A Journey of Dignity / Elliott Bedford

Setting goals of medical care and who speaks for you

(This week, we begin a new quarterly column titled “A Journey of Dignity.” It is a collaboration of the archdiocesan Office of Human Life and Dignity, Ascension St. Vincent and Franciscan Health.)

The Catholic Church affirms that we are created in “imago Dei,” in the image and likeness of God. Consequently, we are called to honor him through prudent stewardship over the great gift that is our very life.

But just what does “prudent stewardship” actually mean? What does it look like?

One clear aspect is care of life itself—our body and its health. But here things tend to get fuzzier. Due to the significant development of medical science over the past century, modern medicine can cause many to wonder: Do I have to do everything possible to extend my life? What does the Church actually teach?

We might summarize one of the principles of the Church’s teaching on care for one’s life this way: avoid the opposite extremes of being neglectful and overzealous. In other words, we should not neglect care for ourselves, but we are not obligated to extend our life at all costs or by whatever means necessary. Instead, each of us is called to find, in our unique circumstances and life situations, the virtuous mean between these extremes.

We do this in two ways: by understanding the relative importance of things and expressing our goals in life. By relative importance, I mean simply this: while both are good, spiritual goods are more significant than material goods.

However, if these goods are well-ordered, they should be integrated. Care for our bodies should be viewed as one component of a healthy spiritual life. Integration and proper ordering of the physical and spiritual is therefore the ultimate goal that we should strive for as prudent stewards of our lives.

Consequently, our goals are incredibly significant.

Consider an example: I am 35 with a wife and three young children. Its my goal to work hard for my wife and family, and to see our children attend Catholic elementary, high school and college so they can be well educated and obtain meaningful work. I want to see them get married or enter religious life, to whichever path God calls them.

But let’s say I am diagnosed with a significant disease, like stage 4 pancreatic cancer, which is exceedingly aggressive. My goals would change as my life expectancy and what is achievable changes. The importance of working would diminish. I would only want medical interventions that would bring comfort and relieve the symptoms. I would want to focus on meaningful time at home with my family. My primary occupation would be reconciling myself with God in preparation for a good and grace-filled death.

Let’s say it’s something less drastic, like congestive heart failure. This is still a significant, life-limiting diagnosis. But with a good medical plan and healthy living, it may be reasonable to think that I could still achieve my life goals. Of course, things might change as the disease progresses. At such times, I would need to re-evaluate my goals and consider whether they could still be achieved or whether I need to change them. I would need to consider whether I thought the medical interventions that physicians were offering would be worth it. Are they reasonably beneficial to me? Or are they excessively burdensome and disproportionate to the good they could achieve?

In both scenarios, we might summarize my goal: I want to maximize the quality and experience of my life, doing good for my wife, kids and community in service of God’s kingdom. I want to live well—the best I can, given the circumstances—no matter how much time I have.

But consider “prudence” a bit further. Does it make sense for only me to know my goals? Is it helpful if I know what I want to achieve, but never tell anyone? Prudence dictates that I tell others about my goals, and that I designate someone to speak on my behalf when I cannot. Communicating my wishes removes the burden of difficult decisions from the shoulders of others.

The Church teaches that we should care for our own life in a way that prioritizes love of God, self and neighbor. Consequently, when we think about this in the medical context, we need to ask ourselves the following questions:

• What do I find meaningful in life? What are my goals that I would want to achieve in life? What is most important?
• If I could not make my own decisions, who would I want to speak for me? Who would best represent me, my values and my goals? Who can I most trust to be my voice?

I recommend sitting down and thinking about these questions. Pray over them and write out your answers. Then act. Tell the people you love your goals and what you find meaningful. Tell them who you want to speak on your behalf. And then tell your doctors so they know how best to support you and your goals.

Being prudent with your life, through advance care planning, helps provide the gift of peace of mind to your loved ones.
 

(Elliott Bedford is the director of Ethics Integration for Ascension Indiana in Indianapolis and a member of the Hospice and Palliative Care Initiative, a collaborative initiative between the Archdiocese of Indianapolis, Ascension St. Vincent and Franciscan Health.) †