ARCHDIOCESE OF MELBOURNE REPORT:
 Tuesday, 17 January 2012By Anna Krohn John Paul II Institute for Marriage and Family and tutor in ethics “TOLD that I would die within five years (in 1977) and having become interested in philosophy, I saw no harm in making the latter my principal interest rather than following a career-orientated path," writes Professor Nicholas Tonti-Filippini, with disarming understatement, in the introduction to his timely new book entitled: About Bioethics: philosophical and theological approaches. The preface to Professor Nicholas Tonti-Filippini's recent book includes many biographical details and wry asides which cast a moving light on his own life, courage and faith. Although a bioethicist of very high profile, Professor Tonti-Filippini first revealed his own daily experiences of a painful, debilitating "end-stage" chronic illness in an letter originally intended for the South Australian parliament in 2011. The letter, which received widespread coverage (see The Age 5 July 2011) was as not simply another story of difficult suffering during terminal illness but a personalised account of the way in which the respect for the dignity of the terminally ill can be so easily undermined and influenced-both in the hearts and minds of patients, their carers and within society as a whole. He wrote of the apparently growing desire for euthanasia within the community: “ As many researchers have found, a request for death often incorporates hidden existential yearnings for connectedness, and care and respect.” For many, the Tonti-Filippini letter defined, with humanity and clarity, two ethically distinct paths within the very complex world of end-of-life care. One road accepts that the deliberate causing or hastening of death can be a legitimate and compassionate “option" in the face of suffering and disability: the other pursues wholistic care of the terminally ill person in the face of suffering and debility- insisting on imagination, good science and virtue but never the deliberate killing of the of the patient. At a recent seminar at St Gregory the Great's Parish, Doncaster designed to provide practical insight into the promotion and protection of patient dignity and involvement in the face of future care planning, Professor.Tonti-Filippini, explored some of the major fears and misconceptions which patients, their families and even medical professionals experience during important discussions about the end-of-life. View gallery The seminar was chaired by Mgr Tony Ireland and was part of the Archdiocese's Respect Life Sunday theme organised by the Life, Marriage and Family Office for 2011 and 2012- 'To Love ... to the End: Planning for a Good Death': is a year long resource and education project which aims to provide constructive and practical insights into the many spiritual, moral and social issues associated with end-of-life care. Professor Tonti-Filippini opened his seminar with a discussion about the very common anxiety experienced by many elderly and sick people: "the fear of being a burden” to family, friends and society. Many studies suggest for many people in Western society this fear is greater than the fear of unrelieved physical pain. Thisshis type of shame he reiterated can be generated at a very deep level by societal attitudes and language. He suggested that the really destructive fiction lying behind such pressure, was the notion human decision making should be made by individualised and "totally autonomous people" with the absolutely "controlled lives." Being "in need" is not, he said, a human "failing" nor is it abnormal. He challenged the audience to think of the positive place of interdependence in human lives and also the way in which "being disabled and needy" gives others around us and society in general the opportunity and stimulus to be "more humane". In responding to the needs of the sick and ageing, the community itself can become more united and learns to value both itself and those in need of care. Despite the fact that we all have times when we "need" the help of others, and despite the fact that our secular liberal society often proposes unrealistic expectations of "personal control", Dr Tonti-Filippini proposed an alternative ethics of "engaged" and active acceptance which enabled people to become involved in forward planning for disability or death in ways that were both consistent with a "culture of life" and attractive to those concerned about human dignity and informed consent in the face of future medical treatment. In Australia, as in other Western societies, there have been a number of methods, both statutory and regulatory, which attempt to preserve a person's ability to both appoint another person as a representative should they lose competency and to protect the person's wishes in the event of such events as dementia, unconsciousness or cognitive disability. Professor Tonti-Filippini briefly explained the options proposed by existing guardianship provisions, the notion of enduring power of attorney and the implementation of so-called "advance directives". He pointed out to the audience of over 80 people, that today many hospitals as well as laws in the Australian Capital Territiory, South Australia and Queensland propose the legally binding documentation of "advance directives": the documentation by a person at one point of time for the delegated future medical treatment choices based on the prediction of "outcomes" in the face of degrees of disability or loss of future loss of "quality of life." Professor Tonti-Filippini commented upon some of the practical and ethical difficulties which arise in some of the "advance directives" processes even when these are done in a fully guided and informed way. These difficulties were outlined as legal, practical and philosophical in nature. He noted that the legal status of advance directives is unclear. In three jurisdictions in Australia, documented directives are legally binding. In others (such as Victoria) they are not. Where they are legally binding the legal difficulties include doubt about the application of such a directive because it is very likely that what the person envisages months, or even years, before signing the directive document may not correspond in detail or completeness with the aactual situation at a later time.This causes great difficulties for the patient's family, the carers and for medical and nursing personnel. The directive may include an instruction that is no longer in the best interests of the patient, or is impossible to achieve or may no longer correspond with the probable wishes of the patient. Some advance directives assert that it is a patient's "quality of life" that is the outcome in the balance rather than promoting a discernment of the proportionate benefit or harm of a particular treatment option. This tends to divert attention from the comfort and well-being of the person in care, to a more utilitarian and yet vague attitude to the human capacity for adaptability and virtue in the face of suffering or diminished function. Professor Tonti-Filippini explained that in contrast with these problematic modes of decision making, and the very real legal difficulties connected with advance directives, a more palliative, flexible and wholistic approach, is entailed in what he called a "future planning" ethos. He briefly outlined the philosophy of "future planning" which promotes the involvement of a community of carers who are informed not only of theoretical or likely health outcomes but of the general wishes,goals and values of the person who formulates their “future planning”. The documentation of these values then offer a more helpful guide to those entrusted with advocating for the future patient or resident while allowing for unexpected medical outcomes and contexts. The "future planning" approach, explained Professor Tonti-Filppini assumes that the person's life no matter how disabled, requires appropriate and competent care- which does allow for appropriate withdrawal of treatment where it is burdensome or futile .and where this is consistent with the patient’s moral and spiritual care. Professor Tonti-Filippini suggested that documentation of these aspects of a person’s wishes can offer a rich, reassuring and fulfilling way for them to plan for disability and a "good death" while helping them to grow spiritually and personally. It enables those facing age and death to reflect pro-actively upon with the values which are most important to them and are shared by good palliative principles. The seminar provoked many questions and discussions and clearly met a genuine need within the Catholic and wider community. Therefore Professor Tonti-Filippini will repeat his presentation on “Future Care Planning” – the seminar will be presented on 16th February, 2012 at Sacred Heart Parish Kew. For more inquiries please contact Anthony Coyte on 03 412 3370 or the Diocesan Office for Life, Marriage and Family. Information on the 2012 Bioethics Colloquium public events in Melbourne, January 22 and 24, here |
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