End of Life Issues

F. Michael Gloth, III, M.D.

The nation's largest and most influential medical organizations, the American Medical Association and the American College of Physicians, as well as many smaller physicians' groups, are on record as opposing physician-assisted suicide. Yet, despite the strong and widespread opposition of the medical community, last year physicians in Oregon wrote prescriptions to help kill 38 of their patients kill themselves. The 38 deaths represent a disturbing reversal in the decline in physician-assisted suicides in Oregon seen in the prior year: from 27 in 2000 to 21 in 2001. One must ask how Oregon came to accept a practice so strongly opposed by organized medicine.

The answer is in large part due to clever media campaigns waged by advocates of physician-assisted suicide, and the willingness of these groups to distort medical facts and disseminate myths with the help of an uninformed or biased media. In today's society, image and public perception are often more persuasive than facts and logic. Advocates of physician-assisted suicide try to obscure its real nature by avoiding references to euthanasia and homicide. Suicide is not advocated, except where it is cloaked as a medical procedure with the qualifier "physician-assisted." Yet, the arguments supporting physician-assisted suicide apply equally to suicide without a physician's assistance, as well as to euthanasia and homicide. Adding the term "physician-assisted" makes it no less suicide, and no less murder — although admittedly it sounds more benign.

The confusion engendered by the lack of clear and accurate media reporting is not the only reason, of course. Many today measure the value of life in strictly utilitarian terms. Seeing diminished value in lives that are no longer robust, they conclude that physician-assisted suicide is a rational choice.

The goal of this article is to provide information on physician-assisted suicide drawn from clinical and public policy experience. Arguments on both sides of the public debate are presented, and it will be shown that as a matter of morality, medicine and public policy, physician-assisted suicide is the wrong approach to end of life care. Current public policy efforts to improve the care given to terminally ill patients will also be examined.
What is physician-assisted suicide? Physician-assisted suicide occurs when a physician facilitates a patient's death by providing the necessary means and information to enable the patient to perform a life-ending act — for example the physician provides a potentially lethal medication and information about the lethal dose and how to administer it, aware that the patient may commit suicide. Most laws against physician-assisted suicide require evidence that the physician intervened to assist suicide. Under Maryland's law for example, physicians who provide medication to relieve pain are not prosecuted even if the dosage could increase the risk of death — unless they acted with an intent to assist a suicide. Physician-assisted suicide is distinct from active euthanasia where the physician himself directly acts to cause death — but the intent of helping to cause that death is the same.
How do states other than Oregon treat physician-assisted suicide? Oregon stands as an anomaly. Physician-assisted suicide is a crime in forty-five states, by statute in 39 states and by common law in the remaining six. Hawaii, Nevada, Utah, and Wyoming have no controlling law on physician-assisted suicide.
In addition to Oregon, four states — Michigan, Washington, California, and Maine — have put the issue of physician-assisted suicide to a referendum. In all but Oregon, the practice was rejected by voters. In the Spring of 2002, an effort to authorize the practice in Hawaii was defeated.
Arguments favoring physician-assisted suicide The arguments for physician-assisted suicide are generally similar to those supporting euthanasia. Most commonly it is argued that death offers the only means of attaining comfort or dignity for patients in extreme duress, such as those suffering from a terminal, painful, debilitating illness. Advocates of euthanasia and physician-assisted suicide buttress this argument with data showing that inadequate pain control is given to patients who are dying with painful conditions. The assistance of a physician is supposed to provide expertise to increase the likelihood of a successful suicide attempt and make the act "cleaner" — both literally and politically.
Arguments concerning loss of autonomy and impaired quality of life are also offered to justify physician-assisted suicide. Advocates of assisted suicide add that systemic changes to medical care, such as improved palliative care, won't benefit the individual currently dying in discomfort. They argue from the premise that immediate death is preferable to suffering with pain or "lack of dignity" in the last days, weeks or months of life.

