“Accompanying someone to death through hospice happens in small steps,” according to Debbie Hoermann of Toms River, New Jersey, who accompanied her 99-year-old aunt, Edith Hipp. “It is like a candle slowly burning out,” she said of those final days. “You have the chance to say everything you could possibly say, and it makes death easier.” Hoermann was very close to her aunt, as Hipp’s three children live out of state.
Hoermann went through hospice with her mother, who died in 2010 at the age of 95. Her father died 11 years earlier, at age 89, just a week after he caught pneumonia. There was no hospice since they hoped he would get better. Hoermann said the lack of preparation for his death made it harder to accept.
Hipp stopped taking her heart and thyroid medications to let death unfold naturally. “The nurse told us she’s in transition,” Hoermann said as the time of death drew near. “Her skin is whitish, and her legs are swollen due to lack of circulation. She’s unable to speak now and not conscious very often.”
In one of their last conversations, Hoermann told her aunt, “You’re beautiful.” Hipp smiled, squeezed her hand and replied, “You’re beautiful.”
“She has been ready for a while,” Hoermann told the Register shortly before her aunt’s death. “She would often smile and point her finger up and say, ‘I’m ready.’”
Hospice care is a sacred juncture from the ending of earthly life to the beginning of the eternal. It is a philosophy of care for patients when death is expected within six months. The goal is comfort — not treatment — during farewells and preparation to meet God. It is not a place, but rather an insurance benefit, where a nurse comes for two or three hours a day to monitor how the patient is doing as they and the family prepare for death.
Hospice is especially a time for spiritual accompaniment, according to the U.S. Conference of Catholic Bishops, and a time for guarding moral principles for the treatment of the dying based on love, compassion and a respect for life. In their document “Ethical and Religious Directives for Catholic Health Care Services,” the bishops stated that care should be “rooted in a commitment to promote and defend human dignity; this is the foundation of its concern to respect the sacredness of every human life from the moment of conception until death.” Thus, euthanasia is never acceptable.
They noted that, whenever possible, dying patients themselves should be consulted, and loved ones should arrange for pastoral care, especially in administering last rites, which include viaticum (Communion for the dying), a commendation for the dying and prayers for the dead. Last rites may also often include the sacrament of extreme unction (the anointing of the sick).
Janice Willet, a pastoral care hospital chaplain in Howell, New Jersey, and a No. 1 best-selling author on Amazon, wrote Dying Without Crying to help patients and their loved ones experience the end of life with joyful anticipation. “It’s a privilege and an honor to be in someone’s sacred space when they are dying,” she explained.
She has been comfortable with dying since she was 18 and her 97-year-old grandmother had come to the end. Her grandmother sat straight up and said there were 12 people around her. “She had a beautiful look in her eyes, and her skin was glowing and translucent and beautiful,” Willet recalled. “She let out a sigh and laid back and died.”
Once, when a man was dying alone at the hospital, Willet sat at his bedside and held his hand. “You’re okay,” she told him. “There’s love around you. You can go. The angels and saints are there.” He then turned his hand the other way and gave Willet a handshake shortly before he passed away.
To make the best of the time in hospice, Willet advises people to respect the wishes of the dying. She said, “If they say, ‘I only want visitors from 2-4,’ respect that and don’t take it personally. It’s about helping them make the journey into God’s arms as peaceful and loving as possible.”
Most importantly, Willet said not to be afraid to talk with a patient about death. She acknowledged it can be hard, especially when it is a child, but that the dying are often very candid about their experiences. Willet witnessed such candor firsthand with a 5-year-old daughter of a friend. “I find children are very accepting and so full of grace,” she said. “Their lack of fear helps give courage to the rest of the family.”
While hospice has many blessings, Dr. Lisa Honkanen, a geriatrician in East Northport, New York, with a medical practice dedicated to the homebound elderly, warns against ignoring easily correctable situations. “For instance,” she said, “a urinary tract infection is often easily remedied with antibiotics, but untreated it can cause serious distress.” Honkanen also cautions against overmedication. “Patients not in severe pain usually do not need controlled substances, which are often overprescribed and with too high of a dose,” she explained. “Of course, you don’t want to deprive a loved one of needed pain management, but sometimes the recommended regimen is too aggressive.” As the disease advances, Honkanen said they may need higher doses, but in older, frailer patients, starting with small doses is important to avoid unnecessary sedation and side effects, including premature death. “If you are concerned about overdosing, usually sedation or excessive sleeping is the first obvious sign,” she said. Unless there is a serious need to continue those doses, she said that a decrease is likely warranted.
Patients should not be deprived of consciousness out of convenience, she said. “This medical option should only be used in rare instances,” Honkanen said. “In the case where it is morally appropriate and there are no other alternatives to relieve the patient’s symptoms, make sure the patient has received the sacraments and spiritual ‘loose ends’ have been addressed.”
Father Stefan Starzynski has been a full-time chaplain for more than four years at Inova Fairfax Hospital in Virginia, a 1,000-bed facility. For someone dying, he offers last rites and especially the anointing of the sick as part of these rites for the dying. According to the Catechism of the Catholic Church on the anointing of the sick: “This last anointing fortifies the end of our earthly life like a solid rampart for the final struggles before entering the Father’s house” (1523). He also offers the apostolic pardon, which is an indulgence offered to the dying for the remission of punishment due to sin. “Then I do the Litany of Saints and the Chaplet of Divine Mercy,” Father Starzynski said.
Father Starzynski said that the prayers and sacraments bring peace and help people struggling with their faith at the end. He encourages loved ones to pray the Rosary and Divine Mercy Chaplet with the patient.
He also provides some pastoral advice, warning loved ones against oversedating a patient and advising them to let the patient know that he or she is not a burden. “So often, they feel that they are,” he said. Once a patient is prepared, Father Starzynski said that the family should let them go to God. “I see hospice as a human response to this: helping to prepare the patient and family for death,” he said. “It is one of the most beautiful parts of this ministry, escorting a soul into heaven with prayer.”
Deb (Liffrig) Kaul, a nurse for 15 years with Hospice of the Red River Valley in Fargo, North Dakota, said that it was a privilege to accompany the dying: “The superficial focus goes away then, and people care about what is most important: their spiritual walk, relationships and healing and forgiveness. It was gratifying to see those things happen.”
In that way, she said that although a terminal diagnosis is often hard, she witnessed the opportunity it is for people to decide what they want to do with their remaining time on earth.
One memorable patient in his 70s looked forward to his death because, years earlier, he had a near-death experience where he saw his body below and was drawn to a beautiful light. “He was disappointed when he was pulled back,” Kaul said.
“He told me, ‘I can’t wait to die. I got a taste of what it was like.’”
As Kaul added, “Not everyone feels ready to leave loved ones, but their time to say good-bye is sacred. I always felt like I was walking on hallowed ground.”
Patti Armstrong writes from North Dakota.
Ensuring Proper Care
According to gerontologist Dr. Lisa Honkanen, it is morally imperative to remember that food and water, even when administered by medically assisted means, are considered ordinary care due to all patients.
Unless a patient is imminently dying (in which case food and water will not make a difference), nutrition and hydration should be provided except if there is a medical contraindication against it and providing such actions would pose a great burden to the patient (inability to absorb/assimilate it, causing pain, etc.).
It is not wrong to request a feeding tube to assist with providing food and water even though most hospice providers will discourage that even when it is morally appropriate.
Listen to your instincts, ask questions, and seek good advice. The National Catholic Bioethics Center is available to assist in these difficult situations, at NCBCenter.org or (215) 877-2660.
Above all, pray, and trust in God!
— Patti Armstrong