The Vatican served up a reminder of the point this week with a new "little end-of-life lexicon," which not-so-subtly amends an earlier Vatican ruling on the issue of withdrawing artificial nutrition and hydration from chronically ill patients 17 years ago.

New end-of-life lexicon

The new lexicon was issued by the Pontifical Academy for Life.

While it doesn't have the force of law or express any new teaching, it nevertheless clearly marks a departure from the position taken by the Vatican in 2007, which was framed in the wake of the anguished Terri Schiavo case in the United States.

The lexicon, by way of contrast, so far has been issued only in Italian, and doesn't appear linked in a direction fashion to any current high-profile case.

The Schiavo case

Though it may be difficult to remember now, the Schiavo case was perhaps the most notorious, and controversial, end-of-life debate in the United States throughout the late 1990s and early 2000s.

It became a political football during the 2004 election, in part because it was unfolding in Florida, a premier presidential battleground state, which at the time was governed by Jeb Bush, the brother of President George W. Bush.

To recap, Terri Schiavo went into cardiac arrest at her home in St. Petersburg, Florida, in 1990, experienced massive brain damage, and was eventually diagnosed as being in a persistent vegetative state.

For the next several years various therapies were attempted without a favorable result, and in 1998, Schiavo's husband decided to remove the feeding tube which was keeping her alive.

That decision was immediately challenged by Schiavo's parents, Robert and Mary Schindler.

Among other things, they insisted that Schiavo was a devout Roman Catholic and would not have wished to defy Church teaching, including the idea that withdrawing food and water from a patient is tantamount to a form of euthanasia.

The clash between husband and parents triggered an explosive legal and political debate which played out for the next seven years, until the feeding tube was definitively withdrawn and Schiavo died on March 31, 2005.

The case aroused wide and passionate Catholic activism, often driven less by the Church's official leadership than by a sprawling, informal horizontal network of pro-life activists and movements. Read more

• John L. Allen Jr. is the editor of Crux, specializing in coverage of the Vatican and the Catholic Church.

And the rest of the church needs to know who it is.

Otherwise, arguments over his treatment can divide the church for decades, even after his death. Read more (Scroll down)

He was speaking to the president of the Pontifical Academy for Life and European World Medical Association representatives who met last week to discuss "end of life" issues.

"Greater wisdom is called for today, because of the temptation to insist on treatments that have powerful effects on the body, yet at times do not serve the integral good of the person."

This wisdom is needed to analyse issues in relation to "overzealous treatment," patient and doctor relationships, global inequality in healthcare, the need to be close to the sick and to pay attention to the needs of the most vulnerable.

Sometimes withdrawing from overzealous treatment is wiser than using them, he said.

Francis drew some of his comments from Pope Pius XII's 1957 address to anesthesiologists and intensive care specialists.

These included his comment that it is "morally licit to decide not to adopt therapeutic measures, or to discontinue them, when their use does not meet that ethical and humanistic standard that would later be called ‘due proportion in the use of remedies.'

"It thus makes possible a decision that is morally qualified as withdrawal of ‘overzealous treatment'," Francis said, adding that "such a decision responsibly acknowledges the limitations of our mortality, once it becomes clear that opposition to it is futile."

He said understanding this promotes a focus on accompanying the dying.

While it means ethically avoiding excessive treatments, "it is completely different from euthanasia, which is always wrong, in that the intent of euthanasia is to end life and cause death."

He acknowledged many cases and situations can be "difficult to evaluate," and that there is no one-size-fits-all rule that can be adopted.

"There needs to be a careful discernment of the moral object, the attending circumstances and the intentions of those involved," he wrote.

The patient needs to be at the centre of any discussions and have the right to decide on treatment by discussing it with their doctors.

These discussions include deciding the "proportionality of the remedy" and "refusing it if such proportionality is judged lacking," Francis said.

He also pointed out the "personal and relational elements of the patient's life and also death", which are "after all the last moment in life," must be considered when evaluating his or her care.

Source

• Crux
• Crux
• Catholic Herald
• Image: The Privacy Sugeon

The initiative seeks to raise awareness about advance care planning so that people start thinking, talking and planning for their future and end of life care.