Another argument in favor of assisted suicide is the prevention of "botched" suicide. Most terminally ill patients who wish to commit suicide want it accomplished by medical means, nonviolently — suicide by self-administered drugs is not always easy to accomplish. Failed attempts can cause greater trauma for the patient and caregivers than the natural course of the disease itself. In such circumstances, patients may beg caregivers to complete their failed attempt to die. This scenario is meant to bolster the argument for physician-assisted suicide, on the theory that such assistance prevents a greater harm than it causes.

Reasons to oppose physician-assisted suicide Catholic teaching condemns physician-assisted suicide because it, like murder, involves taking an innocent human life:

Suicide is always as morally objectionable as murder. The Church's tradition has always rejected it as a gravely evil choice: To concur with the intention of another person to commit suicide and to help in carrying it out through so-called "assisted suicide" means to cooperate in, and at times to be the actual perpetrator of, an injustice which can never be excused, even if it is requested. In a remarkably relevant passage Saint Augustine writes that "it is never licit to kill another: even if he should wish it, indeed if he request it because, hanging between life and death, he begs for help in freeing the soul struggling against the bonds of the body and longing to be released; nor is it licit even when a sick person is no longer able to live" ( The Gospel of Life, no. 66).

Policy makers and the public are not always receptive to appeals to Catholic moral teaching. Fortunately, well-established principles of medicine and bioethics provide sound and abundant grounds for opposing physician-assisted suicide.

In fact, the chief argument — that assisted suicide is needed to avoid the excruciating pain and suffering that may accompany a terminal illness — is based on a fallacy. Advances in pain management now make it possible to control pain effectively in dying patients; only rarely is it necessary to induce sleep to relieve pain or distress in the final stage of dying. But it is true that many physicians don't provide adequate pain relief. It is also true that changes in health care are required to better train and prepare physicians for pain control, and to better understand and provide end of life care. However, health care providers who specialize in pain relief and those involved with hospice are much more knowledgeable than the average physician about providing comfort and dignity at the end of life. In 2002 the American Geriatrics Society released guidelines emphasizing the availability of treatment for pain in older adults.

Although untreated pain is an argument that sways many in the general public to support physician-assisted suicide, it is not among the top reasons why patients request it, as Lois Snyder, Esq., Director of the Center for Ethics and Professionalism for the American College of Physicians, has noted:

The more compelling arguments for physician-assisted suicide — about avoiding great pain and suffering — do not seem to be motivating requests for physician-assisted suicide in Oregon. Based on current evidence, people seeking physician-assisted suicide there are more often concerned about loss of autonomy and control. We question whether it is medicine's role to give patients control over the timing and manner of death.

This finding is supported by a report from the Oregon Health Division's Fifth Annual Report on Oregon's Death with Dignity Act, indicating that the dominant reasons for requesting physician-assisted suicide were loss of autonomy (84%), decreasing ability to participate in activities that make life enjoyable (84%), and losing control of bodily functions (47%). Federal Law The federal government has also tried to address this issue. The Pain Relief Promotion Act passed the House of Representatives in 2000, but was not brought to a vote in the Senate. The bill promoted pain management and palliative care through the education and training of health care providers. It also banned dispensing federally-controlled drugs with the intent to assist in a patient's suicide. It provided a safe haven for physicians who dispense pain control medications in accordance with the federal Controlled Substance Act.

Paradoxically, some physicians and even some health-related organizations opposed the legislation, despite its specific language protecting providers who prescribe medications for pain relief. The strategy for convincing legislators that a bill promoting pain relief would actually do the opposite and impede pain relief is laid out in some detail in a book entitled Handbook of Pain Relief in Older Adults, to be released by Humana Press later this year. Advocates of physician-assisted suicide and euthanasia knew that support for their agenda was thin, both in the medical community and in the general public. Seniors, a rapidly growing political force, are particularly leery of measures that may appear to be incremental steps toward arbitrarily limiting life. There is, of course, overwhelming support for providing pain relief for those who are suffering. Therefore opposition to the legislation, could not be based on opposition to pain control or support for assisted suicide, instead, doubts had to be raised about the effectiveness of the bill in advancing pain control.

