By Sandra Lucas
When I was in CPE, I never learned about the Ethical and Religious Directives of Catholic Health Care Services, but it became an important resource after I got a job at a Catholic facility.
Now, when others arrive at Mercy Health in Youngstown, OH, in the same situation, Deacon Paul Lisko is the one who teaches them. Paul has worked in the spiritual care department for 16 years and is currently the site supervisor at St. Elizabeth Boardman Hospital. Before this position, he was the director of nuclear medicine in the same healthcare network. When Paul was in his diaconate training, he made a decision to change professions and he became a chaplain.
I chose to interview Paul about the Ethical and Religious Directives because he teaches the subject to CPE students, medical residents, and other hospital staff at Mercy Health as well as to the deacons of the Roman Catholic Diocese of Youngstown.
Q. Can you identify some areas in your ministry as a chaplain that you had to learn on the job?
A. There are two areas where I had a big learning curve. The first area was organ donation. The second was medical ethics. I had no training in either area in CPE. Fortunately, I was able to attend a 13-week course through the Ohio organ donor organization which prepared me for the role that spiritual care has on the transplant team. For my ethics training, the mission director at that time made arrangements with an ethics professor at Youngstown State University to present extensive classes in medical ethics to better prepare the chaplains in our role of coordinating ethics conversations and consults.
Q. What was your familiarity with the ERDs during CPE?
A. As a new chaplain, I had little familiarity with the Ethical and Religious Directives, and it was not something I learned in CPE. And I didn’t receive instruction in the ERDs in my diaconate training, although I now teach the ERDs to new and current deacons.
Q. What aspects are the most critical in our understanding of the role and mission of a Catholic healthcare facility?
A. Part One on social responsibility is critical in shaping the foundation and practices of Catholic healthcare. That section names the principles that inform the Church’s healing ministry, which include a commitment to human dignity, the biblical mandate to care for the poor, and our responsibility to contribute to the common good and to exercise responsible stewardship. (pages 7-8)
The purpose of the ERDs is to provide a moral compass for those of us working in Catholic healthcare, including administrators, physicians, chaplains, sponsors, trustees and all healthcare personnel. When I teach the medical residents about the ERDs, I tell them, “You don’t have to believe it or accept it, but working in a Catholic healthcare facility, you have to abide by it.” Once they become more familiar with its principles and see that everything is based on the dignity of the human person and the sanctity of all human life, their understanding and acceptance grows.
Q. If you were to pick one or two chapters of the ERDs that would be mandatory reading for all chaplains, which would they be? And why?
A. I’m not sure I would make any of it mandatory. However, I think all chaplains in Catholic healthcare should have a working familiarity with the whole booklet, especially Parts Two and Five.
Part Two, “The Pastoral and Spiritual Responsibility of Catholic Health Care,” clearly states that medical care for a patient is incomplete without including the spiritual dimension of a person. It points out that pastoral care within a Catholic institution needs to encompass “the full range of spiritual services, including a listening presence; help in dealing with powerlessness, pain, and alienation; and assistance in recognizing and responding to God’s will with greater joy and peace.” (p. 11) That’s the part that should be mandatory for chaplains — to be a listening presence, yes, but also to have the skills and training to recognize, and minister effectively, in areas of spiritual distress and spiritual pain.
It’s also important to be familiar with Part Five: “Issues in Care for the Seriously Ill and Dying,” especially when working with physicians and families in conflict around end-of-life medical care. Often the chaplain is the facilitator of communication and understanding about patient choice, patient rights, and what constitutes extraordinary means.
Q. What are your expectations for chaplains who are not Catholic to have of the ERDs?
A. My expectation is that all chaplains know the ERDs well. We work with patients and families from diverse religious backgrounds. And families often look to the chaplain to provide guidance in making decisions about end-of-life care.
Q. What role do the ERDs play in your pastoral encounters with patients and families? Can you give an example?
A. Recently a Catholic family member expressed gratitude to me because I was with her loved one when a decision needed to be made about withdrawing life support. When the family understood that it was OK to withdraw life support, it lifted a huge burden. Even though it was still hard to say goodbye, they were able to do so in peace knowing they were supported in their decision by their church.
Q. There has been controversy about Directive 58 and its revision. What is your understanding?
A. Some wording changed in the fifth edition of the ERDs, but the bottom line is still the same. The patient can forgo or withdraw medically assisted nutrition and hydration when it becomes “excessively burdensome for the patient or would cause significant physical discomfort” (p. 27), in other words when the burdens outweigh the benefits.
The Church reminds us in Part Five that “God has created each person for eternal life” and that “We are not the owners of our lives and, hence, do not have absolute power over our life.” (p. 25) In our ministry as chaplains, we encounter patients, families, physicians, and healthcare providers who think that life is to be extended, at all costs, through the assistance of medical technology. The ERDs help us come to the understanding that we ultimately serve God as we serve the well-being of our fellow human beings.
Sandra Lucas, BCC, serves on the Editorial Advisory Panel for NACC. She is the regional director of spiritual care of Mercy Health, in Youngstown, OH.
All excerpts are from the “Ethical and Religious Directives for Catholic Health Care Services” Fifth Edition, United States Conference of Catholic Bishops, 2009.