Facing the End of Life:A Pastoral letter from the Bishops of Illinois

Posted by permission of Catholic Conference of Illinois (CCI). Originally posted at https://www.il-cha.org/facing_the_end_ccc.htm.

 

When Americans talk about death and dying, they often talk about controversy. Debatesrage over assisted suicide and euthanasia, the role of medical technology, and the cost ofhealth care.

We, the bishops of Illinois, write to you to proclaim that as Catholics we need to considerdeath in the context of our faith. Jesus Christ suffered, died, and rose from the dead. Thiscentral truth of our faith provides meaning to our lives. Because of who Jesus is, we arecalled to eternal life.

It is an unfortunate characteristic of American culture that issues of great importance areoften separated from the context in which they can be understood. When we think aboutdeath and dying, it is hard to find meaning and hope if we forget our faith. We want toshare our hope and conviction that the Catholic community can provide evidence of whatit means, as we face the end of our lives, to be a civilization of love amidst a culture ofdeath. In the words of the Apostle Paul, we will show you a “more excellent way” toconsider the end of life. (1 Cor 12:31)

What We Believe

What was from the beginning,
what we have heard,
what we have seen with our eyes,
what we looked upon
and touched with our hands concerns the Word of life —
for the life was made visible;
we have seen it and testify to it
and proclaim to you the eternal life
that was with the Father and was made visible to us —
what we have seen and heard
we proclaim now to you,
so that you too may have fellowship with us;
for our fellowship is with the Father
and with his Son, Jesus Christ.
We are writing this so that our joy may be complete.
(1 Jn 1:1-4)

We begin with the message of eternal life and fellowship with God promised us by JesusChrist. This is the context where we must start for any authentic understanding of the endof life. Only the fabric of faith provides us with the texture and richness to understand themeaning of the individual thread of our own life and death. We are not simply looking atmedical technology, or the use of procedures, or how we can best care for people as theydie: we are considering the purpose of human life. Because of our faith, we understandhuman life to be more than our time on this earth. The reason we are created, the point ofour lives, is to spend all ages enjoying God’s presence. Our time on earth has tremendousimportance for it determines how we respond to God’s call. But the value of human life istruly found in our supernatural destiny and recognition that death is not the end. As JohnPaul II wrote in his encyclical “Evangelium Vitae”:

“Man is called to a fullness of life which far exceeds the dimensions of his earthlyexistence, because it consists in sharing the very life of God. The loftiness of thissupernatural vocation reveals the greatness and the inestimable value of human life evenin its temporal phase.

“. . . At the same time, it is precisely this supernatural calling which highlights therelative character of each individual’s earthly life. After all, life on earth is not an”ultimate” but a “penultimate” reality; even so, it remains a sacred reality entrusted to us,to be preserved with a sense of responsibility and brought to perfection in love and in thegift of ourselves to God and to our brothers and sisters.” (Ev Vitae, 2)

Our life on earth is a sacred reality but one that is relative to the reality of our eternal lifewith God. We recognize that we all will die. But this death is not the end of ourexistence. Death remains as a frightening limit and a boundary beyond which we cannotsee, except with faith.

Preparation for death is an essential part of life for a Christian. Those who avoid the topicof death and dying are making a serious mistake. Many individuals are misguided in theirpursuit of money, pleasure, and personal advancement rather than attending torelationship with God, an acceptance of Jesus as Lord and Savior, and the honest prayerthat the end of life will find them ready to meet God and enter Paradise. The key to dyingwell is living well. Living well means a life characterized by love of God and love ofneighbor. Recognizing that the goal of our lives is eternal life with God, we prepare forthat by prayer, reception of the sacraments, and care for those around us, especially thepoor and the forgotten.

As we face a serious illness or come to the end of our lives, the sacraments become anurgent responsibility. Although it is important to consider the types of medical therapywe would or would not want as we face a serious illness, Christians must also think aboutthe means by which we can be spiritually strengthened and comforted. Through theSacrament of Penance, the Sacrament of the Sick, and the reception of Holy Communion,Christ is present to us as we face the difficult realities of sickness.

Our faith in Christ’s resurrection and our hope for eternal life does not, however, removethe worry and concern that many have about how they will die. We must alsoacknowledge that fear of pain, unnecessary suffering, and the specter of dependency andhelplessness are reasons why some are so frightened of the end of life. Some individualsseek control over every aspect of dying, and even ask for assistance in suicide oreuthanasia. To those who are so frightened of the end of life they seek to control orhasten it, we respond by a consideration of three crucial issues: the role of medical care atthe end of life, the proper understanding of suffering and the value of suffering, and thedifficulty we as Americans have with loss of independence and control.

