Friday, June 29, 2012

Science & Faith: End of Life Decisions

   While attending Mass on the Duquesne University campus I read of a "Controversies in the Catholic Church: Faith & Science" seminar at the "Catholic Newman Center" on Tuesday June 26th (from 7:30 PM to 9:00 PM).  I attended the seminar led by Fr. Joshua Kibler (Director of the Newman Center at Duquesne) led a discussion of readings related to end of life issues relating science, faith and decisions that involve medical care.  The discussion was enriched by Fr. Kibler who clarified the focus of the church and its position on such issues.  In addition to graduate and undergraduate students there were two nurses in attendance who had frequent experiences in seeing the end of life medical options as a function of professional experiences.
    Those in attendance read aloud and then commented on the article titled "Esther's Guarded Condition" by Anthony Esolen from Touchstone: A Journal of Mere Christianity (July/August, 2007): 20-24.  This is a magazine authored and edited by members of Protestant, Catholic and Orthodox Christian denominations.  In addition those in attendance were provided with John Paul II "International Congress: Life-Sustaining  Treatments and Vegetative State: Scientific Advances and Ethical Dilemmas" which was provided for enrichment reading.
    In the opening of the article the author exposes one of the themes of his writing.  Medical professionals often provide decisions relating to end of life to a person uninformed about the procedures described and unprepared to make those decisions.  This is true even if the person is in command of intellectual faculties.  The father of the author, faced with a terminal condition but fully cognizant, was provided a number of confusing options relating to the comfort and extension of life.  The summarizing quote:
         Finally, at one point, he threw up his hands in exasperation. 
         'Why are they asking me what I think?' he said. 'What do I 
          know about it? I was an insurance salesman!' 
     In the remainder of the article the author provides an event by event recollection of how he and his wife dealt with the numerous actions taken to care for her dying mother.  Every decision is clouded by an uncertainty about the length of remaining time with or without life extending measures.  
     If nourishment can not be taken orally (and normally) then it can be provided intravenously.  In the article this decision is clearly rejected as a non-decision:  "If somebody is going to die of hunger you feed them." is a statement of basic premise.  The authors were surprised that nourishment would be an action to be decided. The possibility of the person recovering is the premise.  Starving your loved one would seem to accelerate.  Hydration has the same ranking.  Nourishment and hydration, even by mechanical means, are a basic right if available.  John Paul II states that part of normal care is the providing of nutrition and hydration and that failure to provide these, in all circumstances (including long term vegetative state) is minimal care and withholding these is "a serious violation of the law of God".
   The attitude of those called to serve those vulnerable end of life patients also are examined.  Nurses and doctors can be distant, non-communicative and appear uncaring.  Sharp exchanges with the staff by the author and his spouse point out a lack of compassion for the relatives of those who may be unaware and in their final earthly hours.  
  Those charged with care may wish to accelerate the end in order to free up resources for others.  Accelerating the end of life can occur by omission (nourishment and hydration being with held) or by the use of pain killers (such as morphine) which can bring comfort while also hastening the end by slowing oxygen absorption (less labored breathing).
   A nurse present for the reading and discussion shared an experience that was informative.  She said that one end of life patient she dealt with visitors, arranged family meetings and had discussions.  She then requested the the supplemental oxygen she was receiving be removed even though she knew this meant the end would be hastened.  The nurse indicated that she had a difficult time with this.  Fr. Kibler pointed out that enriched oxygen was considered extraordinary support (unlike nourishment or hydration) and that at this point the church would say this was a decision of the person dealing with the time of life issue.
    In the end the overall issue is the readiness of the person to meet their maker.  The soul is the most important aspect of this time of life.  Is the person ready to meet the end of earthly tenure with a soul that has been rightly nourished and comforted.  The church, beyond meeting nutritional, hydration and physical needs for comfort is primarily concerned with the soul of the person.

Please note that the views expressed here by me do not  represent the views of McGill-Toolen Catholic High School, Archdiocese of Mobile or any  part of the Universal Catholic Church.


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