Opponents therefore broadcast their "fears" that physicians would misunderstand the bill, that this would have a "chilling effect" on physicians prescribing medication for pain, and, thus, that pain relief efforts would be impeded. Ultimately the strategy was effective and even persuaded some well-recognized experts in palliative care to oppose the Pain Relief Promotion Act.

When a bill bans physician-assisted suicide but affirms and protects physicians using controlled drugs for pain management, does that have a chilling effect on patient care? Experience with state legislation shows the opposite is true. Maryland, for example, banned physician-assisted suicide in 1999. Now that the law has been in effect for a few years it is clear that such legislation has not had a "chilling effect" on pharmaceutical prescribing. To the contrary, Drug Enforcement Administration records from 1992-2000 show that in Maryland, as in every state that passed a similar law in that time period, there has been an increase in the per capita use of opioids, like morphine, used for pain control (see figure 1). When physicians attending lectures I've given on pain management throughout the country learn about these protections for prescribers, they react with a mixture of relief and elation that such legislation exists.

Opponents of a ban on physician-assisted suicide continue to raise the issue of its supposed "chilling effect" on pain management, but they carefully avoid reference to the accumulating evidence against this argument in state after state. Their other arguments — for example, that physicians fear government intervention and oversight, or that assisted suicide is a "states' rights" issue — are specious. The real agenda of many groups organized against bans on physician-assisted suicide is to promote legalized euthanasia. They fear that banning assisted suicide will hurt their cause, whereas allowing it will be an incremental step toward their goal of permitting active euthanasia. The Federal Courts In 1997, the U.S. Supreme Court ruled that state laws that criminalize physician-assisted suicide are not unconstitutional. That ruling did not make physician-assisted suicide a crime. It simply declared that criminalizing physician-assisted suicide is a matter that each state may decide for itself.

But the court will likely consider the issue again. In November 2001, U. S. Attorney General John Ashcroft issued a directive entitled "Dispensing of Controlled Substances to Assist Suicide" (the "Ashcroft Directive"). The directive concludes that assisted suicide is not "a legitimate medical purpose" for drugs controlled by the federal government under the Controlled Substances Act. Under the directive, doctors who use these drugs to assist suicide are subject to having their federal narcotics prescribing licenses suspended or revoked.

Opponents of the directive have again raised the unfounded fear of a "chilling effect" on pain relief. They claim the directive will undo years of work spent in overcoming apprehension about addiction and securing adequate pain relief for patients. In April 2002, U.S. District Judge Robert Jones permanently restrained the Ashcroft Directive, stating that the U.S. Attorney General had "overstepped the authority of the federal Controlled Substances Act when he declared that physician-assisted suicide was not a 'legitimate medical purpose.'" The Attorney General has appealed Judge Jones' decision and the case is pending before the 9th Circuit Court of Appeals as of this writing.

The role of physicians The nation's largest medical specialty organization and second-largest physician group, the American College of Physicians, has officially announced its opposition to physician-assisted suicide as a matter of principle. It has also expressed concerns about effectively regulating the practice and protecting vulnerable populations, as well as the potential for abuse. The College continues to be concerned about research showing that physicians and other clinicians are often not well trained in end of life care. If physician-assisted suicide were to be accepted as standard practice, the College believes it would undermine the physician-patient relationship as well as improvements in end of life care.

The nation's largest medical group, the American Medical Association (AMA), has taken a similar stance, stating that allowing physicians to participate in assisted suicide would cause more harm than good. The AMA maintains that physician-assisted suicide is fundamentally incompatible with the physician's role as healer, would be difficult or impossible to control, and would pose serious societal risks. The American Medical Association's 156-year-old Code of Medical Ethics prohibits physician-assisted suicide in the same strong language it uses to prohibit physician involvement in euthanasia.