The Role of Medical Care at the End of Life

Our society demands clear answers and sharp distinctions. Catholics intent on faithfullyfollowing the dictates of their faith know that the Church’s teaching authority does notextend to a definitive pronouncement on every clinical decision. We often are obliged todo our best in difficult situations guided by a conscience that is informed by the faith ofthe Church and the competent advice of a caring physician.

There are two extremes that must always be avoided. The first is an attitude that one canend life, either by an action, like a lethal injection, aimed at killing a patient or bydeliberately withholding therapy with the goal of bringing about a person’s death. Thesecond extreme mistakes our respect for the value of life with vitalism, the erroneousbelief that our life on earth has absolute value and all means must be taken for itspreservation. The role of medicine is to respect the inestimable value of life whilerealizing the death of the body is not always a defeat.

We have emphasized our faith in Christ and the resurrection, but we need to fulfill thatfaith with works that speak clearly of the value of life, the dignity of the human person,the necessity of adequate pain and symptom control, and the power of our shared love forour brothers and sisters. Catholic health care should set the standard for excellence in endof life care for our nation. Hospitals and care facilities need to provide excellent palliativecare services as part of the treatment plan for all serious illnesses, not just cancer.Hospice care should be a priority for development. Ideally, hospitals and parishes canwork together to provide skilled and compassionate care for the dying and their families.Quality indicators of care must be developed and care pathways implemented thatmeasure pain control, work to improve the relief of pain and other symptoms, andprovide resources for doctors and nurses as they care for hospitalized patients. Thedignity of those who suffer from chronic illness or who are in nursing homes must berespected.

Doctors need to learn more about pain and symptom control. Treatment of serious illnessmust always consider the need to relieve the physical distress of the person suffering aswell as recognize the reality that all people will die. Physicians should not imposeaggressive life sustaining therapies on persons for whom such treatments will simplyprolong the dying process. Likewise, doctors do wrong who insist on maintaininginvasive life support when the patient or his or her family make clear that the burdens oftreatment far exceed the benefits. A good Catholic doctor speaks openly about death anddying with her or his patients, is frank about the limits of medical care, works hard topreserve life and never deliberately takes life, but recognizes that there are times whentreatments should be withheld or withdrawn.

Nurses, too, bear a special responsibility to ensure the comfort of their patients as well ashelp the dying and their families. Nursing care plans should be devised that emphasizesymptom control, support for the family, and the importance of compassion. Experiencednurses can guide families and explain some of the symptoms in the last hours of life,easing fears and providing comfort for the patient. Likewise, wise nurses can help doctorsgrow in skill and recognize the necessity of expert pain control and relief of otherdistressing symptoms. Nurses, in their role as patient advocates, can work to ensure thepatient is cared for as a person and that the individual is heard and understood, not simplyapproached as a disease to be treated.

Those who are not health care professionals also have a responsibility in improving endof life care. First, we need to work with legislators and others to improve access to healthcare in our country so all individuals with life-threatening illnesses can receive excellentcare. Second, as individuals, we need to consider the type of care we would like toreceive in the event of a life threatening illness. In Illinois, the Durable Power ofAttorney for Health Care allows an individual to appoint a spokesperson to assist thephysician in making decisions about care in the event the patient is unable to participatein the decision making process. Third, when we face end of life decisions for ourselves orour family members, we should choose on the basis of a conscience informed by our faithin Jesus Christ and Church teaching.

Several points can guide us in formulating an advance directive (such as establishing aDurable Power of Attorney for Health Care) or when we are faced with the necessity ofdeciding about life-sustaining therapy in the midst of a medical crisis.

There is no obligation to resort to every type of therapy in an effort to preserve liferegardless of the likelihood of outcome. At the end of chronic illnesses like cancer ordementing illnesses, the benefit of life prolonging therapy is greatly limited. For thosewho are suffering from metastatic cancer, end-stage congestive heart failure, or advancedAlzheimer’s disease or other dementia, it is difficult to see any justification forresuscitation in the event of cardiac arrest or the prolonged use of intubation andmechanical ventilation. The fact that aggressive therapy need not be continued is not tobe misconstrued as an allowance that one can refuse ordinary care.

