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Tuesday, June 28, 2011

The Importance of Preparing For End of Life

I first met Mary twelve (12 ) years ago, through one of her daughters, she was eighty (80) years of age with three daughters and two sons. Mary was short, and a little plump, full of life, and active in the community where she lived. The years that I visited a relationship developed, but really, got to know her with each visit. A couple years later, her husband made the decision to move, from an apartment, to a Nursing Home, where their every needs could be met, but still have the freedom to come and go as they pleased, soon after the move her husband died, and one of her daughters also. Although it was painful for her she had a very good support system in place. Within the time of her husband's death and moving they both made out a Living Will, and all the necessary legal paper work.

The Diagnosis:

Mary was diagnose a year later after her husband's death, with bone Cancer, and yes it was a blow to her, and could not imagine how she got Cancer, especially bone Cancer, but talking to her, she said that it ran on her side of the family, because two of her sisters, died from cancer.

The Treatment:

 Mary had to undergo radiation treatment twice a week  for twelve weeks, and it showed every time she finished a treatment, which left her weak at times, after the treatment she regular checkups to make sure the cancer was not spreading too fast, after two years, the Doctor's were satisfied that the cancer, had reduced in sized.

After the radiation treatments, Mary had regular check ups, at the Cancer Hospital, to see if the cancer was spreading, but found out that it was not, and was given the okay to continue doing what ever she wanted to do, with help from medication it helped with keeping the cancer at bay. Mary knew that the cancer could return at anytime, but continues to live her life the way she  had always done. Two and a half years ago the cancer returned, and progressed to the point, that Mary did not want to undergo any radiation treatment knowing how it had affected her energy level.

 Side Effects:


Mary showed signs of that of a sick person, lacking energy,and not wanting to do anything or go anywhere. She was contented to satay in her room, watch TV, read and knit, she said that she feels okay, but the signs on her face said otherwise, all that was due to the heavy medications she has to take to help her through the day.

My  Observation:

 I visited Mary about twice a week, and on one of my visits with her daughter, noticed she was looking rather pale and was not up to par, and mentioned it to her daughter whom I went with that day, she immediately made an appointment for her to see the doctor. Mary was told that  the cancer had returned and progressed faster than ever, and gave her about four months to live.


Advance Directives:

The progression of the cancer gave Mary a scare, and had asked her eldest daughter to get her Living Will updated, and make any changes that were needed, and also to be the Power of Attorney. The other form that was also written out was  the Values History Form, which addresses all that was needed in case of any serious implications knowing that she had only a few months to live. 

Technology Equipment:

 The look on Mary's face said it all it showed signs of frailty, and her breathing was helped with the aid of pure oxygen, which helped in a way, but was uncomfortable having by the air hose in her nostrils. Mary also had the use of an air mattress, which helped her to feel comfortable while laying on her back to ease any pains.


Medical and Caregivers:

Although Mary was given medication for her pain, she also had a good team of Caregivers that saw to her every needs, twenty- four seven (24/7 ) she had the best care that could have been provided, and was well 
looked after, she was waited on, and was granted anything that she wanted to eat or drink at anytime day or night.

Family Involvement:

During the last couple weeks before Mary's death, she had round the clock attention by her family, everyone doing their part to be with her. I had the chance to spend twelve hours with her, tending to her every needs,and doing what ever I could to make her as comfortable as possible. They were always family around her, and music playing softly in listening range. As the time drew near the Priest from her Church was called, to anoint her with Holy Oil, which is part of the last rites for many Christians that were dying. The family made the decision that the oxygen should be unplugged, and let her breathe on her own which was one of the stipulations written in her Values History.

Death Song:

As Mary lay on the  bed of her last days, the death song were being played constantly, the gasping for air, wheezing of her lungs, the asking for something to drink, and that her lips be kept moist, what was most discomforting for her was the constant itching she had from laying on her back which had to be rubbed with cream to relieve some of the itching. It was so sad to see the person that was so active, and full of life lying on her bed awaiting death, the skeletal frame of Mary, with her eyes sunken into her sockets was seen as a fragile individual awaiting a death sentence. Mary died two days after, during the night in her sleep a good death knowing that her family was with her when she died.

Preparation:

Lets take a look at Mary's life and the planning  she did on or before her death. We know that she and her husband, made a Living Will, and that Mary had amended parts of it to reflect what she wanted happen after her death. Although they both planned ahead preparing for each other, and did not leave any burden on their children, which was well though of.

