Decisions of Life & Death Webinar - Notes

Professor Steve Bozza & Dr. Matthew Bunson

I. Asking the right questions is so important!

• For example: Is mom in the state of “medical

futility”?
• Futility tells us that there is nothing more that
any physician can do to stop the inevitable –
death.
• We cannot accept the response that “Well, we
can make a case for it” because you can make a
case for anything and we do not want to do that.
• We want to know the FACTS – the CLINICAL
FACTS – YES OR NO.
• If there is something else that can, in fact, be
done, then we have other assessments to make.

II. We must be FORWARD THINKERS and educate

ourselves. Here are two resources:

• OSV (Our Sunday Visitor) puts out an excellent

pamphlet by Professor Steve Bozza called
“Frequently Asked Questions – End of Life
Issues.” See links below:
❖ https://www.orderosv.com/product/frequ
ently-asked-questions-end-of-life-issues-2
 ❖ https://resources.osv.com/catalog/PDFs/P
1772.pdf
• National Catholic Bioethics Center
(https://www.ncbcenter.org/) You can call
them for a phone consultation. They will
provide you with the authentically Catholic
position.

III. “Quality of Life” – Stay away from that term. The

issue of quality of life is extremely subjective. For
example, my quality of life may be different from your
quality of life.

It might be better to talk about “Human

Flourishing.” Is this person going to flourish? Will
they be able to live what is normal for that person?

Death is a part of life but it is not something that we

should be causing.

The “contraception mentality” has led to a

“Devolution of Ethics” because if we believe we
should be allowed to determine when life begins,
then it is only a matter of time before we believe that
we should also be able to determine when it ends.

IV. Pope Pius XII: “Life, health, all temporal activities,

are, in fact, subordinated to spiritual ends.”
This leads into “Redemptive Suffering”:
• In terms of a person’s health, we can do the best
we can to alleviate pain and we ought to; it is
inhumane not to.
• But, at the same time, we are not going to be able
to get rid of all of it.
• As Catholics we are very fortunate to have the
revelation of Redemptive Suffering - meaning
that we can join our sufferings to the sufferings
of Christ.
• Ways that our suffering can be redemptive:
1. It is redemptive for the SUFFERER (can lead
to repentance, offering suffering as a
penance for past sins, etc.)
2. It is also redemptive for those watching the
sufferer (it can unleash a deeper love and
compassion in their hearts. This could be
their ticket to heaven or, without this
opportunity, to hell.) In God’s plan, suffering
is meant to be purifying for everyone
involved.
3. It is up to us to use our free will to bring
ourselves to a place of repentance,
forgiveness, penance, etc.
4. When we decide “I don’t want to suffer,” we
rob ourselves or our loved one of the process
of reflection on how life has been lived and
seeing the things that need to be corrected in
order to enter into eternal life.
 5. Read Salvifici Doloris – On the Christian
Meaning of Human Suffering by Pope St.
John Paul II
(http://www.vatican.va/content/john-paul-
ii/en/apost_letters/1984/documents/hf_jp-
ii_apl_11021984_salvifici-doloris.html ) to
learn more about redemptive suffering.

V. Guiding Principles VS. Blanket Statements

• RESUSCITATION – For examples: Should paddles
be used?
o The Benefits & Burdens need to be assessed.
o Example: Does this person have weak bones
(many elderly people do). Will this crush
his/her bones.
• Proportionate vs. Disproportionate Care
Disproportionate – means that this action doesn’t
offer reasonable hope of benefit; or, the burdens
are going to be more pronounced than the benefits.
If the burdens are becoming too great for a person,
you do not need to go there. If there are more
benefits than burdens, we ought to consider it.

• OBLIGATORY VS. OPTIONAL MEDICAL

CARE/MEANS
Ordinary Care:
o Something done almost routinely

o Not experimental
 o Not burdensome
Extraordinary Care (not obligated to do):
o Experimental
o Not offering reasonable hope of benefit.
o Is basically disproportionate to a person’s
care.
• DNR, DNI

What are these terms and what should we, as

Catholics, look out for when doctors are suggesting
them?

We have to look at the actual facility (place where

healthcare is being received) because at times the
facility might take upon itself to change the
definition of what these terms mean.
o DNR – Do not resuscitate This has everything
to do with cardio pulmonary resuscitation (for
example: the paddles or whatever else the
person needs to start breathing again and/or
have cognitive abilities. Some facilities are
construing DNR’s to mean “do not give certain
types of medication.” They wrongfully have
levels such as DNR 1, DNR 2, DNR 3. THAT IS
BALONEY!
 A DNR is specifically Cardio-pulmonary
resuscitation – bottom line! We can’t let that
morph into something else!
The problem with DNR’s is also when they put
one into a “Living Will.”
We should never do that, simply because, if I
write my living will today, how do I know if,
years from now, when that has to be executed, I
am going to be in the medical condition to justify
this DNR? What if I could live for another
number of years?
We put in a DNR only when we are ready to say
that for ourselves – at that time.

o DNI – Do not intubate This has everything to do

with being fed. Do not put this in living will for
the same reasons. Pope St. John Paul II said that
feeding tubes are ORDINARY CARE & ALWAYS
OBLIGATORY. There are certain times when we
can take them out:
1. If the dying process has already begun. In
this case, the nutrition and hydration is not
going to be absorbed into the body.
2. If we are at a place where it is too difficult
to administer (because, for example, the body
cannot tolerate the ports).
3. If death is IMMANENT – (not next month,
not in two weeks, but within hours!) If death is
 not immanent and we remove food and
hydration, they will die of starvation and that
is one of the most painful ways to die. It
usually takes two weeks for a person to starve
to death.
4. 99.9% of the time, we should keep the
food and hydration going.