Decisions around the refusal or removal of artificial feeding and hydration can bedifficult and troubling for families as well as physicians and staff. We want to providewhat is the most compassionate and productive care for the good of those we love. Whena person can swallow and digest food, it is never appropriate to stop feeding by hand andgiving sips of water. On the other hand, to provide artificial feeding and hydration insome cases at the end stages of terminal diseases, like cancer, might directly increase thesuffering of the patient and perhaps even, inadvertently, hasten death. In every case andon every occasion we may not do anything that is aimed at causing or hastening the deathof a patient. The National Conference of Catholic Bishops has provided principles thatassist family members and physicians in making the necessary moral and ethicaldecisions on the provision of artificial feeding and hydration. Realizing that each casediffers from every other case, families, physicians, and staff should feel free to consultwith competent Church ethicists and advisors in reaching a decision. This consultationcan also provide comfort for the caregivers in knowing that they have made a morallysound decision that best serves their patient and loved one.

We must not let some of the ambiguities of end of life decision making lead us, on onehand, to a neurotic fear that we will incur Christ’s judgment for not acting with sufficientcare, and on the other hand, to choose reckless or misguided care for our loved ones. Inconsulting with legitimate Church teaching, our consciences can be formed so thatdecisions made even in emotionally laden situations are moral, compassionate, andappropriate.

The Place of Suffering

We have emphasized that some may favor assisted suicide and euthanasia because of afear of untreated pain. Pain should be treated aggressively. Catholic physicians and healthcare institutions have a solemn obligation to improve care for the dying with excellentsymptom control. At the same time, suffering at the end of life is more than pain from thespread of cancer, or shortness of breath from emphysema, or weakness and fatigue fromheart failure. Suffering is part of the existential burden of knowing that our time on earthis ending, facing the loss of relationships and the good things of life, and dealing with theloss of independence and freedom that terminal illness often brings. Even as people offaith, we fear death, for it is the end of the life that we have experienced. This too, is partof the suffering that we find as we face our dying.

We believe that suffering has value to the extent that it allows the individual to be open toJesus Christ and experience the grace of a life transformed by the power of Christ evenwhen, physically, that life is ending. Such suffering is salvific, for the person experiencesthe love of Christ in a way that recalls Christ’s own love as demonstrated in his willingacceptance of death on the cross. There are those who would twist our Catholicappreciation of suffering into a peculiar glorification of pain. This is nonsense and aperverted caricature. Being in pain is useless. Uniting one’s suffering with Christ isredemptive. This is part of our faith and a great truth that should not be lost.

Who Controls Our Death and Dying?

When we talk about the end of life, we face our limits: not only limits on our humanlifespan, but limits on our knowledge, limits on our ability to understand our world andourselves, our partial apprehension of the truth, and our fragmentary sense of what itmeans to be human. Acknowledging limitations and recognizing that we are unable tocontrol all the aspects of our lives is not well accepted in our society. We are urged to bein charge, to control our destiny, and to reject anything that limits our independence andmastery.

Our Catholic faith transcends any culture. In the face of a culture that asserts individualautonomy and the ability of individuals to control all aspects of life, we worship one who,as St. Paul writes: “though he was in the form of God, did not regard equality with Godas something to be grasped. Rather, he emptied himself, taking the form of a slave,coming in human likeness; and found human in appearance, he humbled himself,becoming obedient to death, even death on a cross.” (Phil 2:6-8).

As disciples of Jesus, the one who accepted the limitations of being human, we believethat there is a more excellent way to face the end of life than individualism, isolation,assisted suicide, and euthanasia.

Building a civilization of love amidst our current American culture of death will requiremany things. Most of all, building a civilization of love means we look to Jesus as ourmodel of what it means to be human. St. Ignatius of Loyola, in a contemplation thatencourages individuals to experience the depths of God’s love, makes the tellingobservation that love is shown more in deeds than in words. How are we, as Catholics,showing our love for those who face the end of life?

A love shown in deeds, rather than just pious slogans, requires a major effort on the partof Catholic health care facilities, Catholic health care providers, Catholic social services,and our parishes, as well as a renewed recognition among all people that Christ’s deathbrings with it the power to transform our own dying. There is an urgent need for markedimprovements and rigorous standards in care for the dying. Individual Catholics, throughprayer, service, and the development of prudent advance directives, can witness to thepower of our faith in the resurrection. Parishes must consider how best to serve those whoface the end of life, whether by special parish initiatives or by partnering with localCatholic hospitals. As citizens dedicated to the common good, we must continue tochallenge our political system to provide universal access to basic health care.

We ask you to work with us to build a civilization of love that cares for the dying withthe dignity and respect they deserve.

Illinois Catholic Health Association
65 East Wacker Place – Suite 1620
Chicago, Illinois 60601
312-368-0011