The consensus is that the general public on the whole, thinks that an Advance Directive is not required at the very moment. The thought then, is nothing is going to happen to me, for the most part is the way people think, until something major happens, like an accident where it is very serious, and they are facing the End of Life.

If we think, about what we know about illness, death and what there is to do, why? are so many of us fail to plan for the End of Life, is it that we need to be more educated on the subject, or are we just acting ignorant to the fact that we just don't care about those things right now. By planning for what may happen in our lives, it makes sense, to have in place Legal Documents, that our children knows about, and what our wishes are in case there is an emergency, when we cannot communicate or make decisions for ourselves.

 These legal documents include, a Living Will and Health Care Proxy also known as a ( Durable Power of Attorney.) Since wishes are communicated through the Advance Directive we should also have Values History Instructions which is optional. What is included in an Advance Directive?

Directions that lets the Medical Team knows the treatment that the patient want  done, and do not want in case of extending or shortening life in any terminal conditions.

That there is a person designated to make decisions for the person, if they are hurt in an accident or incapable of doing so.

The kind of comfort care he/she decided, such as reducing pain,and suffering.

Preference based on his/her religion.

Mary made sure that all Legal Forms were signed, and all that was needed to take care of the burden that was going to be left for the children to sort out. They can now look forward of taking care of her wishes,and desires that were on the Advance Directive.

Mary's story was simple, with all the Legal and Financial Documents signed, and other important papers made available to her eldest daughter, she could rest, and be assured that her wishes for everyone and herself would be carried out. We know that death is certain, but we do not know the time, place or how it is going to happen, when the river of life runs smoothly, and suddenly there is a stone (illness) that disrupts everything it is definitely not the time to start thinking about an Advance Directive.

The Advance Directives answered all of what Mary wanted, and together with the Power of Attorney every thing possible was done to make her very comfortable. Mary I must say died well, and had a good death, with her family gathered in her room, and had a Priest anointed her with Holy Oil, which is the last rites , for a dying person of Christian faith.

What I should point out here was the Caregivers understanding of the family concerns, and they catered to Mary and the family every needs, everyone that worked with Mary, showed such patience when she did not want the oxygen hose in her nostrils, which was removed no questions asked, because the answer to that question was already filled out in her Values History Instructions.

Managing pain was foremost on the mind of  children at this stage, and pain management was helped by medication. Mary's smile could be seen on her skeletal frame as her loved one told her how much she would be missed, and was loved. She left this world knowing she was loved, missed and her children, grand and great grand children would be taken care of, as stipulated in her will. I will say this, that it is very important to have all Advance  Directives made out ahead of time, and signed just in case some misfortune happens.

Monday, June 20, 2011

The Teaching of The Catholic Church on Death and Dying

Belief and Faith:
The Catholic Church  see it's teaching as a strong connection to the faith, and beliefs of its parishioners. The teaching on faith is so strong that it's many believers will agree, that faith, and belief plays a very important role in their every day lives.

This is due to the teaching, and the vast number of parishioners that have been educated in the Catholic schools, taught by Nuns, and Priests of which I was part of the teaching. The Church defines faith as " The act of the intellect asserting to a divine truth owing to the movement of the will, which is itself moved by the grace of God."

My own definition of faith is the understanding, of my circumstance given to anyone that would make a wise decision, about what needs to be done, and make it with a clear conscience with out doubts, to things that are right. Without belief there is no faith, if we do not believe then we have no faith, this is why Catholics profess their faith by saying "I believe" or "We believe" as |Catholics what do we believe in.? We believe that God became man born of the Virgin Mary, died, and was raised from the dead.

Since this is a mystery, we have to believe by expressing our faith with prayer, which sends a strong message to our faith, and beliefs, along with prayer, sacrifices, rituals, and meditation are all forms of our religious experiences.

Euthanasia:

The Catholic Church views euthanasia as wrong, any act of killing that deprives any individual the right to die. The Church social teaching declares the right of any individual or person, not to use unusual means that would prolong life, and at the same time rejects active intentional taking the life of a human being. It is seen as any procedure or  failure that by its very nature, or wilful purpose which causes death and having the authority of putting an end to the suffering of any person(s).

Every human being have the right to live  in a manner that is provided, since life is viewed as sacred, and is given by God. He alone has the right to pronounce death. It is written in the Bible " No man knows the time, place or where he will die" God alone knows that answer.

