By Patricia Pitkus Bainbridge
Associate Director, Respect Life Office
For the past several months, people who pay close attention to the “news” have been fed a lot of misinformation about the case of Terri Schlinder Schiavo. Terri is a 39-year-old woman whose husband and parents are battling over whether she will be allowed to live or whether she will be forced to die by dehydration.
Casual conversation in the work place and at social events reveals that many Catholics are confused about the decisions associated with the Terri Schiavo case and end-of-life decisions in general. And while end-of-life decisions may be fraught with complexities—making decisions difficult— the moral teachings of the Church regarding such crucial judgments provide the guiding principles.
A Proper End to Suffering
No rational person longs for suffering and no compassionate person wishes suffering on another. In fact, most people would avoid personal suffering if they could and certainly would help others do the same. Suffering, or more aptly, the avoidance of suffering appears to be the basic issue for most people when it comes to end-of-life decisions.
As is the case with the beginnings of life, it is no surprise that the culture of death is in direct conflict with the culture of life regarding end-of-life decisions. Those who reject God and/or the teachings of His Church, think it humane to hasten a suffering person’s death. Our Holy Father addresses this in Evangelium Vitae when he writes, “In reality, what might seem logical and humane when looked at more closely is seen to be senseless and inhumane.”
Popular culture appears to be excessively preoccupied with the fear of “being hooked up” to medical devices, being unable to care for ourselves, being burdensome to others, not having a good “quality” of life, and avoiding suffering at all costs. The culture of life teaches us that all human life has value and that we are to provide care, not death, for those who are suffering. Our Holy Father writes, “true compassion leads to sharing another’s pain; it does not kill the person whose suffering we cannot bear.” (Evangelium Vitae, #66).
Just Leave Me Alone
Compassion does not, however, mean that everything possible must be done for someone who is handicapped, sick, or dying. The Catechism #2278 speaks to this:
Discontinuing medical procedures that are burdensome, dangerous, extraordinary, or disproportionate to the expected outcomes 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 interest must always be respected.
Many individuals—often led by misguided medical professionals and sadly, even by some well intentioned, but misinformed moral theologians and clergy—use this teaching to justify the removal of feeding tubes on patients who are not in the process of dying. On October 2, 1998 Pope John Paul II said, “…a great teaching effort is needed to clarify the substantive moral difference between discontinuing medical procedures that may be burdensome, dangerous or disproportionate to the expected outcome, and taking away the ordinary means of preserving life such as feeding.”
Are Food and Water Extraordinary Care?
Technological developments make the once exceptional seem quite “ordinary” today. While medical advances have made it increasingly difficult to define “extraordinary” in reference to caring for the disabled, the sick, and the dying, common sense (and the teachings of the Church) tell us that food and water—even if given through artificial means— are to be considered ordinary care. Artificial nutrition and hydration (ANH) is ordinary care that requires simple technology.
The United States Conference of Catholic Bishops (USCCB) in its Ethical and Religious Directives for Catholic Health Care Services states, “There should be a presumption in favor of providing nutrition and hydration to all patients, including patients who require medically assisted nutrition, as long as this is of sufficient benefit to outweigh the burdens involved to the patient.”
Notice, the reference to “burdens…to the patient.” When a person is in what the medical profession refers to as a persistent vegetative state (PVS), it is very rare for ANH to present a burden for the patient. In some cases, however, the spouse or family feels that the burden is too great and they are the ones who insist on removing ANH—not because the patient is dying, but because he or she is not dying. The removal of ANH in these cases, causes death, it does not allow death.
ANH may become burdensome to the patient when he or she is truly in the process of dying from disease. When death is expected within a few hours or a few days, it may be morally acceptable to cease ANH as long as comfort care (including keeping the mouth, nose, and eyes moist) is provided. However, the USCCB Office of Pro-Life Activities paper, “Questions About Medically Assisted Nutrition and Hydration” states that “Even in the case of the imminently dying patient, of course, any action or omission that of itself or by intention causes death is to be absolutely rejected.”
Do I Need A Living Will?
A Living Will is a type of advance directive—a legal document—that purports to “speak” for a patient who is unable to speak for himself. Rita Marker, Esq. of the International Task Force on Euthanasia and Assisted Suicide writes, “It’s absolutely essential that anyone who is 18 years old or older have an advance directive—but not just any type of advance directive.” Marker continues, “There are many types of advance directives, and some, like the ‘Living Will’ are downright dangerous.” One of those dangers is that the wording is usually so vague that the person’s intentions are often misunderstood.
Even secular publications acknowledge this risk. The July 24, 1989 issue of U.S. News and World Report offered the following: “The problem is language. The vernacular of living wills—such phrases as ‘terminally ill,’ ‘no reasonable expectation of recovery,’ ‘heroic measures,’ and ‘life-prolonging procedures’—is so fuzzy and open to interpretation that doctors frequently are left with no clear idea of which measures the patient wants started, stopped, or maintained.”
In the January 10, 1997 issue of USA Today, Dr. Joanne Lynn, director of the Center to Improve Care of the Dying at George Washington University in Washington, D.C. said, “A general living will says stop (extraordinary measures) when it’s hopeless, but the question is, how hopeless did you mean it to be?”
How, then, does one follow Rita Marker’s suggestion that everyone over the age of 18 have an advance directive? One way is to have a Durable Power of Attorney for Health Care (Health Care Proxy) drawn up by your attorney. This process will involve naming an “agent,” “proxy,” or “surrogate” to make medical decisions for you if you are no longer to do so for yourself. One should take care, however, that the “agent” is of good moral character and that he or she is familiar with and faithful to the moral teachings of the Catholic Church.
If you want to learn more about end-of-life issues, a good source are the websites for the International Task Force on Euthanasia and Assisted Suicide at www.internationaltaskforce.org and the USCCB at www.usccb.org/prolife/issues/euthanas/index.htm