Illinois bishops on death and dying, The

Health Progress, Mar/Apr 2002 by O'Rourke, Kevin D

A Pastoral Letter Presents Church Teaching in a Succinct and Understandable Manner

In the past 15 years, American bishops-acting at times alone, at other times in state conferences, or as members of a committee of the U.S. Conference of Catholic Bishops-have issued more than 15 pastoral statements concerning the care of people approaching death.

Some of these statements were written in regard to specific people. For example, local bishops made statements regarding the care of Paul Brophy, Elizabeth Bouvia, Nancy Beth Cruzan, Christine Busalacchi, and Hugh Finn. In most cases, these statements acknowledged the anguish and suffering of those family members who had to make decisions about removing life support, and the bishops usually agreed that the family involved was not trying to kill its loved one but merely seeking to discontinue useless treatment or to remove an excessive burden.

Other statements have been issued by state Catholic conferences-for example, the conferences of Louisiana, Pennsylvania, New Jersey, and Washington-and by several bishops from the state conference of Texas and the Pro-Life Committee of the National Conference of Catholic Bishops.

All statements of this latter kind have been general in nature, considering issues from a more didactic point of view than did those issued for specific clinical cases. Often these statements seemed more concerned with combating the growing evil of euthanasia in the United States than with offering practical advice about death and dying. However, they did not always agree on the use of specific therapies. For example, some statements discouraged the removal of artificial hydration and nutrition from patients in persistent vegetative state (PVS). Others, basing themselves on the traditional teaching of the church as contained in Directives 56, 57, and 58 of the Ethical and Religious Directives for Catholic Health Care Services (ERD), have been inclined to allow removal of these devices if they were of no benefit to the patient or imposed an excessive burden upon the patient, the family, or society.1

The bishops of Illinois have recently issued a statement, entitled Facing the End of Life: A Pastoral Letter from the Bishops of Illinois, in regard to the ethical decisions that patients or their proxies must make.2 Is this statement any better or worse than the aforementioned statements of individual bishops or groups of bishops? Does it contain new insights in regard to difficult medical and ethical decisions? Will it be helpful to people who must decide whether to use or forgo life-support devices designed to prolong life? For example, will it be helpful to the patient who realizes that, although an artificial heart might prolong his or her life another six months, it will not improve the quality of life significantly? The following considerations are intended to answer these questions.

DOCTRINAL TEACHING

All of the U.S. bishops' general statements referred to above begin with doctrinal considerations. Basing themselves on principles of faith, the bishops make it clear that death is a natural and integral part of human life, not something that we experience apart from life. More than anything else, preparing for and experiencing death, whether it be one's own or that of a loved one, helps us to realize what it means to be human. Moreover, the various statements of the bishops integrate the many decisions that must be made as death approaches-whether medical, familial, or economic-with the spiritual good of the patient. Thus spirituality is not a separate aspect of dying; it is an integrating element for everyone involved in the dying process of one of God's children.

Given these general ideas, each of the bishops' statements has its own identity. The Illinois bishops' statement is characterized by brevity. It is brief enough and clear enough to be understood by people facing death, by their families, and by the health care professionals providing the care. Most of the statements written by state Catholic conferences are simply too long and too opaque, so far as the general public is concerned. Often such statements were written by theologians for theologians, employing theological terms in a manner that neither laity nor health care professionals can grasp easily. The Illinois bishops' document is only six and one-half pages long. After presenting some foundational teaching that enables the reader to "consider death in the context of our faith," it highlights what it calls "three crucial issues":

* The role of medical care at the end of life

* The proper understanding of suffering and the value of suffering

* The difficulty Americans have with the loss of independence and control

In "considering death in the context of our faith," the pastoral letter focuses on the purpose of human life. "The value of human life is truly found in our supernatural destiny and a recognition that death is not the end," the bishops write. "Preparation for death is an essential part of life for a Christian.... The key to dying well is living well. Living well means a life characterized by love of God and love of neighbor.... Recognizing that the goal of our lives is eternal life with God, we prepare for that by prayer, reception of the sacraments and care for those around us, especially the poor and the forgotten" (p. 107). In carrying on the tradition of treating death as a part of life, the Illinois bishops call on the Catholic community to help build "a civilization of love amid our current American culture of death" (p. 109).