End-of-life care the real battleground of moral theology, author says

End-of-life care the real battleground of moral theology, author says

End-of-life care the real battleground of moral theology, author says

In this Tuesday, June 18, 2019, photo, pro-life demonstrators gather outside the Victorian State Parliament, opposing the voluntary assisted dying laws, in Melbourne. (Credit: James Ross/AAP Image via AP.)

Father Jeffrey Francis Kirby is the author of 2019’s “We Are the Lord's: A Catholic Guide to Difficult End-of-Life Questions.” As the Church prepares to mark the World Day of the Sick on Feb. 11, which in 2020 is dedicated to end-of-life issues, Crux spoke to him about the book.

[Editor’s Note: Father Jeffrey Francis Kirby is pastor of Our Lady of Grace Parish in Indian Land, South Carolina,and an adjunct professor at Belmont Abbey College and Pontifex University/Holy Spirit College. He is well-known to Crux readers as our senior contributor, who writes a weekly spirituality column. He is the author of several books, including 2019’s We Are the Lord’s: A Catholic Guide to Difficult End-of-Life Questions. As the Church prepares to mark the World Day of the Sick on Feb. 11, which in 2020 is dedicated to end-of-life issues, Crux spoke to Kirby about the book.]

Crux: Why would you write a book about the end of life? Isn’t such a book a little morose?

Kirby: I didn’t set out to write a book about the end of life, but bioethics is where moral theology is thriving, and this is where the pastoral needs of my parishioners led me. Out of a desire to allow theology to be of some use in explaining the Christian way of life, I started writing down the most common end-of-life questions that I received, as well as the best answers and context in which they could be best understood. These exercises led me to eventually write We Are the Lord’s since I wanted to provide a helpful, easy-to-read guide to the most common questions surrounding death and dying. And so, while the subject of death and dying maybe not be one of our most joyful subjects in theology, it is one of the more pressing and pertinent subjects.

This year, Pope Francis dedicated his World Day of the Sick Message to end-of-life questions. Do you see your new book as echoing some of the pope’s themes and concerns?

Yes, I think Pope Francis also sees the pastoral needs of believers. Having the “smell of the sheep,” the Holy Father wishes to address the real concerns and questions of the People of God. These issues and themes are predominantly on the topics of death and dying. The book, We Are the Lord’s, is certainly in this spirit.

How is this book different from some of the other bioethical books and resources we find in print today?

There are a lot of really good bioethics books and some of them are written from a Catholic perspective. In my experience, however, these books rely heavily on philosophical, medical, and other fields of knowledge. Many times, these fields eclipse the theological and spiritual. In such a perspective, the warmth and hope that come from our faith are diminished. In We Are the Lord’s, I want the believer to encounter Jesus Christ and see how the teachings on death and dying are related to God’s grace, discipleship, and the promise of heaven.

Your book has a self-disclosed Catholic perspective. Would it be helpful to fallen away Catholics or to non-Catholics? Why the designation “Catholic” in the scope of the book?

Certainly, We Are the Lord’s can be for anyone. I know of some families who have returned to the faith because of the help it provided them in terrible situations. I know of non-Catholic spouses who appreciated its explanations of Catholic teachings in trying to understand the wishes of their Catholic partner. And, more broadly, the book can be read by anyone of goodwill. The “Catholic” designation was placed in the subtitle out of a spirit of honesty. If someone picks up the book, I want them to know the perspective the book uses and the worldview from which it’s written.

What is the greatest challenge when it comes to end-of-life questions?

The greatest challenge for Western believers is an exaggerated (and unrealistic) notion of autonomy. The insistence that anyone can do whatever they want, whenever they want, and however they want is, without any reference to anything or anyone outside of themselves, is narcissistic for anyone and particularly suffocating to the call of faith and discipleship in the life of a believer. As I sometimes joke, I can’t even put out my garbage can on any day of the week I want to. As someone in a community, I’m told when I can put out my garbage. If I don’t listen, then I get a fine. As human beings, we live in relationships. These relationships include God, our neighbor, and creation. Our autonomy must be tempered and matured by these relationships. This realization is a tremendous help in understanding how we can die well and in God’s grace.

It seems that your book favors Chapter 7, which is a series of direct questions-and-answers. Why wouldn’t you just compose the entire book this way?

Admittedly, Chapter Seven is the “go to” chapter of the book. It consists of the most common end-of-life questions with quick answers. The introduction of the book points readers to the chapter if they are in pressing need of an immediate answer. I wanted that chapter in there since I knew some people would pick up the book in the middle of some urgent situations. But I didn’t want the whole book to be just a huge exercise and Q-and-A. I think it’s important that, when there’s time, believers understand why we teach certain things. I think the broader context is important. Our faith shouldn’t be merely quick answers given to us by someone else. Sometimes this is needed, but other times it’s good to dive into the reasons and the justifications of the answer. This is why I developed certain themes in the book, such as the definition of dignity, redemptive suffering, burden versus benefit, and the distinction between ordinary and extraordinary care.

What are some of the more pressing end-of-life questions?

The top three most urgent questions relating to end-of-life care are artificial nutrition and hydration, pain management, and informed consent and the naming of a medical proxy. These three topics are the ones that have the most questions in areas surrounding end-of-life care.

Could you explain the whole realm of artificial nutrition and hydration? What if someone doesn’t want to be fed by a tube?

The whole area of artificial nutrition and hydration – which means being given food and water by a tube – is one of the battlegrounds of end-of-life care. As a help in understanding the opposition, the word “extraordinary” means that something is morally optional. If something is extraordinary care, then there is no moral obligation to do it.

The battle over artificial nutrition and hydration happens in large part because the medical community classifies this care – across the board – as extraordinary. But our moral teachings as Catholics takes a more holistic approach. If our bodies can still receive and assimilate the food and water, then such nutrition and hydration is extraordinary, even if it’s administered artificially.

As Catholics, we would even take such care out of the designation of medical care and place within our human vocation to provide our neighbor with a basic human need, namely, food and water. Only when our bodies are unable to receive such nutrition and hydration is it then re-classified as extraordinary care and can it be suspended.

If someone is able to assimilate food and water, but refuses such care, then caregivers have the moral obligation to persuade and assist the person in receiving it. It is helpful to remind the person that both in life and in death, we are the Lord’s. As we have lived our entire lives for him, so we are called to give him our dying process. This means that even when we are dying, we are called to follow our moral teachings and to seek a happy and holy death.

What are some take-aways for people who have been through the end-of-life process for a loved one?

After a loved one has passed, the caregivers oftentimes need a few weeks or months just to catch up on sleep. This usually suspends the grieving process for them. And so, the first take-away to a caregiver is to be patient with themselves and to let themselves rejuvenate and grieve as needed. The other take-away is the realization of their own mortality. In caring for a loved one who is dying, we are all reminded that one day we will also make such a final journey in this life. It’s a blessed realization and a graced opportunity to ask ourselves how we want to live and who we want to be with the time we have left.


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