hello, behalf of the archdiocese of san francisco, welcome to tran90 we have experts in bioethics, we will talk with them about something that none of us can live without. you won't think it is a joke if i say that none of us can live without dying. it was a joke in the old jackie gleason routine in the straightman asked jackie have you lived your whole life in brooklyn? any answer, not yet. and that captures our situation, we are not dead yet but we will be.

now 100% of us must di someusnyuswill accompany our loved ones to enter death. a smaller group a few of us will be among the professionals, the medical and support people whose vocation is to aid and guide the sick and dying. how does any of us in any of these categories approach these tasks? how is it charging these great responsibility is, what we need to know and understand and do. important questions and after this brief rake please join us for a catholic conversation on death and dying.

hello and welcome to mosaic. we are talking about death and dying. a serious subject with some lively people as guests. very entertaining and very interesting and knowledgeable, bioethics experts. this is vicki evans and vicki, on your title i put cpa and stl beauty work as a cpa that is her vocation but i know that you are also a writer, a giver of workshops in end-of-life issues and i understand that you've got an advanced degree, which is stl. so you are a licensee of

theology fits you are advanced. and you're working with the archdiocese of san francisco. what is your title? >> i am the respect life coordinator, the department of human life and dignity. i've been there for 15 years and spent four in rome getting my degree from the pontifical university. and then i came back and now i speak on the subject in end-of- life issues, beginning of life issues. >> a wonderful colic. this is dr. thomas cavanaugh. graduate of the college in california. and notre dame phd in philosophy. you are a professor of philosophy at the university of san francisco. and you said started in 1994 so ars now. yes. tful nk it's 25 >> is you'teach a first

seminar course what is with them. that be interesting to take. and medieval literature. and you specialize, in medical ethics. you have written books on it. very interesting time right now. you study the hippocratic oath in the place of the origin of western medical profession. so you are the experts and i said this is a catholic conversation on death and dying. it is not for catholics but for everyone necessarily. i try to paint a picture of a pyramid with 100% of us on the bottom level all going to die. many of us on the next level, helping others die and the top, professionals, who are working in this business. i'd like to ask you this question, what do the catholics have to tell us about death? what is the catholic teaching for us and why do we come to them? >> there is a very beautiful document promulgated by the vatican in 1980 called declaration on euthanasia. at a great title. it is more uplifting than the title makes it sound. and the catholic church has an

amazing body of knowledge around death and dying. catholic social teachings for the principles of what we call end-of-life care. the declaration on euthanasia goes through various points, very practical points, talking about death, first of all. death is a part of the human condition. it's needed to be feared or avoided at all costs nor is it to be actively procured. so, we know that is part of life. and, by looking at some of the principles of catholic teaching, we can see what the best way to die is, what pricat what we should be doing and shouldn't be doing and how to help each other through death and his spiritual and physical and mental way. >> you do provide practical

resources for people who need to know, and your job. your website, at the archdiocese, all the resources there come people can study that and they can also talk to you personally to find out what there is to know.>> we have up medical ethics hotline on our e ne is having a problem either with a relative dying, a friend die north of question about in end- of-life issue, they're welcome to call. we can talk it through. it is very difficult to be at someone's bedside. so you have an elderly person, a parent dying, is the doctor doing this right are they withholding nutrition or hydration. are they giving them too much morphine? you never know, in the situation, whether or not you are doing everything right. every situation is different. sometimes it's good to have a little backup.>> being prepared with the knowledge you may need, i mean, frustrating and confusing and pretend the

circumstances when someone is dying. tom, i think there's a question of a higher order of philosophy or theology understanding, what is the catholics supply for us? >> i think the catholic church has a good message concerning death. it is kind of paradoxical but it is a good message. and the good message is that death is not the end of our existence. so in catholic theology we distinguish between the first death, and the second death. the first death is a separation of our bodies from our souls. and our souls are principal of our life, they vilify us. so when our souls separate from our bodies, we suffer this first death. but that's not the end of the story. and that is the good news, the good message that the church has to share. about death. it's not all over there is an

