Bioethics Matters: Special Edition w/Fr. Prieur
A 50-Year Legacy in Moral Theology: Nuggets of Wisdom for All, Especially Nascent Seminary Professors…
CCBI News – The Elderly & Society; Horizons of Hope; LTC Matters; Indigenous—Learn!
March 18, 2022
Dear Friends of CCBI,
This week we are delighted to include an article by Dr Rory Fisher. Dr Fisher is a Professor Emeritus, Department of Medicine, University of Toronto, and was a member of the Division of Geriatric Medicine, Sunnybrook Health Sciences Centre. He is a passionate defender of the elderly and their treatment.
Caring for the Elderly and the Elderly Caring for Society
In his Catechesis on the elderly during the papal audience on March 16th, Pope Francis challenges the corruption brought on by a life that is too inward and self-seeking, leading us to ignore the plight of others, locally or globally. He stated: “As long as normal life can be filled with “wellbeing”, we do not want to think about what makes it empty of justice and love. ‘But I am fine! Why should I think about problems, about wars, about human suffering, all that poverty, all that evil? No, I am fine. I don’t care about others.’” He then addresses the elderly, recognizing as he speaks that the very word offends some, although I detect a little wry humour there – it’s a mark of our time and culture that such a factual descriptive should be offensive, unless we are doing our best to avoid or deny its meaning. Don’t call me ‘old,’ we say, I’m not there yet! But the Pope then challenges what he calls ‘those of a certain age,’ in the most positive way: “God’s blessing chooses old age, for this charism that is so human and humanizing. What is the meaning of my old age? Each one of us elderly people can ask ourselves this. The meaning is this: being a prophet of corruption and saying to others: “Stop, I have taken this road and it does not lead you anywhere! Now I will tell you about my experience.” He is recognizing not only wisdom gained but also responsibility based on love for others, relating mistakes and successes along the way culminating in a wisdom, a prophetic voice, that can ‘save’ IF the long-serving members of society have the courage to proclaim it. Fear of death, fear of aging, the need for moral decision-making at the beginning and end of life, questions about gender, contraception, family life, euthanasia…The list is endless, and it’s clear that these questions also intersect with a Catholic perspectives on bioethics throughout life’s journey. He gives the elderly/senior citizens/ mature members of society/ long servers / those of a certain age, and so on, reason to continue their active membership in society to help society save itself. Everyone always has a role to play!
CCCB / Archdiocese of Toronto and “Horizons of Hope”
The Canadian Conference of Catholic Bishops recently launched a program for parishes called “Horizons of Hope.” The program is designed to raise awareness about end-of-life and dying matters, including spiritual and practical dimensions, and in the hope of sparking awareness of the possibility of some form of action in these areas by our parish communities. A committee of the Archdiocese of Toronto, headed by Michael Fullan of Catholic Charities, is moving forward in presenting the program in parishes. Two pilot sessions have been completed in St Ignatius Loyola, Mississauga, and St Edward the Confessor, North York. Fr Tim Hanley and Msgr Pat O’Dea were most helpful in launching the pilots which were held ‘live’ and, judging by the evaluations, were found helpful and beneficial. CCBI is fortunate to be involved in this very important and necessary area of service: we all die, after all, and there is much the Catholic community could do to accompany people on the most comfortable, pain-free and spiritual journey possible.
The CCCB website affirms: “When confronted with a life-limiting diagnosis, we can find ourselves in an unfamiliar and even frightening situation. These moments are usually marked by having to make numerous practical decisions surrounding care and support for loved ones and ourselves. More often than not, such decisions require moral discernment through the lens of our Faith…As people of faith in Christ, horizons of hope open before us when we gather around the sick and the dying. Families, friends, parish communities and health care professionals, together, all play an important role to care for and accompany those in need of palliative care that recognizes the dignity of the human person.”
