“For we are dust, and to dust you shall return.” -Genesis 3:19
As Catholics, we recognize our mortality. We recognize there is a natural beginning and end to our lives. We also recognize that there is a dignified, respectable way for life to begin AND end. We often focus on the beginning of life issues, especially right now as they are at the forefront of politics and laws in our society. And this is good and important, however, it’s also necessary to think about and know about end-of-life issues.
End-of-life issues aren’t as easy to talk about. Death is an uncomfortable topic for many of us. We don’t like to think about the mortality of those we love, or of ourselves. And yet, it’s important. Why? Because if we don’t know learn about and don’t reflect on these issues before we’re in a stressful life-and-death situation for our loved ones or ourselves, it is more difficult to make the right moral decision quickly in the midst of critical life-and-death moments.
Four years ago I was blessed to witness the graceful death of man named Edward*. I wasn’t present when he died, but I knew him prior to death, prayed for and with him and his family when he was diagnosed with cancer and later when it became terminal, and I witnessed his all too quick wasting away. And, I will forever have imprinted in my memory the modern-day pieta that I witnessed while in prayer with a couple of family members and friends of Edward.
Edward, truly only skin and bones, lay on the bed in his bedroom at home. On one side, of the bed, his mother, clutching fervently to her sons’ hand. Sitting on the bed with Edward was his wife Monica*, holding as much of her husbands’ body as she dared, cautious to not cause him too much pain but desperate to cling to her beloved. During our prayer she’d often stroke his face and look lovingly into his eyes, holding back tears at times and at other times letting them flow freely. And to complete this modern-day pieta was his three-year old daughter Catherine*, coming in-and-out of the room during our prayer of the Divine Mercy Chaplet, occasionally climbing onto the bed to sit with mom and touch her daddy’s hand.
I don’t know much about what end-of-life decisions Edward and Monica had discussed, beyond that he wanted to be at home when it became apparent that he would not live much longer and that he wanted to be buried nearby in South Austin, so his children could visit his grave.
Prior to Edward’s death I had been to funerals and had even had several family members die, with one of my grandfather’s being the closest family member to have passed away at that time. But I had never thought about the details of decisions that had to be made, nor the difficulty of these decisions if the person was your spouse. Edward’s death was the first time I encountered this, until last week.
At 5:45am last Saturday I received a phone call from my brother-in-law, who hadn’t been too successful in contacting my husband who was out-of-town. My husband’s sister, who had just finished her first round of chemo, was in the hospital and declining rapidly. It was time for the family to come see her and pay our last respects.
The next few days were a blur of exhaustion, time spent in the hospital, emotional ups-and-downs and time with her husband and teen daughter. His sister had set up much of the necessary legal documentation to assist with end of life decisions such as an Advanced Medical Directive (sometimes called “A Living Will”) and Durable Power of Attorney for Health Care. And she had also taken time to discuss her wishes concerning resuscitation, funeral, burial and more with her husband. Yet even with all this, there were still decisions and clarifications that had to be made while she was in the hospital, and upon her passing just a few days after we had arrived from out-of-state to see her. These decisions would have been a lot more difficult to make had she not discussed her wishes with family members and close friends when she was still relatively healthy.
My husband and I have discussed some end of life issues with each other, but we have definitely not exhausted the subject. At different points in our life our preferences may change due to the circumstances of our lives at that time or different medical procedures and advancements. We both want a funeral Mass and to be buried bodily. And we both definitely want the teachings of the Catholic Church to be followed in terms of end-of-life decisions.
These teachings are not always easy to find, and are not as strict as one might think, offering much individual preference. The ordinary and expected requirements follow both the Fifth Commandment (Thou shall not kill) and natural law**, making end-of-life requirements naturally easy to understand why they are to be followed. This requirement is that all ordinary means must be used to preserve life but that no one is required to take extraordinary means to preserve life. Ordinary means to preserve life include things such as water, food, exercise and medical care. Extraordinary means to preserve life includes things like medical treatments which would be unequal to their result, such as if the treatments would place a significant burden on the patient or the family. Significant burden refers to things such as the type of treatment recommended, how risky or complicated it is, its cost, side effects, how painful it will be, its availability, the likelihood of that treatment maintaining or enhancing the life of the patient, and the need to share limited medical resources and the spiritual and emotional aspects of the treatment.
Discussions about death are rarely easy, and as I’ve said, they’re even more difficult when you have them about the ones you love the most. But it’s important for us to know what our family members, and most importantly our spouses, want for the end of their life and entrance into death. And, for others to know our end-of-life wishes are too.
And in a 2007 statement, then-Bishop Gregory Aymond of the Diocese of Austin issued an eloquent statement about a local end-of-life issue concerning a local 17-month old Emilo Gonzales who had become a nation-wide story when the hospital he had spent nearly four months in the Pediactric Intensive Care Unit on a ventilator.
*Names have been changed
**Natural law is moral reason that can be determined from the nature of man without the assistance of the revelation of God. Example: right to life. Most human societies until recent history, have recognized that it is wrong to kill an innocent person, which leads us to conclude that any action that directly and intentionally kills an innocent person is an unjust killing of human life, and so preventing nutrition of food and water is murderous.