Each person dies his or her own way, and every death is unique.

So says Father Tad Pacholczyk, education director and ethicist for the National Catholic Bioethics Center and a well-known speaker and writer on end-of-life issues, as well as other topics.

End-of-life discussions

What has been your experience with end-of-life discussions with loved ones? Add your story in the comments below.

The fact that people cannot predict the time and manner of their deaths makes it difficult to lay down specific and concrete rules on what should be done as death becomes imminent. But those who help people who are dying — and people whose loved ones are dying — have one piece of advice for everyone: Talk to your family about what you want when you die.

Talk to your family when you are getting older, of course, when death becomes a regular visitor in your thoughts. But talk to them when you are young, when death seems to be no more than a shadow way off beyond the horizon.

“I can tell you one thing,” said Bob Andorka, a chaplain at Loyola University Medical Center in Maywood, Ill. “Have the conversation with your family and friends about how you would like to be cared for. It gets very hard when you have a situation and you don’t know the person’s directives.” 

Planning ahead

Andorka has seen it many times. He took time to talk about what he has experienced between calls to the emergency department at Loyola.

Pope Benedict XVI on Death
“Despite the fact that death is often almost a forbidden subject in our society, and that there is a constant effort to distract our minds from the thought of death, this fact of life involves each and every one of us, it involves humans of all eras and all spaces, before this mystery, all of us, even unconsciously, are looking for something that encourages us to hope, a sign that can console us, that can open up some kind of horizon, that can still offer a future.”
 
— Pope Benedict XVI, Nov. 2, 2011, during his general audience.

When people arrive in the trauma center, he said, sometimes chaplains don’t get a chance to talk with them at all because they are unconscious or intubated, and instead spend time with their families. In either case, he told Our Sunday Visitor, they focus on finding out what brings hope and strength to the people they are talking with.

“Some people want to receive Communion or be anointed,” he said. “Some people want to talk about their life. Sometimes they find inspiration from their families. Sometimes they want to live to a certain date.”

Others talk about welcoming death, if it means the end of the pain they are in, he said.

Church teaching is clear that while human earthly life is good, it is not the only or the ultimate good, so it is not necessary to do everything possible to prolong it, Father Pacholczyk said. Rather, those making decisions for patients must weigh whether possible interventions or procedures are ordinary — steps that should be taken because they are likely to extend the person’s life — or extraordinary measures that, rather than preserving life, will merely prolong the dying process, causing more pain and distress for the patient and his or her family than any benefit they confer.

Some measures that would be considered ordinary in some situations would be extraordinary in others, he told Our Sunday Visitor. “When you’ve analyzed one end-of-life case, you’ve analyzed one end-of-life case,” he said.

That’s why many Catholic ethicists recommend that Catholics sign a durable health care power of attorney to delegate decision-making power to someone who understands and respects what the Church teaches. That person with power of attorney for health care will be called on only when the patient is unable to speak for himself of herself.

Some Catholics also sign advance directives specifying what treatments they want or don’t want should they become unable to speak for themselves, but those can be tricky, because so many decisions are specific to each patient’s own situation, Father Pacholczyk said. Many advanced directive forms are available that do not respect the Church’s teaching that presumes that it is morally necessary to provide food and water to patients, even if they need a feeding tube.

“Feeding is usually not a heroic measure,” said Father Pacholczyk. “We feed our babies, we feed loved ones. The general presumption is you continue to feed.”

Even that is not an absolute. In some circumstances — when the patient’s body is shutting down and rejects nutrition, for example — feeding tubes may not be morally necessary. 

Using wisdom

According to the NCBC’s “A Catholic Guide to End of Life Decisions,” Catholics should “make certain that your Advance Directive forbids any action that the Catholic faith considers to be immoral, such as euthanasia or physician-assisted suicide. A Catholic hospital, in any case, will not follow a directive that conflicts with Church teaching.”

Saint of Death

 St. Joseph is known as the patron saint of a happy death. As the spouse of the Blessed Virgin Mary and foster father of Jesus, he is described as a “just man.” The last mention of Joseph in Scripture is in the search for Jesus in the temple in Jerusalem. Scholars presume he died before Christ’s passion. 
 