COVID-19
I think we all realize that the pandemic is fading, but it is not dead and could spread again if further, virulent variants were to appear. The watchword of many Medical Officers of Health and other physicians and scientists is ‘caution,’ that is stay alert and make prudent decisions. One physician interviewed by The Globe and Mail said: “Many people are still vulnerable. It’s just irresponsible to act as if the pandemic is over. That is a level of disrespect and disregard for the vulnerable people in our population that is unconscionable. Why wouldn’t we want to do everything that we can to continue to protect people? …Vaccinations and masking are measures we can use to keep each other safe. We have tools, and we’re saying now we’re not going to bother using them.” As moves to do away with precautions take hold, I thought about what Pope Francis said, above, about senior members of society being prophetic about what works and what doesn’t, and I think that extends to experts in a given field, too. If some measures have been shown to work, don’t just stop them forthwith because we’re ‘tired of the pandemic.’ I don’t think viruses ever tire by themselves!
The Reform of Long-Term Care
Dr Rory Fisher
Pope Francis declared July the 21st as the Day of the Grandparents and the Elderly, reminding us of the value of the elderly, many of whom have died during the covid pandemic. Loss of life has been extremely high in long term institutions leading to a call for major reform. In response, Ontario will spend $2.6 billion on 20,000 new and 15,000 on upgraded spaces. $4.9billion will be spent to hire more than 27,000 staff over four years.
A more balanced approach would be to invest in aging in place at the same time. The Government of Canada provides advice about planning for aging in place, but many seniors will not have the financial means to do this (www.canada.ca). Most seniors which to stay in their homes. A survey carried out for the Canadian Frailty Network found that more than eight in ten Canadians would be satisfied to live in their own homes, if possible, even if they become frail. The survey also showed about seven in ten Canadians are now, have been, or expect to be a caregiver for someone over 65. Nine in ten Canadians want more government investment in healthy aging and community programs to help those over 65 who live at home (www.cfn-nce.ca). Often quite simple measures can maintain independence. More aging in place decreases the need for long term care beds, and decreases the pressure on acute hospitals by preventing unnecessary admissions and allowing for earlier discharges. It would decrease the warehousing of the elderly which has been a long time Canadian response to the aging of the population.
Some provinces provide a wider array of community services than others. Alberta has the Comprehensive Home Option for Integrated Care of the Elderly Program (CHOICE program). CHOICE provides services for older adults who have complex medical issues and want to remain living in their own homes. The goal of the program is to keep clients healthy, at home and out of the hospital system. Services may include medical monitoring, medications dispensed by a CHOICE pharmacy, PT and OT, social work, recreation and social activities, personal assistance with daily tasks, as needed, and health and wellness education. There are also special programs for mental health, late-stage dementia, and restorative care. (www.albertahealthservices.ca)
Entitled Veterans have the Veterans independence program (VIP). This provides annual tax-free funding for services such as ground maintenance (snow removal, lawn mowing, etc.) housekeeping (assistance with cleaning, laundry, errands, etc.) access to nutrition (eg. meal delivery services) professional health and support (nursing services, OT, etc.) personal care, ambulatory care, transportation to social and community activities, home adaptations and long-term care. (veterans.gc.ca)
These are but two examples of what may be done to help aging in place. Community care has long been the Cinderella of the health care system, understaffed and underfunded. Now is the time change that in parallel with improving care long term care facilities. Action now is crucial because of the increasingly aging population.
The “Othering” of Elderly Persons in Long-Term Care Facilities
Bridget Campion, PhD
While researching the many ethical issues raised by practices around urinary incontinence in long-term care facilities, I came across a legal opinion prepared in 2007 by Mary Cornish and Jo-Anne Pickel for the Ontario Federation of Labour. Titled, “Legal Opinion Re: Validity of Continence Care Policies and Practices in Long Term Care Homes” the document “analyses the legality of the continence care policies and/or practices of the homes caring for the over 75,000 vulnerable elderly. It looks particularly at those who direct health care staff to ration incontinence products and to [not] change incontinence pads unless they are 75% or more soaked with urine.”
Apparently there is a blue line on incontinence pads that indicates that the product is 75% full. So, imagine being made to sit in an incontinence pad that is 10% full – 25% full – 50% full – 70% full. It might take hours before a personal support worker (PSW) is allowed to change the pad. Imagine the discomfort, the smell. Imagine how a soaked incontinence pad limits mobility. Imagine how it leads to embarrassment and shame. Now imagine “those who direct health care staff to ration incontinence products” or a Board member of a long-term care home being forced to wear an incontinence product until it is 75% full. Chances are you can’t.
