The Liverpool Care Pathway for the Dying: Part 3 - Care after death and Conclusions

It turns out there is quite a lot to say about the LCP!

Part 1 - Assessment
Part 2 - Intervention

Care after Death
End of life care obviously includes care of the patient after death. The LCP states that the patient's remains should be treated with respect and dignity whilst the final offices are carried out. The patient's reglious views should be respected and their possessions should be kept safe. The family should be given written information about what they need to do next and talked to (and given written information) about where they can find support in their grief. On a practical level, the hospital (or hospice or care home) has a responsibility to communicate the patient's death to certain parties.

Conclusions
A lot of concerns have been raised recently (and indeed since its introduction) about the LCP. I believe that it is important to recognise the distinction between the LCP itself and the implementation of the LCP. In itself the LCP is not a bad thing: it ensures the dignity of dying patients and I cannot see that it is against the teachings of the Church.

But, and it is a very big but, the implementation of the LCP evidently leaves a great deal to be desired.

• Firstly, and most problematically, the initial determination of whether a patient is dying is extremely hard to make, and should not be undertaken by junior staff. In fact, it should probably only be made by experienced palliative care specialists.
• There are accounts of patients languishing on the LCP for weeks or months. This should not be happening. The protocol clearly calls for regular re-assessment of the care plan and that includes the fact of being on the LCP itself.
• Consent - there seem to be issues surrounding consent where the patient is unable to consent themselves. There needs to be clarity over who can consent for another adult. And if you have elderly parents or relatives then get a Power of Attorney agreement drawn up before you need one, because once you need one you won't be able to get it (if a person is confused or unconscious they cannot give informed consent).
• The LCP does not call for a blanket care plan, or a blanket anywhere else. However individual care plans take time, time is money and everyone knows that no-one has got enough. It is quite possible that hospitals (in particular) do not have enough money (or enough palliative care specialists) to properly carry out individual assessments and care plans and it is this sort of thing which leads to blankets all over the place, and heavy sedation.
• It is frequently heard that patients who cannot feed themselves do not get fed. I have seen this happen (staff frequently took my Grandad's meals away, assuming he didn't want them because he hadn't eaten them. Nobody seemed to realise that he hadn't eaten them because even if he had been able to reach the tray, having not eating for several days he wasn't able to lift the fork to his mouth). It is all very well saying that people should be encouraged to eat and drink but there needs to be someone there to do the encouraging. Protected meal times may help some patients eat more, but they also mean that others end up eating less.

I do firmly believe that the LCP is an important step in itself. It recognises that we are all creatures, that death is an inevitable part of life and that all human beings have an inate dignity, which should be recognised even in dying. It also recognises that talking about death helps individuals and their families to better prepare for it. However, it has a huge potential to be wrongly used, and so it is leading to deaths by neglect or euthanasia and this is completely unacceptable. I don't know what the best solution is at this point, but I do think that Catholic healthcare professionals, and others who support life, and who consider themselves sufficiently competent to do so, need to get on board with the LCP on a case by case basis in order to ensure that it is used as it as intended. However, given the huge problems with its implementation, I also don't think there could be any objection to not supporting it or being involved with it. All health professionals should rigorously question their own competence to determine whether they have the necessary judgement and skills to participate in the LCP, and given that we have an ageing population. I, for one, will be reading up on palliative care and perhaps the year of faith could be an opportunity for those who work in healthcare to form themselves in Catholic medical ethics.

The Liverpool Care Pathway: Part 2 - Intervention

In my previous post I discussed the initial assessment which occurs before a patient is placed on the LCP. (Coincidently, Mr Trovato has also been blogging about the LCP here and here.) So, it has been determined that the patient is dying of non-reversible causes, in the last days or hours of life, and this has been communicated to the patient and their relatives and carers. The aim now is for the patient to be as comfortable and dignified as possible. The aim of the LCP is not to hasten a person's death, nor is it intended that all patients will be treated identically. Every person should be individually assessed and treated on a case by case basis. Comfort and dignity do not mean that someone needs to be asleep. This would in fact violate the LCP which has the patient's ability to communicate as its first aim. Being alert, awake and able to communicate with family and friends is arguably much more dignified than sedation, and even more comfortable.

