End of life a murky area for priests

   
    Father Tad Pacholczyk, director of education for the National Catholic Bioethics Center in Philadelphia, offered priests at the Louisiana Priests’ Convention an update on end-of-life issues, particularly the many factors that determine what constitutes “ordinary” or “extraordinary” medical treatment.
    Father Pacholczyk said his center engaged in 1,600 consultations with priests and other individuals last year who wanted clarification on what was considered morally ethical in end-of-life cases.
    “We are one of the largest providers of consultations to individuals and dioceses,” Father Pacholczyk said. “We are contacted by email, fax or phone, and we have an ethicist on duty, rotating each day. Sometimes I’m on duty and the phone will ring. Sometimes, dialysis would be considered ‘ordinary’ care, and sometimes it would be ‘extraordinary.’ It depends on the specifics of the case.”
    Every medical case has certain nuances, Father Pacholczyk said, that could determine whether care is considered “ordinary” or “extraordinary.” Normally, nutrition and hydration are considered ordinary care.
    People have two big fears about medical technology and dying, Father Pacholczyk said. Some worry that they will go into a nursing home, be kept alive with wires and technology, and that “they’re never going to let me die.” Others fear that if they check themselves into a hospital, the medical professionals “may cut some corners and not give me a fair shake.”
    “The right moral path blazes right down the middle of these two fears and avoids the other extremes,” he said. “A person has a moral obligation of using ordinary and proportionate means to preserve life. We are called to make a good, prudential judgment.”
    In general, a person should die “from underlying sickness or pathology and not from an action or inaction,” Father Pacholczyk said.
Appoint a trusted loved one
    Living wills can be very problematic, he said, because often they are vague and can never anticipate the exact nature of a life-threatening illness. It is far better to appoint a loved one with a “durable power of attorney for health care” who can act as the ultimate decision-maker if you are unable to speak for yourself.
    “A living will is like writing a blank check,” Father Pacholczyk said. “You don’t know what hospital you will be in, what problem you will have, what therapy you will need and the options. It’s a blind concept. If you are good at predicting what will happen to you, you have a real talent. You ought to try Vegas.
    “You may have said previously, ‘I don’t want any machines.’ But when you find yourself gasping, of course, you want to be hooked up to a ventilator. In general, a surrogate or proxy is a much better way to go.”
    Father Pacholczyk cautioned priests that POLST forms – an acronym for Physician Orders for Life-Sustaining Treatment – are “coming fast and furious.” They started in Oregon, and they are standing medical orders that the hospital must follow. Some of the forms even state the signature of the patient is “recommended” but not required.
    The National Catholic Bioethics Center offers a four-page guide that explains health care proxy forms and advance medical directives. They are available through www.ncbcenter.org. The center also offers distance-learning opportunities.
    Peter Finney Jr. can be reached at [email protected].