Legalizing physician-assisted suicide would bring subtle and not-so-subtle pressure to bear on terminally ill patients who fear their illness is physically, emotionally, or financially burdensome to families or caretakers. The legal option to commit suicide with a physician's help would be perceived as an obligation by many terminally ill patients concerned about being a burden to loved ones — patients who might not otherwise have considered suicide at all.

Instead of participating in assisted suicide, physicians should respond aggressively to the needs of patients at the end of life. The American Medical Association affirms that patients should not be abandoned simply because a cure may be impossible, as now happens too often. Multidisciplinary interventions should be sought, including specialty consultation, hospice care, spiritual support, family counseling and other assistance. Patients near the end of life deserve to receive emotional support, comfort care, adequate pain control, respect for patient autonomy, and good communication.

For physicians, the issue transcends state legislation. Doctors must not be forced to participate in physician-assisted suicide, abortion, capital punishment or other practices that run counter to professional ethics or personal beliefs. And physician-assisted suicide raises other medical dilemmas as well. My own research and many other studies demonstrate that accurate diagnosis and prognosis cannot always be assured. For some patients who died from physician-assisted suicide, subsequent autopsies revealed that they did not have a terminal illness! The impact such an error has on survivors (not to mention the patient) can only be imagined.

Distinguishing between actively ending a life and allowing the natural progression of events is an integral part of discussions of physician-assisted suicide. Honoring a person's wishes regarding burdensome interventions, such as cardiopulmonary resuscitation (CPR) or ventilatory support neither hastens death nor prolongs life. In such situations, the public often has a misconception of the impact of some medical interventions. Our inability to extend life or even to predict our ability to do so is far different from the impression one might get from watching prime-time television. Oftentimes medical interventions may actually cause more suffering and even unintentionally hasten death. Reviews of the evidence on the use of feeding tubes and CPR in frail older adults have made this abundantly clear. What is important in providing care at the end of life is that physicians maintain the patient-physician relationship no matter what course the patient finally chooses, short of participating in suicide. Withdrawing or withholding treatments, e.g. respirators, CPR, and even hydration or nutrition at the request of a terminally ill patient or the patient's surrogate can be consistent with professional principles and are supported by the American Medical Association's Code of Medical Ethics.

There is, of course, a final reason to advocate for physician-assisted suicide. It is cheaper to kill a person than to provide care. Yet a physician's first obligation is to "Do No Harm." Until that is replaced with "Save more money," it will be difficult to support physician-assisted suicide.

F. Michael Gloth, III, MD, FACP, AGSF, CMD, is an Associate Professor of Medicine and Director, Outpatient Services, for the Division of Geriatrics and Gerontology at Johns Hopkins University School of Medicine in Baltimore, MD.

The following is a month worth of my Spiritual Ponderings Column focusing on End of Life Issues.

Fr. Thomas M. Pastorius
June 5, 2011
Spiritual Ponderings
End of Life Issues

Over the past few weeks, I have been approached by a variety of different people who needed help understanding the Church’s teaching on end of life issues. It forced me to admit to myself that while I knew the basics of the Church’s teaching in this area that I was not on top of the issue the way that I would like to be and so I made sure to check my opinion with those who were experts in the field and I began to seek out more information on the subject. I thought therefore that end of life issues would be a good topic for this month’s Spiritual Ponderings.

As we begin, I think that it is important to go over some basic moral theology principles that guide all of the Catholic Church’s teaching.

1. Every single human being is made in the image and likeness of God. We hear in the first chapter of Genesis: “Then God said, ‘Let us make man in our image, after our likeness; and let them have dominion over the fish of the sea, and over the birds of the air, and over the cattle, and over all the earth, and over every creeping thing that creeps upon the earth.’ So God created man in his own image, in the image of God he created him; male and female he created them.” (Genesis 1:26-27). We believe that each human being carries this image of God inside him or her and because of that each person has infinite value.

