Labels: Contraception

Dear Members and Friends,

Exciting news! Jason and Darcy Bunn have been working to redesign and improve our website at http://lifeisworthliving.com/. Have a look for yourself. If you have any suggestions, please send them to me. THANK YOU, Webmasters Jason and Darcy!

Last Friday found me in the state of Virginia. I had the privilege of spending the day with students at a Catholic high school. See the report in Item #1. In the evening, I addressed "Moral Medical Decision Making" in a talk for adults at Our Lady of Hope Catholic Church in Sterling. Meeting many wonderful people and having the opportunity to share our Catholic pro-life perspective on matters of life and death made for a thoroughly enjoyable, but exhausting day.

Item #2 is an extremely important response to an article that appeared in the November-December 2007 issue of Health Progress, the Catholic Health Association's official publication. The misinterpretation of the Church's teaching on Nutrition and Hydration as articulated by John J. Hardt, PhD and Father Kevin D. O'Rourke, OP, JCD, STM, authors of that article, is soundly corrected by Cardinal Rigali and Bishop Lori. Enjoy!

Have a relaxing and prayerful Memorial Day weekend, as we remember all those who have gone before us, especially those who have died to protect and promote liberty both here and abroad.

In the Sacred Heart,
Julie Grimstad
Executive Director

Item 1. American Life League Sponsored Student Seminar a Success in Fredericksburg, VA
American Life League sponsored an all-day seminar, May 16th, taught by Julie Grimstad, Executive Director of Life is Worth Living, Inc., at St. Michael the Archangel High School in Fredericksburg, Virginia. 20 students and several adults attended. Entitled "WHO LIVES? WHO DIES? WHO DECIDES?" the seminar covered the History of the "Right to Die" Movement, Euthanasia, Physician-Assisted Suicide, Disability Rights, Advance Medical Directives, Nutrition and Hydration, Organ Donation, and more. The students' evaluation forms indicated that the vast majority thought the seminar overall was excellent, the topic was very important to them personally, and the degree of difficulty was just right. They particularly liked the seminar's Power Point format and the DVDs Turning the Tide: Dignity, Compassion and Euthanasia* and Euthanasia: False Light.**

For information about sponsoring this seminar at a school near you, contact Life is Worth Living.

_____
*Turning the Tide DVD available from Euthanasia Prevention Coalition of Canada, http://www.euthanasiaprevention.on.ca/, 1-877-439-3348.
**Euthanasia: False Light DVD available from International Task Force on Euthanasia and Assisted Suicide, http://www.internationaltaskforce.org/. 1-800-958-5678.
_____________
Item 2.
Health Progress
May-June 2008Volume 89, Number 3

On Basic Care For Patients In The 'Vegetative' State
A Response to Dr. Hardt and Fr. O'Rourke

BY CARDINAL JUSTIN F. RIGALI, JCD, & BISHOP WILLIAM E. LORI, STD
Cardinal Rigali is archbishop of Philadelphia and chairman of the Committee on Pro-Life Activities, U.S. Conference of Catholic Bishops (USCCB); and Bishop Lori is bishop of Bridgeport , Conn. , and chairman of the Committee on Doctrine, USCCB.

In a 2004 address on care for patients diagnosed as being in a "vegetative state," Pope John Paul II affirmed the human dignity of these patients and the obligation to provide them with ordinary care, including food and water, even with artificial assistance. On Sept. 14, 2007, through its "Responses to Certain Questions of the United States Conference of Catholic Bishops Concerning Artificial Nutrition and Hydration," the Congregation for the Doctrine of the Faith (CDF), with the approval of Pope Benedict XVI, reaffirmed and further explained this papal teaching. (The CDF's "Responses" was accompanied by a "Commentary," which offered further explanation.) The U.S. Conference of Catholic Bishops (USCCB) has welcomed this important clarification of Catholic Church teaching and has provided its own set of questions and answers to promote a better understanding of it in the United States. (1)

Unfortunately, confusion about this teaching and opposition to some aspects of it persist in some quarters. For example, a recent Health Progress article by John J. Hardt, Ph.D. and Fr. Kevin D. O'Rourke, OP, JCD, STM, titled, "Nutrition and Hydration: The CDF Response, In Perspective," misinterprets the Holy See's documents in important respects, and even makes the charge that the CDF interprets euthanasia in a way that is "at odds with the traditional teaching of moral theology." (2)

As chairmen of the U.S. Bishops' Committees on Doctrine and on Pro-Life Activities, we offer the following points to prevent misunderstanding and to help those involved in Catholic health care ministry more fully understand the church's teaching.

First, contrary to the "Rules for Interpretation" referred to by Hardt and Fr. O'Rourke, (3) the CDF document was not issued in the form of a canonical decree. Nor is it merely a public policy statement motivated by the threat of legalized euthanasia in certain countries in Europe. It is an authoritative statement of moral truth, reaffirming a teaching by the Catholic Church's ordinary magisterium regarding how we are to exercise our freedom responsibly as children of God.

