 I'm Marsha and we are navigating the journey. We're exploring the options and choices for end of life. Navigating the journey is dedicated to exploring the options we have, the choices we have, and we have added people of other faith, other traditions to join us in that journey so we can see not only what we feel as an individual, but what the rest of the community, the different people feel. Today we have two of my new best friends, Father Jack Isko and Father Nick. I am a genius. And you're from the Ecumenical Catholic Church. Tell us first of all, what is Ecumenical Catholic Church? Well, it's a church that's been around for about 20 years now. It's slowly growing throughout the mainland, even in the world. And we have what I call lapsed Catholics that have come from Rome. But we have others that are interested in having a Catholic faith with quite not so... Same doctrine and dog bump, but not a lot of negatives and a lot of positives instead. Oh, very good. Well, first let's... Tell me about you. You're an ordained priest. I've been in the ordained priesthood for 44 years and I've served in various places. We lived in California for 18 years and I was hospice chaplain there for 10 of that 18 years and another year here in Hawaii. I've also, because I have an MSW as well as my MDiv from my seminary and MSW from University of Hawaii. And so we've served as both priests and social workers. I've worked in mental health a lot at the state hospital for 10 years. And before we went to the mainland, I worked for a brief time at Hawaii State Hospital. Originally, I started out as a school teacher of all things. I taught an elementary school for about five years. And then later I've taught as an adjunct professor at Hawaii Pacific University for 10 years and another 10 years in the mainland at Pacific Union College, which was an Adventist school. Wonderful. Wow. Education, ministry and social work somehow. I think ministry and social work sort of... Absolutely. Absolutely are the same, aren't they? I would agree, yes. Yes. So now, tell me, you're a social worker also? Yes, I am. And an ordained priest and then all of these same things also? I've been a preschool teacher. I also worked for the DOE for five years as a paraprofessional tutor, working with elementary school children. I was a social worker at Sonoma Developmental Center for 16 and a half years. I am an ordained priest. That's not what I think of when I think of priests, even though I've known them all my life. This is absolutely wonderful. You came to us because you have been a part of hospice and you have seen a lot of the end of life people, choices, the ends and outs, the do's and don'ts. So talk to me about hospice and what you've seen with patients in hospice. Well, as I said, for 10 years, chaplain and social worker at hospice of Napa Valley, that's sort of where I got my feet wet, it became a wonderful ministry. I really enjoyed it because when people are able to die at home with families, they're usually happy about that in a good way. And my job was made much easier. I was there to counsel them and help them, but most of the time they wanted to talk. And I think that's really good facing what is inevitable for all of us. Sometimes we forget that. It's all coming for us originally. I think hospice makes the journey towards the other side much easier because they're at home with a family and they're given enough medications so they're not in pain. And it almost, it was a very good experience. And doing the hospice, are there any of them that stand out for you, any patients that don't somehow do the others? Well, I did have, I think about this once before. I had a patient, I won't say her name, but she was elderly and she definitely was dying. And she was in a hospital instead of in hospice. We were trying to get her on hospice and she had advanced directives. We can talk about that in a minute. And the hospital would have honored them. That's what I really want to happen with advanced directives if they pay attention to what the patient wants. But the family was split right down the middle. And half of the family literally was saying, hang on, hang on, hang on. And the other side was saying, let go, let go, let go. And the patient was stuck in the middle. And I kept saying, let's not do any heroic methods. Let's follow her advanced directives and the ones that wanted to hang on didn't want to do that. And I kept going on. And people always say, what happened? Well, she died anyway. Of course. Despite of it. But I think it would have been a much easier journey if they had just honored her advanced directives in the first place. Now, legally, I guess I'm confused here. We have the advanced directive and someone else can override that? Well, I think technically they're not supposed to. And that's why I think that hospitals, which increasingly now, in fact, I found out Straub and it may be true at other hospitals here too, anytime a patient comes in for whatever reason into the hospital, they have to fill out an advanced directive. I wish all the hospitals did that. And I think, by and large, the hospitals honor them. They don't do heroic measures to the patient. There's a big discussion about whether you withhold liquids or not. And they have to decide about that. But almost everything else is followed. They're made comfortable and they're able to die in peace. But sometimes I think more than the hospital is not out. The family gets in the middle. And so this is my idea is when a patient, a