Rediscovering the Art of Dying In a Post-Christian World Nuala Kenny SC, OC, MD, FRCP Professor Emeritus Dalhousie University, Halifax, NS Former Ethics & Health Policy Advisor Catholic Health Association of Canada Ottawa, Ontario My Objectives To identify challenges to a good death from Canadian experience To recognize the medicalization of suffering To clarify Church teaching on health decisions and ethical issues at end of life To review dying today and responses to requests for assisted death To propose challenges for all the baptized in the ministry of care and accompaniment 1) The Tradition of A Good Death 1
The Medieval Ars Moriendi Depended upon two fundamental features of the culture: shared faith in the birth, death, and resurrection of Jesus the importance of families and community in social organization Care for the seriously ill and the dying were normal family and community activities. Modern Research on Characteristics of a Good Death Paradigm-shifting medical advances The beginnings of hospice/palliative care Research on a modern “good death” Non-abandonment and continuity of care Avoidance of unwanted technological intervention Respectful communication Completion of life’s “last things” Fundamental Features of Our Culture Death-denying and death-defying Rejection of a religious world-view Corrupt language in public discourse Individual rights, choice and control Belief in technology The legalization of medically assisted death in industrialized nations 2
Medically Assisted Death Some U.S.A. -Canada Differences U.S. Legislative process; State by state Political environment The ‘religious right’ Canada Failure of 30yrs re legislation Supreme Court of Canada decriminalization on a Charter of Rights & Freedoms Challenge Rapid normalization The Supreme Court of Canada Decriminalized MAD for competent adults with a “ grievous medical condition including an illness, disease or disability) that is irremediable (cannot be relieved by means acceptable to the individual) causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition.” 2) Medically Assisted Death is The Medicalization of Suffering Reasons for Requesting MAD: Feelings of loss of dignity Dependence and loss of control Guilt at being a burden to others Isolation and loneliness Uncertainty regarding future care needs Hopelessness and loss of meaning 3
Differentiating Pain and Suffering Chest Pain vs Heartache Jesus’ Experience For it is not as if we had a high priest who was incapable of feeling our weakness with us; but we have one who has been tempted in every way that we are, though he is without sin. (Hebrews 4:15) Gethsemane Avoidance, Denial & Isolation 4
Denial and Avoidance of Suffering “Father” he said “if you are willing, take this cup away from me.” …In his anguish he prayed even more earnestly, and his sweat fell to the ground like great drops of blood.” (Luke 22:42-44) Frank’s Story- 48yr old husband and father with terminal lung cancer denial & aggressive pursuit of a cure Isolation in illness and Dying “ Simon, are you asleep? Had you not the strength to keep awake one hour? You should be praying not to be put to the test. The spirit is willing but the flesh is weak. ” (Luke: 14:36-37) Shirley 76yr widow with COPD long deterioration; d/c RX son knows; estranged daughter refuses; no ACP. Sources of Suffering Loss of dignity and identity Ellie 37yrs cervical cancer & fistula Jocelyn 38yrs multiple sclerosis Gloria 87yrs dementia and Richard 88yrs, her husband Physical-Crushed down by pain Joe -67 yrs multiple myeloma Psychological-Falling into despair Gladys 75yrs hip fracture Spiritual-Falling out of love with God Debbie 32ys and death of 5yr old Sean 5
3) Jesus is Captured Freedom & Health Care Decisions “…And the man called Judas, one of the twelve, who went up to kiss him. Jesus said, “Judas, are you betraying the Son of Man with a kiss?” His followers, seeing what was happening, said, “Lord, shall we use our swords?” And one of them struck out at the high priest’s servant and cut off his right ear. But at this Jesus spoke. “Leave off!” he said, “That will do!” And touching the man’s ear he healed him.” (Luke 22:47-51) Clarifying Catholic Teaching on Health Care Decisions Life and physical health are precious gifts entrusted to us by God. We must take reasonable care of them, taking into account the needs of others and the common good. Catechism of the Catholic Church #2288 Refusal of Non-beneficial & Unduly Burdensome Care “ To forego extraordinary of disproportionate means is not the equivalent of suicide or euthanasia; it rather expresses acceptance of the human condition in the face of death” John Paul II Evangelium Vitae,no.66 1995 6
