"Big Four" Highlights


At the Hour of Death

By Brian Caulfield

What do you do when someone is dying? Call 911, yell for a doctor, perform CPR – these are some natural responses. But I am not talking about someone suddenly found in a life or death situation. Rather, my question is about someone who has been ill for a while yet death is not imminent. Or an elderly person in a nursing home who has taken a turn for the worse. Or someone with a severe stroke who cannot talk or eat or move much at all. What do you do in these cases?

Do you sign a DNR (do not resuscitate) order? Do you demand that every possible means of modern medicine be used to keep the person alive for as long as possible? Where do you go for medical and moral guidance? What is the line between euthanasia and simply letting someone die naturally?

Given the ability of medications and technologies to keep people alive despite critical or chronic conditions, it is very likely that you will face these questions with your mom, dad or grandparents, and that one day you will be the patient facing these end-of-life decisions yourself. You may think– “No tubes! No machines! Spare the pain and expense!” But you may think differently when your dad is in that situation or when you are in the sick bed yourself.

Now is the time to consider these issues and make plans. True, the death of a loved one – or your own death – is not an easy topic to consider, and plans can be put off until someone winds up in the hospital and doctors start asking questions about “aggressive treatment” or “comfort care” that must be answered on the spot. It’s better to have a plan than to be caught in the emotion of the moment.

A helpful guide on how to prepare for the inevitable was recently released by the Catholic bishops of New York state, called “Now and at the Hour of Our Death: A Catholic Guide to End-of-Life Decision Making.” It is a wonderful resource that upholds the dignity of the human person, made in the image of God, and teaches that while death can be sad, it is the doorway to eternal life.

The bishops outline the basic Catholic teaching that “ordinary” care is obligatory, while “extraordinary” procedures are optional. They give guidelines and examples on how to determine what treatments might fall into each category, while acknowledging that individual circumstances and emerging technology can change what is considered “ordinary” or “extraordinary.”

The easy-to-read, 16-page booklet also helps you to raise the inevitable questions with your family, think about them in a balanced way that is in keeping with moral norms, and offers practical steps you can take today to prepare for the decisions you will need to make sooner or later.

“Our Catholic faith offers both a long tradition of reflection and Church teaching to help guide us through these multifaceted issues,” the introduction states. “It is important not to let the struggle over such questions eclipse what should be transcendent and grace-filled moments in the dying process: attending to spiritual needs, healing broken relationships, and saying good-bye.”

Death is not just decisions about treatments and technology. In fact, in the Catholic mind, it is mostly about preparing the soul to meet God while reconciling all our relationships on earth. It is truly a time when heaven and earth are bridged, as the dying person passes (God willing) from one place to the other. It should be a time of peace and acceptance, not of arguments over medical decisions.

The bishops’ booklet is also invaluable for providing a simple “Health Care Proxy” form in the back that can be filled out and signed as a legally binding document in New York state (persons in other states may need to check if this is the case where they live). Catholic ethicists generally advise against signing a “living will” or other document in which exact end-of-life treatments are named. Treatments may change over time, and a procedure that seems “extraordinary” now may in a few years be easy and ordinary.

Instead, the bishops strongly recommend that you appoint a health care proxy who is empowered by you to make medical decisions when you are unable to do so. This proxy should be a practicing Catholic, or someone very knowledgeable about Church and moral principles, and willing to act in your best interest according to these norms. In this case, doctors will be directed by the informed, real-time decisions of your proxy, rather than trying to interpret the words of a “living will” written years ago.

You can find this helpful document on the New York State Catholic Conference website.