E-book available on the topic of dying and hospice care

We are also pleased to share with you an e-book on the topic of dying and hospice care.

Contemporary society attempts to ignore the reality of death. Unfortunately, this leaves many people unprepared and/or unwilling to handle the challenges faced when they, or their loved ones, receive a terminal diagnosis.

Written by Mark Schmidt, the Respect Life/Social Justice Director of the Archdiocese of Dubuque, “Into Your Hands Lord: A Catholic Companion to Dying and Hospice Care” is a simple guide to assist in the journey towards death and into new life. Grounded in the Passion of the Christ and Catholic teaching, this companion will assist families in discussing issues such as: artificial nutrition and hydration, pain medications, coping with the absence of a loved one, and various other aspects of the dying process.

A version of the book for a Christian (not specifically Catholic) audience is also available. If you’re interested contact info@iowacatholicconference.org.

The book is available at this link: into_your_hands_lord_a-catholic-companion-to-dying-and-hosp

Opposition to “physician assisted suicide” motivated by compassion

By Archbishop Michael Jackels of the Archdiocese of Dubuque

Advocates for physician-assisted suicide (PAS) in Iowa have recently begun efforts to get it legalized here, promoting legislation under the name of “Death with Dignity.”

This article is the first in a series by the Catholic bishops of Iowa, intended to encourage a thoughtful reflection on the issue, which will hopefully lead to opposition of PAS.

Advocates of PAS insist that they are motivated by compassion for people who suffer, leaving the impression that those opposed to it are lacking in compassion. But Catholics insist that opposition to PAS is also motivated by compassion for the same people who suffer, as well as for other individuals, and for society as a whole.

For example, there is compassion behind Catholic teaching that seeks to remove the fear of death, to heal the grief of loss, and to affirm the dignity of every person regardless of his/her circumstances, and even of a deceased person’s body.

There is compassion too behind Catholic teaching that directs us to help protect people from the moment of conception to natural death, and to help provide them with things needed to live in dignity, when they cannot do so for themselves.

There is also compassion behind Catholic teaching that inspires us to love life, and to take care of ourselves as good stewards, but which doesn’t require that we use every available means to preserve our life and health.

And there is compassion behind Catholic teaching that recognizes suffering as a part of life, which can inspire solidarity with Jesus and others, creating a compassionate heart, but which we may seek to alleviate through medicine and palliative care.

There is even compassion behind Catholic teaching that judges suicide as gravely sinful behavior, but which also acknowledges that a person may not necessarily be guilty of mortal sin if something adversely affected freedom, and so lessened responsibility in part or in full.

Therefore, motivated by compassion, Catholics are opposed to PAS, out of concern for how it threatens the true well-being of individuals and of society, for example:

  • That people might ground their choices on the most base of moral guides – for me to enjoy pleasure and to avoid pain – instead of more ennobling principles.
  • That people would be free to make a fatal decision that could possibly be based on physician error, misinformation, family pressure, or fear of being a burden to others.
  • That decision-making is influenced not so much by wisdom as by the fact that medical science makes something possible (just because we can do something doesn’t mean that we should, or that it represents an advancement in human society).
  • That PAS will inevitably lead to going further down the slippery slope of a throw-away culture, to include allowing people with non-physical types of pain and issues other than pain to ask a doctor to help them kill themselves, or to allow one person to make such a fatal decision, say, for a child, a person with a disability, the elderly, or someone unable to give consent.

We do not need PAS; there are other, ethical, and humane ways to deal with human suffering.

We do not want PAS, which is an assault on human life and dignity that results in a cold, uncaring society, and that stunts the intellectual, spiritual, and moral growth of individuals.

“Our society should embrace … the way of love and true mercy – a readiness to surround patients with love, support, and companionship, providing the assistance needed to ease their physical, emotional, and spiritual suffering. This approach must be anchored in unconditional respect for their human dignity, beginning with respect for the inherent value of their lives” (USCCB, To Live Each Day with Dignity).