VI. Principle of Subsidiarity

Decisions should be made by the “lowest” (the one closest to
the person who is dying) level and not the “highest” level.
1. Lowest level: The free and competent individual has
the right to make medical decisions for
himself/herself (autonomy).
2. Parents or loved ones are next – they have the right
to make decisions for their family.
3. Physicians are after parents or loved ones.
VII. Hospice Care (Palliative Care)
Is artificial hydration and food considered a “natural means”
of preserving life or is it considered a “Medical Act” and why
is there a qualitative or significant difference?
We live at an unfortunate time when some “Catholic”
bioethicists use a number of excuses to justify NOT putting
in hydration and nutrition.
They have used the concept of “Medical Means & Spiritual
Ends” to justify removing hydration and nutrition. THIS IS
FALSE!
They have also changed the term “REASONABLE HOPE OF
BENEFIT” TO “REASONABLE HOPE OF RECOVERY.” By those
semantic (word) changes (wordsmithing) they are
attempting to switch the meaning and to say that nutrition &
hydration is NOT ordinary means of preserving life but
instead are “medical ends” and because they are medical
ends, this is extraordinary care and therefore, not
obligatory. THIS IS A DEMONIC DECEPTION!
The Terri Schiavo case is an example. She was in a PVS
(persistent vegetative state). She wasn’t dying. To remove
hydration and nutrition was THE act that killed her. They
manipulated the language to make it look like this wasn’t
starvation. Starvation of food and water is a very painful way
to die (medically speaking).
• PVS – Persistent Vegetative State
What are we obligated to do?
To answer this, we need to look at “brain death.” There are
two main sections of the brain: brain stem and upper
brain.
In Terri Schiavo’s case, her brain stem was still alive. She
had a problem with her upper brain which ceased giving
her the ability to act, think, and do the things an ordinary
person can do. Her cognitive functions were injured. BUT
SHE WAS NOT DEAD.
Pope St. John Paul II definitively shut this door of food and
hydration being considered extraordinary care! He taught in
his capacity as Pope that food & hydration are ALWAYS
considered “ordinary care” and NOT “medical treatment.”
If you start looking at it as a treatment, you can make other
cases and we do NOT want to go there.
VIII. Hospice Care & Pain Medication Doses
In regards to the administration of pain medication,
Hospices are known to GRADUALLY increase the dose until
it has reached a LETHAL dose.
The main guideline we need to follow is called “The
Principle of Double Effect.”
What this means is that there is one act, which is good in
itself, and it has two effects:
1. The Intended good effect.
2. The unintended bad or evil effect.
Example: Administration of Morphine
1. Good effect – relief of pain
2. Bad effect – it will depress respiration and in doing
that, the person will die sooner rather than later. It
will “hasten” death. We have to be careful that a
“lethal” dose is not given. That would NOT be the
 authentic interpretation of the principal of double
effect.
We should read “Ethical Religious Directives” about
Palliative Care
https://www.usccb.org/about/doctrine/ethical-and-
religious-directives/upload/ethical-religious-directives-
catholic-health-service-sixth-edition-2016-06.pdf
Pius XII – “We should do everything we can do to keep a
person LUCID while managing their care SO THAT THEY
CAN MAKE AMENDS WITH PEOPLE AROUND THEM AND
WITH GOD! SO THAT THEY CAN RECEIVE THE
SACRAMENTS THAT WILL AID THEM IN THEIR JOURNEY
TO ETERNAL LIFE.”
We should not be robbing a person of this opportunity!
We need to remember the value of Redemptive Suffering – if
a person is able to unite his/her suffering with Christ,
his/her eternal merits are increased and their temporal
punishment is decreased! This is an incredible blessing and
we don’t want to rob them of this chance!
IX. Removing a Ventilator
When? It is considered extra-ordinary, not ordinary
treatment.
X. Living Will vs. Advanced Directives
A living will is a legal document that is almost like a menu –
I want this but not that, etc.
A living will is not recommended. Advanced directives are
much safer.
XI. Responsibility of Caregivers
1. Scripture – 4th Commandment: Honor thy Father and
Mother.
“When I was hungry, you gave me food. Thirsty and you
gave me drink.”
2. Learn – use the resources we have provided to educate
yourself.
• www.NCBcenter.org (National Catholic Bioethics
Center)
• CMA (Catholic Medical Association)
• OSV
• USCCB