1. DEATH AND DYING THE CATHOLIC TRADITION

2. OVERVIEW - 1 October 5, 2015: “End of Life Option Act” in California (already legal in Oregon, Washington, Montana and Vermont). Allows a terminally ill, mentally competent adult to request a prescription for aid-in-dying medication (Pentobarbital and Secobarital). Patient must be able to self-administer. Patient is diagnosed with a terminal illness (6 months). Patient is: “competent to make an informed decision.”

3. OVERVIEW - 2 Physician must refer patient to psychiatric or psychological counseling IF the physician thinks the patient is depressed or suffering from a psychological disorder. Physician must refer patient to another physician for a second opinion. Patient must make two oral requests at least 15 days apart and a written request for the medication (signed by patient and 2 adult witnesses, one of whom must be “disinterested”).

4. OVERVIEW - 3 All insurance policies would have to pay benefits the same as if the person died of a natural death. The cause of death is listed as the underlying illness.

5. ETHICAL CONERNS - 1 Major cultural/societal “pushes” to choose aid-in- dying: –Autonomy as in Roe v Wade (1973) and Obergefell v Hodges (2015). –Fear/dread Machines, e.g., ventilator. Loss of awareness, e.g., Brittany Maynard (29 years old; aggressive stage IV malignant brain cancer called glioblastoma; terminally ill; wanted to avoid a “terrible death”; moved from Oakland to Oregon (2014) to gain access to “Death with Dignity Act”; died on November 2 nd. Being a burden on one’s family/caretakers (#1 reason in Oregon/44.9% in 2007).

6. ETHICAL CONCERNS - 2 Human dignity: –Intrinsic/fundamental (imago Dei). Human life is a basic good but not an absolute good. –“Life, health, all temporal activities are in fact subordinated to spiritual ends.” Pope Pius XII, 1957 –“Life on earth is not an ‘ultimate’ but a ‘penultimate’ reality.” Pope John Paul II, 1995. Vitalism/Biologism: cessation of efforts to prolong life is unconscionable (medical and religious/cultural reasons). –Accrued/designated, e.g., on June 8, 2015 the European Court of Human Rights ruled that there is nothing wrong with stopping medically-administered nutrition/hydration to a brain-damaged, poly-handicapped person. –Personal.

7. THE CATHOLIC MORAL TRADITION - 1 Killing and Letting Die: –Killing, e.g., to give a lethal injection. –Letting die, e.g., (a) not to initiate or (b) to cease burdensome treatment: Treatment, e.g., breathing machines, dialysis, cardiopulmonary resuscitation (CPR), surgical interventions, feeding tubes, for instance, from nose to stomach, directly into the stomach, from nose to intestines. Emotional and Moral difference. Care.

8. THE CATHOLIC MORAL TRADITION - 2 Intention: –Letting grandma drown – morally unjustifiable. –Stopping dialysis – death is foreseen but not intended. –Pain medication, e.g., morphine.

9. THE CATHOLIC MORAL TRADITION - 3 Treatment: –Ordinary (obligatory, beneficial, medically- indicated, proportionate). –Extraordinary (optional, burdensome, medically not-indicated, disproportionate). –Does not mean medically customary or usual, e.g., ventilators, dialysis, organ transplantation, use of antibiotics. –Ordinary/extraordinary is circumstantial, situational and relative to a particular patient.

10. THE CATHOLIC MORAL TRADITION - 4 Criteria: –Great effort, e.g., change location. –Enormous pain, e.g., amputation, aggressive chemotherapy. –Extraordinary expense, e.g., drugs(s). –Severe dread/repugnance (vehemens horror). –Prognosis. –Risks/harms, e.g., medically-assisted nutrition and hydration (infection, loss of mobility, restraints, blood clotting, edema, incontinence, aspiration pneumonia). –Burdens, e.g., pain, emotional distress, prolongs the dying process. –Benefits, e.g., restores health, relieves pain, improves physical and emotional health, prolongs life).

11. PASTORAL CONLUSIONS - 1 Health Care Directives: –Living Will: your intentions about end-of-life treatment. –Durable Power of Attorney for Health Care: name a proxy/agent/decision-maker (honored in a Catholic hospital unless contrary to Catholic teaching).

12. PASTORAL CONLUSIONS -2 POLST (Physician Orders for Life- Sustaining Treatment): –Patient has a terminal illness. –Signed by patient (or agent) and physician only after conversation(s). –Review Advanced Directive for consistency. –Choices: Full treatment. Selective treatment. Comfort care.

13. PASTORAL CONCLUSIONS - 3 Care: –Comfort care. –Palliative care: A team approach which addresses the quality of life of patients and their families while facing life-threatening illness. Provides relief from pain. Affirms life. Integrates psychological, emotional and spiritual aspects of one’s life. Works with the patient’s physician. Aims to improve mood, comfort, stress and overall quality of life.