End-of-Life and Palliative Care
This is a series of articles that explains and explores the Church teachings on end-of-life and palliative care issues. It was written by Dr. Paul Fiacco and Fr. Charles Vavonese and published in the Catholic Sun.
Dr. Paul Fiacco is the president and medical director of CNY AIM, a St. Joseph 's Health clinically integrated network, and is also the medical director of the Trinity Health integrated Care ACO as well as a full-time physician at CNY Family Care in East Syracuse and is a parishioner at Holy Cross Church in DeWitt.
Father Charles Vavonese is a retired priest of the Diocese of Syracuse and the author of I Am the Resurrection and the Life, a resource booklet dealing with end-of-life moral issues. He currently serves patients receiving palliative care as the chaplain for the St. Joseph Health Mobile Integrated Services Team. In addition, Father Vavonese is a weekend assistant at Holy Cross Church in DeWitt.
On May 1-2, 2021, Fr. Vavonese gave homilies at Holy Cross Church during the weekend Masses covering these topics. You can listen to the homily below.
Please click on the appropriate link below to be taken to the full article.
Article 1 – Introduction
Over one hundred years ago, the leading cause of death was infectious diseases; today, most people will die from chronic diseases. While medical care has improved and extended our lives over the last century, it has also presented us with several moral and medical dilemmas.
The articles we've presented over the last several months have aimed to combine medical care with spiritual care, to provide a holistic approach to the difficulties of end-of-life decisions and moral issues. Illuminated also is the Catholic vision of life, and how an understanding of this vision serves as a backdrop to Palliative care and its assistance to individuals when making end-of-life decisions.
Article 2 – A Moral Roadmap
The Catholic vision of life recognizes that our ultimate destiny is to be with God for eternity. Catholic theology provides a road map to navigate the complexities of end-of-life moral dilemmas; it requires that we avoid the extremes of vitalism and subjectivism. Vitalism holds that life must be preserved at all costs and that all available treatments must be undertaken to keep the patient alive. By contrast, Subjectivism holds that life has value only when an individual determines that that life has value. Catholic moral teaching provides us guidance to avoid these conflicting two extremes.
Article 3 – Ordinary and Extraordinary Care
Understanding the difference between ordinary and extraordinary medical treatments is critical and better understood when Catholic moral teaching is applied. Ordinary care provides a benefit to the patient and presents no excessive burden; in Catholic theology, this type of care is morally obligatory. By contrast, extraordinary care may provide conflicting benefit to the patient as well as excessive burden. In Catholic teaching, there is no moral obligation to accept extraordinary treatments.
Article 4 – Burdensome Treatments
There are many considerations for a patient and caregivers in determining if a treatment proposed imposes an excessive burden and can be forgone or withdrawn. Some of these considerations include: the treatment severity, prognosis, risks and side effects; the potential for recovery; and whether the treatment imposes significant spiritual, emotional, or financial expense to the patient, family, or community.
Article 5 – Quality of Life Issues
There are two contexts in which "quality of life" is used in end-of-life discussions. The first is when a patient with a serious condition decides to forgo or withdraw a treatment that is considered extraordinary care or excessively burdensome in favor of enjoying the remainder of life in a comfortable manner. This decision is permissible in Catholic theology. In the second situation, the diminished "quality of life" of a person with a disability or serious illness is used by some to justify terminating lives by those who propose euthanasia or assisted suicide, which is never permissible in Catholic moral teaching.
Article 6 – Pain Management
The administration of medication for pain in terminal patients - though it may shorten their lives - is permitted in Catholic theology by using the principle of double effect developed by St. Thomas Aquinas, a medieval theologian. St. Thomas developed this schema for resolving dilemmas that occur when a single action has both a "good" outcome and an "evil" outcome.
Article 7 – Nutrition and Hydration
The Church teaches that nutrition and hydration - provided by natural or medically assisted means - is basic human care and is also considered ordinary or proportionate care. This is, in principle, morally obligatory even for those in a persistent vegetative state. However, there are situations when medically assisted nutrition and/or hydration may become extraordinary or disproportionate and may be forgone or withdrawn. These situations may occur when death is imminent, when the treatment is determined by the patient or a surrogate to be a burdensome treatment, and when offering the nutrition and hydration would be futile. St. John Paul II articulated that withdrawing or forgoing such extraordinary or disproportionate care in these cases is not suicide or murder.
