Planning for a Holy Death: A Catholic Guide to Advanced Age and End-of-Life Decisions

From living wills to the sacraments, the Church guides us to prepare for death not with fear, but with faith and hope in the Resurrection.

(Photo: Unsplash)

By Deacon John Volk, MD

There’s an old saying: “Don’t rehearse for bad news.” While that can be good advice, sometimes it is wise to have a discussion with loved ones about how to approach medical decisions in the later years and at the end of life. In my experience as a family doctor, often medical conditions arise suddenly, and patients or families are faced with decisions that must be made quickly. This can be difficult when trying to factor in the loved one’s age, underlying health and their Catholic faith. I’ve seen instances where loved ones are unable to make decisions for themselves, and the family disagrees over what course of action should be taken. I’ve also had patients end up on life support when neither they nor the family wanted such a thing.

Have the Discussion

Fortunately, there are tools such as Advance Directives, Power of Attorney, Living Wills, CPR directives and the like that can make these situations easier to plan for. The question is, how does our Catholic faith inform these decisions and, will the person I designate to make decisions for me take my faith into account?

Hence, the wisdom of having these discussions in advance when the seas are calm.

What is “Natural Death”?

We know well the exhortation, “Respect life from conception to natural death.” But modern medical technology has made the idea of “natural death” less clear. Treatments such as CPR, pacemakers, breathing machines, dialysis, chemotherapy, surgery and so many others, can all delay or prevent “natural death.” The question is, morally speaking, which of these treatments are required and which are optional?

Ordinary and Extraordinary Treatment

The Church gives us beautiful counsel when it comes to this question. She says, “One is required to use ordinary means to preserve his or her life.” In other words, life is a gift which must be treasured and preserved. Even though assisted suicide may be legal in our state, I cannot willfully choose to end my life.

The Church goes on to say, “One may forego extraordinary means of preserving life.” In other words, if the treatment being offered is extraordinary, I can morally decline that treatment.

So, the obvious question is, “Which treatments are ordinary, and which are extraordinary?”

Interestingly, there is no list! To determine if a treatment is considered ordinary or extraordinary, the patient (or their decision maker) must weigh the benefit of the proposed treatment against its burden. Imagine a balancing scale. On one side is the benefit of the treatment and on the other is the burden. If the benefit outweighs the burden, then the treatment is considered ordinary and should be accepted. If, however, the burden of the proposed treatment outweighs its benefit, then the treatment is considered extraordinary and may morally be declined.

As you can imagine, this calculation can change depending on the person’s age, underlying health and course of their illness.

For example, a healthy 85-year-old, when presented with a relatively low risk surgery to cure their cancer, may find the treatment to be ordinary and accept it. Whereas the decision maker of a 90- year-old parent with advanced Alzheimer’s disease might consider a pacemaker to be extraordinary and so decline the treatment. Circumstances can be fluid and that is why the Church urges caution with forms that try to “predict the future” such as MOST and POLST and even living wills. It is wise to designate a proxy decision maker who can make decisions in real time as situations arise and evolve.

Spiritual Issues

As a physician and deacon, over the years I have had the privilege of sitting at the bedside of patients and parishioners as they face their final days and weeks of life. Besides the moral aspects, important spiritual issues arise in these moments. This is an important time for the soul.

There is important work to do in the final chapter of life. To avail oneself of the sacraments — Anointing of the Sick and the Eucharist as viaticum (“food for the journey”) — is crucial spiritual preparation for our definitive meeting with the Lord. There are important conversations that take place. Words like, “I love you,” “Thank you,” I’m proud of you,” and “Forgive me” are priceless gifts given to those whom we love.

In that regard, it is not uncommon to receive medication as the dying process progresses which help with pain control and anxiety but also can have a sedating effect. You can express a desire to try to balance pain control with consciousness when possible. Emmaus Catholic Hospice here in Denver provides end of life care through this spiritual lens and is an excellent resource for patients and families.

Finally, let us not forget the beautiful spiritual principle of redemptive suffering. It is not uncommon to experience suffering both in advanced age and at the end of life. Our faith teaches that we can unite our suffering to Christ on the Cross for the good of others. This gives meaning to our suffering and is a way to bear witness to our faith to the end.

“None of us lives for oneself, and no one dies for oneself. For if we live, we live for the Lord, and if we die, we die for the Lord; so then, whether we live or die, we are the Lord’s." (Romans 14:7-9)