Christ the King - End of Life

 

The Gospel today is the last judgment. Our Lord’s coming on the clouds of heaven will be when all His enemies will be put under His feet. When everything will be subject to Him, as King of heaven and earth.

When Jesus comes the second time, He will hand over the kingdom to God His Father. The sheep, who are the righteous will be placed on the right and the goats, who are the wicked will be placed on the left. Jesus goes on to say what each person will be judged on, which is love in the form of acts of mercy. Much of the corporal works of mercy are practiced daily by hospital staff and nursing home workers. This is what Jesus will say to those at the last judgment who practiced works of mercy, “Come, you who are blessed by my Father. Inherit the kingdom prepare for you from the foundation of the world. For I was hungry and you gave me food, I as thirsty and you gave me drink, a stranger and you welcomed me, naked and you clothed me, ill and you cared for me, in prison and you visited me.”

By these words, Jesus explains when we care for the ill, we care for Him. When we feed the hungry, we nourish Him. When we give drink to the thirsty, we give Jesus hydration. Due to doctor’s orders, nursing staff give medicine and take vitals (blood pressure, temperature, pulse). They make sure each patient eats food and drinks water. They have a moral responsibility to care for them when they come to the hosptials when they are sick and suffering.

At times when a patient is unable to eat or drink orally, the patient will have an IV and if unable to eat for a number days, can receive a feeding tube.

Patients can be treated with ordinary care or extraordinary care, which is their choice. Ordinary care includes food, water, medicine & oxygen. Extraordinary care can involve a ventilator, being in ICU, significant surgical operations or CPR, etc…

In this past year, I had 5 surgeries that could be considered extraordinary medical care and I could have morally refused to do them. If I didn’t had some of them, perhaps I would be seriously impaired and unable to do things I had before, or perhaps without them, they could have caused my death. Poor people don’t have insurance like I do and some of them would not have had the choice to do these surgeries. I am happy to be able to continue to be alive.

Sometimes, a person can benefit from extraordinary care to temporarily help them through a difficult illness, until the health crisis subsides.

There is a new document by the Congregation for the Doctrine of Faith, called “Good Samaritan, on the care of persons in the critical and terminal phases of life”. The document was originally created to help prevent euthanasia, but it also speaks about the dignity of life and ethical considerations for the terminally ill and dying.

The document says, “A fundamental and inescapable principle of the assistance of the critically or terminally ill person is the continuity of care for the essential physiological functions. In particular, required basic care for each person includes the administration of the nourishment and fluids needed to maintain bodily homeostasis, insofar as and until this demonstrably attains the purpose of providing hydration and nutrition for the patient. When the provision of nutrition and hydration no longer benefits the patient, because the patient’s organism either cannot absorb them or cannot metabolize them, their administration should be suspended. In this way, one does not unlawfully hasten death through the deprivation of the hydration and nutrition vital for bodily function, but nonetheless respects the natural course of the critical or terminal illness.

The withdrawal of this sustenance is an unjust action that can cause great suffering to the one who has to endure it. Nutrition and hydration do not constitute medical therapy in a proper sense, which is intended to counteract the pathology that afflicts the patient. They are instead forms of obligatory care of the patient, representing both a primary clinical and an unavoidable human response to the sick person. Obligatory nutrition and hydration can at times be administered artificially, provided that it does not cause harm or intolerable suffering to the patient.”

In the hospital we are used to seeing IVs and feeding tubes removed when a patient is placed on “Comfort Care”. But this should only be done if death is imminent (within a few days). If the patient’s dying process is such the patient can continue to live for days or weeks, and if they can benefit from and IV and feeding tube, it is obligatory unless it would cause an excessive burden to the patient. It is an exception for it to become an excessive burden to have a feeding tube and IV. Today, many try to make the exception the rule and so deprive the dying person of something that can help them. Some patients are even purposely overdosed on pain medicine, at the request of the family, when they have little or no pain for the sake of helping them to die quicker.

I witnessed one time a nurse came into the room of a patient and she asked him if he was in any pain, and he said no. She then asked him if he wanted pain medicine, and he said no. She then forcibly stuck a syringe filled with roxenal (morphine) into his mouth and injected it. Within 30 min the man became unconscious. Where is the respect for the patient and his desires? It seemed as though the family just wanted him to die quicker to relieve the agony of themselves watching a loved one die.

However, a doctor or nurse may not do anything unethical even if the family of the patient or the patient wants them to because it goes against their conscience.

The totality of the patient's condition should be taken into consideration and whatever most benefits the person. Not every patient dies the same way or from the same illness. For example, when a person is dying, one person’s kidneys may fail quickly, while another person’s kidneys may not be a problem.

If someone has a stroke and is unable to swallow, and the rest of their health is good, then they should receive a feeding tube.

In this past year I had difficulty swallowing and needed to have my esophagus dilated. There were times food would get stuck in my esophagus and I would choke. If the dilation wouldn’t have worked, I could very well been on a feeding tube.

