END OF LIFE QUESTIONS ON PALLATIVE CARE

INCLUDING MORPHINE:

Catholic Understanding and Teaching concerning Morphine Drip

Isn't a morphine drip just another way to hasten a terminal patient's death? What is the difference between that and assisted suicide?

A morphine (a strong opiate that offers the best, most common approach to severe pain relief) "drip" or continuous infusion (an efficient and convenient intravenous application) is often used when a terminally ill patient is experiencing progressive or intense pain. A morphine infusion (drip) is not prescribed to hasten a terminally ill patient's death, but to provide comfort to the patient. There is a method of gradually increasing strength of pain medicines as the pain changes with disease progression. Both the dosage and type of medicine can be changed to meet the individual's unique needs for relief and prevention of pain and discomfort. Beginning with mild, to moderate to strongest medications, the physician has options to maintain control over the person's pain over time.

There is a distinct difference between the action of prescribing pain medication for a terminally ill patient and prescribing a lethal drug for a terminally ill patient. In the first case, the intent of the prescriber is to relieve pain and the drug of choice would be an opiate such as morphine. In the second case the intent of the prescriber is to purposefully hasten death and the choice of drug would be a barbiturate. While it is true that the terminally ill patient's life may be somewhat shortened as a result of the ingestion of an opiate-that is not the intent of the prescriber. Catholic moral theology recognizes and accepts this situation-calling it the "rule of double effect. " (See discussion below.) Often the person who has struggled with pain for some time may be finally able to "let go" and die peacefully once they are no longer suffering. This can happen simultaneously but is rarely a direct result of the medication. The health care providers must assess and monitor and adjust the medication to achieve the proper dose and comfort balance.

"It is worth recalling here a statement of Pius XII that is still valid. A group of physicians had asked: 'Is the removal of pain and consciousness by means of narcotics... permitted by religion and morality to both doctor and patient even at the approach of death and if one foresees that the use of narcotics will shorten life?' The pope answered: 'Yes, provided that no other means exist and if, in the given circumstances, the action does not prevent the carrying out of other moral and religious duties... death is by no means intended or sought, although the risk of it is being incurred for a good reason; the only intention is to diminish pain effectively by use of the painkillers available to medical science.'"

What is the rule of "double effect"?

The rule of double effect, found in Catholic moral theology, has a long history of use by bioethicists and philosophers as a means to resolve a particular type of ethical conflict in clinical cases. Basically the rule comes into play when a proposed action (such as administering morphine to a terminally ill patient in pain) has two known outcomes. One outcome is intended and desired (relief of pain). The other outcome is neither desired nor intended (hastening death), although it may be foreseen.

Is it wrong to offer increasingly high doses of morphine to a terminally ill patient in severe pain? Won't the patient become addicted?

No, it is not wrong-even knowing that the medicine may actually, although not intentionally shorten the life of a terminally ill person (See discussion of "double effect.") A well informed physician is not worried about "addiction" but about providing adequate pain relief. Addiction is only a problem for those who are receiving curative care and who anticipate resuming ordinary life, or who have no underlying cause for pain and are taking strong pain medicine for the emotional high or escape from the euphoria. When a physical cause for pain exists it is utilized by the body and may need to be increased over time as the body adapts to it and changes occur in condition.

One of the primary purposes of medicine in caring for the dying is the relief of pain and the suffering caused by it. Effective management of pain in all its forms is critical in the appropriate care of the dying. Patients should be kept as free of pain as possible so that they may die comfortably and with dignity, and in the place where they wish to die. Since a person has the right to prepare for his or her death while fully conscious, he or she should not be deprived of consciousness without a compelling reason.

Medicines capable of alleviating or suppressing pain may be given to a dying person, even if this therapy may indirectly shorten the person's life so long as the intent is not to hasten death. Patients experiencing suffering that cannot be alleviated should be helped to appreciate the Christian understanding of redemptive suffering. When a person is more comfortable they have the energy and ability to focus on family, relationships, living as well as possible for whatever time they have. Relief of pain can improve the time and duration of life and provide a window of meaningful celebration of one's life. Family can then use the time to share stories, have gatherings, create lasting loving memories, using the time well with good pain relief. Family's benefit from pain relief just as patient does. When one suffers, the other does too.

A terminally ill patient (or those advocating for him or her) would be wise to seek out a physician who is well informed about pain management. One of the advantages of hospice care is that the medical personnel are well informed and well trained in the application of adequate and appropriate pain medication. Adequate pain relief is a right of every person and should be expected with good hospice or end of life care as well as during earlier treatment phase, as needed.

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Exorcists Correct 4 Errors About Ouija Boards, Tell You How to Protect Yourself on Halloween

Taken from Catholic National Register By Patti Maguire Armstrong

‘Do not turn to mediums or wizards; do not seek them out, to be defiled by them; I am the Lord your God.’ (Leviticus 19:31)

“How to use a Ouija board — your guide to communing with the dead safely this Halloween,” is the title of an Oct. 25 New York Post article. But according to two exorcists who spoke with the Register, the title is a contradiction. Treading into the spirit world to communicate with spirits using a Ouija board is always dangerous.