person makes out an advanced directive, it should be shared with their family. And the family should know that this is what they want to have happen and not happen both at the same time. Right. Now, so now that we've got all this going on, can the person be transferred to home to hospice or do they have to stay all hooked up to all of that stuff? It is possible if the attending physician, which probably may not be the one that's in the hospital, agrees to it. And also if they already are beginning to, the family is in investigative hospice care, then they can have the patient moved. And that would be nice if that was in an advanced directive too. At the end, I would rather be in hospice than be at home. So you could put that in the advanced directive. Absolutely. I can't think of anybody that would not prefer to die at home instead of in a hospital. But I think the last statistic I read, it was close to 70% of people still die in hospitals. Yeah. And run up the bill. Absolutely. I read that the largest amount of Medicare is for older people at the end of life in hospitals. Now, that's just somehow wrong. Not right. I agree. No. I mean, you should be able to be allowed to be at home, to be with your family or however you want to do this. What's your experience with hospice or have you done hospice? As I mentioned earlier, I volunteered with hospice. My volunteer positions was sending bereavement letters on the anniversary of the individual's death to family members, remembering them. Oh, how wonderful. So you keep in contact with the family. Right. Right. That's great. Do all hospice do that? I don't believe so. I'm not familiar with that. But I would think the majority are beginning to do that now. I've seen it, yeah. That's good. So you would just write these letters and... Right. We had a tracking system that in a given month there were these folks who had passed away and we would write to family. Well, now, locally, of course, we had this issue about when you can allow somebody and when does the state step in and when the church says you can't do this and you can't do that. How do we move to where you are to allowing people this option of choosing to be at home, choosing the time and the hour and what have you? How do we get rid of some of these anchors, some of this stuff that's in the way? Father Jack and I had discussed this at one time and that is when Jack was mentioning earlier having family involved with the creation of the advanced directives. Local families can be more direct with the family member, but if their family members were living on the mainland that wouldn't have that opportunity to be involved, we figured an option would be to do conference calls to include the family member that is on the mainland or in other countries. So when you're terminally ill, now you know you're not going to ever get well, so you're terminally ill, you're suggesting that we have a family get together. I love that. A family get together, a conference call with whomever or now that Facebook live, whatever, so that everybody understands, everybody's on the same page. That is a great idea. That is absolutely a great idea. Is this part of your ecumenical? Absolutely, but I want to give a compliment to the Roman Catholic Church, which I usually don't do. Pope Francis and others have come out with a proclamation saying that patients should be allowed to live, to die as naturally as possible and they should not be involved in heroic measures to keep them from winning. They should be able to die in the time in which God wishes them to die instead of trying to hold it against them. And that's been very helpful because many Roman Catholics always said, oh, I can't do that. I have to live, live, live, and I can do everything. That is good, because as you know, the Catholic, the Roman Catholic is a martyr religion. It's about the martyrs. It's about the ring. So this is really a move, a major move for the Pope to say that a person should be allowed to... Yeah, and I think he talked about death should be as natural as possible and all these other measures are not natural. It's not allowing death to die the way we should die, not in pain, but as easily as possible. Yes, because to me, at least, I see so many times that they do... The doctors always come, they're trying to save a life, save a life, and in fact, things that harm the life. I know they don't mean... but there's medication and the surgery when you know it's not going to work, all of that. I would like to hope and think that being that this is a team effort, because nurses involve the social workers and the staff as well as the medical personnel. You need to take a break, be right back. Aloha, my name is Josh Green. I serve as Senator from the Big Island on the Kona side and I'm also an emergency room physician. My program here on Think Tech is called Health Care in Hawaii. I'll have guests that should be interesting to you twice a month. We'll talk about issues that range from mental health care to drug addiction to our health care system and any challenges that we face here in Hawaii. We hope you'll join us. Again, thanks for supporting Think Tech. Aloha, my name is Danelia, D-A-N-E-L-I-A. And I'm the other half of the duo. John Newman, welcome. We are co-hosts of a show called Keys to Success, which is live on the Think Tech Live Network series weekly on Thursdays at 11 a.m. We're looking forward to seeing you then. Aloha! This is Steve Katz. I'm a marriage and family therapist and I do shrink