Use guidance of Church with end-of-life decisions, bioethicist says

Father Tad Pacholczyk, director of education at the National Catholic Bioethics Center in Philadelphia, discusses end-of-life decisions during his Feb. 14 presentation at St. John Paul II Parish’s St. Paul campus in Sellersburg. (Photo by Leslie Lynch)

By Leslie Lynch (Special to The Criterion)

SELLERSBURG—The last days in the life of a loved one can be an overwhelming time, often marked by a nonstop barrage of decisions that many people are ill-prepared to make.

As a result of the best medical care in history, a vast array of technologies are available today, leading to difficult questions regarding the use of such technology:

Under which circumstance should they be employed? What criteria will aid in choosing to decline or discontinue them? Additionally, as Catholics, there are concerns regarding the teachings of the Church, which sometimes run counter to popular practices.

Inspired by Father Tadeusz “Tad” Pacholczyk’s monthly column on bioethics published in The Criterion, the St. Gianna Pro-Life Group at St. John Paul II Parish in Clark County invited him to speak to these issues as part of their community outreach.

The gathering at the parish’s St. Paul campus on Feb.14 drew more than 100 people. Father Thomas Clegg, the parish’s pastor, said, “End of life is a pro-life topic that affects everyone. One of the things St. Gianna’s does really well is to keep all these issues in front of parishioners.”

Father Pacholczyk is the director of education at the National Catholic Bioethics Center in Philadelphia. The center is a research and educational institute committed to applying the moral teachings of the Catholic Church to ethical issues arising in health care and the life sciences.

A priest of the Diocese of Fall River, Mass., Father Pacholczyk earned a doctorate degree in neuroscience from Yale University, worked as a molecular biologist at Massachusetts General Hospital/Harvard Medical School, studied advanced dogmatic theology and bioethics in Rome, has advanced the work of bioethics in the U.S., Canada and Europe, and writes a monthly column on timely life issues.

He has developed a deep understanding of both science and religion, noting that each discipline has its own language and profound influence on society, yet neither speaks the other’s language. He sees his mission as a bridge between the two.

“I wanted to bring science into the priesthood,” he said. In the same way, Father Pacholczyk’s vocation as a priest brings the light of Christ into scientific dialogue.

Marina Traub, a St. Gianna Pro-Life Group member, said, “Father Tad is so educated—and he brings it to a level we can understand.”

The event began with Mass, concelebrated by Father William Ernst, Conventual Franciscan Fathers Kenneth Gering and David Lenz and Father Pacholczyk.

Father Pacholczyk then introduced the ethical and religious directives for Catholic health care services put forth by the U.S. Conference of Catholic Bishops (USCCB), by which all Catholic health care facilities in the U.S. are bound. This document forms a basis for understanding the Catholic approach to ethics in our changing world, Father Pacholczyk said.

“We are not the owners of our lives, hence we do not have absolute power over life. Rather, we have a duty to preserve life and use it for the glory of God,” Father Pacholczyk noted, referencing paragraph #2280 of the Catechism of the Catholic Church. “Suicide and euthanasia are never acceptable.”

However, Catholics are not obligated to preserve life without regard to extenuating circumstances. Directive #56 in the ethical and religious directives states Catholics have a moral obligation to use ordinary or “proportionate” means to preserve life.

This directive assumes a reasonable benefit to the patient without creating undue burden on the patient, family or friends. A complex blend of factors must be taken into consideration, said Father Pacholczyk, such as reasonable hope of success of a specific treatment, risks versus side effects, physical and spiritual resources of the patient, expense, and the specific nature of the patient’s illness.

Making a careful judgment, after consulting experts and seeking the guidance of the Holy Spirit, becomes an expression of prudence, a virtue, he added.

Measures to preserve life that are not reasonably expected to provide benefit to the patient and/or may become burdensome are considered extraordinary, or more precisely, “disproportionate.”

Father Pacholczyk offered an example from St. John Paul II’s writings, stating that the former pontiff wrote that administration of food and water always represents a natural means of preserving life, even when provided by artificial means. Not a medical act, it should be considered proportionate and morally obligatory.

Yet when the patient’s condition deteriorates and the act of continuing sustenance by artificial means becomes painful or the body is no longer able to process nutrients, this act of charity becomes burdensome to the patient, without benefit, and may be withdrawn.

Acceptance, then, can be a morally praiseworthy choice, Father Pacholczyk explained.

In another example, when a rapidly advancing terminal illness is diagnosed, a common response is to subscribe to the “I’m going to beat this” philosophy. While hope is never to be discounted, it should not eclipse the more likely outcome of death.

“One’s time might be better used in preparing for death,” Father Pacholczyk said. He has seen the Holy Spirit bring reconciliation, healing of old wounds, new closeness and times of enrichment when patients and their families embrace this reality. Hospice care can facilitate the transition to the inevitable.

Many options are available for communicating a person’s wishes regarding end-of-life care. A four-page end-of-life document is available from the National Catholic Bioethics Center, Father Pacholczyk noted. It summarizes Catholic thought regarding a number of commonly encountered scenarios. Included are a health care proxy form, and an advanced medical directive which is in line with Catholic ethics.

The center recommends choosing a health care proxy who cares deeply for the patient, is able to make decisions in accord with known wishes, and can do so with the patient’s best medical and spiritual interests in mind.

Father Pacholczyk cautioned strongly against any “check box” advance medical directive such as the Five Wishes form or the form for “physician orders for life-sustaining treatments.” Wisconsin’s bishops have studied the forms and advise Catholics to avoid using them.

Concerns cited are the lack of a requirement for the patient to sign the form for “physician orders for life-sustaining treatment,” and the fact that no health care proxy is able to be chosen on the form.

Additionally, these secular forms lock the patient into a set of rigid medical orders, rather than being flexible and attentive to the patient’s current and perhaps fluctuating circumstances.

To aid in navigating the maze of decisions required at a most stressful time, Father Pacholczyk noted, the National Catholic Bioethics Center has a wealth of information on their website at www.ncbcenter.org. Also, a trained ethicist is on call for consultation 24 hours a day at 215-877-2660.

“The simple truth for Catholics is that death is an invitation to a journey that changes us,” Father Pacholczyk said, noting that people learn compassion and offer consolation.

He added that people also become companions, which literally means “with bread.” That points directly to the Eucharist, God with us, Father Pacholczyk explained.

“Our hope is in a merciful God and his promises for the next life,” he concluded. “With the guidance of the Church, we can preserve the dignity of each person as they prepare to embark on that journey.”
 

(Leslie Lynch is a member of St. Mary Parish in Lanesville.) †