Death and Dying Issues

Moral Foundations Human life is sacred from Conception to Natural Death. The human person is a unity of body and soul. All human beings, regardless of their lack of their physical or mental capacities, possess human worth. Humans are mental, spiritual, and social beings. Anatomical vs. Functional We are stewards of God’s creation – including our bodies. We have the duty to assist others to the extent that we are able to – minimally, not to get in someone’s way to preserve his/her life. Life is a gift, but it is not absolute. We cannot commit evil in order to achieve good. Dying is a process. Death is an event.

Euthanasia There is a difference between letting someone die and making someone die (Euthanasia). Catechism, 2276 Euthanasia can be voluntary, non-voluntary, and involuntary.

Ordinary and Extraordinary Means of Care Ordinary Means of Care – reasonable means (CCC, 2279) Extraordinary Means of Care – More than reasonable means; over zealous treatments (CCC, 2278)

Determination It is always case specific It is always means specific It is not always technologically specific. Three criteria (all three must be met in order for it to be ordinary): The means (procedure, medication, or treatment) is readily available It is a real benefit to the patient It is not excessively burdensome to the patient (physical, psychological, or economical); and not excessively burdensome to others (economic ONLY)

Church Teaching One can forgo Extraordinary Means but NEVER Ordinary Means to preserve life – food, water, exercise, and basic medical care. For those on the last stages of the dying process – is the procedure/treatment sustaining life or a real benefit, OR is the dying process being prolonged? Legitimate reasons to apply Extraordinary Means Something that starts out as Ordinary Means may later become Extraordinary

Feeding Tubes and Hydration St. John Paul Address to Physicians, March 2004: I should like to particularly underline how the administration of water and food, even when provided by artificial means, always represents a natural means of preserving life, not a medical act. Its use, furthermore, should be considered in principle, ordinary and proportionate, and as such morally obligatory… Death by starvation or dehydration is, in fact, the only possible outcome as a result of their withdrawal. In this sense, it ends up becoming, if done knowingly and willingly, true and proper euthanasia… such an act is always a serious violation of the law of God, since it is the deliberate and morally unacceptable killing of a human person.

Types of Feeding Tubes Entral Feed Total Parental Feeding Ways to feed: intravenously, nose/throat, stomach To remove these is not actually removing the feeding tube, but denying food.

A Person in a Persistent Vegetative State (PVS) and Feeding Tubes A person in a coma or stupor A person in a Persistent Vegetative State “Wakeful awareness” not brain dead The cerebral cortex is impaired – responsible for conscious activity

The brain stem continues to function – controls breathing, heart function, digestion, reaction to pain, blinking, waking/sleep cycles

PVS – no measurable sign of consciousness or awareness Patients who have been diagnosed in both a PVS or minimal stage, have come out of the vegetative state. Those in PVS are not dying. The body continues to function normally, except they can’t feed themselves. Those who are not fed die from dehydration and starve to death – we assume that they do not feel themselves starve to death.

Other Specific Issues Organ Donation and Implantation Criteria for the donor: For the deceased – death certification is required. Living donors Must maintain functional integrity, not anatomical; not all organs can be given. Has to be an act of charity and not motivated by force or sale; although this doesn’t mean that there can be no compensation. Criteria for the recipient: Recipient list has to be based on medical need. Social and economic standing should not be part of the criteria. Recipients who need an organ due to their own abusive behavior should not be given preference nor denied the opportunity.

Determination of Death Classical – irreversible loss of heart beat and breathing. Brain Dead Criteria: Partial Total Brain Dead Harvard Criteria

Experimentation and Research on Human Subjects Distinction – Dead and Live Donor Dead Donor Live Donor Therapeutic Non Therapeutic Genetic Treatments and Interventions

Advance Medical Directives The Living Will Advance Medical Directive with a Durable Power of Attorney or Health Care Proxy with an alternate Points of Consideration