Catholic health care and bioethics principles.
Haas began by providing some facts regarding the church’s health care ministry. The Catholic Church is the largest non-governmental health care provider, generating $90 billion in revenue each year with $200 billion in assets. In illustrating the importance of the church’s health care ministry, he cited as an example the Diocese of Little Rock, Ark., which has a statewide 2 percent Catholic population, but which operates 14 Catholic hospitals.
He told listeners, many of whom were medical personnel, that church institutions operate under a compendium of “Ethical and Religious Directives for Catholic Health Care Services.”
“Catholic health care ministry is rooted in a commitment to promote and respect human dignity,” said Haas. “Catholic health care services must adopt these directives as policy, require adherence to them as an institution as a condition for medical privileges and employment, and provide appropriate instruction regarding the directives for administration, medical personnel.”
The president of the bioethics center examined several moral methodologies that are used in decision making, focusing especially on relativist ethics, the law ethic and ethics of the good, more commonly known as natural moral law.
He described how relativistic ethics apply to situationalism, consequentialism and utilitarianism. In situationalism, an act is judged in the situation, the intention suffices, and acts are done for and judged by some dominant value. With consequentialism, the morality of the act is determined by the consequences, and it is impossible to see them all. For utilitarianism, the outcome is measurable, with whatever maximizes pleasure and minimizes pain, and emphasis is placed on the common good.
With this trio, “whether one kills a patient depends on the circumstances,” Haas said.
In focusing on the law ethic, Haas described the approaches as “deontological,” or obligatory and for duty’s sake, and “by the book,” explaining, “God said it (or the law says it) and that’s that.”
Lastly, virtue and Catholic reasoning are the basis of natural moral law, said Haas, a former seminary professor. Virtue seeks what is natural to humans and to act reasonably, and in Catholicism God is the ultimate source of happiness and determinant of human nature, he emphasized, adding “It is unreasonable to kill the sufferer to alleviate suffering.”
In concluding his talk, Haas highlighted the principle of double effect, which asks: When we are going to posit an action and we see that it will have two effects, one good and one bad, may we still go ahead and act?
The answer is “yes,” but only if certain conditions are met. Those are that the act must itself be good, one only intends good, the evil is never the means to the good and there is a proportionately grave reason for positing the act.
Father Tad Pacholczyk
Father Tad Pacholczyk, Ph.D., is director of education, a neuroscientist and staff ethicist at the National Catholic Bioethics Center. The priest also contributes a column to Today’s Catholic newspaper on medical/moral issues.
His topic of discussion, “What Constitutes Ordinary/Extraordinary Means for End-of-Life Decisions,” looked at fears about technology and dying and the obligations a person has to use ordinary or proportionate means of preserving his or her life.
“A person has an obligation to use ordinary or proportionate means of preserving his or her life,” said Father Pacholczyk. “Proportionate means are those that in the judgment of the patient offer a reasonable hope of benefit and do not entail excessive burden or cost on the community.”
He asked: Is it necessary in all circumstances to have a response to all possible remedies?
The priest responded, “In the past moralists replied that no one is ever obliged to use ‘extraordinary’ means. This reply, which as a principle still holds good, is perhaps less clear today, by means of the impression of the term and the rapid progress made in the treatment of sickness.”
A proportionate intervention seeks to answer the following:
Does it offer a reasonable hope of success?
How inconvenient is it and are there associated risks?
What are the circumstances of persons, places, times, cultures?
What is the state of the sick person (both physical and moral resources)?
What burdens may be placed on others (family, friends)?
Does it involve excessive expense?
“It’s a complicated blend of factors when making a judgment. It’s not always simple to discern,” admitted Father Pacholczyk. “Determining whether a treatment is disproportionate requires care scrutiny.”
He discussed the difficulty of predicting an “imminent death” and declining from illness to actively dying.
“We should die from an underlying sickness or pathology,” said the priest, who holds a degree in neuroscience from Yale University. “It is an important difference between a treatment that is excessively burdensome and finding life in general to be excessively burdensome.”
He especially urged caution in using language such as, “I don’t want a bunch of tubes attached to me,” saying, “Depending on the circumstances, tubes may be an important bridge to healing and may be morally obligatory.”
Do not resuscitate orders should be used only when death is imminent and responsible treatment options no longer exist, he stressed, and he emphasized the preference for health care surrogate as opposed to a “living will.”
“The proposed surrogate (health care proxy) is a person who deeply cares about the patient and is reasonably able to make decisions in accord with the known wishes of the patient and with the patient’s best medical and spiritual interests,” Father Pacholczyk said.
Some of the topics discussed at the gathering included, “Will You Survive the Texas Advance Directive Act?” “Embracing our Dying: The Value of Hospice and Palliative Care,” “Moral and Ethical Considerations Surrounding Brain Death,” “Artificial Nutrition and Hydration,” “The Legislative Politics in Texas” and “Are Your Religious Freedoms Protected if you are a Pro-Life American?”
Other presenters included Christina McClean, director of CHRISTUS VNA Hospice and Palliative Care; Andrew Rivas, executive director of the Texas Catholic Conference; and Douglas Deffenbaugh and Lisette Lange, partners in the Law Firm of Deffenbaugh & Lange, P.L.L.C.
The conference was coordinated by Basilica Press in conjunction with the National Catholic Bioethics Center.