Article 8 – Sacrament of the Sick
The Sacrament of the Sick continues the healing ministry that Jesus entrusted to the Apostles. The Sacrament has developed significantly over the centuries. Most recently, the Second Vatican Council (1962-1965) restored the original intent of the rite as Anointing of the Sick as a reaffirming of the healing nature of the sick, and signific antly expanded the number of individuals who may receive the Sacrament.
Article 9 – Advanced Planning
The Health Care Proxy and Advanced Care Directives, guided by Catholic morals and teachings, give instructions for your medical care should you become unable to make those decisions on your own behalf. The Health Care Proxy is the most important end-of-life planning document individuals can execute. Advanced Care Directives, when guided by Catholic morals and teachings, gives instructions for your care to your health care proxy should the
proxy need to make medical decisions on your behalf. Since people can become incapacitated at any age, everyone should consider completing a health care proxy document. Additional resources are available through the National Catholic Bioethics Center (NCBC) for end-of-life moral decisions.
Article 10 – Palliative Care
In its truest sense, palliative care provides life-affirming, comprehensive, and interdisciplinary care for people afflicted with serious illness and their families. St. Marianne Cope modeled this comprehensive care by providing relief to those with Hansen's disease (Leprosy) in the late 1800's. So important is palliative care that Pope Francis recently issued a White Paper calling on policy makers, colleges, universities, health care institutions, medical professionals, the media, spiritual care professionals, and others in the church to advocate for palliative care.
Article 11 – Ambulatory Palliative Care
A new model for delivering Palliative Care into the community augments the traditional office-based model by providing the care needed to patients with serious illness directly into their homes. A community-based palliative care program allows patients to maintain their independence as they cope with the progression of their illness and treatment. The goal is to improve the life and care of patients and their families while reducing the burdens caused by their serious illness. The success of these programs and the ability to reach more vulnerable patients in our community depends on an expanded collaboration between the Church, other faith communities, and healthcare system networks. With this collaboration, palliative care becomes a powerful anecdote to euthanasia and physician-assisted suicide.
Article 12 – End-of-Life Documents
To assist readers to avoid confusion among the numerous end-of-life documents, this article describes some of the more common documents that are used at the end-of-life. It outlines and provides an explanation of the Health Care Proxy, Advanced Care Directive, Power of Attorney, Last Will and Testament, DNR/DNI Orders, Organ Donation Card, and Medical Orders for Life Sustaining Treatment (MOLST) forms.
Article 13 – A Summary
This article is a summary of the all of the articles that have been previously published in this series.
Article 14 – Concluding Thoughts
This article concludes this series and will discuss the synthesis of Catholic moral theology and palliative care as it applies to current health care decision making.
Resources from the National Catholic Bioethics Center
Catholic Guide to End-of-Life Decisions
The National Catholic Bioethics Center (NCBC) has developed A Catholic Guide to End-of Life Decisions which is a succinct summary of Catholic end-of-life moral teaching. It also explains Church teaching on advanced directives, euthanasia and physician-assisted suicide. This guide includes a sample health care proxy and advanced care directive. It is available for download from www.ncbcenter.org/store/catholic-guide-to-end-of-life-decisions-english-pdf-download. The cost to download is less than three dollars. It is advisable to share this guide with your health care proxy, and to attach the guide to your Health Care Proxy form and advanced care directive.
Ethicist-on-Call 24/7
In emergent situations, we may need a Catholic moral opinion unexpectedly. To meet this need, the National Catholic Bioethics Center offers an ethicist-on-call service that is available 24 hours/day and 7 days per week. To access this service, dial (215) 877-2660 and follow the prompts. One of the members of the NCBC team will respond to your call promptly. Since we cannot anticipate when we might need this service, it is advised that this phone number be included among your contacts, and your health care proxy’s phone contact list.