The Church expresses strong disapproval of euthanasia as morally wrong, it has always believed, and taught the complete and unchanging value, of the Commandment "Thou shall not kill." The Catholic Church has always said to its followers that nothing, and no one can in any way tolerate the killing of an innocent human being, whether be a fetus or and embryo, an infant or an adult, an old person, or one suffering from an incurable disease, or a person who is dying.

While the Church does condone the use of euthanasia in some countries it strongly advises its Priest, and Parishioners to  pray for those that are carrying out these deeds, that it sees as mercy killings. What the Church is not happy about is when Doctors play God, and take away the life of a human, it is a doctors Hippocratic Oath to save lives instead of killing one. The Church regards life to be a gift from God, which also is true , as we all know, is unavoidable. We must all be able , not to hasten death, but to accept it with openness, and a conscious, responsibility, and full dignity for death.

Suicide:

As Catholics we have been taught that God has given life to us, and that we are responsible for our lives, suicide therefore contradicts this natural tendency of the human being to preserve, and commit his life, this act goes against the love of our living God. By committing suicide with the intention of showing an example, to a young person takes on the implications of a grave scandal, any and all who are being compelled to go through is committing suicide does so in contrary to the moral law.

What is seen is the persons irresponsibility for not taking ownership for his or her responsibilities, which is in fact the lack of dealing with problems which he or she cannot face, this is terms give us a sense of great fear or hardship, suffering  or torture which can lead to the brink of carrying out this act. We know in years past, that the Catholic Church did not have funeral service for anyone that had committed suicide, or even allowed the burial in a Catholic cemetery. The Church strongly opposes suicide, especially assisted by a physician.

Feeding:

The Church see nutrition, and hydration as a grave matter when it comes to the dying patient, it should be a time when every thing should be done to help the patient. The failure to provide a patient with nutrition or hydration in speeding up the patients death is deemed an act of euthanasia. In cases where both nutrition and hydration does not help the patient, and may cause distress, it is best to let the patient die, say but this do happen to many.

The Church is clear that the guidelines of its teaching be followed without questions.

1. Nutrition and hydration, whether given artificially or orally are considered ordinary care.

2. Catholics are morally obliged to provide ordinary care.

3. Nutrition and hydration can never be withheld unless the person's death  
   is imminent and the use of such would be either harmful or of no benefit.

4. The wilful withholding of nutrition or hydration in order to bring about
     a patients death is Euthanasia.

To re-emphasize the fact, food and water are necessities of human life, the Church is clear on its teaching.  No one has the right to hasten the death of another human being terminal or not this action violate what we believe is the teaching of Christians life is sacred a gift from God. The Church is clear on what it sees as ordinary or extraordinary care. What all of us should expect when we are dying is ordinary care, from our physicians or loved ones, ands what is more natural that feeding one who is hungry.?

Pain Control:

We all at some point manage pain by popping a pill for headache, muscle pain, back pain or what other pain arises, but when the pain is severe after major medical surgery, the pills that we popped for minor pains does not work.  The Church recognises the need for proper pain management, which must be ensured in the clinical setting. From a moral standpoint, a physician has the responsibility to administer medication that control or ease pain even if it may hasten death.

However in saying this, the effect of pain treatment guarantee that no one will suffer a painful death. Health care providers have to make an effort, to ensure that the medicine that is available eliminates or control the pain that is being provided to the patient.The Church knows that although death is imminent, the ordinary care owed to a sick patient cannot be interrupted. The use of painkillers to ease suffering of a dying, can be morally in line with human dignity if death is willed as ends to a means, but is seen as inevitable.

Morality:

The Church definition of morality is that it is rooted in natural law, which is defined by social norms, the values of dignity, fairness, honesty, and integrity are universal in the human experience. Catholic morality is particular tradition, to understand how this may live out, Catholic morality seek to interpret the Christian experience through the scriptures, and tradition ( teaching of Church fathers, conciliar: magisterium, etc) it incorporates the duties towards its members of the Roman Catholic Church community. ( teaching Catholics morals )  What may be considered moral to you or me may not be moral to others, because of the teaching of the Catholic religion, since morality varies from one culture to another, the teaching of moral values may not be taught in communities, thus the lack of morality may exist.

Apart from religion the observance of the moral law  is impossible.  It follows as a necessary consequence from Church teaching, as to the nature of morality. The Church admits that the moral law is knowable to reason: being the regulation of our free actions, whereby morality consists, is simple their right ordering with view to the perfecting of our rational nature.