That a very vulnerable human population is forced to endure behaviours that the dominant population deems utterly unacceptable for themselves is a result of “othering”. It is the result of rendering that vulnerable population as less than human by devaluing their experiences, their capacity to feel, and their very human needs. This is often a fear-based reflex: “we” do not ever wish to be what “they” are and so we relegate “them” far, far away from “us”, physically and psychically.
There is so much more to say here but for now, my take away is this: until we recognize the shared humanity and dignity that connect in an essential way persons who live in long-term care homes with those who do not, real reform in long-term care will not happen no matter how much money it receives.
Sources:
Legal Opinion Re: Validity of Continence Care Policies and Practices in Long Term Care Homes” September 12, 2007 (Updated November 19, 2007) Prepared by Mary Cornish and Jo-Anne Pickel (https://ofl.ca/wp-content/uploads/2007.11.19-Report-LongTermCare.pdf)
I first came across the concept of “othering” in Paul Higgs and Chris Gilleard, “Frailty, abjection and the ‘othering’ of the fourth age” in Health Sociology Review (2014) 23(1): 10-19 (https://www-tandfonline-com.myaccess.library.utoronto.ca/doi/pdf/10.5172/hesr.2014.23.1.10?needAccess=true)
On Being an Ally
Bridget Campion, PhD
When Moira asked me to report on issues affecting Indigenous Peoples in Canada, I was hesitant. I am not Indigenous. The Ancestors came over in the 1840’s, fleeing death by starvation in Ireland. This makes me a settler, living and working on lands that were not mine to begin with, and unaware of the treaties that made this so. In the meantime, First Nations, Inuit and Métis People have lived with oppression and injustices that have left generations traumatized, disempowered, bereaved and yet resilient. As a mother I have been horrified by murdered and missing Indigenous daughters, by Indigenous teenagers who have died while attending high school far from home, by Indigenous children taken into “care” only to be housed in motels more or less on their own, sometimes with tragic results. But like so many non-Indigenous Canadians it was the discovery of the unmarked graves on the sites of former residential schools that forced me to confront the magnitude of the terrible injustices perpetrated against Indigenous Peoples in Canada. I wanted to know how to respond in a way that would be personal, heart-felt and not exploitative especially through self-aggrandizement.
I came across an article on the Land Needs Guardians website. “How to Be an Ally of Indigenous-Led Conservation” offers the following guidance (and here I quote the headings): 1. trust Indigenous leadership; 2. create space for us to speak; 3. continue to learn; 4. understand the connection between land and Nationhood; 5. focus on solutions; 6. participate with interest; 7. recognize Indigenous science; 8. share stories with respect; 9. continue to learn; 10. influence your peers.
I take #3 and #9 to heart: continue to learn. Far from being an “expert” in Indigenous issues, I am a student. As I explore those issues for the CCBI Bulletin, drawing on Indigenous sources (#8), I will be learning. And this is what I hope to share with readers of the Bulletin.
Source:
“How to Be an Ally of Indigenous-led Conservation” https://landneedsguardians.ca/how-to-be-an-ally
Pope’s Intention for March
We pray for Christians facing new bioethical challenges; may they continue to defend the dignity of all human life with prayer and action.
Moira, Bambi, Bridget and Rory
Pope Francis
Pope Francis invites bishops to join him in consecration of Russia and Ukraine
The Consecration of Russia and Ukraine to the Immaculate Heart of Mary will be pronounced by the Pope on the afternoon of Friday 25 March in St Peter’s Basilica. The act of consecration will be performed in communion with the local Churches throughout the world.
The Globe and Mail
Horizons of Hope
Peace in Ukraine
For Peace in the Ukraine – Liturgy of the Word – March 9 2022 – UPD
3 RESPONSORIAL PSALM PSALM 85:8AB-9, 10-11, 12-13 Reader: The Lord speaks peace to his people. All: The Lord speaks peace to his people. Reader: Let me hear what God the Lord will speak, for he will speak peace to his people. Surely his salvation is at hand for those who fear him, that his glory may dwell in our land.