2. Our value is not determined by or dependent upon where we are, how much we produce, or how “normal” we may be. We may be an embryo (an egg fertilized by a sperm –because life begins with conception) in a Petri dish or in the womb, we may be a two year-old in his or her mother’s arm or in an orphanage, we may be a sixteen year-old star athlete and scholar or a sixteen year-old confined to a wheelchair or suffering from some mental illness, we may be an adult who is the most caring and generous person in the world, or we may be an adult who is the meanest and most selfish person you would ever met, we may even be someone in their nineties fully living on our own or we could be confined to a hospital bed in a nursing home; we are all loved infinitely by God and our priceless because we carry His divine image within us.

3. Maybe most importantly, we Catholics believe that we are all tainted by original sin and therefore our first inclinations are not always the right ones. Our first tendency and instincts in life because of original sin is not to be unconditionally loving and caring as God wants us to be but rather to be self-centered and selfish. Personally when my grandmother was getting on in her age, there was a part of me that did not want to visit her because visiting her reminded me of my own mortality and part of the challenged I faced was to overcome my sinful-self who wanted to remain comfortable by ignoring her and to challenge myself to love like God loves. I am grateful to God for giving me the courage and the grace to overcome my sinfulness and to spend time with her toward the end because from that experience came some of the memories I treasure most about my grandmother.

4. God makes all things possible. One of the cruelest things I could do would be to hold up to you these high moral principles if there were no way for us to reach them. It would be something similar to an adult holding a piece of candy just out the reach of a little kid laughing at him or her as he or she strived to get the candy. The good news is though that we can live up to these moral principles and while it may not be easy it is possible because all things are possible with God. As we Christians grow in our faith and prayer life we begin to grow more and more unselfish and we begin to love more and more unconditionally. I think one of the reasons that we do grow more unselfish in life is because we begin to recognize that our human dignity does not rest upon what we have or do but rather it rests of the fact that we are all priceless children of God.

5. While I could go on and on by talking about the Beatitudes, Jesus’ command to love one’s enemies, the Law of Love and the 10 Commandments etc as foundational pieces of Catholic morality (and they are), I think that they can all be summed up in the one simple principle from John Paul II: “Respect everyone and always treat each person as a person and never as means to end.” The opposite of love for John Paul II was not hate but rather selfishly using someone with no regard for them. See if love is wanting what is best for the other person even if it requires a sacrifice on your part then the opposite is using another person with no regard for what is best for them or for your own selfish reasons.

Now that the basics are out of the way, with next week’s Spiritual Ponderings, I will begin to talk about some particular issues.

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Fr. Thomas M. Pastorius
June 12, 2011
Spiritual Ponderings
End of Life Issues

Every human being, no matter what their health, outward appearance, or stage of development has been willed into existence by our loving God and for this reason all human life is sacred with no exceptions. We also realize that to deprive someone of life is a grave wrong but we also must admit that we are mortal beings and that we will one day die. Where is the line that separates the side of prolonging one’s life too long and preventing God’s natural plan to take place verses not doing all that we can or should do to keep our love one alive?

The first step in finding that line is to rule out all selfishness as much as possible and truly want what is best for the person in the situation even if they do not want it for themselves. There are some phases that people use should be automatic warning signs telling us that we could be heading down the wrong path. Any phrase containing the words “quality of life,” should automatically send up red flags. When we begin to talk about “quality of life” we are normally beginning to place ourselves as judge on what “quality of life” is and not God. For example I do not personally want to end up in a nursing home suffering from dementia when I get old and I would think that I am like most people in that way, however this does not mean that me ending up in a nursing home suffering from dementia is not a part of God’s plan for me and maybe as a patient in a nursing home, I end up saying something to one of the nurses or volunteers that changes his or her life for the better. God has worked in stranger ways. I know personally there are times when I do not always want to do God’s will for example forgive someone who has hurt me just because I don’t want to does not mean that forgiving that person is not what is best for me. Remember our faith tells us that there is no actually difference in the value of a person between people confined to a bed in a nursing home and people running the fifty yard dash. It is only our human sinfulness that makes that distinction.