Seeking the face of Christ in suffering

By Bishop R. Walker Nickless of the Diocese of Sioux City

 

Supporters of “doctor-prescribed suicide” often say it is needed to alleviate pain and suffering. In fact, intractable pain is way down the list of reasons why patients ask for suicide.

But an important point is being raised. What should we make of suffering? One commonly hears the so-called “problem of suffering” argument, against God’s existence. Suffering exists, the argument goes. But then God, all-loving and all-powerful as He is, seems to be either incapable of relieving suffering (thus not all-powerful), or willing to (thus not all-loving). Therefore, the argument claims, suffering disproves God.

This is a weak argument for two reasons. First, it never asks what “suffering” actually is; and second, it simply assumes that suffering (whatever it is) and love must be mutually incompatible.

The disciple of our Lord Jesus Christ knows suffering not only through personal experience, but also through the lens of Christ’s saving Passion. This is at the very heart of our faith – that Christ freely chose to endure the agony of the Cross and the grave, out of His infinite, divine love, so that we poor sinners might be saved from the sufferings of Hell. Moreover, as disciples, we know that our suffering can unite us to Christ’s saving Passion, and therefore our suffering, too, can be redemptive.

Nor is faith required to see that love always entails suffering. Parents of every culture and religion willingly make sacrifices for their children, husbands and wives for each other, patriots for their country, and so on. These sacrifices mean people, always and everywhere, freely choose to suffer for love, for the sake of a greater good. Can we imagine even our weak, fallible human love making no sacrifices, accepting no suffering, for the sake of the beloved? If we can, we don’t call it love, but selfishness.

The truth is that all of us experience some kind of suffering, all the time, because what “suffering” actually means is “being deprived of a good.” In the broadest sense, only God is “the Good;” and since He is infinite in His goodness, we, as strictly finite beings, can’t even exist without lacking the fullness of the Good. We quickly learn to take such minor sufferings in stride, since we cannot change them, and to work within our human limits.

But, apart from the suffering resulting from our creaturely finitude, and the sacrifices we freely choose out of love, there is also suffering that we experience involuntarily, as an evil. In a minor key, we daily grow hungry, tired, and cranky; we are sometimes ill; we forget things; we never have as much money or possessions as we want; and so on. More significantly, we spitefully wound others with our words and actions, and are wounded by others; we fight and kill, sicken and die; we grieve helplessly for our beloved dead. This is the suffering our “problem of suffering” envisions. And truly, this “moral suffering” cries out to God for redress (e.g., Psalm 22).

We imagine, today, that we are somehow entitled not to experience this kind of suffering. No matter what form it takes, we label it “unjust” and “unfair,” and seek to avoid it by any and every means – even by the expedient of murdering the one who suffers (euthanasia)! We imagine that our unprecedented wealth and technology can and should preserve us from all this suffering. But as we ponder it, do we not find that this hope is false?

Certainly we can alleviate some suffering, and this is right and good. Indeed, God wills that we do so, using all the gifts of His creation and all the talents of our intellects to unlock them, so that we can actively participate in His love for each of us, by doing what is humanly possible to cause others to suffer less.

As disciples of Jesus Christ, however, we know that we cannot get to Heaven apart from the way of the Cross. Suffering is necessary, in some sense, just as the Passion was necessary for Christ’s mission of salvation. But, even here, in this experience of unwanted “moral suffering,” we see that, far from being unwilling or unable to relieve it, God is present, using us to relieve suffering for each other. We should never, therefore, be afraid of suffering, or seek by unreasonable means (abortion, euthanasia) to avoid it; but when we must suffer, more than can be avoided or alleviated, we should seek there the face of Christ who suffered the Cross for love of us.