wrap, which is now going to every other week, all during the summer and maybe forever after. Take care of your mental health this summer. Have a good time. Do what's fun and take good care of yourself. Bye-bye. Aloha, and we're back with Father Jack and Father Nick from the Ecumenical Catholic Church. And we were talking about hospice and your suggestion of a family get-together to do the advanced directives because I have an advanced directive and all I did was call my daughter and say, you're it, you know? So tell us more about what you think this family gathering to do this directive would be. When we were with the church in the mainland in Napa, California, we had advanced directives both filled out at the hospital where Queen of the Valley, where we normally went. When we came here, we did it a little differently. We got the application from a hospital. We filled it out and we had a family meeting. I'm an only child, so there's not much family to worry about. Nick is the oldest of six brothers and sisters. Most of which are in Hawaii, so we had them together. And we eventually, when it was five, we made copies and they all have copies of it. So I think that helps. The other thing I was saying to you earlier, it would be neat if your attending physician either signed it or there's a copy in the chart. We did that with our attending physician. So Dr. Antio Wong with Kaiser Health, she knows about it and she even said, I would do this when you need it. Now, my memory of hospice with my mother because we had her at home for the last year of her life, there was a chaplain that came regularly and they had an attending physician also that came regularly. And when my mother passed, we had a bedside ceremony immediately. And all of them came and it was the most beautiful moment. And the hospice nurse told me, now when she passes, do not call the police. Do not call the coroner. They just make it horrible. Then it becomes, you know, the bureaucracy and death's supposed to be beautiful. So we called hospice and it was beautiful. Absolutely a beautiful event. The only reason the police should ever be called, in my opinion, and this is absolutely true, I think, is when it's considered an unattended death. Right. But it's been attended by a physician and by the family and who else? There's no reason for them to be involved. Yes. Yeah. So now you're saying just have the doctor sign on also. Would be nice, yeah. Yeah. If the doctor won't just make sure there's a copy in his records as well as in the records of the hospital. Now, when you're terminally ill and you know that you're not going to get well and the pain is, the whole thing is just much too much to bear. Is it possible to ask for medication to help? Absolutely. And that should be written in the advanced directive too. Use pain medication liberally as needed. That should be in writing. Yeah. And anything else if they want them, some people want to withhold fluids and a person will die more quickly without fluids, but sometimes people feel that's a little too much. That seems cruel, yeah. So they can put exactly what they want. One of the things I do recommend against when they're that far is not to have feeding tubes. Oh. Because patients can be kept alive and be a vegetable for months. Yes, that seems horrible. But families and the individual patient is the one that should be able to make a lot of these decisions. And I would like to see it honored by the hospital, by whoever is involved. Now, let's go back. You said something really exciting. Okay. And that's to talk about the Pope and his directive. Now, is this his thinking? Is it a directive from him? How is that transmitted to the rest of the church? You're right. That's what you're asking. But it's definitely been published throughout the church and all the priests in the world and all the churches that had it to look at it. And it's asking not to do unusual measures, but to let people die peacefully the way the Lord intends to take them home, something like that. And can we get a copy of that? You said it's published. Yeah, I don't think you would have a connoisseur. Vatican news, you could find it. What is said about death and dying? Oh, I love that. I love that. And I can't remember what year. It hasn't been that long ago. No, because he hasn't been Pope that long. I was very excited when that came out. He's thinking. A lot of things that haven't been made into canon law is what he's thinking about. And that's pretty liberal. Very exciting to have him talk that way. It is. It is because that's been a stumbling block locally is that these different religions say you can't do this and you can't do that. And in fact it's part of our quote law because they take a position we can't do this. So I think it's absolutely wonderful to have the Pope say this that we can absolutely see this new modern thinking. And I don't think that's so modern though because the church up to a certain point always and everyone was at home when they passed. It's only with this new medicines that we moved from being home into the hospital. There's another thing I wanted to talk about too. We don't believe in physician assisted suicide. I don't. But there is something called passive euthanasia. A lot of people don't know what that means. What it means is people are giving narcotics to whatever it might be to help alleviate the pain and eventually as the dosage goes up it may hasten death but it's not the direct result of what they've been giving. And so that's why it's