The first step is a review of the medications which the person normally takes. Every single time a medication is prescribed and administered it is based on a risk-benefit assessment by the doctor and the pharmacist. This assessment is normally implicit, a lot of the work has already been done by the licensing authorities who decide which medication can be prescribed for which patient in which conditions. Sometimes the risk-benefit analysis becomes more explicit, for example in children, in patients with liver or kidney disease, if someone is unable to swallow, if part of their intestines has been removed, if a woman is pregnant or breastfeeding... These all alter the risk-benefit ratio. The same is true in end of life care. Side-effects which were manageable or slightly irritating may become distressing. Elderly patients in particular are often on about 6 different medications; in the over 70s it is extremely common to see daily aspirin, a statin to control cholesterol, two tablets for blood pressure, a laxative, something for diabetes, at least paracetamol for pain relief...the more illnesses one has, the more one is likely to get, and every new medication probably ends up being two in order to manage the side effects of the first.

Each of these needs to be re-considered in the light of the fact that the patient is dying and stopped if not essential. This is perfectly legitimate (CCC 2278). The particular circumstances of the patient must also be taken into account: maybe they can swallow tablets, maybe they don't want to, perhaps they are being fed through a tube... Medication for symptom control in palliatve care is often delivered using a syringe driver (sometimes called a "pump") because they give minimum discomfort and allow careful and rapid adjustment of doses. It's possible that medicines might be changed from tablets to something which can be given in the driver to make life easier for the patient.

The LCP calls for "when required" prescriptions to be written for the symptoms common in dying patients: pain, agitation, nausea or vomiting, breathlessness and 'respiratory tract secretions'. This does not mean the person will be given these medicines, it means that they can be given them as soon as they are needed, if they are needed. Only what is necessary and no more should be given to the patient for their comfort. Again the use of syringe drivers is helpful because it allows delicate control of doses which helps to prevent unwanted side effects such as sedation. The LCP does not call for sedation.

If you have ever been in hospital you will know that it is rather annoying to have your pulse, blood pressure and temperature checked every 4 hours or so. Routine monitoring of this type may be discontinued, likewise routine blood tests. However, these kind of tests do provide the means for nurses to see patients regularly, and I would imagine that frequent, regular visual observations of the patient would continue even if these tests were no longer deemed necessary.

Particular controversy surrounds the part of the LCP relating to nutrition and hydration. In fact the LCP does not call for the withdrawal of fluids in order to hasten death. Quite the opposite: it recommeneds that patients who can eat and drink should be encouraged to do so. However, as the body winds down, people who are dying are often not hungry, or may find it too tiring to eat or drink. Fluids (and even food) can be given by other means, but it is as important to avoid fluid overload (which can occur if the person's heart, liver or kidneys are not working well) it is to prevent dehydration as both are life-threatening. Dry mouth can be caused by things other than thirst, and good "mouth care" is essential.

"Do not resuscitate" orders (DNRs) are also sometimes controversial, but often this is because a DNR from a previous hospital admission has not been revoked, or because the patient and their family or carers have never discussed it, and by the time they do the patient is not capable of consenting.

The LCP requires that every patient be individually assessed for each of these interventions. Palliative care, unlike most areas of medicine, takes a holistic view of the patient, and the LCP is no exception, calling for emotional, social and spiritual support for both the patient and their family.

Liverpool Care Pathway for the Dying: Part 1 - Assessment

According to the Daily Mail, there is to be a review of the LCP following complaints by relatives who did not know their loved one had been place on the LCP. However as the above article also implies that the LCP is a form of institutionalised euthanisia, whereby "patients judged to be dying are left without treatment, food or fluids" I am inclined to be a little skeptical, because I have actually read the LCP guidance and it doesn't say that. But what it does say is that firstly, the LCP "does not replace but supports clinical judgement" and secondly that the LCP is "only as good as the people who are using it". In fact it states that the pathway should not be used without education and training. Interestingly, it also states that the "death [of dying patients] must not be considered a failure; the only failure is, if their death is not as restful and dignfied as possible".

A quick look at the Catechism gives the following (annotations my own):

 

2276 Those whose lives are diminished or weakened deserve special respect. Sick or handicapped persons should be helped to lead lives as normal as possible.

2277 Whatever its motives and means, direct euthanasia consists in putting an end to the lives of handicapped, sick, or dying persons. It is morally unacceptable.

Thus an act or omission which, of itself or by intention, causes death in order to eliminate suffering constitutes a murder gravely contrary to the dignity of the human person and to the respect due to the living God, his Creator.
The error of judgment into which one can fall in good faith does not change the nature of this murderous act, which must always be forbidden and excluded.

2278 Discontinuing medical procedures that are burdensome, dangerous, extraordinary, or disproportionate to the expected outcome can be legitimate; it is the refusal of "over-zealous" treatment. Here one does not will to cause death; one's inability to impede it is merely accepted.
The decisions should be made by the patient if he is competent and able or, if not, by those legally entitled to act for the patient, whose reasonable will and legitimate interests must always be respected.

