By Rosemary Lewallen
St. Irenaeus Health Ministry held a workshop on Advanced Directives Thursday, April 3, that focused on how you want to live your last days rather than on dying. Fr. Romeo Ascan, AM gave the opening prayer. Then Jennifer Dagarag, RN, and Faith Community Nurse, introduced herself and Rebecca Freeman, Pastoral Care Coordinator for the Diocese of Orange.
Jennifer Dagarag, RN, has seen it all regarding end-of-life care in her 27 years as a nurse: the good, the bad, and the ugly. She advocates for “whole person care,” which is a statewide initiative that promotes preparation for your death by making your wishes known in writing in consultation with your family and choosing your healthcare proxy who can make medical decisions for you if you cannot speak for yourself. The document that accomplishes these objectives is an Advanced Directive.
The steps needed to create an Advanced Directive were delineated. First, pick a healthcare proxy, someone who will follow your wishes, and a backup proxy. The proxy and backup proxy must be at least 18, clearheaded, willing to honor your wishes, even if he or she disagrees with them, and available when you need them. The second is to prioritize your values. Attendees at this workshop played the game, “GoWish,” to choose their most important wishes for end-of-life care based on their personal values.
Nurse Jennifer made a distinction between “ordinary care” and “extraordinary care.” Ordinary care is beneficial, such as nutrition and hydration. Extraordinary care is excessively burdensome. Four factors of patient burden are excessive pain, great financial cost, grave effort, and severe dread or repugnance. The Catholic Church does not insist on extraordinary care at the end of life but allows for a natural death (AFND) while keeping the patient comfortable. Regular pain management assessment is necessary for healing and lowers the risk of addiction. Regular assessment and management of pain is necessary for patient comfort and healing.
Jennifer explained when CPR is necessary. CPR is done when a person is not breathing, and the heart is not beating. It is most effective when the patient is young and fit with no major health problems. It requires vigorous pushing on the chest at a 2” depth, 100-120 pushes per minute. Ribs may be broken. The patient who responds to CPR will always be intubated and sedated. After two weeks of intubation, a tracheostomy is an alternative. This allows the patient to be active and awake and can be temporary or long-term.
Organ donation was also discussed. The Catholic Church does not consider it obligatory, though it is considered a meritorious act. Note that in California, if you mark “yes” on your driver’s license form on organ donation, that can override the wishes of your family surrogates when you die.
Nurse Jennifer encouraged Catholics to receive the sacrament of Anointing of the Sick and add this request in their Advanced Directive. This sacrament is no longer referred to as Extreme Unction. Anointing of the Sick includes anointing with oil, penance, and receiving the Eucharist. It is spiritual preparation for passing into eternal life. Call early to request a priest for the Anointing of the Sick before surgery or for terminal disease.
The “take home message” from this workshop was to open the conversation about your death with someone you love. Be sure to tell your proxy that you have chosen them. Planning for how you want to live your last days is well worth the effort.
For further information, reach out to Jennifer Dagarag RN at jdagarag@sticypress.org or call St. Irenaeus Parish at 714-826-0760.