Tending the garden of our lives

By Bishop Martin Amos of the Diocese of Davenport

In the Book of Genesis, we read that the first couple was commissioned to care for the Garden that God had planted. They were to serve as caretakers, not rulers; tenant farmers instead of owners. Their vocation as stewards was to till the earth on God’s behalf. It was only when we tried to become like God—by eating the fruit or, later, by building the Tower of Babel—that disaster followed.

We did not learn our lesson. The Prophets had to remind the kings of Israel repeatedly that they were only stewards, that Israel had only one true king – God – and that those who sat on the throne did so as caretakers. The kings were to tend the garden of Israel on God’s behalf, as stewards and shepherds not absolute rulers.

The Wisdom writings of the Old Testament also remind us that all we have comes from God; we are not owners, but caretakers; stewards not masters. Psalm 8:5-6 proclaims:

What is man that you are mindful of him,

and a son of man that you care for him?

Yet you have made him little less than a god,

crowned him with glory and honor.

We are so much more than just animals; but we are not gods. There are limits on what we can (and should) do. I will be the first to admit: such a message is hard to hear in a culture that says that if we can do it, we should; that there are no bounds on how we might manipulate nature. There are those who advocate for increasing control of human reproduction, even to the point of changing our genetic code. And there are those who argue that it is a “right” to decide when and how we are to die.

We hold that creation, that life, is not an accident, but that it has a Source; that it is not meaningless, but that it has a purpose, an end. We are part of a web of intimate and intricate relationships, and we have a unique place and role as creation’s stewards. But we are still partof creation; we are creatures and not the Creator. We are again forgetting the lessons of the Garden and of Babel.

The Creator has entrusted us with the care and use of the natural world, including our bodies. It is no wonder that the Church holds life not just in respect but in awe. Life is a precious gift, never to be squandered. So our tradition insists that taking care of ourselves is a moral responsibility, a response in gratitude to the gift we have been given. This is good stewardship.

At the same time, we insist that the various qualities that make up our lives do not add to or detract from its inherent value. Human life has an ultimate meaning beyond this existence. We are created for relationship with God; a relationship that begins in the here and now and that reaches its ultimate fruition at the end of time. Jesus died and rose so we might enjoy eternal life. Physical death, therefore, is not the ultimate enemy. With Saint Francis of Assisi, we can learn to welcome Death as our Sister who leads us to the Father.

We are called to neither fear death nor hasten its coming. There may come a time in each of our lives when physical healing is no longer possible. Once we are dying, our focus ought not to be on pursuing the impossible but on preparing to let go of this life and trustingly abandon ourselves into the hands of God. Comprehensive end-of-life care, which focuses on the physical, emotional, relational, and spiritual needs of the one who is dying and of those close to them, is where our time and energy need to be spent. This, too, is good stewardship.

As stewards, we have the privilege of caring for the gift of life, even in the midst of dying. We are called to tend the garden of our lives with gratitude, humility, and trust in the One who made us, redeemed us, graces us along the way, and calls us to everlasting life.

Compassionate, faith-filled care at the end of life

By Bishop Richard Pates of the Diocese of Des Moines

Pope Francis often refers to travelling the journey with the vulnerable, especially in this Jubilee Year of Mercy. But what does it concretely look like to accompany those who suffer, or, as Pope Francis phrased it, engage in the “mission of affectionately and tenderly caring for the sick and dying?“ More personally, how do we make faith-filled and clinically informed decisions about our own care when we end up facing a difficult health condition?

To begin, we must prayerfully consider the options that are available when we or those whom we love receive difficult news. Most commonly, health care professionals use terms like palliative care, comfort measures, or hospice. Each of these alternatives is in accord with Catholic teaching and can bring peace to both the patient and family, but understanding the terms is a first critical step.

Palliative care supports people who are seriously ill, with the goal of improving the quality of life for both the patient and the family. A palliative care team normally includes doctors, nurses and support staff who work to relieve patients of pain and who address the stresses associated with health issues. Palliative care is appropriate at any stage of an illness and allows for fullness of life even in the midst of illness.

