I recently attended a panel discussion of advance medical planning at a conference organized by health care workers. Advance medical planning encompasses those legal tools that we can use to prepare for a time when, due to illness or other incapacity, we cannot make care decisions on our own. This oftentimes is near the end of life. Such tools include medical powers of attorney and health care directives or living wills, which can express our values and give guidance to others faced with yet-unknown decisions concerning our healthcare.
The panelists’ conversation centered around end-of-life medical orders, which some think would be helpful advance planning tools (though oftentimes come with significant ethical concerns). A number of panelists shared about difficult experiences they had had in making end-of-life medical decisions with their families, common yet complex decisions that many persons make with or for a loved one towards the end of life.
One panelist in particular sticks out in my mind. In sharing about the facts and circumstances of her father’s final illness and medical condition – which, of course, are highly individualized and particular to him – this panelist shared, “and, you know, he was not contributing anything to society.”
“Not contributing anything to society.” This statement – offered as a factor in the decision of whether to authorize or withhold certain medical care for an incapacitated elderly man – caused me to stiffen in my chair. If it doesn’t shock us to some degree, that’s evidence of how far this insidious idea has already crept into our own thinking.
A person’s worth is never contingent upon his usefulness, what he contributes to society. As our faith teaches us, dignity is inherent in our very being. It’s a very serious mistake to slip into a utilitarian mindset about the dignity of the human person. This mindset subtly coerces the sick and elderly, and it doesn’t serve the common good.
The utilitarian view, according to St. John Paul II, reflects a “descent into arbitrariness and the dominion of the strong over the weak.” Indeed, the great Polish saint reminds us, “society will be judged on the basis of how it treats its weakest members; and among the most vulnerable are surely the unborn and the dying.” In our lives as citizens, we should seek laws that respect the innate dignity of all, regardless of their utility.
Yet knowing that a person’s usefulness is not a legitimate factor in healthcare decision-making, what are legitimate principles that arise from our innate dignity?
The Church teaches that we have a moral obligation to use “ordinary or proportionate means to preserve” life. Extraordinary or disproportionate means are optional if they “do not offer a reasonable hope of benefit or entail an excessive burden, or impose excessive expense on the family or the community.” Furthermore, food and water – even if medically assisted – is not optional, including for those in chronic or presumably irreversible conditions, unless it cannot be reasonably expected to prolong life, would be excessively burdensome for the patient, or would cause significant physical discomfort.
For more information on end-of-life healthcare decision-making, the National Catholic Bioethics Center is a sound resource. Search for A Catholic Guide to End-of-Life Decisions at www.NCBCenter.org. Furthermore, to view a sample Advance Directive, visit www.rapidcitydioces.org/social-justice-commission/
– published in the West River Catholic, November 2018
