END OF LIFE: Making medical, moral decisions

By KATIE LEFEBVRE, Globe staff reporter
August 23, 2007

End-of-life issues pose difficult decisions for most families at some point. What does the Catholic Church recommend?

"I just dealt with a family this past week who had to make the decision about continuing life support for a 39-year-old mother of two," said said Father Jerry Feierfeil, pastor at Nativity Parish in Sioux City. "She had sudden cardiac arrest. The options were to continue things like respiratory assistance or insert a feeding tube."

In this case, there were no vital responses. Her heart was strong and a ventilator could sustain her breathing, said the priest.

"There was no hope of recovering consciousness or brain activity. The best they could do was keep breathing functions going," said Father Feierfeil. "The family asked, 'Is it legitimate to remove life support (discontinue respiration) and not insert the feeding tube?' In that circumstance, there is no benefit to be expected from it. You are not required to go ahead and continue the respirator or insert a feeding tube. It was a permanent vegetative state."

Her husband in this case, along with her parents, were those who were responsible for making the decision.

"The majority opinion today is when they reach a permanent vegetative situation, with no hope of restoring conscious life, moral responsibility is what it comes down to," said Father Feierfiel. "You should always provide palliative care and pain reducing care."

There comes a point when people need to decide how much they are going to do. There are ethical, medical and family issues that need to be dealt with, he said.

"The most critical issue has to do with the extent to which you do life support for a terminally ill patient, especially someone who has become comatose or someone who is in a vegetative state," said Father Feierfeil, who serves on the medical ethics board at Mercy Medical Center-Sioux City. "The issues are especially difficult if there has never been any indication on the part of the person as to what their wishes would be."

If there is not a family member designated to make decisions, the medical team will make the best decision they can with guidance from the medical ethics committee. There are difficult decisions to be made even if there is someone in the position to make the decision, he said.

Respect for human dignity

"The basis of all Catholic teaching on medical issues is the dignity of the human person," said David Lopez, chancellor for the Diocese of Sioux City and director of diaconate formation. "Every person is made in the image and likeness of God. Every person has dignity based on their relationship with God, the creator, prior to anything else."

He explained that all actions have to "respect that dignity and foster the possibility of salvation."

"The dignity is also Christ-like. One of the things that Christ demonstrates is that suffering is not something that we avoid," said the chancellor. "Part of the dignity of the human person is our positive response to suffering. It is positive in terms of our salvation, in terms of something that we need and in terms of something that someone else may need. That is part of the working out of Christ's salvation in the world. The bad things that happen to us may be the means of someone else's salvation."

"In historical terms, suffering is something that should not be inflicted either - actively by error or passively by doing nothing," said Lopez. "Medical technology, the various breakthroughs over the last century or so, are also providential for us. They are given to us by God for us to use both in terms of social justice and eschatology (what happens to the soul after death)."

People have the moral obligation to care for the sick and to relieve suffering where it is found, he said.

"We also have a moral obligation to recognize the limits of our ability to relieve suffering and to respect the need someone else has to bear their own suffering past the limit of our ability to relieve it with dignity," said Lopez. "We are to do everything that is in our power to heal diseases and injuries. For those things that are not within our power to do we have to provide moral care to help the person understand the purpose of their suffering."

Two types of care

There is a distinction that needs to be made in terms of types of care - palliative care or extraordinary care. Palliative care in basic terms is food, water and air.

"If someone had heart disease, depriving them of food, water or air would be criminal as well as immoral," said Lopez. "If someone had lung cancer, our desire not to deprive them of air might be limited by our technical abilities to treat the disease. We may not be able to give them air because of the nature of the disease despite our best efforts."

He said that not giving someone oxygen because they have lung cancer is not an option. An effort still needs to be put forth.

Extraordinary care is over an above palliative care, for example experimental treatment or overly expensive treatments.

"We are not required to take extraordinary measures to sustain life when death is inevitable and especially when it is eminent," said Father Feierfeil. "The difference is between someone who is terminally ill and someone who is in the act of dying. We can in advance of those situations say 'if I enter a permanent vegetative state, I do not wish artificial respiration or artificial nutrition.' It is good to have that decision in writing."

One solution is a living will that spells out what an individual would or would not find acceptable in the event that they are in an incapacitated state and someone else is making the medical decisions on their behalf.

"As Catholics, we want to make sure that any stipulations made in a living will are moral actions in terms of the Catholic Church," said Lopez. "For a Catholic to have a living will is perfectly fine. For a Catholic to have a living will that says, 'If I am brain damaged and unable to communicate, take my oxygen away and let me die,' that is immoral. It is what is in the will that is critical."

The church provides these guidelines in order to help people make decisions in these situations or before these situations arise, he said.

Father Feierfeil said that the "most important thing" to be aware of is that the decisions should be made in advance when people are still healthy and in full command of their faculties.

Another solution is to have a durable power of attorney, a person who is entrusted with the decisions once someone is no longer able to make decisions.

There are model documents that Catholic hospitals and Catholic doctors have for people to reference, said the priest. Information about living wills and other documents about end-of-life issues can be found on the United States Conference of Catholic Bishops Web site at www.usccb.org.