“O St. Joseph, whose protection is so great, so strong, so prompt before the throne of God, I place in thee all my interests and desires. O St. Joseph, assist me by thy powerful intercession and obtain for me all spiritual blessings through thy foster Son, Jesus Christ Our Lord, so that, having engaged here below thy heavenly power, I may offer thee my thanksgiving and homage.
 
“O St. Joseph, I never weary con-templating thee and Jesus asleep in thine arms. I dare not approach while he reposes near thy heart. Press him in my name and kiss his fine head for me, and ask him to return the kiss when I draw my dying breath.
 
St. Joseph, patron of departing souls, pray for me.”
 
— This prayer was found in the 50th year of our Lord and Savior Jesus Christ. In 1505 it was sent from the pope to Emperor Charles when he was going into battle.

The full guide is available at www.ncbcenter.org. Those who order the pamphlet from the online store for $2.50 also receive an advance medical directive and health care proxy that conform to Catholic teaching on end-of-life care. Such forms also are available from several dioceses and other Catholic organizations.

Andorka’s urging that people share their wishes with loved ones was echoed by fellow hospital chaplains Kathleen Brannigan, who works at Loyola and at RLM Hospital in Hinsdale, Ill., and Dierdre Manning, who also works at RLM, a long-term acute care facility.

Patients at RLM often come from intensive care units at short-term acute care hospitals and many are on ventilators; the goal is to help them get well enough to go to a rehabilitation center or home, but some never get better.

Then, Brannigan said, the question goes from “What now?” to “What are you hoping for?”

“All of life is woven into end-of-life care,” she said. “What gives your life meaning? What did you regret? What gives you peace and joy?”

She saw that in a personal way when her father was dying. He was already ill when the family went on vacation to Wisconsin Dells. When he got worse, he returned home and went into the hospital. Over the next few days, he spent time alone with everyone — lots of children, children-in-law, even a 3-year-old granddaughter who climbed up on Papa’s bed to read him a story.

Now, Brannigan said, she makes an effort to facilitate one-on-one time between people who are dying and their family members.

“It’s been for me a very sacred work,” she said. “There’s nothing superficial anymore. It’s the core of who you are. You get to see the strength and the compassion.”

Manning agreed.

“To be able to listen and share, it’s such a privilege,” she said.

The Little Sisters of the Poor, a religious congregation founded in mid-19th-century France, have a slightly different perspective. They take care of the aged poor, so all of their residents have lived full lives.

At St. Mary’s Home, a Chicago nursing home run by the congregation, Sister Ann Marguerite Donnelly has spent time with many residents as they approached their deaths. Unlike the hospital chaplains, her experience is only with the elderly, which she acknowledged is different from helping younger people who must come to terms with death before their children are raised, for example, or before they had the opportunity to have children.

“These are people who have had the full continuum of life and are living their last days,” Sister Ann Marguerite said. “It’s not unfair. Death is the moment for which they’ve lived their whole lives.” 

Crossing the threshold

That doesn’t mean they are always at peace.

“To old age, we bring a lot of memories, a lot of relationships that may not be resolved,” she said. “There may be a separation with a sister or a brother.”

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Many of the elderly people, whether Catholic or not, served by the Little Sisters turn to their faith as their lives come to an end, Sister Ann Marguerite said. They have lived through many changes — changes in themselves, in society and in their church — and their faith has been tried and in many cases grown stronger, and they have grown closer to God.
“You get someone who has lived a good, long life, and there has been peaceful resolution,” she said. “They get to the point where there are not a lot of loved ones left. They may be the last one.”

Many of the elderly die counting on the mercy of God, and many of the Little Sisters’ residents want the sacraments before they die. With a priest living at the home, several have been anointed as they are put in an ambulance for their last ride to the hospital.

When death seems imminent, a sister or staff member tries to remain at the resident’s bedside, or to make sure a family member comes. They sing, or pray, or do whatever seems to bring peace and comfort to the resident.

“You have to know someone and walk with them,” Sister Ann Marguerite said.

But sometimes the patients, even those who appear to be unaware of their surroundings, seem to want privacy at what is a sacred moment in their lives, crossing the threshold from life to death when the person sitting with them leaves the room.

“Sometimes there are 20 people in the room, but the only two people this involves is the person (who is dying) and God,” said Sister Ann Marguerite.

Michelle Martin writes from Illinois.