As mentioned earlier, Di Carter and I attended one of the main presentations given at the recent Parish Life Conference of the Antiochian Archdiocese here in Cincinnati. I asked Di to please write up a summary of the presentation by Drs. Dan and Jane Hinshaw on suffering and death from the perspective of being both physicians and Orthodox Christians. Her fine summary is below, together with an addendum to an excellent example of a durable power of attorney concerning end of life issues by Fr. Roman Braga. I believe that we desire to both live and die as Orthodox Christians. Both Drs. Hinshaw and Fr. Roman present, in these two diverse ways, a genuine witness to that desire.
I would like to introduce these two texts that you will hopefully read with care, with a further quote from Dr. Tristram Engleheart, a prominent Orthodox ethicist, that is both provocative and challenging:
"Few individuals will sell all that they have to pursue eternal salvation, while many will sell all they have to receive a few more years of earthly life."
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Doctors Dan and Jane Hinshaw are a husband and wife team from the University of Michigan whose primary concern is to address the issues relating to suffering and death from the perspective of both Orthodoxy and the medical profession. Father Steven and I were privileged to attend a conference at which they spoke. Their talk was excellent and very comprehensive.
The Orthodox Church has much to say about the theological understanding of death. The Hinshaw’s talk translated this theology into a practical response to the current approaches in this country to the care of the dying. Their first talk dealt with suffering at the end of life where they explored the understanding of suffering within the context of the multiple dimensions of ‘Total Pain’. Because a person is not just a physical being but rather a psychosomatic unity, pain needs to be understood in its totality – physical, psychological, social and spiritual – and all of those elements of pain need to addressed when caring for the person. Indeed, Doctor Hinshaw maintained that unresolved spiritual, social or psychological pain can cause physical pain to be unresponsive even to massive amounts of narcotic pain relievers. The integrity in the psychological, social and especially spiritual domains of the person can minimize physical distress. And so the goal of palliative care is the achievement of the best quality of life for patients and their families.
The Hinshaws maintain that access to and delivery of pain treatment and other palliative measures are seriously deficient in the present health care systems in the United States. Rather, the focus is on curative treatment where, at the time of diagnosis, great energy and resources are expended to effect a cure. Often little attention is paid to the patient’s primary concerns unless they coincide with the curative treatment goals. If this treatment fails the patient is told “there is nothing more we can do” and referred for palliative care. Typically this happens very late in the course of the illness leaving little time for addressing the many serious issues the terminally ill need to confront. The Hinshaws recommend an alternative approach which incorporates palliative care at the outset of treatment and, if the prospect of cure diminishes with time, the steady increase in caring for the patient’s total needs continues seamlessly to the end.
The importance of all of this was not seen simply as a more compassionate model, but also from the conviction that the end of life is a critical time for growth and that there is important work to be done as we approach death. In fact, it can be a time of true healing; the healing of relationships, repentance, finding meaning in suffering, and spiritual growth. It is not possible to do these things if we are in too much pain or if we are too medicated.
Doctors Dan and Jane also dealt with the practicalities of the living will, and durable power of attorney for healthcare. They made available a copy of an addendum to a durable power of attorney which was written by an Orthodox priest and which could be used as a model for us (see immediately below this article).
Unfortunately, even with the best of efforts, palliative care can relieve most but not all terminal suffering. In a culture which does not recognize any value or potential good associated with human suffering, this ‘deficiency’ has opened the door for advocates of physician-assisted-suicide (PAS) and euthanasia. We were warned that this slippery slope is real. PAS is legal in Oregon and Washington State. Similar legislation was defeated in Michigan and other states but we will see future attempts to get the law changed.
We then heard from Father Paul of St Elias Antiochian Church in Sylvania Ohio. In response to these deficiencies in the healthcare system this parish is planning to launch St Elizabeth’s Ministry and Home for the Dying. They are going to begin by running a palliative day care centre which would combine the best of adult day care with respite care for individuals enrolled in hospice in a venue provided by the church. Hospice would provide the medical oversight and volunteer training. The parish would provide the volunteers, use of the parish hall, food, recreational activities etc.
The talk was punctuated throughout with quotations from Orthodox theologians and saints, including this one from Father Alexander Schmemann:
“In Christ suffering is not “removed”; it is transformed into victory. The defeat itself becomes victory, a way, an entrance into the kingdom and this is the only true healing.”
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ADDENDUM TO MY DURABLE POWER OF ATTORNEY FOR HEALTH CARE
I am an Orthodox Christian and an Orthodox Priest, I make this statement of my wishes a part of my Durable Power of Attorney for Health Care. If 1 am not competent to make my awn health care decisions. 1 state that I want all decisions about my medical care to be made in accordance with this document and my Durable Power of Attorney for Health Care.
Orthodox Christians believe that in death life is transformed by the power of Christ's death and resurrection into eternal life. Because of this belief, it is not always necessary to use every possible means to resist death. I ask that if I become terminally ill that I be fully informed of this fact so that I can prepare myself spiritually and emotionally for my eternal destiny with God.
If I am not competent to make my own health care decisions, I direct that the following be done for me. I direct that my advocate (and any agent, surrogate or health care provider) carry out my wishes expressed here and that I be cared for in accordance with Holy Tradition and the teachings and values of the Orthodox Christian faith.
If I am dying or in an irreversible coma or persistent vegetative state and there is no hope for recovery, I direct that no death delaying treatment be started or continued for the sole purpose of prolonging my life. I direct that I be given medications and treatments to relieve pain even if this results in shortening my life, but not for the purpose of ending my life.
I ask that I be cared for by my Christian community, family, friends and health care providers in a dignified and compassionate manner. Please keep my mouth and lips moist, please touch and comfort me and please read my favorite prayers and passages from the Bible to me. Please ensure that I am given the opportunity to receive the Sacraments. I ask my Christian community, friends and family to join me in prayer as I prepare for death and that they continue to pray for me after my death. Please care for
me in accordance with Holy Tradition and the teachings and values of the Orthodox Christian faith.
I direct that after my death, my body be handled in accordance with Holy Tradition and the teachings and values of the Orthodox Church. If I have donated any of my organs or if there is an autopsy preformed on my body, it should be done in a manner that will best prepare my body for an Orthodox Christian funeral and burial. I ask that I be buried in accordance with Holy Tradition and the teachings and values of the Orthodox Church.