A Catholic Guide to End-of-Life Support

Help for those accompanying Catholics facing end-of-life decisions

Australia's Catholic bishops have released a new document to guide priests, chaplains and pastoral workers who are asked to provide pastoral support to Catholics who are considering accessing the Voluntary Assisted Dying (VAD) scheme. The Companion Guide has been written as a tool to help Catholics reflect and learn from To Witness and to Accompany with Christian Hope, a document endorsed by the bishops in November 2023.

To Witness and to Accompany with Christian Hope was produced in the wake of the Voluntary Assisted Dying legalisation in all Australian states.

"This is a timely resource which offers guidance for carers, chaplains, family and friends of the sick and the dying," said Bishop Tim Harris, the bishop delegate for the Euthanasia Taskforce.

"In challenging circumstances, it is important for those caring for the sick and dying to have access to compassionate and relevant pastoral advice and spiritual support which this resource provides.

"The Church continues to respect the dignity of the person especially when they are at their most vulnerable. This guide supports and assists those facing difficult and challenging circumstances at the end of life."

In preparing the original document, the bishops consulted widely with a range of people including church leaders and health professionals. The bishops have also worked with the Dicastery for the Doctrine of the Faith.

Catholic Health Australia, the peak body representing 80 public and private hospitals and 350 aged care facilities, says governments must invest more in palliative care services.

"When it comes to end-of-life, our members choose to specialise in palliative care," said CEO Jason Kara.

"We know that a large majority of Australians support government investment in palliative care, but chronic funding shortfalls are limiting access to quality care particularly in rural and regional locations.

"Without quality and accessible palliative care, there is a real risk that some patients decide to explore the option of ending their own lives when they may not otherwise have done so."

One of the many reasons individuals seek out Catholic healthcare services is due to its focus on pastoral care in the
form of accompaniment, conversations, prayer and spiritual guidance for patients and their friends and family.  

Thanks to the ACBC

So, what should I do?

Coping as a carer 

Even when you know the end of life is approaching for a family member or friend, you might not feel prepared. Looking after a person who is dying can be stressful. It’s common to feel like you don’t know what to do, what to say and how to cope.

If you’ve never been around someone who is dying before, you may be afraid of what will happen. Learning what to expect can help you feel less frightened and confused and allow you to plan ways to manage the emotional and physical challenges ahead. 

There are many things that family and friends can do to help support someone at the end of life:

• prepare meals.
• help with bathing and toileting.
• sort out the paperwork, discuss the person's choices for their future health care, and arrange legal advice if needed.
• record social media details.
• do odd jobs and run errands.

When you don't know what to say

People often wonder what they should say to a person who is dying. It’s understandable that you don’t know what to say – what you feel might be so complex that it’s hard to find the right words or any words at all.

It is common to worry about saying the wrong thing. Most times, the person who is dying will find comfort in you just being there. Listen to what the person who is dying tells you. Try not to prompt an answer that confirms what you think or your hope that things could be better. 

• If you think they'd find it easier to talk to a chaplain, offer to put them in touch with one.
• Try to treat someone who is dying as normally as possible and chat about what’s happening in your life. This makes it clear that they’re still a part of your life.
• Avoid talking in an overly optimistic way, for example, 'You’ll be up in no time.' Such comments block the possibility of discussing how they’re really feeling.
• Apologise if you think you’ve said the wrong thing.
• Let them know if you feel uncomfortable. They might be feeling uncomfortable too. It’s okay to say you don’t know what to say.
• Accept that you or the person dying may cry or express anger. These are natural responses to a distressing situation.
• Ask questions. Encourage them to talk about their life if they’re able to and interested. Talking about memories can help affirm that their life mattered and that they’ll be remembered.
• Just be there. Sometimes it’s the companionship that is most appreciated – sitting together and watching television or reading.
• Even if they’ve shown no religious interest in the past, that could change as death approaches. You could offer to pray together, but respect their wishes if this is not something they want.

