What concerns should I keep in mind for my Health Care Directive?

by Father Dale Kinzler


Father Dale Kinzler

These questions beg for a long and complex response, but I will try my best to summarize a few basic principles of end-of-life care and our care for vulnerable persons. In the first of three paragraphs, the questioner writes:

“One of the things that I have not been able to completely reconcile in my mind is why so many of the elderly spend so much time in nursing homes and wonder especially what they are accomplishing for the faith when in a coma, and seemingly cannot communicate any longer.”

On Easter Sunday, I went to visit my 98-year-old aunt in the nursing home. My aunt evidences the usual signs of senility but was able to form coherent sentences, and gratefully received communion. Should she lose the ability to converse in the near future, I would not consider her any less valuable to the caregivers in that facility, nor to our family.

What we do in our physical and spiritual care for the elderly, the comatose, and the dying is of great value to us, fulfilling the corporal work of mercy, “I was sick and you visited me” (Mt 25:36). From the perspective of the elderly, the sick and the dying, they may identify with the suffering Christ who bore the pains of the Cross for our salvation.

Redemptive suffering is a difficult concept to embrace. Yet the hope and promise of eternal life can inspire us to bear this relatively short time of human suffering on earth with a view to the reward of life forever with God.

Our questioner’s second paragraph notes that both parents were in a comatose state before their death. In the father’s case, his heart was strong and kept him alive for three months.

“I believe he lived so long because he was being kept alive by a feeding tube my mother had signed for. Later I was appraised of the fact that this is not necessary according to the Catholic faith, and did not sign this to be done for my mother, who also was in a coma, before she died. She died within a couple weeks, but was kept comfortable by medications, I understood.”

Here we have a complex set of considerations, which require case-by-case responses, rather than a “one size fits all” statement. Nevertheless, we do have a set of general principles I will summarize briefly.

Our Ethical and Religious Directives for Catholic Health Care Services (USCCB, 5th Ed, 2009) states:

“A person has a moral obligation to use ordinary or proportionate means of preserving his or her life. Proportionate means are those that in the judgment of the patient offer a reasonable hope of benefit and do not entail excessive burden or impose excessive expense on the family or the community” (ERDs n. 56).

“In principle, there is an obligation to provide patients with food and water, including medically assisted nutrition and hydration for those who cannot take food orally. This obligation extends to patients in chronic and presumably irreversible conditions (e.g. the “persistent vegetative state”) who can reasonably be expected to live indefinitely if given such care” (ERDs n. 58).

However, “As a patient draws close to inevitable death from an underlying progressive or fatal condition, certain measures to provide nutrition and hydration may become excessively burdensome and therefore not obligatory in light of their very limited ability to prolong life or provide comfort” (ERDs n. 58).

It is not quite correct to say a feeding tube is “not necessary according to the Catholic faith.” We need to know more in each situation. In the father’s case, it would seem that provision of medically assisted nutrition was an appropriate means of palliative comfort care during his comatose phase of the dying process. Our concern in the mother’s case would be whether or not her body systems were already shutting down, such that she would not benefit from nutrition and hydration.

Morally responsible caregivers should respect the dignity and sanctity of the patient’s life as a gift from God, not ours to take. In principle, a person should not die from dehydration, but rather the ravages of old age or terminal illness. We have seen an increasing tendency to “sedate and dehydrate,” where care facilities withhold medically assisted nutrition and hydration and sedate for the sake of “keeping comfortable.” The patient, given no fluid, generally dies within a couple weeks. We cannot fully know what the patient suffers during this period. However, we want to avoid what is known as “passive euthanasia,” where our direct omission of proportionate care becomes the cause of the person’s death (See ERDs n. 60).

Our questioner’s third paragraph asks:

“Please explain the Church’s thinking on this, as I am now approaching this time in my own life and have signed a living will with the order that no external means of extending my life be administered. Is this correct Catholic theology? Is there anything else within Catholic teaching I should be aware of in my living will?”

In a future article, we can revisit the question of advance health care directives. We encourage Catholics, and members of all faiths, to visit the North Dakota Catholic Conference web site, ndcatholic.org. There you will find a copy of a “Catholic Health Care Directive” or one suited to other Christians.

We recommend this form of directive, which names a health care agent to assist in decisions based on your beliefs and wishes. Through communication with pastors, health care providers and other significant persons, the health care agent can assist in making the most morally responsible choice in a given situation.

Father Kinzler serves as the pastor of St. George’s Catholic Church in Cooperstown as well as pastor of Sacred Heart, Aneta; St. Olaf’s parish, Finley; and St. Lawrence’s parish, Jessie. He can be reached at dale.kinzler@fargodiocese.org.