A second option, hospice care, provides comfort and support to patients with advanced illness as well as to their families. Hospice care is specifically for patients with a terminal condition who will live six months or less if the illness or condition runs its normal course. While receiving hospice care, patients can live at home, at a home-like hospice residence, or in a nursing home.

Comfort care is a term you most frequently hear in a hospital setting. It is often used when all options for cure have been exhausted and the goal of all who are involved is to keep the patient comfortable. Though no aggressive treatments are continued, comfort care does notmean “giving up.” Instead, the health care team provides relief on all levels – physical, spiritual, and emotional – as one nears the natural end of life.

The methods of care discussed above are all fully in line with the moral teachings of the Church. As Catholics, we should do all that we can to familiarize ourselves with the Church’s guidance on these matters, so that we can be prepared to navigate the morally complex situations in serious illness as well as those that arise at the end of life. One benefit of seeking treatment from Catholic healthcare facilities is that the physicians, nurses, and chaplains employed there are committed to offering care and counsel according to the approved ethical directives of the Church.

Healing the sick was an integral part of Jesus’ earthly ministry. Jesus wept when he was confronted with the death of a friend (John 11:32-37), and he had compassion for the sick who were brought to him (Matt. 14:14). Care for those very seriously ill and who are dying is one of the ways that we follow the example of our Lord in living out our mission as the body of Christ.

Today, certain social currents are making it increasingly challenging to provide end-of-life care that respects the dignity of each person. We can offer powerful testimony to the Gospel by defending the dignity of human life from conception until natural death, and by making faithful decisions about end-of-care life for ourselves and our loved ones.

There are numerous resources available to help us better inform our consciences on these matters. During this Year of Mercy, let us redouble our efforts to know and live the truth in this area of our lives, so that others might see our good works and glorify our Father who is in heaven (Matt. 5:16).

May 2, 2016

Recommended Resources:

Ethical and Religious Directives for Catholic Healthcare Services (USCCB):

http://www.usccb.org/issues-and-action/human-life-and-dignity/health-care/upload/Ethical-Religious-Directives-Catholic-Health-Care-Services-fifth-edition-2009.pdf

Evangelium Vitae, by Pope John Paul II:

http://w2.vatican.va/content/john-paul-ii/en/encyclicals/documents/hf_jp-ii_enc_25031995_evangelium-vitae.html

Article prepared in consultation with Des Moines Diocesan Supportive Care Iowa Team

Ethical and Religious Directives of Catholic Health Care Services

“The purpose of these Ethical and Religious Directives then is twofold: first, to reaffirm the ethical standards of behavior in health care that flow from the Church’s teaching about the dignity of the human person; second, to provide authoritative guidance on certain moral issues that face Catholic health care today.”

The Ethical and Religious Directives of Catholic Health Care Services, in its fifth edition, is created by the United States Conference of Catholic Bishops as a template for applying Catholic teaching to our relationships in the realm of health care. It provides guidance for the Catholic community of providers and patients as it strives to reflect Christ’s mission to serve the life and dignity of all.

Click here to go to the Ethical and Religious Directives document.

ICC opposes “doctor-prescribed suicide” bills

Bills have been introduced in the Iowa House  (House File 65) and Iowa Senate (Senate File 2051) to legalize doctor-prescribed suicide, also called “physician-assisted suicide.” The Iowa Catholic Conference opposes the bills.

The Iowa Catholic Conference opposes the legalization of doctor-prescribed suicide, also called physician-assisted suicide. Many people are understandably concerned about what they may face as they near the end of their life. People don’t want to suffer and are concerned they’ll be forced to endure life-support machines indefinitely. Many wrongly believe that life-support systems can never be removed.

From the perspective of our religious faith, the Catholic Church supports the protection of human life from conception until a natural death. The dignity of the human person is the foundation of a moral vision for society and fundamental to Catholic social teaching. Each and every person is created in the image and likeness of God. The Catholic Church teaches that consciously choosing to end one’s life is wrong, and assisting with someone’s suicide cannot be condoned. We should not eliminate suffering by eliminating the one who suffers.

