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Pastoral Center lecture explores end of life issues

byJim Lockwood
9/25/2009

Dr. Peter Cataldo, an official with the National Catholic Bioethics Center and the Director of the Respect Life Office for the Diocese of Manchester visited the archdiocese’s Pastoral Center Sept. 16 to deliver a talk on a key issue in today’s aging society: end of life issues.

The presentation entitled, “Three Beliefs: A Catholic Guide on Durable Power of Attorney for Health Care in New Hampshire,” was sponsored by the Archdiocese of Boston’s Pro-Life Office.

Cataldo’s presentation addressed the Catholic definition of conscience and how one must use a properly informed conscience to make reasonable health care decisions for themselves or loved ones, as well as advance health care directives such as durable powers of attorney for health care and living wills. He also spoke on how to discern whether treatment options present “reasonable hope” or “excessive burden”, those living in a vegetative state, and organ donation.

Cataldo also informed attendees of Massachusetts laws in these areas and explained how the Diocese of Manchester helped develop a legally-binding document concerning power of attorney.

“It affirmed my thoughts about every situation being different and you have to look at each person at each particular time,” said Kathleen Hallee, the Catholic chaplain at Quincy Medical Center. “You can’t make general observations that every person is the same.”

Cataldo’s first belief is that health care decisions must reflect an informed conscience, informed by facts and moral values, and such decisions should be “consistent with human dignity.”

He compared durable power of attorney, called a health care proxy in Massachusetts law, to a living will. Under the power of attorney, one designates another individual to make health care decisions on his or her behalf when a person cannot make health care decisions for himself or herself.

A living will, on the other hand, reflects an advanced set of health care decisions made when a person is healthy and anticipating end-of-life issues.

According to Cataldo, a power of attorney is “morally preferable” to a living will, because it can take into account medical advances or changing circumstances, whereas a living will may not. He said a power of attorney provides for a more informed consent or refusal of care.

“A lot can happen in medicine in six months or 20 years,” Cataldo said.

In the case of a living will, he said, “members of the family are restricted by a 20-year old document that does not take into account the changes in medicine.”

He said decisions about “life-sustaining treatment and care” should be made in good conscience. Conscience, he said, is not relativistic -- where a person decides his or her own morality based on strong feeling and the circumstances of each situation.

“That is the cultural assumption today -- if I have a strong emotion or feel strongly about something, than that must be my conscience.”

Rather, he said, conscience is the ability to know moral right from wrong, and the “power to evaluate one’s actions with this knowledge.”

Since we received the gift of life from God, Cataldo said, we are “stewards of life.” Therefore, with respect to health care decisions, we should make decisions appropriate to a person’s specific circumstances and avoid euthanasia and “over-zealous treatment.”

“We want to try to hit the mean between the extremes,” he said.

In making these important health care decisions, one needs to evaluate whether treatments pose an “excessive burden” or “reasonable hope” of success. Factors to be considered include whether a treatment is appropriate to the problem, its complexity, risk, cost, and possibilities, and the results it could realistically achieve given the status of one’s health and physical and moral resources, according to the Vatican’s “Declaration on Euthanasia.”

On the other hand, if a treatment has a “reasonable hope of benefit and no excessive burden” then it is morally obligatory.

“It is a balancing of judgment we make. It’s taking all these factors and applying them to what can be expected for this set of circumstances,” Cataldo said. “We might compare these things to another person and might come out with a different result.”

Health care needs for those in a vegetative state must be considered as well, according to the same guidelines.

“They are not sub-human. They are not in another class of humanity,” Cataldo said. “They are the same as us.”

Cataldo’s also addressed organ donation, saying that it is endorsed by the Catholic Church when death is properly declared -- either when the heart irreversibly stops functioning or brain death.

Today, with developments in other states, coupled with the recent debates on universal health care, there is a renewed interest in end-of-life issues.

Last year, voters in the state of Washington passed Initiative 1000 by a margin of 59-41 percent to make it legal for doctors to prescribe lethal medication for patients expected to live less than six months. A similar law passed in Oregon.

Meanwhile, in Montana, a state district judge said that mentally competent patients with a terminal illness have a right to physician-assisted suicide under the state constitution. According to amednews.com, Montana Attorney General Steve Bullock, a Democrat, said he will appeal the decision.

“If that were to come to the Supreme Court, we could have another Roe v. Wade on our hands,” said Marianne Luthin, director of the archdiocese’s Pro-Life Office.

Luthin also cautions that proponents of euthanasia are targeting New England, a region that along with the Pacific Northwest is one of the least churched areas of the country.

“It’s important that people understand end of life issues,” said Father Joseph B. Whittel, pastor of Our Lady of Perpetual Help in Connecticut, who attended the presentation. “It’s going to be a relevant topic moving forward.”