“They say in the article that it’s dangerous,” Father Patrick [not his real name], an exorcist for almost 20 years, parish priest and former U.S. Army combat engineer, pointed out. He likened it to detonating explosives in the Army. “We were taught how to deal with them safely, but you are not around when they go off. Why would you want to be around when a Ouija board goes off? The only way to be safe is to not use it. You can’t control that dimension of spirituality.”

Any communication that occurs through a Ouija board is not your relative wishing you well from beyond the grave, but rather an evil spirit, according to Msgr. John Esseff, a retired exorcist of the Diocese of Scranton, Pennsylvania, who at the age of 95 celebrated 50 years as a priest this past May.

“The dark side has insulated itself so that people think they have some kind of protection against the darkness,” Msgr. Esseff said. “But it always ends up bringing them down. There is suffering that comes when people have sold themselves.”

The article recommends “experimenting with necromancy” while following basic rules from “experienced psychic advisors.” But both the Old and New Testaments are replete with stern warnings against it. Necromancy is communicating with the dead, such as through mediums and Ouija boards.

“Necromancy is a sin,” Msgr. Esseff warned. “Any communication is going to be from a demon.”

Father Patrick said that many people think demonic activity is fun.

“As an exorcist, I’d love to take them with me when I’m helping people having problems with demonic activity, and they wouldn’t think it’s funny. It’s dangerous.”

He explained that opening the door to the demonic can affect a person or place or both. For instance, when a house is haunted, he said the spirits can do very disturbing things.

“If you watch a movie about a haunted house, stuff like that happens. Demons can appear and manifest in different ways like in images, or moving things, or holding you down, or physically attacking. Anything that can happen to you by a person can be done by a demon.”

Here are some of the psychics’ supposed false safety rules [which are not safe rules at all!] contrasted with the exorcists’ warnings [to avoid these rules as they lead to danger]:

1. FALSE SAFETY RULE #1: “Don’t use a Ouija board alone.  "Seances should be a team sport” due to the “potential for psychological or emotional distress,” the article advised. It claimed that doing it as a group also helps process it in a “healthful way later.”

Msgr. Esseff noted that there can be group deception and darkness.

“There can also be a fake togetherness,” he said. “People come together and feel they are together and there is an element of sharing, but what they are sharing is darkness.”

2. FALSE SAFETY RULE #2: “Be polite.”

Be sure to say goodbye as a respectful farewell, which “closes the lines of communication with a proper send-off,” readers are told.

Yet, if saying goodbye to a demonic spirit was all that was necessary to end a relationship with an evil spirit, exorcists would have a lot more free time on their hands. Father Patrick recalled a student who called him from college after using a Ouija board the night before.

“You were right, Father,” he admitted, referring to a warning the priest had given in youth group while he was in high school.

“He had woken up with scratches on his back,” Father Patrick said. “I told him to go to reconciliation. The Lord allowed him to see the seriousness of what he had done. At least he showed spiritual wisdom calling a priest.”

Opening up communication with the devil doesn’t end with just a mere goodbye, according to Msgr. Esseff.

“It always begins with fun,” he said, “but it turns out disastrously.”

Sometimes the help of an exorcist is needed although often just going to confession can bring relief. “One confession is worth more than 100 exorcisms,” Msgr. Esseff said. He further explained that it restores grace in the soul, while an exorcism is a blessing to move someone toward the sacraments.

3. FALSE SAFETY RULE #3: “Set your boundaries.”

The Post’s false experts advised setting clear boundaries and keeping open communication between participants and spirits when using a Ouija board. 

Setting boundaries for dark spirits seems akin to nailing jelly to a tree. Instead of crossing God’s boundaries to stir up spirits, Msgr. Esseff recommends praying for the dead and having Masses said for them to help them reach heaven if they are not there yet.

“The person who died is benefited by that Mass,” he said. “And when a person dies, a funeral Mass assures them they are being prayed for.”

4. FALSE SAFETY RULE #4: “Maintain a positive and respectful atmosphere.”

The last suggestion says that treating “participants, and any potential spiritual entities with respect contributes to a positive experience for all involved. Happy Halloween and merry necromancing, one and all.”

A truly positive and holy experience while celebrating Halloween, according to the priests, would be to reflect its very meaning — All Hallows’ Eve, in recognition of the next day being All Saints’ Day. That includes choosing wisely for decorations and costumes.

“The reality is, that when we dress like something or wear something, we are saying that we support it,” Father Patrick said. “We wear a number shirt of our favorite football player, and we like that team. We are establishing a relationship with that number and with that team. With costumes, when we dress up as something in the spiritual world, we are establishing a relationship with that.”

Father Patrick shared that recently, he and another priest stopped at a restaurant for a bite to eat. It was decorated for Halloween full of macabre images. “I have a gift of discernment of spirits, and felt some dark spiritual activity there,” he said. “I broke all the ties and prayed prayers of protection.” Then, they found another place to eat. 

“Don’t forget that demons are on a short leash,” Father Patrick reminded. “When you let God be in charge, he offers protection.” It’s up to us who has authority over our lives, he said. “Giving God authority also allows our guardian angels to protect us. God loves us, so therefore, the angels love us.” He also recommended saying the Prayer to Your Guardian Angel daily.

Msgr. Esseff agreed. “There are so many beautiful examples of dressing your children up for All Hallows’ Eve,” he said. “With the saints, we can imitate and follow holy men and women. The beautiful saints glow like lights in the darkness of life as beautiful examples of people we should be like.”

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