2279 Even if death is thought imminent, the ordinary care owed to a sick person cannot be legitimately interrupted.
The use of painkillers to alleviate the sufferings of the dying, even at the risk of shortening their days, can be morally in conformity with human dignity if death is not willed as either an end or a means, but only foreseen and tolerated as inevitable.
Palliative care is a special form of disinterested charity. As such it should be encouraged.

 

So what does the LCP actually say?

1. Deterioration in the patient's condition suggests that the patient is dying. At this point there must be an assessment by the multi-discplinary team (MDT).

2. The patient is deemed to be dying from non-reversible causes and in their last days or hours of life. Specialist referral may be sought.

3. The patient's relatives/carers are informed that the patient is dying. The care plan, including the LCP, is discussed. 

4. The LCP is implemented. This includes ongoing regular assessments.

 

1-2. It is hard to tell if a patient is dying. It is even harder to say if they are in the last days or hours of their life. The LCP takes steps to address this by requiring an assessment to be made by the MDT. However, especially at weekends (and at night) the MDT may be somewhat thin on the ground...there will be nurses, there will be junior doctors, but the number of senior doctors is probably low and there are unlikely to be any other health-care professionals around - pharmacists, physiotherapists, speech therapists (who carry out assessments of a person's ability to swallow) etc who would normally be considered a legitimate part of the . I once worked with a GP who joked one day that Mrs X was ruining his reputation. The extremely elderly lady in question was in a care home, and was barely eating or drinking. He informed Mrs X's family and they gathered round her bedside...six weeks later she was still going strong. I have seen deteriorating patients unexpectedly recover, and recovering patients unexpectedly deteriorate and die. I would not consider myself competent to make this decision. So on paper we have no problem, but in practice we have a big question mark over 2277. Not because the intention of the LCP is to hasten the death of the patient, but because if a patient is wrongly placed on the LCP then it will hasten their death, not because of the intention, but because of the act in itself.

 

3. The LCP emphasises that it's not just about telling the family that the person is dying, it's about helping them to understand this. This will probably take a while to sink in. The guidance says that the care plan should be "discussed". Although not stated, this should include consent, because consent is required in UK law. Treating a person without consent would make you liable for assualt and battery. However, consent must be informed, which requires competence (ie the capacity to understand the situation and give that informed consent) on the part of the person giving or refusing it. If the next of kin (assuming the patient themselves is not competent) does not understand that the person is dying, then technically they are not competent. The level of competence required varies from case to case, from illness to illness and treatment to treatment. Also refusal of treatment requires a higher level of competence than acceptance (for example, children under 18 can overrule their parents and consent to treatment if they are considered competent, but however competent they are they can never overrule their parents and refuse treatment).  But the LCP involves discontinuation of some medications and initiation of others, so I am not sure what level of compentence would be required. This is in accordance with the second part of CCC 2278.

 

4. There have been stories of patients being on the LCP for weeks or months. This should not happen because the MDT should re-assess the patient every three days OR there is any improvement which suggests the patient is not imminently dying (there's a list) OR the patient, relative, carer or "team member" expresses concern about the plan. He we have an ambiguity over what is mean by "team member": does this mean a member of the MDT in general, or the specific group who originally assessed the patient? I think it would have to be the former, ie any healthcare professional who is involved in the care of the patient. Now communication becomes key. Too often, healthcare professionals communicate by writing in the patient's notes. Surgeons have the worst writing, and pharmacists usually the best (they suffer a lot from other people's bad writing). If the patient is very ill then there may be several pages of nursing notes between each assessment by anyone else, always supposing they are in the same place as the medical notes. And I have even seen a note saying "Dear Dr Y (the specialist consultant who had been called in to review the patient), Thank you for seeing this patient and for the plan. I have carried out 1 and 2 but I can't read 3" or words to that effect. I have no idea if this specialist was going to be coming back to the patient. Was he going to see this note? In this case it probably wasn't an emergency because it was point 3, not point 1, and the doctor left instructions, rather than implementing 3 himself.

 

The 3-day rule is a good one: if the patient has been diagnosed as in the last hours or days of their life, and the MDT come back after 3 days and the patient is in the same state as before, then frankly I think you need to question your initial assessment.

 

 

Who takes responsibility for this guesswork?

