The morals of dying Catholics turn to the church for legal guidance on end-of-life issues

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Thomas Kelly embraces life, having survived two bouts with cancer. But when the end comes, the retired nurse is leaving nothing to chance.

Appalled by seeing swollen hospital patients on feeding tubes and respirators during his career, Kelly, 78, of North Kingstown, R.I., signed a legal document with the encouragement of his Roman Catholic priest. It permits his wife to stop those treatments once death is imminent – and not any sooner.

Catholics around the country are turning to their churches for similar fill-in-the-blank documents that turn Catholic teachings into legally binding agreements about how they want to die. Many signers cite Terry Schiavo, whose case sparked a 15-year legal battle that grew beyond her family all the way to the White House over whether she should be allowed to die.

In a persistent vegetative state, her husband ordered her feeding tube removed against her parents’ vehement opposition, and she died in 2005. Some, including the Vatican, likened her death to murder.

“I don’t think I have any right as a Catholic to say when my life should end,” Kelly said. “I don’t think I have a right to take my own life, a right to take anyone else’s life, and I certainly don’t want anyone taking my own life.”

Troubled by the Schiavo case, Kelly attended a seminar organized by the Rev. Christopher Mahar, associate pastor of Our Lady of Mercy Catholic Church in East Greenwich to help guide his parishioners following Schiavo’s case.

Mahar said he intended to hand out a legal form the diocese produced about a decade ago, but stopped when he realized it was more permissive than more recent guidance from the Vatican about when feeding tubes should be removed.

“To remove it would be considered passive euthanasia,” said the priest, who’s now working to draft a new document. “I guess what the church is trying to do is keep up with the times.”

Known as a durable power of attorney, the document eventually will become the centerpiece of an information packet about death that Catholic leaders in Rhode Island could someday hand out in hospitals, hospices or local churches.

The form allows the signer to designate a medical decision-maker in case the signer becomes incapable. That person would be constrained by church teachings, including prohibitions against mercy killing.

The Roman Catholic Diocese of Portland offers an end-of-life packet that includes an advance life directive and living will.

Dioceses in Maine, South Dakota, Florida, Michigan and

Washington state distribute similar packets, some with legal paperwork that people can easily complete and sign.

“I am a Roman Catholic,” the Statement of Faith on the living will form used by the Maine diocese says. “As a Roman Catholic I elect to make decisions regarding my care and treatment that are morally permissible according to the teachings of my church. I believe that I have been created for eternal life in union with God.

“The truth that my life is a precious gift from God has profound implications for the question of stewardship over my life,” it continues. “I have a duty to preserve my life and to use it for God’s glory, but the duty to preserve my life is not absolute, for I may reject life prolonging procedures that are insufficiently beneficial or excessively burdensome.”

The Vatican’s top health official recently backed the use of living wills, a similar legal document, in Italy.

The National Catholic Bioethics Center, which advises many Catholic institutions, also revised its own durable power of attorney after the Schiavo case. It has shipped thousands of the forms from its Philadelphia headquarters, and demand peaked when the Schiavo case headed to court.

“They were going out in extraordinary numbers then,” said Edward Furton, an ethicist who works at the center.

While all the documents work off the same core church teachings, they sometimes reach different conclusions, particularly on when and how feeding tubes can be removed.

In general, the Catholic Church teaches that believers are morally required to seek ordinary care, or medical treatment that offers a reasonable hope of benefit and isn’t overly burdensome.

Anything else is usually termed extraordinary treatment and considered optional.

Applying centuries-old guidelines in an age of respirators and feeding tubes has challenged church authorities.

Before Schiavo died, the late Pope John Paul II said that feeding tubes should be considered mandatory care for vegetative patients, even if hope for a full recovery wanes. Theologians say exceptions can be made when patients can’t digest food or water or when the tube itself causes other serious medical conditions.

Deciding when the benefits outweigh the burdens has never been an exact science, said the Rev. Kevin O’Rourke, a Catholic priest who studies bioethics at the Stritch School of Medicine, part of Loyola University Chicago.

He helped author a power-of-attorney document in the early 1990s in which patients can authorize their decision-makers to stop artificial feeding. O’Rourke said people who insist on indefinitely feeding vegetative patients are selectively emphasizing abstract guidance from the Vatican that is supposed to be applied on a case-by-case basis.

“The goal of life is friendship with God, and it may happen that prolonging life doesn’t increase your progress toward that goal,” he said. “I don’t think you’re respecting the person if you keep them in that condition.”

Other Catholics who have signed similar documents are less focused on the feeding tube debate. Jeremiah Murphy, 76, an attorney and Catholic lobbyist in Sioux Falls, S.D., drafted his own Catholic durable power of attorney after undergoing emergency heart surgery in 1988.

As he was wheeled around the hospital, Murphy said he realized many generic living wills would allow a surgeon to make life-or-death decisions for him in a crisis. He had always assumed a longtime family doctor or his wife would make any difficult choices.

“It’s not. It’s the last specialist who gets his hands on you,” Murphy said. “They don’t know anything about my philosophy or anything else. And this guy’s going to decide whether they turn the key or not?”

For more information, call the Roman Catholic Diocese of Portland, 773-6471, or visit www.portlanddiocese.net. Click on the subject Housing, Family & Health for the link to end-of-life care.