Listening to what patients are saying rather than assuming knowledge of what’s best for them was a key theme at talks presented in April at a meeting of Catholic medical professionals in the Pontifical College Josephinum’s Jessing Center.
“If you don’t have a good relationship with the patient, forget it. It doesn’t matter how many degrees you have,” said registered nurse Teresa Sipos, chaplain of Appalachian Behavioral Healthcare in Athens, at the beginning of a presentation on “A Catholic Response to the Mental Health Crisis.”
Dr. Natalie King of St. Elizabeth Healthcare in northern Kentucky, speaking on “End-of-Life Decision Making and Palliative Care,” talked of the challenges physicians face when patients are near death.
"Often, when we are fighting disease, we can lose sight of the person behind the disease. When a patient is succumbing to sickness despite our best efforts, we can feel like we've lost and we are a failure. We must keep the patient, who they are, and their values and beliefs in the forefront and remember that mortality is universal to the human condition."
“The Vocation of the Catholic Medical Professional” was the topic of a talk by Drs. Paul Day and Amber Day, a married couple with respective practices of pediatrics and family medicine in Cincinnati. They spoke of qualities such as docility, sincerity, meekness and magnanimity, which are related to the cardinal virtues of prudence, justice, temperance and fortitude.
“Docility, for instance, has been given a negative connotation by society, when what it means is a willingness to be taught and to say, ‘I don’t know,’” Amber Day said. “This is a rejuvenating and refreshing thing. It opens you up to learning and opens patients to responding because they know you’re listening.”
Those talks were among seven presentations made Saturday, April 22 during a program on “Catholic Medicine in a Secular Society.” It was the second event in what is to be an annual series titled “Converging Roads,” sponsored by the St. John Paul II Foundation, the Diocese of Columbus and the Catholic Medical Association (CMA) of Central Ohio.
Addressing the quality of sincerity, Paul Day described it as “truthfulness, honesty and an enthusiasm to work with others. Genuineness is a challenge here – not being manipulative to get the decision we may desire. Sincerity isn’t trying to treat patients in an impersonal manner but being open to what they say and practicing what we preach. Are we willing to be open to them?”
“Meekness is another quality that’s often misinterpreted,” Amber Day said. “It’s not being a doormat but having a serenity of spirit while focusing on the needs of others, allowing yourself to be malleable, maintaining inner peace by avoiding fear.”
Paul Day described magnanimity as “the quality of seeking with confidence to do great things with God’s help, having a large soul. It’s a balance between egocentrism – ‘I can do it all’ – and inadequacy – ‘I can’t do anything.’”
The Days described the miracle of the loaves and fishes as an example of magnanimity: “The Apostles had a few loaves and fishes. Jesus said, ‘Bring them to me. That is enough,’ and everyone had enough to eat, with 12 baskets of leftovers. If we bring the gifts we have to Him in the same way, He will multiply them.”
The couple, who met at a CMA event in Columbus, spoke of Sts. Gianna Molla and Joseph Moscati, Italian physicians who lived in the 20th century, as models for Catholic physicians to emulate. The couple was asked if their shared profession made their marriage stronger, Amber Day replied that it had, describing the CMA as “a uniting factor for us” and quoting from a plaque in the couple’s home which says, “Marriage is looking outward together.”
Dr. King began and ended her presentation on palliative care and end-of-life issues with a photo of a forest displaying bright autumn colors. “A leaf in the fall is most beautiful just before it dies,” she said. “I see so much beauty in my work with the seriously ill and those nearing end-of-life, encountering them in the richness of their personhood. It is truly a gift and a privilege to accompany patients and their families during this time."
She said that although palliative care has become a familiar phrase in this century and the last part of the 20th century, many people do not fully understand what it means. “Palliative care in a Catholic context provides for those with serious illness nearing the end of their lives, doing so with dignity and consistent with Catholic teaching,” she said.
Because of continued medical advances, “suffering today is really tough because we’re not sure how to respond to it. We’re uncomfortable with it as a culture. Technology allows us to live longer but requires frequent, sometimes difficult interventions. Just because we can do something doesn’t mean we should.
"Our culture often operates with a sense of denial of mortality. We look at death as an attacker from the outside to be resisted, rather than originating from within as a part of the human condition. Therefore, death, and any suffering related to it, should be avoided at all costs."
Advances in medical technology have made the end-of-life period of someone's life often longer, and more difficult to define and predict. Medical decisions around this time of life can be complex and wrought with stress. Dr. King highlighted the Ethical and Religious Directives for Catholic Healthcare Services, from the U.S. Conference of Catholic Bishops, which provides guidance around these tough issues.
King said the key to a Catholic response to end-of-life issues is what the directives prescribe as proportionate care. “Proportionate means are those that in the judgment of the patient offer a reasonable hope of benefit and do not entail an excessive burden or impose excessive expense on the family or the community,” the directives say.
“A person may forgo extraordinary or disproportionate means of preserving life. Disproportionate means are those that in the patient’s judgment do not offer a reasonable hope of benefit, entail an excessive burden or impose excessive expense.”
One example of proportionality involves the use of feeding tubes for nutrition and medication. This is considered as ordinary basic care, but when death is imminent and a patient is unable to take in food or medication, it can be disproportionate, depending on the situation.
“It becomes a case of balancing extremes,” King said. “How to live well without clinging to life, and how to die well without ignoring the dignity of life, especially in cases where we cannot cure. There is no strict right or wrong. The question becomes, ‘What good (or harm) can this do for the dying person?’