Over at the Hermeneutic of Continuity, Fr Tim Finigan mentioned (and I believe I am supposed to touch my forelock to him, but am new at this whole blogging thing so I am prepared to stand corrected) the case of Adrian Smith who was demoted from a managerial position for posting comments on facebook about same-sex marriage taken place in churches. I went and found the article in the Manchester Evening News because surely for such measures to be taken against him, citing gross misconduct, he must have written something actually bigoted (rather than just expressing an opinion, which is what is taken for bigotry these days) or incited people to burn down churches where same-sex marriages are performed or something equally extreme.

In fact, no.

Then I thought that maybe this is part of the recent spate of facebook/twitter crimes, by which an individual writes something more or less offensive (often whilst drunk) and gets sent to jail for it. I heard of a newly qualified teacher who didn't get the job he applied for because the governors saw pictures on facebook of him acting stupidly whilst drunk and decided that he didn't have the necessary character for forming young hearts and minds. People need to realise that twitter is public (and should be avoided when drunk) and that there is nothing private on the internet, including facebook. And, I think, the law needs to take account of modern means of communication which are changing much faster than the law ever can. Did Mr Smith, then, say something which he thought he was just saying to his nearest and dearest but turned out to be public?

In fact, no.

Mr Smith's 'crime' (bearing in mind that he is not being prosecuted, just sanctioned) turns out to be breach of his employer's code of conduct which, according to the MEN, states that employees must not "expressing religious or political views which may upset co-workers".

I think that warrants closer inspection...

Firstly, if you express views which may upset co-workers as long as they're not religious or political then that's fine. So if you were to express "Darcey's earrings are way too big but at least she's a better judge than Arlene was", or "I hope that Saddam rots in hell", "I am saddened and disappointed by the content of JK Rowling's new book. She may not agree but I think as a well known children's author she has a certain responsibilitiy" or even "I can't believe anyone thinks (insert name of celebrity) is good looking. He/she looks like they've been hit by a bus, and is also completely devoid of talent" all those are also fine. However, if you say "I don't see how Nick Clegg in conscience can remain head of the Lib Dems seeing as how he did a U-turn on tuition fees which has always been one of their manifesto promises," or "The government don't have a mandate for same-sex marriage and I can't help thinking that the furore is a cover-up to distract us from the failing economy, much like the issue of the Falklands in Argentina" that is not OK. And secondly, I feel there is a problem with the wording "may upset co-workers". It doesn't matter if no-one is actually upset by your religious or political views, just as long as they might be. But in this case, who decides? We're back to people being told that they can't wear a cross because someone "might" be offended. If no-one is offended, what is the basis for thinking they might be. And is there a difference if I say "I think abortion is wrong" and am a Catholic or if I say it and am an atheist. The statement equally "might" offend someone who has had an abortion but only in one case could it be argued to be a religious view.

It would seem that Adrian Smith has made two mistakes. Firstly, signing up to work for a company with such a ridiculous code of conduct and secondly using facebook whilst Christian.

Help required

EllaOne, the morning after pill which works for up to 5 days after (er...the 5 day after pill?), is now available from Co-op pharmacies without a prescription, the Telegraph reports. I'm feeling a bit out of the loop because I didn't know anything about this and apparently it's been around for a while now. I did a little googling and found that the Mail reported on it a couple of years ago.

The article in the Mail says that the manufacturers state that EllaOne can 'help stop an accident from becoming something more life-changing'. This is the first thing I would like explaining: how is having sex is an accident? I know that's not what they mean. It seems our brains are completely broken in this pleasure-seeking society. For one thing, accidents should make you stop and think, and then see how you can stop them from happening again, whether that means looking before you cross the road, fitting a stair gate or padding the corner of the cupboard where you always bang your head (maybe that's just me).
The Telegraph says that 250,000 women use emergency contraception every year. In 2011 there were around 190,000 abortions which is very slightly down on 2010. The morning after pill became available over the counter in 2001 since which time there has been a general upward trend in the number of abortions, which peaked in 2007 and seems to have remained stable for the last few years (although the number of abortions for non-residents is falling off, so actually the number of abortions for residents is increasing). However, considering that the goverment strategy of throwing contraceptives around is supposedly for the purpose of reducing abortion one has to ask what is going on: yes, the number of abortions has decreased slightly in women under 20, but this is more than compensated for by the increase among those in their 20s and 30s. AND 250,000 women take the morning after pill every year. It is clear then that increasing the availability of the morning after pill is not really affecting the number of abortions carried out.