The second step is to try to figure out if the medical procedures that are your options are what the Church would call “ordinary means” or “extraordinary” means. Something that is ordinary means is something that is routine, basic, non-complicated compared to other medical techniques. For example if you cut your hand, ordinary means would dictate that you put a bandage on it. Extraordinary means is the term for when something is out of the ordinary, burdensome, experimental, may not provide a huge benefit in regards to the amount of pain and trauma undergoing the procedure would require. An example of extraordinary mean is to imagine that cut on your hand and instead of putting a bandage on it, you amputated the hand, put a bandage on it, and then reattached it. While there might have been some medical value to going through all the extra steps there was definitely more trauma involved than needed to be.

In the Church’s teaching in end of life issues ordinary means must always be tried and extraordinary means may be tried but are not required. Please note though that one procedure might be ordinary in one situation may not be in another. For example chemotherapy has become pretty much ordinary means in our country when dealing with a stage one cancer. It would still be considered extraordinary means for someone suffering a stage four cancer because the trauma of receiving the chemotherapy would be considered pretty great and the benefit (a possible few more months of living) would seem relatively small. I wish to caution people though because I do know of walking miracles. People who doctors have said would live only 2 years and are now living 10 to 15 years past the doctor’s diagnosis. Remember doctors are not infallible. It is important to get a second or third opinion if necessary. Just recently “Baby Joseph” an infant whose doctors in Canada said would never breathe on his own is now breathing on his own because of the doctors at Cardinal Glennon Children’s hospital.

I think the third step in dealing with end of life issues is to be as open and honest with someone as we can. If I am the patient, then I must admit my fears to a love one – my fear of being dependent, being in coherent, possibly even my fear of death. If I am the relative or friend, then I must let that person know that I am here for them and I want what is best for them. It is important for everyone to remind everyone that they are loved by God and that this world is not the only world but rather that our true home is in heaven. Above all of this, pray for guidance and talk to someone who is well informed on these issues.

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Fr. Thomas M. Pastorius
June 19, 2011
Spiritual Ponderings
End of Life Issues

As we continue to look at the end of life issues, I wish to reflect real quick on two sections from the Catechism of the Catholic Church.

Whatever its motives and means, direct euthanasia consists in putting an end to the lives of handicapped, sick, or dying persons. It is morally unacceptable.
Thus an act or omission which, of itself or by intention, causes death in order to eliminate suffering constitutes murder gravely contrary to the dignity of the human person and to the respect due to the living God, his Creator. The error of judgment into which one can fail in good faith does not change the nature of this murderous act, which must always be forbidden and excluded. (2277).

Discontinuing medical procedures that are burdensome, dangerous, extraordinary, or disproportionate to the expected outcome can be legitimate; it is the refusal of “overzealous” treatment. Here one does not will to cause death; one’s inability to impede it is merely accepted. The decision should be made by the patient, if he is competent and able or, if not, by those legally entitled to act for the patient, whose reasonable will and legitimate interests must always, be respected. (2278)

With these two paragraphs from the Catechism as our guide let us look at the issue of food and nutrition. I will admit that seeing a feeding tube in someone is an unsettling site but just because something is unsettling does not mean it is not the right thing to do. The question that should drive our decision about “feeding tubes” should simply be this: “If I remove the feeding tube from the person, will he or she die of starvation first or from the illness?” If they would die from starvation first and not from the illness then I would venture to say that most of the time (I will leave room for some exceptions here because I cannot for see every possible scenario) then the patient should receive the food and hydration. Biblically, I cannot see how one can get around the idea of having to help your neighbor in need, and logically if I say there is no difference between an old man in a nursing home and a newborn baby who cannot feed himself either then I must treat them the same and because I would be compelled to feed the newborn baby, I am also compelled to feed the patient in the hospital bed.