sometimes called passive euthanasia. I don't think it's really euthanasia at all. It's making people comfortable. And I think we need to... I hate the word suicide because that just is a misnomer. That's not what we're doing. This is not what we're talking about. Suicide is when a healthy person makes a decision to end. We're talking about terminally ill people who will never get well, who should be allowed to be comfortable in those last moments. Now that, to me, is what we're talking about. And a physician's oath is not to harm and to make a patient as comfortable as possible. So they will give maybe more narcotics to make them comfortable. They may not hasten the death, but at least the person gets to die without pain. Right. And they get to choose. Right. It should be their choice. That is their choice. It should be their choice before they lapse into something where they can make a decision. Well, I think that's most important that we understand that the patient needs to make this decision. Absolutely. That somebody else can say, well, let's get grandma out of here. We need to understand what we're talking about and that the patient needs to make this decision. The patient needs to be of sound mind that they can make this decision early enough so that you can't say, oh, well, they were just trying to get rid of grandma. I agree. There are some Roman Catholics that I have met who somehow believe because Jesus suffered, they should suffer also. Well, that's the martyrdom. Yeah, it really is. But I've seen these same patients that begin to suffer say, can't you give me something so it's not quite so painful? Yes. Especially when we know, you know that this brain tumor is not going to go away. It's just going to get bigger. I don't mean to get theological, but Jesus suffered once and all for us. And yes, I mean, that's what he said, right? That's the way it's written. This was for us. But the Catholic Church is all the martyrdom. The Roman Catholic. Okay, the Roman Catholic. I'm going to remember the difference. Now tell me where you're located as the... The Ecumenical Catholic Church. Well, right now we have seven churches in the world so we're not really big, but there are divisions already of Ecumenical Catholic. We all talk to one another, but I don't know, human beings seem to differ and sometimes there's splits that occur. But here we have actually seven members and we have a Franciscan order. So that's what we are even more than Ecumenical Catholics. So we meet at our apartment at Queen Emma Gardens once a month for what we call mass and chapter. And then we go to zippies for dinner. I found a long time ago, if you offer food, people will come. You have to invite me. Oh, I would invite you. I like going to zippies. And we pick up the tab too. Yes, absolutely. Only once a month? Yeah, so far only once a month. But we're both chaplains for another organization called Dignity which works with the LBGTQ community of Roman Catholics that can't have it in their own church. And we meet there every Sunday night at St. Mary's Episcopal Church and we're there twice a month. That's on South King Street. Almost to McCully. It's on the Malca side of the street. St. Mary's Episcopal. Episcopal Church. And they have a cute little chapel which was the original church that we meet in. It's perfect. We have about 17 members. Now where is this again? This is every Sunday? Every Sunday. At what time? At 5.30 p.m. At St. Mary's Episcopal Church. At St. Mary's Episcopal Church. On South King Street. And that's for dignity. But increasingly, because people know us, other people from our church that are not necessary LGBT have started coming. And we always like it when I preach. So praise God I seem to preach pretty well. And not long. I'm short and to the point. Oh, very good. Very good. I like that. You keep sitting there and not saying a word. See the two of us could keep talking forever. I'm aware of that. I'm listening. And when something like that occurs in socializing, I'll have to sometimes raise my hand. Raise your hand, yes. Me, I'm here. The conversation more is he's the expert. He's really the one that's seminary trained and had many experiences in lots of denominations. Well, I would like to spend this last few minutes talking about a tradition is not a tradition yet. How we can create a tradition. What you did with the bereavement letters and notes and whatever. So that the person just doesn't disappear. That there is something that the family gets that says we care. We need to create that as a new tradition. I want to see that happen, not just for the ecumenicals but for everyone. I don't know all of the hospice people, organizations, but it just seems such humane thing to do. So I'm going to need your help and I need everybody else's help out there to see that this happens. It just seems like such a good idea. And I thank you both for being here. This has been a real pleasure. I've learned so much and I am going to come to the hospital once a month. Yes. Oh, yes. Definitely call me and I'll tell you which. This month is going to be on the 15th of December. It's usually on a Thursday. Is that a Thursday? The 15th of December, I would like to do that. And I'll give you my address and all that. Quickly a plug for a book and unfortunately I don't remember the author, but it's called Nurse Midwife for the Dying and it covers all of this. Wonderful. Thank you so much. It's been a real pleasure. Again, thank you for joining us and we'll see you next week.