Here are some reasons why this might be:
(1) It doesn't work. However, we should probably discount this one as it is demonstrated to be effective.
(2) The women who took the morning after pill weren't pregnant anyway. We have no way of knowing this.
(3) People have stopped using other forms of contraception. Difficult to say for sure without other prescribing data but would explain why chlamydia rates are rapidly increasing.
(4) Increased promiscuity - as postulated beforehand, and likewise explains STD rates.

 As STD rates are increasing so fast, I have to say that, sadly, (4) seems the most likely, which is reinforced by the general sexualisation of society which surely influences sexual behaviour. It would be interesting to see a breakdown by age of women taking the morning after pill.

As a final note 255,000 women died in 2010 in the UK. That means that EVERY YEAR APPROXIMATELY THE SAME NUMBER OF WOMEN TAKE THE MORNING AFTER PILL AS DIE! I grant you that there may be women who take the morning after pill more than once, and those who died are definitely exclusive, but still...doesn't anyone else find this a bit worrying?

A lack of logic is a dangerous thing

One of my cousins sent me a link the other day to a video of a guy defending same-sex marriage. He was calm, eloquent and believed in his cause. And dangerously convincing. No doubt using words like "dangerously convinving" make me a homophobic bigot, but what I'm actually talking about is logic, or a total lack thereof.

The problem is this: no-one is taught logic anymore and therefore very few people can recognise when the flaws in an opponent's argument have nothing to do with the point at stake. These days, hardly anyone bothers to put together an argument which has any more content than maligning the opposition. This guy talks about logic, talks as if he's being logical, attacks "so-called homophobic logic" and you have to really pay attention to see where his logic totally falls apart and reveals itself to be a big pile of...fallacies.

When I clicked on this link, the first thing that happened was that I was asked to respond to the following statement: "I believe that everyone should be treated equally regardless of gender, race or sexual orientation". There is a long-standing, regularly exploited ambiguity of the words equal and same. For example, I believe that men and women were created equal in dignity, but men and women are obviously not the same, whether on a biological, psychological or spiritual level we are clearly different. But when people start talking about gender equality they usually mean that everyone is the same. But "treating people equally" doesn't mean "treating everyone the same" and everyone being equal and treating everyone equally and treating everyone the same are three different things. If they were the same, then I should give money to everyone who asks me for it, whether they need the money for medicines or illegal drugs. I should carry out brain surgery on two people who have fallen down some stairs and injured their head even though one of them is a 92 year-old whose blood pressure medication made her dizzy and the other is 20 and was drunk. Equality comes in ensuring that both get the treatment with the best risk-benefit ratio, giving them the best prospect of recovery. How that is decided, and who decides it, is another issue. As for sexual orientation, everyone is called to live chastity, and for the record that is not something which is lived on a purely physical level. If I don't have a boyfriend, but have sexual fantasies about a good-looking guy I saw on the bus, am I chaste? If I am married and do the same, am I chaste? No: "sexual pleasure is morally disordered when sought for itself, isolated from its procreative and unitive purposes" (CCC 2351) whether in the mind, the heart or the act.

Returning to the website, I might easily agree with the equality statement, but then I could well be left questioning myself over why, in that case, I don't agree with same-sex marriage (it being obviously discrimination, myself an unknowing homophobic bigot). I might even end up deciding that as I'm not a bigot and I am in favour of equality I therefore had better start supporting same-sex marriage because it's totally in line with my priniciples. You see...dangerous, and the guy hasn't even started talking yet.

Sometimes there are no shades of grey

A couple of weeks ago pro-abortion campaigners delivered 600 coathangers to the Department of Health in protest at Jeremy Hunt's supposedly pro-life views. Their concern is that if the abortion limit is reduced (not that anyone seems to have plans to do so) that abortion will become "illegal and unsafe".

As a young adult, I had rather contradictory views on abortion. I was convinced that the unborn child was a person, and arguments at what point exactly it became a person seemed deeply flawed to me. However, I also believed that it was inevitable that women would have abortions and therefore it was better for them to have legal access to abortion so that they didn't die in back-street abortions. In short, I subscribed to the 600 coathanger view.

I have long since changed my mind about this. I realised that if the unborn child was a person (and furthermore, if we cannot say definitively that it is not) then there can be no justification for abortion. The "people will do it anyway so lets make it legal" argument has long been applied from everything from prostitution to speeding and doesn't hold water: if something is objectively wrong then making it legal doesn't make it objectively right.

After reading about the coathanger delivery I started thinking about it again, and I realised that what really worries me is what it is that drives women to seek an abortion at all costs. Things have changed since the Abortion Act was first introduced. Single mothers, although obviously they have extremely difficult lives, are not ostracised from society. And if she really doesn't want to or can't look after a baby, then there are hundreds of couples out there going through IVF and surrogacy who do want to have a child.

