As a mission and ethics leader at a large Catholic health system, I encounter patients and families at the end of life. Sadly, many unconscious patients and others no longer capable of making decisions have not left behind written instructions, called advance directives, regarding their care. This leaves families scrambling to figure out how their loved one would want to be cared for at the end of life.
The outcomes of these cases are often poor for all concerned. Patients do not receive the comfort care they require; families are burdened with guilt and shame, wondering if they did the “right” thing; and health care professionals are left deflated and weary. More needs to be done to encourage everyone to prepare for death, and Catholic parishes can play a vital role in this objective.
Above all, the Catholic parish, through its witness to the paschal mystery, can help the faith community understand death to be—as stated in the Catechism of the Catholic Church—the fulfillment of their new birth initiated at baptism. Many of us fear death, but as our faith teaches us, death does not have the last word, so our fear need not be paralyzing. We will all eventually pass from this life to the next. We should strive to be prepared for the inevitable, not only for our sake but for that of our loved ones.
Parishes can promote a more balanced perception of death so that our communities are not afraid to discuss it. In addition, a Catholic funeral should not only meet the need for families to grieve but also celebrate the life that was and the new life with God that has begun. The sacrament of anointing of the sick, frequently misunderstood by Catholics as “last rites,” could be offered more frequently in a parish context, where fellow worshipers can extend hands and hearts in blessing over their sisters and brothers in Christ.
Another issue is that Catholic parishioners may not have a grasp of the ethical nuances involved in end-of-life care. Clarifying Catholic teaching about medical technologies and care at the end of life would be another helpful step Catholic parishes could take. But pastors need not offer this education alone; it is possible to draw upon expertise in the parish to help with this endeavor.
In my work, I have heard Catholic families express to health care professionals their resistance to discontinue life support for their dying loved one due to their faith commitment. Certainly, making decisions for loved ones can be grueling, and families should feel welcome to choose from several options, but it is unfortunate when misunderstandings of the Catholic moral tradition drive decisions.
“Ethical and Religious Directives for Catholic Health Care Services,” a document issued by the U.S. Conference of Catholic Bishops, explains the stewarding of our earthly lives: “We have a duty to preserve our life and use it for the glory of God, but the duty to preserve life is not absolute, for we may reject life-prolonging procedures that are insufficiently beneficial or excessively burdensome.”
That is, while there may be good reasons to continue life-prolonging procedures in particular contexts, it is not required by Catholic moral teaching if these procedures, technologies or interventions are not providing sufficient benefit and are imposing a significant burden on the patient. Catholics can rejoice that our earthly life is not everything and that our life continues, albeit in a different form, after death. Our parishes need to hear this message proclaimed from the pulpit, for it is a core tenant of our faith.
The best way to communicate our faith-based end-of-life decisions is by utilizing an advance directive. Living wills and durable powers of attorney are two examples of advance directives. The former is a written declaration of one’s health care wishes in case one approaches the end of life and is unable to communicate, and the latter designates a health care proxy who has legal authority to carry out your wishes in the event you need assistance. The Catholic directives endorse both of these, provided the patient’s wishes do not contradict Catholic teaching (for example, by calling for physician-assisted death). The durable power of attorney should go to someone who understands your values and how proposed treatments may or may not be consistent with those.
How powerful might it be if a pastor and parishioners talked about their own advance directives and end of life wishes? The point is not to dictate how others need to proceed but to make the topic less taboo and more tied to one’s life of faith in the church. The parish can be a nexus for information and sharing hopes and fears about the last stage of life.
I belong to a vibrant, diverse Jesuit parish on the northwest side of Detroit called the Gesu Catholic Church, which has worked to make end-of-life planning a more peaceful, manageable and normalized topic. The parish offers numerous education and social justice programs, organized primarily by parishioners and staff.
For example, I accepted an invitation to join a small group of volunteer parishioners offering an end-of-life program that we titled “Dignity at the End of Life: Spiritual, Medical, Ethical, and Legal Issues.” We drew upon the expertise of a few parishioners to present and recruited other speakers from the community to enhance the program. We also invited local organizations to set up tables and distribute information. Folks representing hospices, organ donation programs, Catholic cemeteries and “green” burials had ample time to converse with attendees.
Our pastor opened the program with prayer and then asked all present to consider meeting with him and our music minister to plan their funeral. He said that he would keep a file of all funeral plans so that families who lost a loved one would not be saddled with this additional responsibility. We also distributed advance directives so those in attendance could declare their end-of-life treatment choices. Equally important, they were encouraged to discuss their wishes with family members.
Based on the evaluations and informal conversations I enjoyed after speaking to those gathered, I would say our fellow parishioners were hungry for this program. It should not be surprising that people had burning questions regarding end-of-life care, legal processes and the ethical dilemmas that sometimes emerge concerning death. This is not an easy landscape to navigate, and it is made all the more strenuous by our culture’s denial and fear of death. People want to do what is best for themselves and their loved ones at the end of life, but we do not always know how, and so we stumble toward life’s finish line messily. By drawing on our faith tradition and the wisdom of fellow worshipers, our parish communities can relieve one another’s burdens and doubts about death. We can learn how to approach life’s last stretch with dignity and faith.