On the other hand, if a person would die from the illness first and not from starvation then one could in most cases (once again leaving room for some exceptions) think of food and nutrition as extraordinary means and thus not necessary. I personally have witnessed one case in which food and nutrition would have hastened death (because of the type of cancer absorbed the nutrients and grew quicker) and therefore it was refused.

John Paul II said the following about the issue of food and nutrition: “I should like particularly to underline who the administration of water and food, even when provided by artificial means, always represents a natural means of preserving life, not a medical act. Its use, furthermore, should be considered, in principle, ordinary and proportionate, and as such morally obligatory, insofar as any until it is seen to have attained its proper finality, which in the present case consists in providing nourishment to the patient and alleviation of his suffering.”

While seeing our love one suffering with a feeding tube may be hard for us to endure, it may be the moral choice. I would like to end today’s reflection with a quote from Pope Benedict XVI.” “The true measure of humanity is essentially determined in relationship to suffering and to the sufferer. A society unable to accept its suffering members and incapable of helping to share their sufferings and to bear it inwardly through ‘com-passion’ is a cruel and inhuman society.”

A great resource that I found in regards to ethical and moral issues is the National Catholic Bioethics Center’s 24 hour hotline – 215.877.2660

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Fr. Thomas M. Pastorius
June 26, 2011
Spiritual Ponderings
End of Life Issues

As I come to the end of this month’s reflection, I know that there is much more that I could write about on these issues but there is a part of me that is reluctant because I feel that it is more appropriate when facing these issues that we do so while in consultation with those who know Catholic ethics like your parish priest or someone he recommends.

The United States Catholic Conference of Bishops (USCCB) put out a pamphlet called “The Gift of Life n the Face of Death” and I want to reflect a little on the following quote from it as I end this month’s Spiritual Ponderings:

“Dying need not be a time of pain and despair. It can be a time when we come to terms with life. A time to say ‘I love you’ and receive love from others. A time to concentrate on what is really important, and to make our peace with God. It can be our final stage of growth, and our gateway to eternal life.
‘Assisting’ death abandons people whose real problems we do not want to deal with. What people need—especially when they are sick and helpless—is assistance in living with dignity.
Pope John Paul II called such assistance ‘the way of love and true mercy.’ It requires true compassion, which means to “suffer with” the person in need. It involves controlling pain, caring when we can no longer cure, and treating each person like the unique and precious individual that he or she is. Each of us deserves nothing less.

If you are facing end of life issues or if you want to “assist others to live with dignity” as they face end of life issues here are a few things that you can do:

1. If you are a caregiver join a support group. Do not think that you have to do this alone or even try to do this alone. You will get burnt out too quickly. Allow others to support you as you support the person whom you are caring for.

2. Seek out people in your family and community who are at a risk of dying alone and keep them company. Your presence will mean more to them then you will ever know.

3. Volunteer or provide assistance to your local hospice organization.

4. Pray for dying patients and their families at home and at Sunday Mass. Pray that they may receive the respect and care they need and that they will trust in the Lord’s plan and not give into any fears.

5. Become an extraordinary (Eucharistic) minister in your parish or hospital and bring the Eucharist to those who are sick and those who are homebound.

6. Volunteer at a nursing home, or provide respite care for families caring for their seriously ill members at home.

7. Learn more about moral issues involving the end of life, and share your knowledge with others. For more resources check out the Archdiocese of St. Louis’s Respect Life Apostolate’s webpage: www.archstl.org/respectlife.

8. Teach your children about the value of all human life.

9. Pray for those who do not respect human life

10. Choose your language carefully when talking about end of life issues and talk to a trusted family member expressing them your wishes to follow God’s will.

I will leave you with one final quote: “The measure of love is to love without measure.”