afterlife. the soul continues to exist after death and now we are not that soul, we are the union of body and soul of the soul continues to exist after death. the great good message is that as it were, when jesus tells us i am the resurrection of the life, he who believes in me, though he is dead he shall live and who shall never die. that we will rise again from the dead, just as jesus did. that's the good message the church has to share. the second death, the second death is the one that we want to stay away from, that death is a separation of the soul from god. with our source of lies. and the church offers sacraments and ways of avoiding the second death. we will all go through the first death, jesus calls that, like the little girl who had died, she had fallen asleep,

she fall asleep and then they ridiculed him because they said she is dead. but jesus knows she is not dead in the second death, her soul has separated from her body but she is not separated from go d at the end of our lives the church offers of the last rites so we have, in the church we have the anointing of the sick it is a sacrament in the catholic theological tradition of a sacrament that anoints the sick kitty can be used when we are not imminently dying but it can certainly be used when we are dying. and we have anointing of the sick and we have confession and the reception of the eucharist. so all of these needs are available to us so that we can die well.>> spiritual medicine. we will be back in a few minutes to dyin

hello and welcome back, where talks about death and dying. end-of-life care is what we call it now. talking about the medical practice and the personal practice of this inevitable stage of life. so i was reading the head of the catholic healthcare group that wrote the story that says my parents deaths taught me about end-of-life care. one parent died hard and one died easy. he says i've said many times, if we can improve patient experience in the last two years of life, we will go a long way toward improving healthcare for people at every cause the lauamakeen ofe care, medical care, it

could be a big waste of resources and a big waste of time. it could go down as money spent the last years of life and he is saying no it is a time in which we can practice and learn know things new things. does that sound right to you?>> i think that when you are talking about procuring end-of- life, it is always a good idea to have it in the hat advanced health care directive. we have a great catholic healthcare directive on our website. it's not just good for catholics but for anyone. it takes up a few of the main questions that occur when people are dying. how much medication, pain medication is too much if you're given a lot of morphine will accelerate your death? rp, as loas the intent xpeto goi is not to cause death, intent is the most important word. it is okay to give pain

medication even if theoretically, it could reduce the lifespan of the person did another issue that always comes up, is coming nutrition and hydration. artificial nutrition and hydration is considered necessary healthcare could it is not a healthcare procedure because you're eating and drinking. but i get a lot of calls from family members saying, i'm afraid we will not feed my mother or father or we won't hydrate enough and we killed them. there is a point at which the body can no longer assimilate food and water, when you get very close to the dying process. and so, cutting off food and r itmoy you look at these advanchealthcare directivesrougts veriefly. d s peoplethink about, what do i want when i'm

dying? you know, if these are the parameters that maybe i don't want to be as strict with myself if i would otherwise be. >> surely everyone should have one. is there a statistic on how many people do not? the majority people per night hops? >> more and more people do have them but there are still, probably over 50% don't. because people don't like to talk about the issue or think about it.>> tom, let me ask you, i think this stillman is talking about a new way of doctoring which involves more revealing of the persons or what they want, and needs and who they is so they can prepare for this stage of life. as the man says, if we at this kind of behavior as a habit, which we need to do, it can leak back into prior stages of medical care. is that right? >> it strikes me as remarkably similar to the literature considering ours more in. the art of g, thert of

dying and there are treatises concerning the art of dying. in those treaty sees, remarkably, they say, if you can prepare adequately for death, it will transform the way you live. so, what this comment from this gentleman, this doctor about the death of his parents. it strikes me as very similar to the experience of these thinkers, these theologians, in the 1400s, they began to be written in this time. where we have, we are mortal creatures. we are going to die. if we can maturely think about that truth about ourselves, and how we want to do it, it is understandable that given we are mortal eatures,that sform way esperfse so the doctr-

patient relationship adequately addresses and maturely addresses the issue of dying, it will understandably thereby address medical issues associated with living. it makes perfect sense. >> as i recently a catholic press populated a press release for someone to ask questions if there terminally ill. as i'm pretty healthy but i could open this book and do this now and it would help me in thinking about what kind of ded get a be life. you he to remember people davchinesand hoital if the the catholic church or anywhere for you to be hooked up to machines at the end of your life. you can refuse treatments that are extraordinary.>> it does seem the doctors have a