Ethics:

 Since morality is antecedent to ethics, it denoted those concrete activities of which ethics is the science. It may be defined as human conduct in so far as it is free, subordinated to the ideal of what is right, and uplifting. Ethics directs the activities of the will, that which must be good. hence ethics is seen as the science of moral rectitude of human acts in accordance with the first principle of natural reason.

Ethics is practical, and directive:  for it orders, the activity of the will, moreover ethics not only directs a man how to act, if he wishes to be normally good, but sets before him the obligation to do good and avoid evil. Since we know what is ethical, is it ethical for doctor's to withhold the truth from a dying patient? in most part the answer is yes, with respect to the patient they have the right to know what the diagnosis of their illness is, what the treatment would be to sustain life.

It is not right for the patient to know the truth, so that if the outcome of the diagnosis is fatal, they can get all the necessary papers in order, and if death is imminent. If the doctors withhold this information from the patient, and the patient dies, then the doctor must be held accountable, and ethical responsible for failure of telling the truth.

Dying:
At some point in our lives, whether it's sooner or later, we are all going to die, but it does not have to be painful. The Church offers the sick, and terminal patients the comforting grace of anointing of the sick, and Eucharist, which is looked upon as the Sacrament of passing over from death to life, from this world to the next.

The Church shows compassion to the dying, as Jesus showed compassion to his people while on earth. As catholics we look forward to meeting Jesus face to face when we die, because Catholics believe, that there is a heaven, and Hell and when we die, if we were good on earth we will see Jesus in heaven.

As a person is dying the warmth touch of human hands is the form of being accompanied through the final mystery of life. Since none of us wants ti die deserted, and isolated from human hands that gives us a sense of peace as we leave this world, The Church also teaches us that confession is good for the soul, and stresses that the sick confess his or her sins to the priest for forgiveness before dying, in this way what ever is made known on earth is also made in heaven, and by doing so our sins would be forgiven.

Death:

We know that death is the end of life here on earth, but as catholics we believe that after death we are joined in heaven with our Heavenly father. Since our faith shapes our attitude towards death, the Church teaches that to respect life is to respect death. The Church vision of death is expressed in the funeral liturgy, when we pray " Lord for your faithful people life is changed not ended." When the body of our earthly dwelling lies in death we gain an everlasting dwelling place in heaven as Catholics.

As mentioned before Catholics believe in heaven and hell, but also in purgatory, this is a place for those who have died in a  " state of grace "   "that is they have committed a venial sin "  or forgivable sins, may not go straight to heaven. Therefore death is the end of our earthly life, and our lives are measured by time, in the course of which we change, grow old, and with all living beings on earth, death seems like the normal end of life. That aspect of death lends urgency to our lives, remembering our mortality helps us realize that we have only a limited time in which to bring our lives to fulfillment.

Funerals  (Rituals):

A Catholic funeral is different from the other Christian funerals, and can be with or without Mass considering the circumstances. There is a Virgil  for the deceased, which is a service of prayers or songs either at the home of the deceased or in Church, before the day of the funeral by friends or relatives, but in most cases that I know off  ( some Caribbean Islands ) it takes place after the burial.

Introduction To Rites:

At the funeral service the Priest greets the congregation and say " the grace of our Lord Jesus Christ, and the fellowship of the Holy Spirit be with you all " leading the coffin down the aisle Holy water is sprinkled, and there is an opening song and prayer. The liturgy of the word begins with a sermon passage from the Holy Bible, which is read out, as well as a Homily, and a Psalm ( Psalm 23: The Lord is My Shepard ) following the  liturgy of the word is the Eucharist; there is a preparation of gifts, a Eucharist prayer is said, and Holy Communion is received.

The Mass ends, after the final commendation prayers are said, and the coffin is taken out of the church, and is proceed to the graveside or crematorium, here the final resting place the rite of committal or the final prayers are said, before the burial ( lowering of the coffin into the grave or cremation ) this closes the curtain of the deceased. In some cases family return to the deceased home, and say prayers again hoping that the deceased finds his or her way home to God.

The Catholic Church defines what a funeral is as follows:
The Christian funeral is a liturgical celebration of the Church. The ministry of the Church in this instance aids at expressing efficacious communion with the deceased, the participation in the communion of community gathered for the funeral, and at the proclamation of eternal life to the community.