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The Hour Of Our Death
Catholic Teaching On Who Decides
BY PAUL A. BARRA REGISTER CORRESPONDENT October 21-27, 2007 Issue |
Posted 10/16/07 at 10:50 AM
end of life series, part 3
In earlier parts of this three-part series on end-of-life
issues, we discussed how some hospices are redefining extraordinary treatment,
showing less concern for the sanctity of life than for a quality of life, and
how right-to-life organizations are concerned about eroding values in the care
of the terminally ill. In this final part of the series, we hear from experts
in the teachings of the Catholic Church on these issues.
Legally, the battle for “dying in God’s time,” in the words
of anti-euthanasia activist and North Carolina resident Betty Wickham, may
already have been lost.
In 1975, the Catholic parents of Karen Anne Quinlan were
allowed by the New Jersey Supreme Court to disconnect their comatose daughter
from her respirator, but her parents would not remove her feeding tube; she
lived for another nine years.
The court quoted Pope Pius XII, who said that ending
extraordinary medical treatment such as a mechanical breathing machine did not
constitute euthanasia in a case like hers.
But in 1990, the U.S. Supreme Court did not refer to Church
teaching in the case of Nancy Beth Cruzan, when it ruled that Cruzan’s parents
could remove her feeding tube. She died 11 days later, probably from a
combination of starvation and dehydration.
A North Carolina bill that was signed into law in August
allows for “back door euthanasia,” according to the vice president of the state
chapter of the Catholic Medical Association, Dr. Kenneth McElynn.
“All coma patients across the board are placed in serious
jeopardy,” said McElynn. “The bill creates a dangerous new advance directive
form called a ‘Medical Order for Scope of Treatment,’ also known as the MOST
form. The form originates from Oregon’s right-to-die movement and its promotion
is part of their national campaign.”
The problem that pro-life medical professionals such as
McElynn see with new directives and with the changing terminology being used in
palliative care these days is that caregivers and the terminally ill are
beginning to accept what used to be unacceptable — and what the Church still
finds unacceptable. And even when they don’t, euthanasia appears to be on the
fast track to becoming the new de facto law of the land.
John Luce and Ann Alpers, writing in the American Journal of
Respiratory and Critical Care Medicine, said so-called terminal sedation, where
a patient is rendered comatose by medication and then, since the patient is never
expected to regain consciousness, may have food and water withdrawn, is fast
becoming legally acceptable. The same might be said of outright mercy killing,
in fact if not always in statute.
“Overall, cases of suspected assisted suicide or euthanasia
are difficult to prosecute successfully. … If the patient and family consented
to palliative care,” Luce and Alpers wrote.
Food and Water
John Brehany, an ethicist and executive director of the
Catholic Medical Association, noted that a debate has been going on for years
about the moral acceptability of withholding food and water from a terminal
patient. He said the association supports Pope John Paul II’s March 20, 2004,
statement to the International Congress on “Life-Sustaining Treatments and the
Vegetative State.”
“The sick person in a vegetative state, awaiting recovery or
a natural end, still has the right to basic health care (nutrition, hydration,
cleanliness, warmth, etc.) and to the prevention of complications related to
his confinement to bed,” the Pope said on that occasion. “I should like to
underline how the administration of water and food, even when provided by
artificial means, always represents a natural means of preserving life, not a
medical act. Its use, furthermore, should be considered, in principle, ordinary
and proportionate, and, as such, morally obligatory.”
“In principle, nutrition and hydration are considered
ordinary and proportionate means of care. If you can feed them, you should,”
Brehany said. “There are occasions when feeding someone may rise to the level
of extraordinary [care]; then, you can withhold it.”
Those exceptions, Brehany said, might be when a dying person
cannot assimilate food and/or water, or when one or the other causes serious
discomfort.
Father Tadeusz Pacholczyk, director of education for the
National Catholic Bioethics Center, agreed with Brehany and added as an
exception a situation where a feeding tube fails to provide actual nourishment,
as in the case of advanced cancer of the digestive tract.
“As a general rule,” Father Pacholczyk said, “we should die
from a disease or ailment that claims our life, not from an action by someone
that causes our death. … There should be a presumption in favor of providing
nutrition and hydration to all patients, including those who require the
assistance of a feeding tube.”
Terminal Sedation
According to the principle of double effect, we can relieve
someone’s pain — if that is our intent — while still rendering him comatose or
shortening his life as a secondary effect. But that necessary intent is missing
when palliative care professionals induce what is known as terminal sedation.
“They have something else in mind,” Brehany said. “Their
purpose is to end any consciousness and then withdraw nutrition and hydration.
The boundaries have been slipping, and food and water have been defined by some
as extraordinary medical treatment.”
Many hospitals recommend that people fill out a living will,
a form of advance directive, telling medical personnel how to treat the patient
as far as extraordinary care goes if he becomes seriously ill. The trouble with
living wills is that they cannot anticipate every possible scenario. Father
Pacholczyk calls them “blunt instruments.”
“There is a better choice available to Christians than a
living will,” he said. “We can choose a surrogate, a living person, who will
make health care decisions in real time on our behalf if we are rendered unable
to do so. The surrogate is someone who cares deeply about us, who loves us, and
is reasonably able to make decisions in accord with our known wishes and with
our best medical and spiritual interests in mind.”
Brehany said that Catholics can be easy in mind about
end-of-life decisions, because their Church has the moral authority and the
expertise to work out all the complicated value judgments ahead of time.
“The teachings of the Church are very reasonable,” he said,
and we just have to get out there and witness to them in a charitable manner.”
Paul A. Barra writes from
Reidville, South Carolina.
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