Aside from faith-based concerns, there are many reasons to question whether legalizing doctor-prescribed suicide (physician assisted suicide) is good health care or good public policy. Unfortunately, the intent of this legislation does not protect vulnerable people from its dangerous content.

Advocates of physician assisted suicide argue that it is an act of compassion giving relief to patients who are experiencing excruciating physical pain. But does it really address the needs of the terminally ill patient? In an editorial in the New York Times, Ezekiel Emanuel, M.D., Ph.D., pointed out that “patients themselves say that the primary motive [for requesting assisted suicide] is not to escape physical pain but psychological distress; the main drivers are depression, hopelessness and fear of loss of autonomy and control.” (“Four Myths About Doctor-Assisted Suicide,” New York Times Oct. 27, 2012) Should we not offer these patients counseling and caring rather than death? In this bill, a counseling referral is not required unless the doctor believes depression is causing impaired judgment.

Will this proposal ensure a “good death” that is quick and painless? Assisted suicides can go wrong. Citing a study in the Netherlands, Ezekiel Emanuel, M.D., Ph.D., has reported that “patients…vomited up their medications in 7 percent of cases; in 15 percent of cases, patients either did not die or took a very long time to die – hours, even days; in 18 percent, doctors had to intervene to administer a lethal medication themselves, converting a physician-assisted suicide into euthanasia.” (“Four Myths About Doctor-Assisted Suicide,” New York Times Oct. 27, 2012)

What would this proposal ultimately mean to those who are diagnosed with a terminal disease? Will they be pressured? Do you think it’s possible that patients – particularly the elderly – might feel pressured into choosing assisted suicide to avoid being a burden or a financial liability to loved ones? What kind of demands will ultimately be put on patients who are a financial drain on the health care system.

What will this mean for suicide rates in general? A recent report on suicide trends and risk factors for the Oregon Health Authority (where they have doctor-prescribed suicide) found the state’s overall suicide rate was 41 percent higher than the national rate. (AP, May 2, 2013)

What will doctor-prescribed suicide mean to the medical profession? We believe it brings a new dimension to the healing profession – that of enabling death. Does it lower the standard of care by only requiring a person to act in “good-faith compliance” with the provisions of the bill? “Good faith” is a loose legal standard and it’s much weaker than the negligence standard physicians are generally held to.

Can we trust health insurance companies or government-provided insurance to do the right thing, or the least-costly thing? Cost containment in health care is already a much-discussed goal. Already in Oregon, in some situations the state will call the patient and deny medical coverage the patient wants and may need, but instead offer coverage for a prescription which causes death. Once doctor-prescribed suicide becomes a “medical treatment,” it becomes the most cost-effective “treatment” available.

Why are the so-called safeguards in this bill only applied to the requests for a prescription and not to the act of suicide itself? Who else will have access to the medication while it’s in the home? There’s no way to know if a person was pressured into taking the lethal drugs. There’s no way to know if the drugs were mixed into the patient’s food without their knowledge.

Why is the only reporting about doctor-prescribed suicide self-reporting by the doctors prescribing lethal drugs? As the Oregon Health Division noted on the issue in 1999: “There are several limitations that should be kept in mind when considering these findings…. For that matter, the entire account [by prescribing physicians] could have been a cock-and-bull story. We assume, however, that physicians were their usual careful and accurate selves.” Center for Disease Prevention & Epidemiology, Oregon Health Division, CD Reports, March 16, 1999, at 2.

We are fortunate to live during a time when the advances in drug therapy and technology, particularly in palliative care, are developing rapidly and making great strides in pain management. Medical and hospice care is such today that much pain and suffering can be relieved. Medical professionals in Iowa are well-qualified to address the top concerns of those who support prescribed suicide. Because of the possibility of coercion and abuse, passage of this legislation would make life more perilous for those who are very sick and elderly.