Focus of end-of-life care should be on patient - Experts explain that sometimes interventions can do more harm to a person suffering in their last days

By Michelle Martin
Sunday, October 16, 2016

When it comes to making decisions about health care at the end of life, Catholic teaching emphasizes that the focus must be on the care for the patient.

“The Catholic understanding is we always care,” said Franciscan Father Thomas Nairn. “Sometimes care means we try to cure the patient. Sometimes care means we try to keep the patient comfortable.”

Nairn, senior director for theology and ethics at the St. Louis-based Catholic Health Association, discussed the Ethical and Religious Directives for Health Care Services with more than a dozen priests, deacons and others engaged in pastoral care at Little Company of Mary Hospital in Evergreen Park on Sept. 28.

The directives talk about “ordinary” and “extraordinary” interventions, but those words are not necessarily used in their usual senses. Rather, ordinary care is that which can be reasonably expected to benefit the patient without imposing undue burdens, either in terms of suffering or cost.

The decision as to what counts as benefit or a burden is up to the patient, he said, as long as the patient is able to speak for himself or herself. The patient is not capable, the decision belongs to whomever has the right to speak for the patient.

Using those guidelines, interventions that are quite common can be seen as too burdensome to be “ordinary,” Nairn said, and some experimental, unusual treatments can be seen as not extraordinary.

For such guidelines to work, patients, their families and medical professionals must work together to understand what their options are and what their likely effects would be.

“We are not owners of our lives. We are stewards,” Nairn said. “We have the duty to preserve life, but that duty is limited. Life and physical health are precious gifts extended to us, we must take reasonable care of them, taking into account the needs of others and the common good.”

That includes taking into account limited financial and medical resources.

“St. Alphonsus Liguori said no one is obligated to spend a lot of money to preserve his life,” Nairn said. “Families are going bankrupt because of medical expenses. Think about that.”

One issue that comes up with some frequency is whether a feeding tube can ever be seen as “extraordinary.”

After Pope John Paul II in 2004 said that nutrition and hydration are basic care, and feeding tubes are “morally obligatory” for patients in a persistent vegetative state — who can live indefinitely — many people got the impression that Catholic hospitals insisted on feeding tubes for just about everyone, Nairn said.

“I mean, people thought if you went into a Catholic hospital as a visitor, you’d come out with a feeding tube,” Nairn said.

That’s not the case, he said. When people are approaching death, their bodies begin to shut down and can no longer absorb food and water. Some research shows that feeding people on the brink of death can actually increase their levels of pain, he said, and feeding tubes can have complications, including infection at the insertion site.

It can also be argued that a feeding tube would be too burdensome for a patient in the advanced stages of dementia who would have to be physically restrained 24 hours a day to keep the tube in, said Father William Grogan, the archdiocesan vicar for health care.

“The biggest takeaway for me is that it is based on the patient,” said Father Larry Sullivan, pastor of Christ the King Parish and vicar for Catholic Cemeteries.

Nairn discussed the benefits of durable powers of attorney for health care and advanced directives for their care. He suggested that those in the audience should make sure have their own documents on file so that they can use that as an example when they speak to members of their congregations.

Such documents are important for everyone 18 or older, he said, and, as they are personal documents, they can be written to reflect the patient’s values.

But he cautioned against trying to get too specific. It’s more important, he said, to choose someone to have durable power of attorney — that is, the right to speak for you when you are incapacitated — who understands your values and who will respect your wishes, and then talk to them about what you want.

“Doing advanced directives is an act of faith,” Nairn said. “It’s a very concrete act of faith.”


  • euthanasia
  • halthcare
  • little company of mary hospital
  • thomas nairn

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