I was reading a friend's column in El Colombiano yesterday, in which she explains that being pro-life isn't just about mindlessly shouting about something you disagree with, but that it is important to inform your conscience about why abortion is wrong. I then read the comments section. I try not to do this, it generally annoys me. What I found was that whilst the comments where anti-abortion, quite a lot of them said things like "there's no need for abortions in this day and age because we have contraceptives". (That is something that I still struggle with. I am 100% with the Magisterium on this, but it has been so well drummed into me throughout school and university here in the "geopolitical epicentre of the culture of death" that contraceptivees are the solution to all the world's evils that often it is the first answer to pop into my head. I choose to reject this answer, but it is still there.)

What we have lost here is love. Love of a mother for a child is surely the most fundamental kind, and if a mother can argue that her child is not a child, or puts her right to what she considers life over his or hers then we have lost something fundamental. And for those women who have abortions because they are desperate and struggling and genuinely see it as the only solution, well, they are also called to make a great act of love, and so are the rest of us, to support them (practically, spiritually, psychologically) in that love. And if, horrifyingly, a child has been conceived in rape then that woman is also a mother and she too is called to make a sacrificial act of love. Acts of love are not easy. We must die to ourselves, say no to our own comfort, our own plans, in order to love. And "dying to ourselves" is not just a nice turn of phrase: Jesus really died on the cross out of love. And that is the measure for which we must strive.

On quick fixes...

The papers are apparently full of sleeping tablets. That is to say, the NHS is spending rather a lot of money on benzodiazepines and the so-called Z drugs (with 15.3 million prescriptions last year), commonly prescribed for insomnia and anxiety. Furthermore, an additional £40million was spent on over the counter sleeping rememdies. Benzos and Z drugs are what health-care professionals would call "dirty drugs". They come at a price...side effects and, in particular, tolerance and withdrawal which add up to addiction.

Physical tolerance means that the body requires more and more of the drug to get the same effect. Withdrawal means that stopping the drug causes side effects, which are relieved by the drug. It may also lead to 'rebound' symptoms of whatever the drug was being taken for in the first place. It is for these reasons that guidelines state that sleeping tablets should only be used on a short term basis.

We have now embarked on the usual cycle of blame. Patients blame doctors for ruining their lives with addiction. Health-care professionals blame patients for self-treating without medical advice. Warnings about what not getting enough sleep can cause (early death) are now balanced by warnings about the long term effects of sleeping tablets (Alzheimer's). I would say that there isn't a clear direction of causality with these effects. Both Alzheimer's and early death could be caused by some underlying factor which also causes sleep deprivation. The brain and the immune system are involved with sleep and neither is fully understood. But all this has no doubt led to increased anxiety over sleep: waking up in the night is now a disaster which makes us so stressed out that we can't get back to sleep.

Working in healthcare I have seen an increase in the use of "lifestyle" drugs. Increasingly we want a quick answer to an annoying problem. I am not denying that depression, anxiety, insomnia and obesity (to name a few) are not real diseases. However, I think we often seek a rapid solution to something that needs addressing in the long term. Stress and anxiety contribute to many illnesses, and once again I would argue that they could well stem from individualism. The need for a quick fix can be traced to the nihilism and hedonism which now underly our culture. Thus both the problem and the equally problematic solution come from the same place. A lack of community, and the difficulty of forming true friendships mean no-one to talk about our problems with. We distract ourselves with alcohol, food, sex, exercise, television, whatever. Of course we lie awake at night worrying about our jobs, our children, our spouses or lack thereof, money, keeping up with the Joneses...because we are unable to rest. We have nowhere to rest. Without God, without heaven and hell, we have nothing to work for in the long term either. We need the solution now. If I cannot manage to renounce biscuits  (and sitting here I have just absent-mindedly eaten an entire packet) for the sake of eternity, how I am going to be able to renounce them for the benefit of my waistline in this life. Of course I want a tablet. If I have no-one in whom I can truly rest then of course I am going to lie awake worrying about my problems. If there is a magic pill to solve my problems, great! And if I have no room or no need for a God who suffered out of love for me and who is with me in my sufferings then I am definitely going to want to eliminate all suffering from my life as fast as possible.

Catholic-Link launched in English!