The Morality of “We Must Do Everything Possible” We regularly hear of demands for doing ‘everything possible” to prolong biologic life as a duty of those who stand for life. If morality requires respect for the life of the body, it does not make it an absolute value. Catechism of the Catholic Church #2289 Accepting limits and Advance Care Planning “Human life, however, has intrinsic limitations, and sooner or later it ends in death. This is an experience to which each human being is called, and one for which he or she must be prepared” Pope Benedict XVI Message for the World Day of the Sick February 11, 2008 Advance Care Planning: A Spiritual Activity Clarification of values Opportunity for evangelization Communication, communication An advance directive for when you are not competent to decide The decision must be made as the patient would want ‘Best interest’ for those who have never had capacity Substituted judgment for all others 7
Simon Helps Jesus “On their way out, they came across a man from Arimathea, Simon by name, and enlisted him to carry his cross.” Matthew 27:82 Mark a 56yr old father and successful radio announcer with ALS and progressive neurological deterioration Thinking of ending it all to save his family from suffering Palliative Care Much confusion re palliative care “Palliative care is an expression of the properly human attitude of taking care of one another, especially of those who suffer.” (Pope Francis) Palliative care’s philosophy Neither hastens nor prolongs death Balances pain and symptom control with the ‘last things’ Focuses on the dying person and their intimate others Misunderstanding Pain Control “The use of painkillers to alleviate the sufferings of the dying, even at the risk of shortening their days, can be morally in conformity with human dignity if death is not willed as either an end or a means, but only foreseen and tolerated as inevitable.” ( Catechism of the Catholic Church , no. 2279) 8
Jesus is Crucified and Dies on the Cross It was the third hour when they crucified him. (Mark 15: 24-25) The last words of Jesus show him responding to the Father’s will and demonstrating his care and concern for others until his last breath Trajectories of dying today Isobel 80yr Italian matriarch with CHF and then a serious stroke She accepts dying but her family can’t. They demand MANH so she does not “starve to death” Rosa 59 yr devout wife and mother with terminal breast cancer Ready to die but circumstances become difficult and distressing for all Palliative sedation is now and issue 9
Food and Drink vs MANH Confusion about medically assisted nutrition and hydration, especially at end of life Special concerns: Social significance of feeding Anorexia at the end of life is normal The importance of non- abandonment and ordinary care The 2004 Papal Allocution Palliative sedation Palliative sedation (PS) is the lowering of patient consciousness using medications for the express purpose of limiting patient awareness of suffering that is intractable and intolerable.” (Kirk & Mahon, 2010) 4) Responding to Interest in MAID: Challenges for Medicine & Ministry “Sit down; lean in”; review care and assess spiritual issues Recognize a continuum of issues Balance the duty of care and non- abandonment with non-complicity with evil Judge when they are in conflict 10
Rejecting Euthanasia and Assisted Suicide “ Euthanasia is a false solution to the drama of suffering, a solution unworthy of man. Indeed, the true response cannot be to put someone to death, however ‘kindly’ but rather to witness to the love that helps people to face their pain and agony in a human way” (Pope Benedict XVI, February, 2009) The Continuum of Issues Approach will differ across pastoral- orthodoxy perspectives and the principle of cooperation Recognize a continuum of issues expression of interest request for eligibility assessment firm commitment completion of the act Catholic Conceptions of Conscience Conscience: is essential to the moral life formed by Scripture, tradition, especially Magisterial teaching, and experience Conscience has two components: a commitment to morality the activity of judging past or future acts as violating that commitment 11
Recommend
More recommend
