Section Two: End-of-Life
1. Is it okay to accept that it is time to die?
Once a person realizes that an illness or condition has reached the point that a cure through treatment is no longer possible, then the person is faced with the reality of death. Many people go through several different phases of denying death, struggling with the implications of dying and mortality, seeking further medical opinions and so on, but most people gradually come to an acceptance that life as they know it is coming to an end. It is important for our own spiritual and emotional state of mind that we do accept this reality, and many not only accept that it is time to die, but accept that it is God’s time, and they move into the dying stage with this attitude.
2. When it comes to the term proportionate/disproportionate, what does this mean in terms of burdens/benefits of care?
The terms used here are both helpful and pastoral in their approach to making decisions about whether or not to begin or to end a course of treatment. Treatments are judged to be proportionate if they have been shown to be successful in similar circumstances, if they are easy to obtain where the patient is located, and if there are few or no side-effects.
Other treatments are judged to be disproportionate if they are unlikely to have substantial curative results, if they are difficult to obtain for any reason, and if the patient finds them too difficult to tolerate. Catholic teaching says that patients are the ones who should make these judgments in light of their own experience.
3. Do people have a right to know the extent of their illness? How is it helpful for them person to know the details of their medical condition?
It is a legal right to be informed, but the personal reasons for this information are even more important for faith-filled people.
Catholic teaching says that people who are capable should be fully informed of their condition, in a careful, gentle, and perhaps gradual, way. First, knowledge of the extent of the illness will help them plan for the future, no matter how limited that might be, including how they will live out the time left to them. Second, it allows people to make good decisions about medical treatment, and to explore options for remaining at home, being admitted to hospice, etc. Third, it allows people to say goodbye to their loved ones and to reconcile, if possible, with any people from whom they have been distanced. Fourth, it allows people to receive the Sacrament of the Sick and the last rites, as well as allowing them to make peace with God.
4.When do I start to plan?
This is a good question, since the answer is ‘now!’ Catholics have many questions about the end-of-life and it would make sense not to wait until that point to look for answers. People are concerned that their decisions will be in line with Church teaching, and it is important to be informed. There are many sources of information: courses and sessions offered through dioceses by people who are specialists in their fields, Catholic physicians and hospitals, parish nurses where available, and hospices that offer courses and information.
5.Can I change my care plan from prolonging life to comfort?
Yes, if the person has reached the stage where it is clear that treatment is not curative, but is prolonging life, then the person may make the decision to stop that treatment and to opt for comfort care in preparation for the death that will eventually result.
6. What is an advance directive/care planning?
Advance planning directives of any kind mean that a person expresses his or her wishes for future treatment in the event that the person not be capable of making or communicating these wishes. The person should choose someone to speak on his/her behalf and to make decisions in specific circumstances that arise. People are often concerned that heroic measures might be taken that will leave them in a condition that they might reject if capable, e.g., surviving through the use of extraordinary means.
7. Can a person remain pain free?
Most palliative care specialists say that severe pain can be controlled almost 100% of the time in most cases. Nothing is 100% and even deep sedation might not always be recommended, therefore there are sometimes circumstances where pain cannot be avoided, but on the whole these are rare, and we should feel confident that comfort care and pain management are reliable.
8. How can I make my wishes known about the care I would like in the future?
See # 6 above; also consider a writing down your wishes: http://www.advancecareplanning.ca/making-your-plan/
9. Is it okay to take treatment/pain medication that might shorten my life?
Depending on WHY I take these treatments, the answer could be ‘yes’ or ‘no.’ The answer will be NO if I take any treatment or medication in order to shorten my life. The answer will be YES if I am doing so in order to deal with pain and suffering at end-of-life, even if there is a possibility that use of a treatment or drug might contribute to dying a day or so before death would occur otherwise. Catholic teaching says the latter is morally permissible.
10. What kind of supports will I need?
This will depend on your individual situation and condition, and, in a sense, supports will be provided according to that, medical, nursing and spiritual. Some people are able to be looked after at home, supplemented by home visits from physicians and health care workers who will look after how medication is provided, etcetera; people who need more supervision may end their days in a long term care facility; where available, people who are dying receive comfort care in hospice, where health care workers also supervise their care: others receive similar care in palliative care units in hospital.
Counselling support is available through Catholic Family Services and other agencies, parish nurses make home visits in some areas, The Diocese of Hamilton, through the Family Ministry Office can provide contact information for other counsellors and supports. Pastoral workers and priests from the person’s parish will visit at home, and both, as well as chaplains, can be requested to visit in most facilities.