To celebrate the launch of Catholic Link's English language site, with permission I have published below an interview with Mauricio, a member of the Sodalitium Christianae Vitae (SCV), who blogs at Catholic Link's Spanish site by Fr Joan Carreras del Rincón. Fr Carreras is the founder of Asociación de blogueros con el Papa [Association of Bloggers with the Pope] which will be holding their second meeting in early October. Mauricio talks about how Catholic-Link started, the principles behind it and the lauch of the English language version.

The SCV is a Society of Apostolic Life of Ponitifical Right, founded in Lima, Peru in 1971. They do not have a presence in the UK, but their sisters, the Marian Community of Reconciliation (also known as the Fraternas) have a community in Manchester.

Catholic-Link is a great resource for catechists and really for anyone doing apostolate with young people. The launch of their English version is excellent news.

Fr Carreras: I am lucky enough to be interviewing a young blogger for whom I feel great admiration. He is the author of a very young, dynamic blog: Catholic Link. I feel admiration because he unites various qualities which are not often found in young people: critical maturity, thoughtful statements, wise commentary. To these characteristics found in those hardened by experience he adds those typical of youth: technological mastery, being in tune with young people’s problems, a certain unworried air…

Mauricio, how did the idea to create this blog come about? How long have you had this liking for blogs? Are your interest in blogging and your eagerness to evangelise related in some way?

Mauricio: Catholic-Link arose very quietly. The truth is that at the beginning I never through that it could reach the dimensions it now has. Before launching the blog I used to send different videos, which I thought were useful for apostolate, to various brothers from my community (I am a member of the Sodalitium Christianae Vitae); one of them, a priest who is a good friend of mine, advised me to create a blog where I could put all the material, organised by categories, with labels. The idea seemed a good one so I did it and started to publish things there. Initially, and I think it’s stayed that way, the blog had a very informal, familiar style, that of a friend explaining to another friend how to do apostolate. It seems to me that this was one of the elements which sparked the warm welcome which the blog started to receive. Very rapidly, many seminarians, catechists, consecrated men and women, and people generally involved in apostolate (the majority being young people) started to write to us saying that they were using our videos and that the page was helping a lot in their apostolate. VE Multimedios, an association which produces websites for the Church, even offered to upgrade our site for free when they saw our work.

 In considering all these testimonies, I started to realise what a great responsibility we were assuming. This was the point, I think, at which I started to get interested in blogs. I discovered that Catholic-Link was a channel for encountering other people and, through them, thousands more. It’s easy to underestimate the impact which a blog can have. However, in the times in which we live, globalisation and interconnectivity mean that a blog really can become a wonderful source of apostolate. That’s why we bloggers see our role as one of such great importance within the mission of the Church. We need Catholic bloggers, passionate about what they do, keen to form themselves, enterprising, attentive to the signs of the times, available not just to write excellent posts but also to place widgets on their blogs. Beyond all this, the most important thing according to my way of seeing things… we need Catholic bloggers who are in love with Christ and the Church. If Catholic communicators are not the greatest lovers of Christ and his Church, who will believe us? We can have great communication skills – creativity, knowledge, eloquence, etc, - but if I am lack love then “I am a clanging cymbal”.

Catholic Link has a very modern, young style. Sometimes, Catholic evangelisers don’t connect with young people: do you think the language and pictures used on occasion can not only not attract young people but put them off?

I’ve been a religion teacher in a Catholic school in Rome for a year now. For me, it’s been a gift from God; I’ve learned a lot from my pupils. One of the things that I’ve understood is that young people have real difficulty understanding how they can make the contents of the faith become part of their lives. My pupils understand that God was made man, that the Lord Jesus died on the cross for us all, that he rose on the third day and appeared to the disciples, but they don’t understand how this has changed their lives. They don’t understand how these events can alter their relationships and their understanding of their surroundings, how this is the greatest marvel which has occurred not only 2000 years ago but here and now. And I don’t blame them. Our culture, even in Italy, is no longer a Christian culture. A culture which is interwoven with Christianity reconciles the rupture between faith and life; the culture in which we live lamentably widens it. Young people, and the rest of us too, are victims of this. Therefore our language often serves to distance others from faith, because we ourselves don’t really know how Christ illuminates the simplest things in our lives. Our posts, our publications, the pictures we put on facebook and the videos which we edit, sometimes, not always, show little co-naturality with a God who became flesh, who became human life, whose incarnation and sacrifice revolutionised the way of understanding everything, starting with myself from the most superficial to the deepest.

