Respect Life—Have the Conversation

When we think “respect life” we usually think of the unborn.  They are the most vulnerable and should be at the top of our list of those whose lives we want to respect. Here are some good resources to use for Respect Life Month.

But there is another class of vulnerable persons whose lives deserve more respect: the elderly.  They too are at “the edges of life,” just as unborn children and infants are. In the last two years,  COVID has brought to light the many weaknesses in our elder care system, e.g., 

• Poorly staffed long-term care facilities, often the result of inadequate funding, especially for Medicaid patients. 
• Inflexible care options which often focus only on nursing homes, which is the last place most people want to end up.
• Excessive focus on clinical issues, sometimes to the exclusion of spiritual issues. 
• Also, lack of effective coordination between acute care (hospitals) and long-term care; the elderly, who cannot speak up for themselves, end up caught in the middle. 

In a recent book, (Losing Our Dignity: How Secuarlized Medicine is Undermine Fundamental Human Equality) Charles Camosy cites many examples of the crisis in senior care, He says one of the main problems is that “Contemporary medicine is often geared to avoiding or forestalling death – which is at odds with a religious approach that emphasizes the reality of death and highlights the limitations of medicine to avoid or forestall it.”  

Also, see some of the goals of Leading Age, an important organization that seeks innovative ways of providing better senior care.  They recommend: 

• Advocate for public policies that safeguard the industry from laws and regulations that impede a long-term care provider’s ability to provide quality care in an efficient and cost-effective manner
• Provide for appropriate reimbursement levels for care and services
• Promote the development of a seamless continuum of care
• Allow consumers to receive care in the most cost-effective, appropriate, and least-restrictive setting
• Providing information, programs and services so members can proactively implement systems and processes to achieve regulatory compliance
• Promoting innovative and creative care delivery models
• Increasing the public’s awareness of the unique value offered by mission driven providers
• Enabling members to maximize their limited financial resources and direct them toward quality resident care
• Preparing members to proactively meet the challenges they face from a changing demographic marketplace and increasing regulatory climate

There is a Catholic tradition of “the happy death.”  We need to redefine that today, in an era when there is so much health care available.  How do we choose well, and not just choose “everything?” 

It is well known that care at the end of life is too expensive (care in the last year of life accounts for 10% of our total health care expenditures, and up to 25% of all Medicare expenditure);  often inappropriate – that is, it does not help the patient –, and that it does not respect the patient’s wishes. Worse, our clinical focus often does not allow patients the opportunity to prepare for death or to think about what “the happy death” would be for them.   Many times patients, especially the elderly are so medicated that they can’t make decisions or express their wishes. We focus on “what to do next,” instead of how do I prepare for my death.

“Having the Conversation.” 

Many of these problems could be avoided if people “had the conversation” about end-of-life care before they are unable to do so. Almost every high-profile case involving end-of-life care was the result of family conflict, because the patient’s wishes were not known and because the patient had not named anyone as attorney for health care matters. 

The Gospels for all four weekends this month show Jesus in conversation with his disciples; clarifying, asking them questions, helping them to understand, especially in view of eternal life. 

He provides a perfect model for the conversations we should have with those who are likely to care for us or to make decisions for us as we near the end of life.  
Having these conversations is an excellent way to “respect life” in the aged and dying.  We should design these conversations in a way that enables us to talk about what kind of care we would like, what is important to us as we prepare for death, how our faith in eternal life shapes how we want to make that passage from death to life. 

Check out The Conversation Project for suggestions about how to have a fruitful discussion about end of life. It is an excellent way to reflect on the gift of life as well as our mortality.  It is also an excellent way to respect the aging and ill, by bringing them into this holy conversations