"Completing an advance care plan is appropriate for any time of life," Middlemore Hospital renal department senior medical officer Joe Hancock says.

"We want people to start having conversations with their family, friends and wider social networks about their future health care.

An advance care plan is a statement made by the patient to guide their medical care under circumstances where they are unable to speak for themselves," Hancock says.

"This helps the patient's family and medical team to make decisions which are consistent with the patient's values and wishes."

The plan starts with an open and honest conversation between the individual, their family and their medical provider.

The wishes and feelings of the individual and of their family are explored and established and statements can then be made in the form of an advanced care plan.

This year's theme is "get them talking" and the target audience is active retirees.
Advanced Care Planning Checklist

• Understand any health condition(s) you have and how these may progress.
• Discuss these with your health care provider, including treatment options.
• Think about what you would like and what is important.
• Share your wishes with family and whanau.
• Nominate someone to speak for you when you can't and consider an enduring power of attorney.
• Write a will with directions for legacies or gifts.
• Keep a file of important papers and documents.
• Leave funeral plans if you have a view about this (including pre-paying).
• Complete your advance care plan.

Source

• stuff.co.nz
• scoop.co.nz
• Image: facebook.com

SPIEGEL: Doctor Gawande, are you beginning to feel your age?

Gawande: Without question. I had to switch bifocals this year. I was always near-sighted and now I'm also far-sighted.

My 19-year old daughter has started beating me at word games because I just don't process like I used to. While playing tennis, I never had to stretch nor worry about injuries. That's over as well. Overall, it's the kind of little aches and pains that make you think: Yes, I'm getting older.

SPIEGEL: In your book "Being Mortal," you describe vividly what happens when we age: Our heart muscle's performance begins to deteriorate at 30, before the age of 40 our brain power starts to decline. At the age of 60, on average, we'll have lost one third of our teeth. Does your own decline scare you?

Gawande: It's an experience that definitely bothers me. The mental image I have of myself is still the person who was 30 years of age rather than the person turning 50 this year.

SPIEGEL: Four years ago, your father passed away at the age of 76. Did the experience of his death magnify your concerns?

Gawande: Surprisingly, no. It actually helped me. Up until the end, my father had things he loved and cared for. We should consider ourselves lucky to become older than the generation before us.

Many of us will become dependent, that's inevitable, but that doesn't mean one can't have a good life. For my book, I talked with a 94-year-old man. Every joint he had was aching. He had to support himself with one of those walkers that had tennis balls on each of the legs. Sometimes, he seemed confused. Yet, he had things he loved about life and that was true of my father as well. Continue reading

Sources

• Spiegel Online
• Image: AnswerCare

Vincent Lambert became a quadriplegic and was left in a comatose state after a motorcycle accident in 2008.

In 2013, Lambert's wife and six of his eight siblings asked courts to rule that his hydration and nutrition be disconnected.

In response, his parents, who are Catholics, initiated a legal fight to protect their son's life.

The case went all the way to the European Court of Human Rights, which approved the removal of hydration and nutrition.

French end of life law allows the suspension of treatment in futile cases.

The Catholic Church in France has protested that Lambert is not undergoing any treatment, but is simply receiving food and water via a feeding tube.

He is not in a vegetative state as such, given that his body reacts to certain stimuli and is able to feel pain.

The hospital in Reims said it did not intend to switch off the machine sustaining the patient.

"This procedure cannot go ahead given the current lack of calm and certainty," doctors explained.

They referred the issue to the health ministry last Thursday.

Doctors had reportedly feared that there could be plot by pro-life activists to abduct Lambert from the hospital and kidnap members of his medical team.

Lambert's nephew said the doctors' decision to continue hydration and nutrition was due to intimidation.

Public prosecutors have been asked to look at the case.

The row over Vincent Lambert is similar to a legal fight over Terri Schiavo, a Florida woman who suffered brain damage in 1990 and was left in a vegetative state.

Eventually her husband won a protracted court case to have her feeding tube removed and she died in 2005.

Sources

• Vatican Insider
• Catholic News Agency
• The Telegraph
• Image: Paris Match