REVIEWED BY FR. KEVIN O’ROURKE, OP, S.T.M., J.C.D.
DEATH WITH DIGNITY: ETHICAL AND PRACTICAL CONSIDERATIONS FOR CAREGIVERS OF THE TERMINALLY ILL
BY PETER CLARK, SJ, Ph.D.
University of Scranton Press, 2011
251 pages, $20
After briefly explaining the ways in which the culture of death has changed over the last few decades and defining the elements of a "good death," author Peter Clark, SJ, states: "This book will attempt to address these complex issues and other confusing issues in a practical way so that patients, family members and health care professionals will have some guidance dealing with end-of-life issues."
In so many words, Fr. Clark describes the purpose of Death with Dignity — then he admirably fulfills that purpose with a compete account of the issues that complicate the act of dying or confuse dying patients' families, caregivers and clinicians.
The major considerations are the definition of death; the definitions of ordinary and extraordinary means to prolong life; the meaning of medical futility; advanced directives such as Do Not Resuscitate orders, living wills and durable powers of attorney; pain management, palliative care, hospice and, finally, spirituality and end of life. The various topics are supplemented when necessary by documents that explicate them.
A main attraction of the book is its inclusion of clinical cases and clinical and personal experiences that give life to the many practical problems under discussion. Clearly, Fr. Clark's experience as ethicist for a group of Catholic hospitals, combined with his role as professor of bioethics and director of the Institute for Catholic Bioethics at St. Joseph University in Philadelphia, give a firm and personal explanation to the issues considered.
Perhaps the most useful section of the book explains the history and interpretation of Catholic theologians' teaching in regard to ordinary and extraordinary medical means to prolong life. The author discusses Pope John Paul II's March 2004 statement on care for patients in a persistent vegetative state, a papal address that some thought counteracted the traditional teaching of the church — that is, applying to individual cases the criteria of benefit to the patient and of excessive burden from the patient's perspective.
John Paul II's address seems to counteract these criteria. Without denying the validity of the papal allocution, Fr. Clark points out the problematical implications of applying the pope's statement beyond persistent vegetative state patients to all dying persons, and the possible conflicts that might occur with the civil law in some states in regard to patient care. It might have been beneficial if Fr. Clark had included a reference to John Paul II's later, more general statement on the theme made in November 2004 to the International Conference of the Pontifical Council for Health Pastoral Care.
The consideration of this section concludes with "Rules of Conscience in Moral Decision-Making" and demonstrates the proper method of applying a non-infallible moral teaching. Anyone seeking to apply the papal allocution would do well to study this section
I believe the title of the book could be misleading. Does dignity accompany death in most cases? The author agrees that the two words are not to be used in tandem without great effort on the part of caregivers. "To die with dignity and respect is not an easy task because dying is never dignified," he writes. Caregivers, then, must be more concerned about giving patients a reason for hope than about "denying death"; an attitude which seems to dominate the medicine and technology surrounding the dying person today.
When the publisher reprints this valuable work, it would help to place the book's notes at the end of each chapter, and to revise the bibliography so that it is more representative of the Catholic tradition that the book faithfully presents.
From the editors: CHA and Health Progress are saddened by the death of Fr. Kevin O'Rourke, OP, the noted health care ethicist and canon lawyer. Fr. O'Rourke, age 85, passed away on March 28, 2012, in Chicago. He was a frequent contributor to Health Progress and will be greatly missed.