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Quality of life at the end of life

Interfaith Panel Explores End Of Life Care Beliefs


Six Chicago-area faith leaders addressed the importance of end of life decision-making and discussed how their respective beliefs, rituals and traditions impact the process during an event this week at Northwestern University.

Orthodox, Hindu, Islamic, Jewish, Protestant and Roman Catholic perspectives were represented during the panel, hosted by Life Matters Media in collaboration with the Council of Religious Leaders of Metropolitan Chicago. More than 100 attended.

“I can’t think of a time in life in which our own faith beliefs might be more critical than near life’s end,” said LMM President Randi Belisomo, who served as moderator. “Among those for whom faith matters, it is impossible to discuss true end of life preferences without considering the tenants of one’s own religion.”

EASTERN ORTHODOX

Perry T. Hamalis, the Cecelia Schneller Mueller Professor of Religion at North Central College, spoke about Orthodox Church teachings on death, something he said is not natural nor intended by God. The Church’s ethical framework exemplifies moral realism, meaning that it centers on God as both creator and redeemer of humanity.

“Humanity has been created in the image and likeness of God, as persons with intrinsic dignity, and given freedom and called to a life of communion with God, neighbor and all of creation,” Hamalis said. “But the world is broken, as a result of primeval rebellion, or sin, which led to alienation from God, a spiritual death, and ushered in physical death, or mortality. So sin and death are not natural, because they were not intended by God to be part of the original, natural, normative human condition.”

Hamalis said the problem of decline and then death, both physical and spiritual, can be cured only by God. Orthodox Christians believe in the saving mercy and grace from the Holy Trinity.

For adherents, life is viewed as a sacred gift from God, and humans are only stewards of their body.

“We are pro-science, pro-medicine, we venerate many saints who were physicians and involved in health care,” Hamalis added. “We have tremendous respect for human freedom… We also acknowledge the uniqueness of every human person, so counsel and care must be personal.”

The end of life is a time for repentance, confession and communion in preparation for spiritual resurrection, he said. “We are against suicide in all forms, we regard euthanasia as suicide, and we affirm the distinction between killing and letting die,” Hamalis said. “We allow for the withdrawal of life-supporting technology in most circumstances. We support palliative care.” Organ donation may be viewed as a form of philanthropy.

It should be the goal of both family and designated caregivers, according to the Orthodox Church in America, to ensure that the final days of a terminally ill person are spent reasonably free of anxiety, tranquil and aware. Integral to maintaining this type of condition is the administration of proper pain medications.

ROMAN CATHOLIC

John J. Hardt and Perry T. Hamalis discuss end of life care

John J. Hardt and Perry T. Hamalis discuss end of life care. Photo by David Pierini

John J. Hardt, a bioethicist and Vice President for Mission Integration at Loyola University Health System, offered a Roman Catholic perspective on end of  life care.

“Our bodies are not our own, but we are to be stewards of that gift. Life is a precious gift, life is sacred. But at the same time, we are all destined to die,” Hardt said. “Life in the Roman Catholic tradition does not have infinite value, it has finite value… The only thing that has infinite value is God.”

When Catholics approach end of life decision-making, they must navigate the gray area of contention between those two poles.

“How do we at once value the sanctity of life and also acknowledge that life is something that will leave us as we know it here,” he added. “We are called to a different life, which makes this life of relative value, but sacred value.”

Concerning contemporary medicine and technology, Catholics should not “throw everything” at a patient to prolong life or seek to hasten death. Hardt said he believes Catholics facing the end of life can find comfort in Jesus Christ’s death and resurrection, as described in the Gospels.

The Church also teaches that effective pain management is a critical component of appropriate end of life care, and Pope Francis recently addressed the importance of palliative medicine– care designed to treat side-effects of both disease and aggressive treatments.

“I therefore welcome your scientific and culture efforts to ensure that palliative care can reach all those who need it,” Pope Francis told an assembly. “I encourage professionals and students to specialize in this type of assistance, which has no less value on account of the fact that it ‘does not save lives.’ Palliative care recognizes something equally important: recognizing the value of the person.”

The Church does not accept that human beings have a right to die and strongly opposes physician-assisted suicide, sometimes known as “Death with Dignity.”

PROTESTANT

The Rev. Myron McCoy, senior pastor of First United Methodist Church: The Chicago Temple, offered his experiences as both a Protestant minister and an African-American.

“When confronted with end of life considerations, it is ever so important to remember that this is a significant time in persons’ lives and in the lives of practitioners, as they do the hard and sacred work of preparing for death,” McCoy said. “Having just celebrated the life of a member earlier this week… with their decision not to prolong life, I’m readily attuned to the fact that we must do more in pondering questions surrounding end of life care.”

The Rev. Myron McCoy, senior pastor of First United Methodist Church

The Rev. Myron McCoy, senior pastor of First United Methodist Church. Photo by David Pierini

There are no final or clear-cut answers in Protestantism, he said, because every situation, family and patient is different. Protestantism comprises many different Christian denominations with a wide range of beliefs, tracing common origins to the Reformation. However, all mainline Protestant denominations oppose euthanasia, as Christians view life as a gift from God that should not be taken away.