Sign of Change

Some people find that information about the physical process of dying helps ease their fear and anxiety. Others prefer to take one day at a time and ask health professionals for explanations as the need arises.

Each death is different, but as a person nears the end of life, there are often common signs. These physical changes don’t occur in any particular order. In medical terms, the dying process is viewed as the body’s systems closing down and may include:

• sleeping more
• eating and drinking less
• little interest in the outside world
• breathing changes, such as becoming rattly, irregular and laboured
• bladder and bowel changes
• disorientation and confusion, memory loss, hallucinations (seeing or hearing things that aren’t there), delusions (false beliefs), mood swings and sleep disturbances.
• restless moving, twitching, groaning or calling out
• cool skin, especially the hands and feet
• dry mouth and dry or cracked lips.

Witnessing these physical changes can be distressing. Speak to your Catholic Chaplain for support.

How you can help in the final stages

Wherever someone chooses to die, family and friends can help in the final stages. If you are providing care at home, ask the palliative or health care team how you can help. In a palliative care unit, hospital or residential aged care facility, ask the staff how you can be involved. 

Ways to help may include:

• offering comfort (apply lip balm and keep the mouth moist with ice cubes or swabs, put incontinence sheets or pads under the bedsheets, keep the person warm with a blanket and use cushions so they are comfortable, help them change positions often)
• being a gentle presence (be there so they don't feel alone, sit with the person and talk or hold their hand, gently massage their hands or feet with a non-alcohol-based lotion, speak gently, and occasionally remind the person of the time, place and who is with them)

• creating a calm atmosphere (use soft lighting, have their favourite music playing in the background, quietly read a favourite poem, passage from a book, or spiritual or religious text)

   

After someone dies

Even when death is expected, it’s common to feel upset, sad or shocked. An expected death is not an emergency, and what you need to do depends on the circumstances.
 

What to do after the death

If the person was at home and had a carer and expected to die at home, you don't need to call an ambulance or the police. You can take some time to sit with them or call a friend or relative to support you. When someone dies during the night, you can wait until morning to call the doctor and the funeral home.

A doctor is needed to sign a death certificate so you can make funeral arrangements. The funeral home can register the death with the births, deaths, and marriages office in your state or territory, and they will provide a death certificate.

If the death occurs in a palliative care unit, hospital or residential aged care facility, there’s usually no need to rush. You can have time alone with the person before the nurses explain what needs to be done. Some people want to wait until other family members or friends have had the opportunity to say goodbye. 

You may find information from Services Australia helpful. Contact a Catholic Chaplain through the Defence Switch: 1300 333 3623 for funeral services or the Chancery Office of the Military Ordinariate of Australia phone 0436 382 104

Time to Grieve

The physical and emotional response you have to losing someone you love is known as grief. The feelings you may experience include sadness, numbness, disbelief, loneliness, guilt, anger, relief and acceptance.

You might have trouble sleeping, cry a lot or have difficulty crying, lose your appetite, or not be interested in your usual activities. There’s no right or wrong way to grieve, and everyone mourns in their own way and in their own time.

Coping with grief doesn’t mean getting over the person’s death. It’s about finding ways to adapt to the loss. It may be according to religious or spiritual practices, but it can also be more personal. Even though your relative or friend is no longer physically present, they remain part of you and your life. This ongoing connection can be a source of comfort in your grief.

If you’re concerned that your grief is stopping you from living your life, professional support may be helpful.

Contact a Catholic Chaplain through the Defence Switch: 1300 333 3623

Ways to remember

You may want to do something special to acknowledge and honour the life of your family member or friend after they’ve died. Some people find this helps them cope with their loss.  

• Cook their favourite meal or cake on their birthday
• Organise to have a memorial plaque put in a favourite spot
• Plant a special tree or flower
• Frame a photo, cherished note or other memento
• Create an annual award or scholarship in their name
• Create an online memorial page with photos and stories
• Make a contribution to their preferred charity or community group
• Talk about the person with others who knew them