Put another way, reality is Catholic! Reality comes from God. The world is standing on my territory, and not the other way around. Faith is not an aspect of life that we have to get other people to start living. Faith is reality itself, seen from a more realistic angle. I think this is the point. To witness with great valour and joy that God loves and sustains the world. He became incarnate! And he is present in my life and yours, he takes care of the least and the greatest, from the precarious weekly finances of my house to the mystic prayer of the most spiritual Carthusian. God has revealed that he is close to us, that he is not indifferent to human suffering or human joy. Well, I could be wrong, but I think that doing apostolate on the internet doesn’t have so much to do with connecting with young people as with connecting, first of all, with the immense, daily, simple, boundless, practical, theoretical, incarnate riches of our Catholic faith. From this perspective, I think that it would be very difficult for a young person not to find themselves questioned by the apostolate we carry out.

It’s also important to be very respectful in terms of the stages a young person has to pass through in order to know the Lord. Christ himself taught his disciples progressively, a little at a time, until the day he found that they were mature enough for him to reveal that he would have to suffer the cross. Our apostolate must try to imitate Jesus’s reverent love. I know that one can have one’s heart in one’s hand and want to announce to everyone, once and for all, that life is more ‘full’ on this side; however, if we don’t patiently spend some time building a boat, it probably won’t be enough to throw a rope, especially when the river that must be crossed has burst its banks.  

Recently, you offered an English language version of Catholic-link. How do you do this? Do you translate everything?

We translate some content, especially when time is short. But the idea is to produce our own material, being that the English-speaking countries have different ways of thinking and approaching the faith. Thanks be to God, some young people - two Americans and a Philippine - are taking the project forward.

Has the spread of viral videos ever given you any problems in terms of copyright violation?

As I explained, Catholic-Link came about in a very informal, familiar way and has continued to grow, carrying the vices and virtues of this way of doing things. So far we haven’t had any problems with copyright violation but we are aware that the size and spread of the site demands greater care and attention to this important aspect.

What are your expectations for the II meeting of Bloggers with the Pope, in Santander, from the 5^th – 7^th October?

For us, it is very special that we have been invited to the meeting. Among the bloggers who will participate we are definitely the most inexperienced so our main expectation is to learn from very experienced bloggers and evangelisers. We believe that initiatives such as this one help to strengthen links of friendship which can benefit the apostolate of the whole Church. I have to say, as well, that (modesty aside) this meeting is not like any other meeting of Catholic bloggers: the Association which has invited us and of which we form part has among its principal objectives the promotion of fidelity to the teachings of the Holy Father. I think that one expectation shared by all the participants will be that of seeing how to become effective, faithful spokesmen for the Church. Fr Federico Lombardi, who is in charge of the Holy See’s Press Office, considers Catholic bloggers to be the “public opinion” of the Church. What a responsibility! This II Meeting of Bloggers with the Pope could be an excellent occasion to organise ourselves as a concert of voices in tune with the reconciling message of the Pope; something which is so very necessary in these times.

How would you encourage young people to start a blog?

I think that there are many well-intentioned young Catholics who want to start blogging but think that they have to be well formed in theology and humanities, so they end up getting discouraged and giving up. It’s true that one has to be very well formed to be able to communicate the Truth. However, starting a blog doesn’t mean that you’re going to stop being formed, does it? On the contrary, a blog could be the perfect occasion to take your Catholic formation more seriously. On the other hand, a Catholic blog doesn’t necessarily have to deal with theology, philosophy, defence of life or the analysis of reality. One doesn’t have to restrict oneself: the evangelisation of culture, to which the Vatican Council II invites us, directs us towards the evangelisation of all human realities. Do you study law, economics, architecture or medicine? Well, there you have wonderful scope where the Church undoubtedly needs you! Go for it!

One further idea. Go for it, yes. But go for it if you love the Church and understand its place in the world and the Plan of God. Ambiguous speeches by Catholics sometimes do more harm than the strongest onslaughts of those outside the Church. Firstly, be convinced; study, pray and when you are ready, then go for it. If not, well, there are many kinds of blogs you could start whose topics will not be an occasion for you to cause damage.

How are you thinking of contributing to the Year of Faith? Will you do something special on Catholic-Link?

Undoubtedly so. We have some quite ambitious projects which I wouldn’t want to give away due to discretion and healthy mistrust of self. For now, every day on Catholic-Link we are trying to grow in the service that we offer, forming ourselves better, listening to the Holy Father and publishing material which can help many people to nurture their faith and love for the Lord Jesus and his Church. I am sure that the II Meeting of Bloggers with the Pope will be an excellent occasion to find ways of collaborating for this purpose.

Thank you very much for the interview.

Thank you, Mauricio, for the sincerity and passion with which you have spoken. I hope to see you in Santander in less than a week. Until then!