Part two of a two-part series.

In February, the Register explored the extent to which the hospice movement is linked to euthanasia. This week, we ask: What can Catholics do about it?

OREGON, Ohio — Long before hospice care became part of the American health care lexicon, religious communities that care for the elderly knew what to do for the dying.

The Little Sisters of the Poor, for example, whose mission is care of the elderly poor, have always kept a vigil with their dying residents, making sure no one is alone at the moment of death and providing each with pain relief, hydration, light food and access to a priest and the sacraments. And the Dominican Sisters of Hawthorne, N.Y., care for terminal cancer patients at home-like settings around the country.

“They’re so fragile, so every comfort measure becomes very important,” Sister Alphonse Marie Jones, director of nursing at the Little Sisters’ Sacred Heart Home for the Aged in Oregon, Ohio, said. “The main thing is just a very loving, prayerful and reassuring presence. We try to assure them how much God loves them at that moment.”

The Little Sisters also let it be known before a resident enters one of their homes that they will protect him or her from all forms of euthanasia.

“If they have an advance directive saying they want assisted suicide, this would have to be canceled,” Sister Alphonse said. “We cannot honor that. We will not honor that.”

Most families are glad to have loved ones in places like the 32 homes run by the Little Sisters in the United States. There, because of the sisters’ commitment to the Church and the sanctity of life, they can be assured that Catholic teaching on end-of-life issues is consistently applied.

Bernadine Wasserman, for example, whose daughter, Sue Kline, is on a feeding tube and has been in a Little Sisters home in Oregon, Ohio, for 15 years, said, “It’s wonderful care that she’s getting…. They’ve been excellent with her and try to do the best they can with her. It’s hard when people can’t talk to you to tell you what’s what, like she can’t.”

Wasserman said when she learned that her daughter, who has multiple sclerosis, was to be admitted to the Little Sisters’ home, she said, “Now I can die with a clear conscience…. I was so glad she had a safe place to be.”

But in a world that is becoming increasingly receptive to hastening the end of life (there are reports that hospital workers may have euthanized patients in New Orleans in the midst of the Hurricane Katrina disaster last year), families need to be vigilant in seeking care for members who are terminally ill or suffering from degenerative conditions.

Food and Water

Hospices provide a range of services dealing with management of pain and physical symptoms and psycho-social needs. They differ from hospitals or nursing homes in that they are not about “curing” diseases but in keeping people who are in the process of dying comfortable.

Although many people have had positive experiences with hospices, the forced starvation and death of Terri Schiavo in a Florida hospice in March 2005 has raised questions about whether hospices are becoming involved in accelerating a client’s death.

Over the last 10 years in particular, former hospice nurse Ron Panzer of the Hospice Patients Alliance in Rockford, Mich. (www.hospicealliance.org), said he has heard from families with concerns about the ways in which their loved ones died in hospice care. Along with this, he also has noticed a move to reshape how Americans think about dying through discussion about living wills and advance directives.

Judie Brown of the American Life League said in the wake of the Schiavo case that there is every reason for Catholics to be suspicious of hospices. “The fact that [Terri] was ever accepted into a hospice bothered all of us because we understand hospice as a place where people are taken because the family desires them to be cared for and to be provided with common comfort care,” Brown said. “Terri was not dying, but the fact that she was starved to death in a hospice raises the question of whether hospice now defines the basic provision of food and fluid as a treatment.”

Church teaching is clear on the subject. Even when death is thought to be imminent, the Catechism of the Catholic Church (No. 2279) states that “the ordinary care owed to a sick person cannot be legitimately interrupted.”

Pope John Paul II, in an address to the international congress on “Life-Sustaining Treatments and Vegetative State: Scientific Advances and Ethical Dilemmas” on March 20, 2004, said: “The administration of water and food, even when provided by artificial means, always represents a natural means of preserving life, not a medical act. Its use, furthermore, should be considered, in principle, ordinary and proportionate, and as such morally obligatory, insofar as and until it is seen to have attained its proper finality, which in the present case consists in providing nourishment to the patient and alleviation of his suffering.”

Guidelines

Brown does not recommend avoiding hospice altogether because she said each program has to be treated individually. But she said, “The hospice in your community is the one you need to know everything you can about.”

Panzer said families and patients should ask whether sedatives are routinely given and why. They also should question what kind of pain medication is provided and how decisions are made about the amounts given.

“Many families report that the patient was taking aspirin or Motrin or a low level of pain medication,” he said, “then hospice comes in and slams them with maybe 100 times the dosage.”

Families, he said, should be certain that medication is given only if the patient has a real symptom that requires medical intervention.

Daughter of Charity Sister Carol Keehan, president and chief executive officer of the Catholic Health Association, said patients and families also should inquire about a hospice’s philosophy and mission.

“Let them tell you,” she said. “Probably 99% of the time, you will have people who can articulate very clearly what their mission and vision is … what they aspire to, what their sense of the dignity and rights of the patient and their respect for the traditions of the patient are.”

Dr. William Chavey, a Catholic physician and assistant professor of family medicine at the University of Michigan in Ann Arbor, said he advises patients and families to be very candid with hospice programs about what they expect in the way of care and what they will and will not tolerate.

The issue of greatest contention, he said, is typically whether intravenous fluids will be allowed. “There are some hospice organizations not as willing to allow IV fluids and IV hydration among patients,” he said.

When properly applied, Chavey said, hospice can be a very life-affirming way in which to receive end-of-life care. He acknowledged, however, that it can be manipulated by people with other agendas. That could be family members or a nurse who believes it is compassionate to hasten the death of a terminally ill person.

Jon Radulovic, vice president of communications for the National Hospice and Palliative Care Organization in Alexandria, Va., said hospices make an effort to find out what the patient wants. Ultimately, he said, families have a lot of control over the care that is given.

“If a family wanted to pursue more aggressive therapies,” he said, “that’s absolutely fine. Generally, hospices try to meet the needs of the family and patient.”

Sister Alphonse of the Little Sisters of the Poor said in the few instances in which a resident has received hospice care while remaining in the home, the sisters clarify at the outset what their role will be and what hospice’s role will be.

But, she said, “Having hospice come to our home is different from having a patient in the hospice facility. It would be similar to having hospice come to a private home. We don’t need their nursing assistance, and in the first meeting it is important to make clear that the sisters and the staff will be the immediate caregivers.”

Informing Yourself

This means that for residents who cannot eat, every effort is made to nourish them and see that they have adequate fluids. Even when a dying person doesn’t want artificially-delivered hydration or nutrition, Sister Alphonse said, it is possible to give him nutritional beverages, sherbet, pudding or ice cream.

“You can still maintain a good state of nourishment by using these things, though you may have to feed smaller amounts at more frequent intervals,” she said.

In the later stages of dying when the person cannot take water, Sister Alphonse said a patient’s mouth can be kept moist with sponge applicators or sprays or by giving the person an ice chip or piece of hard candy.

Judy Roberts is based in

Graytown, Ohio.