Article

Clergy, Covenant clinicians review end-of-life issues at CHA forum

April 1, 2019

By KEN LEISER

LUBBOCK, Texas — For most of human history, just one in 10 people knew ahead of time that they were going to die. Today, people facing death are far more informed about their plight — so much so that most people will know in advance that they are dying.

w190401_EthicsEndofLife_a-2
Members of the Diocese of Lubbock participate in a table discussion at a CHA workshop developed to help clergy be a resource to parishioners making end-of-life care decisions. From left, Fr. Renato Cruz, Fr. Philip Pasupil, Fr. Samuel Oracion, Fr. Angelo Consemino and Fr. Jeganathan Arulsamy discuss end-of-life ethics. Justin Rex/© CHA

Despite clinical and legal advances aimed at helping people nearing end of life, the Catholic church is not doing a good job at helping people die well, Fr. Charles Bouchard, OP, told about 60 priests and deacons from the Diocese of Lubbock and members of the ethics committee of Covenant Health of Lubbock, part of the Providence St. Joseph Health system. The group gathered for a workshop on Feb. 28.

"Most of us in this room will have some kind of progressive illness in which we will have a lot of time to know that we're facing serious illness, that we are in the process of dying and maybe even be told by a doctor that you have six months to live or two years or whatever," Fr. Bouchard said. "So we have the benefit of a whole lot of opportunity to reflect on death and dying, but we're not taking advantage of it."

w190401_EthicsEndofLife_a-3
Fr. Joy Thachil discusses preaching on end-of-life issues during the workshop.
Justin Rex/© CHA

CHA is offering the workshops to dioceses across the country in an effort to help clergy be a resource to parishion-ers facing the end of life. Fr. Bouchard, CHA's senior director of theology and sponsorship, and Nate Hibner, CHA's director of ethics, led the two-part workshop at Covenant Medical Center's Knipling Education Conference Center in Lubbock.

Bishop Robert Coerver, leader of the Lubbock diocese, participated in the daylong workshop. He said he views the collaboration of medical professionals and clergy as "essential." His diocese covers 25 counties in West Texas, with 136,000 Catholics in 61 parishes.

"I feel very strongly that many in the medical profession still are lagging behind in their appreciation that religion should be a part of the care of the whole person," Bishop Coerver said. "Catholic hospitals? That is not usually the problem, but it can be an issue with other hospitals."

w190401_EthicsEndofLife-Turner_a-6
Turner

Lee Turner, chief mission integration officer at Covenant Health, read about the CHA workshops and reached out to the diocese to bring one to West Texas. He said Covenant will use the forum as a springboard for ongoing dialogue with local clergy.

Letting go
Fr. Bouchard told forum participants that pastors have a role in helping Catholics facing the end of life to rely on the mystery of faith and find solace in the recognition that death is a transition to life with God in the next world.

When looking at death and dying from a spiritual perspective, he said, the most fundamental spiritual discipline is "letting go." That applies to voluntary asceticism (the call to let go of nonessentials); as well as advancing age and the accompanying diminishment of physical condition.

On the other end of the spectrum is avoiding thinking about mortality, which Fr. Bouchard characterized as "one of the biggest problems we face in our society today." It leads to overtreatment, and futile treatment that contributes to soaring health care expenses in the U.S., he added.

"How can we get Catholics, our Christian brothers and sisters first, to think about death in a way that enables us to see it as part of our life's journey?" he said. "And also to make that an operative principle in our Catholic health care systems?"

The church's role
Fr. Bouchard asked the pastors and deacons what comprises a so-called "happy death." Pain-free, said one member of the audience. Dying with dignity, said another.

w190401_EthicsEndofLife-MsgrCruz_a-7
Msgr. Cruz

"I'm just re–minded of obituaries saying, 'he died' or 'she died surrounded by their loved ones,'" said Msgr. David Cruz, founding pastor of Saint John the Baptist Catholic Church in Lubbock and vicar general of the Diocese of Lubbock.

Preparing people for death should be part of a Catholic health ministry's mission, Fr. Bouchard said. "When we can't cure, can we also help people die, especially through palliative and hospice care?"

Legal, ethical considerations
During the morning session, Hibner led the clergy members and clinicians through a wide-ranging discussion covering the Ethical and Religious Directives for Catholic Health Care Services and their application to end-of-life decision-making.

w190401_EthicsEndofLife_a-4
Bishop Robert Coerver of the Diocese of Lubbock listens to a colleague during a break. Justin Rex/© CHA

While much of the workshop's focus was on Part Five of the ERDs, "Issues in Care for the Seriously Ill and Dying," Hibner cautioned that the guidelines do not hold the answers to all the questions that arise at the end of life. Health care is too complex, he said, and medical advances don't lend themselves to black-and-white answers about what is best for the patient. "So we do have to be able to draw from our moral tradition to kind of fill it out a little bit," he said.

The workshop also touched on Parts Two and Three of the ERDs, "The Pastoral and Spiritual Responsibility of Catholic Health Care" and "The Professional-Patient Relationship," respectively.

Hibner invited participants to apply the directives and Catholic moral teachings to two hypothetical cases involving patients, their families and caregivers faced with common end-of-life issues — ranging from legal complexities to family squabbling. Hibner said the case studies were instructive to members of the clergy, who are in a position to talk to patients and their families about end-of-life decisions and to do so before matters reach critical junctures.

One case study involved John, a comatose 28-year-old truck driver. Following an emergency surgery, the doctor told John's mother that her son's prognosis was bleak, his chances of survival minimal. John's girlfriend, whom he had named his durable power of attorney for health care just six months earlier, insisted on aggressive treatment and a second opinion. She argued that ceasing treatment was against the tenets of her Catholic faith. The primary physician avoided John's girlfriend but continued treatment, fearing a lawsuit. John died within three weeks.

w190401_EthicsEndofLife_a-6
Dr. Kerrie Pinkney, chief medical officer for Covenant Children's Hospital in Lubbock and a member of the Covenant ethics committee, responds to a presentation on end-of-life ethics. Bary Moynihan, associate chaplain and spiritual care manager at Covenant Health, is at right. Justin Rex/© CHA

In this scenario "there is a lack of communication all around," Hibner said. "What we're trying to do is promote that conversation. Because if you have it earlier and you have it often, then when we get to moments like this, it can be much easier for people to recognize this is what John wanted or these are the values that John had."

Do not resuscitate
The second hypothetical case included a review of "do not resuscitate" or "do not attempt to resuscitate" orders. Hibner stressed that the orders — generally written by physicians after consultation with a patient or a health care proxy — are applied narrowly to cases of cardiac arrest. Other treatments remain available to patients with do not resuscitate orders.

Still, Dr. Kerrie Pinkney, chief medical officer for Covenant Children's Hospital and a member of Covenant Health's ethics committee, said care should be taken in how to refer to the orders. Pinkney said her staff prefers the use of an "allow natural death" order because of the negative connotation of an order beginning with the words "do not."

Declining resuscitation efforts, she said, "places huge guilt on the family. I tell them there are a whole lot of things we can do. And if you feel that's appropriate for your child, we will. But we are not withholding anything. We are just not interfering with the natural process."

 

 

Copyright © 2019 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3490.