To help with navigating these challenging scenarios, King spoke about the medical specialty of palliative care. “Palliative care provides an extra layer of support for people at any age and in any stage of an illness, along with curative treatment,” she said. “It’s a team effort using many professionals to treat physical symptoms as well as psychological, spiritual and social issues and to coordinate advanced care planning and set goals of care using a total person approach.”
She also spoke of the importance of advanced medical directives (AMDs), which are legal documents that provide instructions about a patient’s health care when they are unable to speak for themselves because of a medical condition. These include living wills and durable medical power of attorney documents.
King said all advanced directives for Catholics should provide a declaration of the desire for care in accordance with Catholic teaching, the importance of assessing that care to determine whether it is proportionate and a rejection of assisted suicide.
King also worked to correct many commonly held misconceptions around hospice care. Hospice is appropriate when patients have a serious illness with a life-limiting prognosis and decide not to further pursue disease-directed healthcare interventions. They and their families decide to shift to pursue comfort-directed care, most often in their own home, surrounded by their loved ones. She shared how hospice is not a place, but rather a philosophy of care that comes to where the patient lives. Hospice workers help to relieve symptoms of disease to help people live their lives to their natural death, in a setting of peace and comfort.
Sipos’ talk on a Catholic response to mental health issues focused on her work in Athens and at the Maryhaven behavioral health center in Columbus.
“Most of my patients have been involuntarily committed, usually by court order, following a crime and have been diagnosed as having schizoaffective disorder, often because of substance abuse. But if you listen carefully to them, you will find many cases of extraordinary spirituality,” she said.
“Part of the treatment at Appalachian Healthcare and Maryhaven is spiritually based. About one-third of my patients regularly attend spiritual care group, and a lot have talked to me about the holiness and dignity of life.
“I love the patients I work with. I ask them about the value of suffering, and they give profound answers, beginning with ‘I am alive.’ They understand that suffering has brought them to a place of understanding.
“They are not having a difficult day; they are having a traumatic life, which many of them have endured for decades. This gives them a perspective many do not have in a superficial, secular world,” Sipos said.
“Many of them had bad experiences in the emergency room, of being talked down to. Some of them have been incarcerated and suffered horrible treatment in jail, especially the women, and have developed unhealthy survival skills.
“One of my patients ‘accidentally’ painted the face of Jesus on a canvas, with a Sacred Heart image on the other side. There was no way the paint ‘bled through’ to make that image. He didn’t know it was there, and it looked like a real human heart.
“He also painted images of Mary on a lake and Peter receiving the keys to the kingdom. He didn’t have any religious upbringing or art training. These came from the spirituality which had formed inside him in spite of living a hard life.
“As a chaplain, I’ve seen several instances where patients’ real spirituality wasn’t accepted by people in authority. One man said he talked to God, and you could see his face shine like that of Moses when describing these encounters. A psychiatrist tried to give him involuntary psychiatric hospitalization and force him to take antipsychotic medication for being spiritually delusional.
“But he was able to get a public defender who was a practicing Catholic and ordered a second psychiatric opinion. The second psychiatrist and the judge did not find the man psychotic and released him immediately.
“In another case, two believing Christian women in a state psychiatric hospital were labeled spiritually delusional. After a believing advanced-practice registered nurse ordered faith-based counseling for them, the diagnosis for them was rescinded. There are many other cases like this.
“I see my patients loving each other,” said Sipos, who also chairs the Columbus council of the National Association of Catholic Nurses. “Please take good care of them. Like the abandoned people that Mother Teresa served who were dirty, smelling and dying, they are the face of God.
“As she said, ‘Do all things with great love.’ In loving one another, through our works we bring an increase in grace and a growth in divine love. We greatly underestimate the power of prayer and the difference it will mean in our world,” Sipos said.
Other speakers and topics were Dr. Ashley Fernandes of Ohio State University and Roland Millare of the St. John Paul II Foundation on “Christian Anthropology as a Foundation for Ethical Medicine”; Dr. Dominique Monlezun of the University of Texas MD Anderson Cancer Center on “Catholic Social Doctrine and Its Implications for Health Care”; Dr. Alicia W. Thompson of Westerville on “Infertility and Artificial Reproductive Technologies”; and Drs. King and Thompson and registered nurse Michele Faehnle on “Ethical Challenges in Accompanying Women With Holistic Medical Care.”
Bishop Earl Fernandes, Dr. Fernandes’ brother, gave opening remarks, and the program closed with Mass and a reception.
About 100 people attended, including several laypersons, among whom was Barbara Distelhorst of Powell St. Joan of Arc Church, who registered on the day before the conference.
“My husband’s father had been a doctor, and my husband was a lawyer, and I understood all the conflicts that are out there today,” she said. “So, I came because I wanted to listen to what the Catholic medical community has to say.
“I need encouragement where all of this (bioethics) is concerned because I’m older, so I know what we’ve come from. And I’m grateful, I am encouraged. I’m taking hope away from this.” Distelhorst had her registration fee refunded by winning a raffle among last-minute ticket purchasers.
During the lunch break, medical professionals recited the Promise of the Catholic Health Care Professional, a variation of the Hippocratic Oath, and the CMA presented its annual awards.
The St. Luke Faith and Reason Award for fourth-year medical students was presented to Dr. Ansel Malin, who will be graduating from the Ohio State University medical school later this year. Pro-life pharmacists Dorie and Greg France were recipients of the St. Mother Teresa Service to Medicine Award for nonphysicians.
Dr. Dennis Doody, a pediatrician for more than 40 years who was among the founders of the CMA, received the St. Gianna Courage in Medicine Award for physicians or priests. The Pope St. John Paul II Culture of Life Award for organizations exemplifying the CMA’s mission and values went to the Women’s Care Center of Columbus and was accepted by center representatives Madeline Pesavento and Katie Beiter.