“In my tradition, Protestant and United Methodist, we believe care for the dying is an aspect of our stewardship of the divine gift of life,” he said. “Human interventions and medical technologies are only justified by the help that they can give. Their use requires responsible judgement about life-sustaining treatments that truly support the goals of life and when they have reached their limits.” There is no moral or religious obligation to use them when they only extend the process of dying, and families should have the freedom to stop them.

McCoy highlighted the attitudes of some African-Americans towards end of life care, as African-Americans are far more likely to request aggressive and artificial life-sustaining treatments than other populations. He called for more discussion and education regarding these health care decisions, as patients should not default to aggressive, often futile treatments in the absence of previous discussion. There is a historic distrust between African-Americans and the medical community, due in part to their history of receiving inappropriate, and sometimes harmful, treatments.

JEWISH

Rabbi S. Joseph Ozarowski, rabbinic chaplain with the Jewish Healing Network of Chicago, said that although Judaism has evolved over thousands of years, its teachings remain squarely based on the Torah, also known as the five books of Moses, and oral traditions which have endured over time.

One cannot understand the Torah without oral traditions, he said. Today, the largest movements are Orthodox Judaism, Conservative Judaism and Reform Judaism, a more liberal strand in which some adherents accept physician-assisted suicide and voluntarily stopping eating and drinking (VSED).

“In Judaism, life is a gift from G-d, and we are custodians,” Ozarowski added. “Life has infinite value, but life is finite. Life really is cherished.”

Life should be sustained at all costs, according to traditional Jewish law, and almost any commandment in the Torah can be broken if it involves the saving of a life. Therefore, Jewish law forbids euthanasia and regards it as murder, because every moment of human life is considered equal in value.

However, there is also no commandment to extend death or prolong suffering, which is why proper pain medications or remedies aiming to alleviate suffering “are kosher.” Ozarowski said he often advocates palliative care for patients nearing death.

MUSLIM

Dr. Aasim Padela offered a Sunni Muslim perspective

Dr. Aasim Padela offered a Sunni Muslim perspective. Photo by David Pierini

Dr. Aasim I. Padela, director of the Initiative on Islam and Medicine and an emergency physician at the University of Chicago Medical Center, offered a Sunni Muslim perspective on end of life care. Most Muslims are of two denominations: Sunni (75–90 percent) or Shia (10–20 percent), according to PEW Research Center.

Padela said Muslims seek guidance and moral reasoning from revelation revealed in the Qur’an, believed to the be literal word of Allah, and the Sunnah, recorded sayings of the Prophet Muhammed.

“Moral reasoning, because the Qur’an is considered our revelation, is the only axis we have to any understanding of what God’s will and desire is, particularly about the afterlife,” Padela said. “There is this idea in ethics called theistic subjectivism: that things are right and good because God says they’re right and good… and for Muslims, we must look towards the scriptural source texts to determine what is good and right. What can we tie from the scriptural source texts to sin?”

For example, most Muslims oppose euthanasia and maintain that all human life is sacred, because it is given by Allah. Only Allah chooses how long each person will live (Qurʼan 4:29).

Devout Muslims contend that do-not-resuscitate (DNR) orders represent a soft form of euthanasia– Muslims cannot kill or be complicit in the killing of another, except in the interests of justice. However, it is permissible for doctors to stop trying to prolong life in certain cases in which there is no hope of cure.

Death can have “goodness,” in it, Padela said, because it is essentially a transition of one form of life to another. Unlike other faith traditions, Muslims seek to trust in God’s will, whatever it may be. Suffering and disease should be accepted as part of God’s plan, because humans should not seek a sense of control over their body. “Affairs should be left to God, and be happy with any decree.”

HINDU

Swami Sharanananda, resident acharya with Chinmaya Mission Chicago, began by offering a meditation and prayer.

He described death as a “rebirth,” because although it is inevitable, it is simply a change from one state of being to another.

“In the Hindu scriptures, life is different from living. The end of life is the end of living,” he said. “There is no death in life, life is continuous. Death is an event in life, not the end. Life is spirit.” Therefore, Americans should not fear death or focus their whole life on avoiding disease or “eating organic foods” just to live longer.

Family and community interconnectedness and karma are other major tenets of Hinduism. Karma creates a system of actions and reactions throughout the soul’s journey through reincarnated lives.

Reincarnation gives great comfort to the dying and to their families, because they trust they will be reborn and into new life. Enduring suffering may lead to spiritual growth and a more fortunate rebirth, but palliative and hospice care are compatible with Hindu values, according to a 2010 article published in the Journal of Hospice and Palliative Nursing. Typically, death should neither be sought nor prolonged.

“Everybody dies, but nobody dies,” he offered. “Death is as holy as birth… to have a good life, one must know what death is. Death is the key to life.”


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