For others with multiple serious health issues which may be causing death, the patient may prefer to not have a feeding tube, because perhaps then it would become excessively burdensome.

I have heard people say, “I don’t want to be a vegetable.” But this phrase dehumanizes people. We have human dignity. If we need a feeding tube and an IV, we may not have the quality of life we would prefer, but life is worth living. But that does not mean we should do every thing possible to live as long as we can, when it may be excessively burdensome to stay alive. Rather, we should attempt to understand what benefits the person the most and what God is wanting for him or her.

Every hospital and nursing home should have some dying patients who are on a feeding tube and an IV, but not every dying patient should have these.

DNR’s (Do not resuscitate) are often used, but they don’t take into consideration all the factors a person may undergo. For example, a person may temporarily use a vent, to help them through an infection, until the antibiotic can get rid of it and allow the person to breath on their own again.

When a patient is unable to make his or her own decisions, it’s often better to have a Catholic Power of Attorney for healthcare, so someone who will follow Catholic principles will do so, rather than to do a DNR.

I had a tube in my belly twice this past year each time for a month. I know what It's like to have a tube in the abdomen. For the first several days its uncomfortable, but after that you don’t even hardly notice it. I didn’t need any pain medicine for it. For me, it would be difficult to see how it could be an excessive burden for myself.

However, for those with severe dementia, it may not be possible, because they may try to pull out the tubes.

The document is saying, when a feeding tube or an IV no longer benefits the patient due to the inability to absorb them or metabolize them, or if it were to be an excessive burden, then it respects the natural course of the terminal illness.

However, when the patient can benefit from an IV and a feeding tube, then they are obligatory, because they are not medical therapy, rather ordinary care which can benefit the human person. In other words, we all need food and water even when we are dying when we can benefit from them.

What we are really doing is providing food and water to Jesus in patient, as Jesus said, “What you do to the least of my brothers, you do to me.” For when I was hungry, you gave me food, when I was thirsty you gave me drink, when I was ill you cared for me….”

Likewise, oxygen should also not be removed when a patient is dying, because that too is ordinary care. We don’t want to remove oxygen for the purpose of causing the patient to die quicker. Rather, the patient has right to oxygen to be able to take breaths as easy as possible when dying. Receiving the supply of oxygen helps them to be more comfortable.

Jesus, the King of heaven and earth is the author of life and no one but Him determines life and death. We cooperate with Him in understanding His will, by documents of the Church which give us principles on how to respect the human person from the moment of life until natural death. When we see a loved one going through agony, it’s difficult for us, but especially them.

In the bulletin are two documents. One document by the Kansas Conference of Bishops, is the Catholic Declaration for End of Life, which is a statement that can be signed requesting how a Catholic should be treated.

The other document is the Directives for Catholics Concerning Artificially Administered Nutrition and Hydration by Bishop Olmsted which explains how food and water are ordinary medical means and should not be withdrawn when a person can benefit from them. It also explains that a person’s death should be caused by an illness or disease and not by a lack of food and water.

When they are dying, we should never deprive them of ordinary care, food or water, unless it would be futile such the inability to assimilate food or water, such as when the kidneys no longer work or the colon is blocked.

We need to be careful to avoid false mercy, which seeks to alleviate pain and suffering at all cost, even to more quickly cause death, for the sake of our own needs, rather than for what is best for the person. This is really euthanasia in disguise. We may also forget about the value of redemptive suffering and the dignity of each person.

It is up to us to be sure they receive the Last Rites, confession, anointing of the sick, the Apostolic Pardon, which washes away all punishment due to sin and also Viaticum, which is Holy Communion one last time.

We should support them by our prayers, most especially the Holy Rosary and the Chaplet of Divine Mercy. I have seen patients die immediately after the family gathered around their bed and finished the Rosary. I also seen the same for the Chaplet of Divine Mercy, just after the family finishes the Chaplet, the patient dies. These are truly beautiful deaths. To die surrounded by family is consoling the patient.

We should also pray to St. Joseph, the patron of a happy death because its believed Jesus and Mary were present when he departed this life.

Jesus told Saint Faustina, "My daughter, ... Write that when they say this chaplet in the presence of the dying, I will stand between My Father and the dying person, not as the just Judge but as the merciful Savior (Diary, 1541). Jesus also said, “Say unceasingly the chaplet that I have taught you. Whoever will recite it will receive great mercy at the hour of death. I desire to grant unimaginable graces to those souls who trust in My mercy." (#687)

On this solemnity of Christ the King, we pray every terminally ill or dying patient who can benefit from artificial nutrition and hydration, will be able to receive them and die a holy death in union with the death of Jesus on the Cross. We pray that we will be prepared before we go to the judgment seat of Christ, the King.

For those who care for them and who do their best to follow the Church's teachings on death and dying, will hear the words of Jesus at the Last Judgment, “Come, you who are blessed by my Father. Inherit the kingdom prepare for you from the foundation of the world.”

May the Queen of Heaven, help us to care for others in their dying days with dignity and respect always providing ordinary care when it can benefit our loved ones.