dilemma, and that the medicare is such that we have such great tools that you can aggressively give more treatments at the end of life, or, we now have the capability of ending life voluntarily. this is in the law these days. so the medical practice can divide. we can do one thing or the other and it is hard to know what exactly is the right thing to do.>> if we draw a boundary and we say, in the hippocratic oath we have i will not give a deadly drug if i am asked, nor will i counsel this plan. that is a boundary. he drives a bounacces the art of medicine. and the art of medicine, you can excel in a practice, only when one has a boundary you can't excel, become excellent at something if you have no

boundaries within which to conduct that practice. he lays that out. so then we have -->> we are going to take another break and we will talk about how we will learn more about these things. thank you, we will be right back.

thank you for being with us. we are talking about death and dying. to learn more, vicki you are putting on a conference in november, november 17 in san francisco. you and some associated catholic groups. it is for professionals, with continued education units but also for the laymen who are thinking of going it's not a high price and i may pay. it's a full day gaining knowledge in these very things we are talking about. we will run a slide to show the flyer for the program, there it is. it is at st. mary's cathedral and all day on november 17. to know more about that, go to our website. tell me, the title of the conference is interesting. both titles, the heart of the end-of-life. >> converging roses for the medical practice and ethics converge because they do, certainly. the title of the conference is

the heart of end-of-life care's social teaching and we have the catholics have a great body of social teaching, underlying the end-of-life care. if we would like to learn more about it, we're having a conference and john was mentioning this, november 17. we have speakers from all over the country, dr. cavanaugh is one of our speakers. we have speakers and is for healthcare workers because continuing education credits are available but also for the general public. these principles will be very helpful for yourselves and your loved ones, for everyone towards the end li so, we are looking forward to a good conference. >> i want to come in and you've advised us we have to get prepared. it is serious business to get prepared for ourselves and for

what do you think we should all be doing to get prepared for end-of-life. vicki has a very practical side of things but what about you? what is the main thing we should take away? >> i think what we are doing now is a model of what we should do, talk about dying. we need to talk about dying to our families. the good deaths, which ones have we experienced or seen or been part of? where they good deaths? what bad deaths ordered deaths that went badly have we been part of, and why did they go badly? what can we do, looking forward to our own deaths and the deaths of our loved ones and friends and family to make sure the bad things don't happen. sharing these stories with one another is crucial.>> vicki, do people just not talk about this to make>> one way you can get them to start talking about is when you're filling out the advanced health care directive. the most important thing on the form is a pointing a healthcare

proxy, power of attorney for healthcare who knows your wishes and important thing you can do. as you are assigning this on picking out your powers of attorney for healthcare, that's when a conversation can start and that is what tom is talking about.>> we are coming up on halloween as well the day of the dead. october 31 and november 1 and november 2, we talk about the dead. the people who are saints and those in purgatory. we think about loved ones remember them and talk about the fact that we are mortal and associated with that national holiday that we have, halloween it comes from irish. the church has a lot to say about it, too.>> november in the catholic church is the month of the dead. it's a time when you particularly remember the dead and pray for the dead and re- involve the dead in your life

so they are not forgotten. that's important. so i am going to concretize your suggests and then say everyone sit down and talk about your preparations. that's true. even this detail, as i think is we've had two funerals in my family, sit down and write down what you want for your funeral service, what you want to happen. because otherwise the grieving people are kind of wondering and blowing in the wind trying to figure out what to do. so time to get ready. interesting. tom, let's talk about your book if i may for a moment. you will be at the conference? you will have your book there.>> i will there, hippocratic oath.>> we will have a white mass dedicated to medical professionals. after the conference there is a 5:30 white mass and there is a book signing afterwards. nice way to end the day.>> tom, i am reading your book where

there is latin and greek but is really interesting. give me come in 30 seconds, the gist of the book. >> that hippocrates found medicine as a profession by having an makes promises to patients about how he or she will care for the patient. and what norms the physician will honor, and abide by. and that's a confession to stand in front of other people and tell them what you stand for, how you will conduct yourself before them and in your interactions with them. hippocrates really found medicine, as a profession. we've come to think of medicine as a profession but we forgot precisely where the initial conception began to to begin th oc2500 year you e taking art which u willupand of d good luck work ahang you.

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