October 1, 2014 By Suzanne Pietropaoli Ogdensburg – Life-extending treatments and technology. Patients with multiple health problems. Artificial nutrition and hydration. These were among the complex and confusing issues addressed by noted ethicist, Father Tad Pacholczyk, at Wadhams Hall Sept. 6. In a lively multimedia presentation punctuated by input from the audience, the priest, who is Director of Education for the National Catholic Bioethics Center in Philadelphia, brought clarity to the many difficult questions that arise at the end of life. Drawing on his vast educational background and his ongoing experience, Father Tad offered a hope-filled understanding of the dying process, of its intrinsic value, and of the principles which should guide the final journey of each person towards God. Father Tad introduced his topic with the reminder that human life is received as a precious gift from God; it comes with duties and responsibilities, one of which is to preserve our own life. However, that duty is not absolute, since we “may reject life-prolonging procedures that are insufficiently beneficial or excessively burdensome,” he said. While this means that there are situations “in which it is OK to decline surgery or blood transfusions or artificial nutrition/hydration, we must be very careful about such decisions. People are inclined to think these are ‘all just gray areas.’ But we must use caution against this mode of thinking,” the ethicist explained. “We need due diligence in these situations,” he said. Stick with it, pursue the facts, consult with knowledgeable people - and above all, pray. “When we do these things, that big gray area will shrink to a fine line,” he said. “God does not leave us in a vacuum.” Noting that everyone has an obligation to use ordinary means to preserve life, Father Tad suggested that the terms “proportionate” and “disproportionate” are actually more helpful in discerning a morally correct course of action. “Proportionate means offer reasonable hope of benefit, have reasonable hope of success, and do not impose undue burdens on the person or his/her family,” he said. “Proportionate means are always required.” So, he said, it is necessary to ask: is there a reasonable hope of success with this treatment? What are the risks and side effects? Is this an ordinary treatment in this particular time/place/culture? What is the state of the sick person; does he have the physical and personal resources to deal with the treatment? Does the treatment involve excessive expense? What burdens does it place on the family? “These are all complex factors,” Father Tad concluded, “and they require good prudential judgment. We need to think carefully and choose judiciously to the best of our ability in order to discharge our duty before God.” That said, we must understand that “terminal illness is, for the living, an invitation to undertake a transformative journey with a person we love,” he said. “We cannot forget that the word ‘compassion’ means ‘to suffer with,’” he said. “Nor should we forget that ‘consolation’ requires that we be with another in his isolation. Any effort to comfort, support, and love a dying person is the deepest kindness and an act of tremendous generosity.” This is made more difficult in a culture that turns away from suffering and does everything possible to avoid thinking about death, often “clinging to crazy hopes, he said. “Yet it is important to know when to roll back the interventions and help an individual begin to prepare for death,” Father Tad explained. The ethicist also discussed advanced directives - various medical and legal approaches by which a person is encouraged to “plan ahead” by making medical choices for situations that may (or may not) arise in the future. “Similarly POLST (Physician’s Orders for Life-Sustaining Treatment) and MOLST (Medical Orders for Life-Sustaining Treatment) are problematic documents,” he said. “They create standing orders for your future care which must then be acted upon as written; they are not merely an expression of the patient’s wishes. “What you need is to designate a healthcare proxy - an individual who cares deeply for you, and who will be able to make decisions in your best interest if you cannot,” the priest said. “That puts feet on the ground in real time to decide your care,” he said. The Church teaches that food and water, even if administered by artificial means, constitutes ordinary care; it may be discontinued only if it imposes high burden on the patient with little or no benefit, Father Tad emphasized. “Feeding, even through a feeding tube, is a part of normal care,” he said. “We may not withhold feeding to stop someone’s suffering, but we may use analgesics and morphine for this purpose. After all, it is VERY painful to starve or dehydrate to death. “This is true for an elderly person with dementia, and it is true for a person wearing the label, ‘Persistent Vegetative State,’” he said. “This label is inaccurate and debasing. A person who has sustained massive brain damage is still a human being. A more correct term would be ‘Chronic Neurological Unresponsiveness’.” Decisions about end of life care are invariably difficult, and require clear thinking, much prayer, and good communication among everyone involved. But, Father Tad reminded, it is important to remember that “short-circuiting the journey can deprive us of time and graces that God wants for the dying person. “Dealing with a dying relative is a new experience and a privilege: allow God’s grace to be given,” he said. “Dying well is a blessing for all of us. Asking and giving forgiveness around a deathbed is very powerful and important. Suffering—our own or a loved one’s—is never easy. “The question is: What does God want us to do spiritually with our suffering? Hopefully we all had parents who taught us, ‘Offer it up.’ Great graces are connected to great suffering,” he said. The day-long event, sponsored by the diocesan Respect Life Office, drew more than 100 participants and closed with a Mass celebrated by Bishop Terry R. LaValley.
Photos by Colleen Miner
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Bisop LaValley presided at the closing liturgy for the day. He was joined at the altar by Deacon James Snell of St. Mary's Parish in Canton, Deacon Larry Ambeau, St. Cecilia's in Adams; and Father Tad Pacholczyk.