Some help with end of life care.
Last week, I sought to answer how the truth is known when two who both think they are doing God’s will disagree. In giving that answer, I first spoke of our easiest means to know the truth and then appealed to an example from end of life care that showed different levels of authority that ought to be consulted in seeking to know God’s will. Given the example of end of life care, I thought this column (originally written some years ago that was republished here at St. Ben’s over a year ago) would be good to revisit, if for no other reason than to make all aware of a short publication of from the National Catholic Bioethics Center in Philadelphia entitled “A Catholic Guide to End-of-Life Decisions.” Thus:
In deciding on treatments for serious illness, the distinction between “obligatory medical means” (sometimes called “ordinary means”) and “optional medical means” (or “extraordinary means”) is at the heart of this question. In general, those treatments that are deemed obligatory or ordinary would be required in every circumstance, as they do not create a grave burden on the person. Most medical care fits this category. Treatments that are optional or extraordinary would be those that contain little hope of benefit to the person, and are seen as burdensome. In such cases, a patient is free to refuse anything where the benefits may be doubtful or where the burden of the treatment or procedure clearly outweighs the foreseen benefit. Extraordinary means may also include “aggressive” or “experimental” treatments that can be pursued where there is a reasonable hope that the patient will benefit from them; but such are not strictly required.
Said more plainly, when a person is seriously ill, any treatment that will help them without much burden is required. On the other hand, when a treatment may give only some help, and has grave risks or is seen as greatly burdensome, the patient on their own choosing has a right to refuse it. An example might be that of chemotherapy and dialysis (as was asked in the original writing of this column): if chemotherapy would be a grave burden and offer little hope – the side effects being as they are, and the particular patient’s recovery from the cancer being questionable at best, it can be refused. Such a refusal, however, must be done only after the patient has been told all the accurate information on treatment options, their possible benefits, side effects, and costs. It is always for the patient to decide. This decision can be made in consultation with a doctor. A patient who is in imminent danger of death may refuse treatments that would result only in a “precarious and burdensome prolongation of life.” Kidney dialysis, as asked here, would be considered under the same principles.
Thus, to answer the question as simply as possible: in some circumstances, the refusal of chemotherapy and dialysis is justified. However, this is not the case for all uses of chemo or dialysis – but only when the above principles regarding the reasonable hope of benefit from these treatments and the burden on the patient are met, both in the treatment itself, and in the ongoing consequences of that treatment.
Be sure to inquire if you are interested in more information on these matters. The pamphlet “A Catholic Guide to End-of-Life Decisions” can be read online at the
website for the National Catholic Bioethics Center: at www.ncbcenter.org under the “Publications” tab, click on “End-of-Life guide” for any who would be wanting more information, particularly on the questions of what are called “advance medical directives” (or sometimes called “living wills”) and “health care proxies.”