Second, not everything in the CDF's "Responses" applies solely to patients in a "vegetative state." For example, the CDF's first response states that "the administration of food and water even by artificial means is, in principle, an ordinary and proportionate means of preserving life." Certainly this basic principle applies when patients have chronic but stable debilitating conditions that are less extreme than the "vegetative state." As the CDF "Commentary" notes, helpless patients with conditions such as quadriplegia, mental illness or Alzheimer's disease also must not be deprived of basic care and "abandoned to die" because their long-term care may burden others. The phrase "in principle" (which in this context means "as a general rule") is also important, because providing assisted food and fluids may cease to be obligatory in particular circumstances. The U.S. bishops asked whether such circumstances occur only when food and fluids "cannot be assimilated by the patient's body or cannot be administered to the patient without causing significant physical discomfort," and the CDF answered in the affirmative. The CDF "Commentary" notes that such circumstances will be "rare" and "exceptional" for a patient in a "vegetative state"; they may occur far more frequently for patients with progressively deteriorating or terminal conditions.

Also, the CDF "Commentary" notes the obligation to provide assisted feeding may not apply "in very remote places or in situations of extreme poverty" because we are not held to do something that is impossible in practical terms. But the CDF's statement about the general or presumptive obligation to provide food and fluids as a form of ordinary care clearly has broad application.

Third, in applying the church's longstanding moral tradition against euthanasia to the present question, the CDF is in full accord with that tradition. In 1980, the CDF (with the approval of Pope John Paul II) issued a "Declaration on Euthanasia" defining "euthanasia" as "an action or an omission which of itself or by intention causes death, in order that all suffering may in this way be eliminated." (4) In its more recent "Responses" and accompanying "Commentary," the CDF is stating that this issue is of particular concern regarding medically assisted food and fluids. Food and water are basic necessities of life, without which anyone (sick or healthy) would soon die. When they are withdrawn from a seriously disabled patient who needs help from others to obtain such basic care—withdrawn not because the means themselves are useless or excessively burdensome, but because someone has judged that patient's continued life to be useless or burdensome—the patient's death is the first result, and any other intended goals would seem to be met only through this death. The argument that in such cases the cause of death is merely the underlying condition (the inability to eat and swallow for oneself) is not valid, and is explicitly rejected by the CDF:

Patients in a "vegetative state" breathe spontaneously, digest food naturally, carry on other metabolic functions, and are in a stable situation. But they are not able to feed themselves. If they are not provided artificially with food and liquids, they will die, and the cause of their death will be neither an illness nor the "vegetative state" itself, but solely starvation and dehydration.(5)

Fourth, this brings us to the argument by Hardt and Fr. O'Rourke that the "significant financial hardships" of providing assisted food and fluids to patients in the "vegetative state" in the U.S. may justify withdrawing such care and letting the patient die. (6) In reality, providing the complete range of long-term care for these helpless patients may indeed become very costly, and families should not be abandoned to carry these burdens alone. But providing food and fluids generally accounts for a very small fraction of this cost. If food and fluids are targeted for removal because this will lead to the patient's early death, thus saving the significant costs of other care, then it seems clear that the patient's death is being intended precisely as a means to saving these other costs. In other words, this would be a decision to practice euthanasia by omission.

Fifth, nothing in the CDF's "Responses" or in Pope John Paul II's address of 2004 provides a basis for withdrawing food and fluids based on a far broader category of "psychic burden." Hardt and Fr. O'Rourke say that some may "feel" the continued life of a patient in a "vegetative state" is a burden to others, or is not a benefit. This may be true, but such feelings do not justify euthanasia by omission or the deliberate withdrawal of basic care owed to patients because of their human dignity.

Sixth, regarding advance directives such as the "living will," Hardt and Fr. O'Rourke claim that under the Ethical and Religious Directives for Catholic Health Care Services (ERDs) people may continue to make advance decisions regarding their care (Directives 25 and 28). (7) This is true as far as it goes. However, Directive 28 provides that "the free and informed health care decision of the person or the person's surrogate is to be followed so long as it does not contradict Catholic principles " (emphasis added). Moreover, Directive 24, not cited by Hardt and Fr. O'Rourke, also speaks of generally respecting patients' and surrogates' decisions, but adds:

The institution, however, will not honor an advance directive that is contrary to Catholic teaching. If the advance directive conflicts with Catholic teaching, an explanation should be provided as to why the directive cannot be honored.

The CDF's "Responses" provide clarifications as to what Catholic moral principles require of us on the provision of food and fluids, out of respect for the perduring human dignity of even the most severely cognitively disabled of our brothers and sisters.

On the relationship between the ERDs and the CDF's "Responses," the USCCB had this to say in its Q&A document:

Directive 58 already speaks of "a presumption in favor of providing nutrition and hydration to all patients, including patients who require medically assisted nutrition and hydration." The Address and the Responses clarify how this presumption applies to the patient in a "vegetative state" as to other patients, and provide further guidance as to how the Directives should be interpreted and implemented. (8)

We fully intend that the next edition of the ERDs will be amended to reflect this doctrinal clarification.

While we disagree with other claims by Hardt and Fr. O'Rourke, we believe these are the most important points in need of clarification. Certainly, when they say it is "questionable" whether the Catholic community will rise to the challenge of caring for the basic needs of patients in the "vegetative state," we hope their pessimism is unwarranted. It is precisely in caring for the poorest and most helpless of patients, those whose value and dignity are dismissed by others, that Catholic health care most clearly lives up to its mission and demonstrates the need for specifically Catholic health care providers in our secularized society. It is in meeting the moral challenge of caring for the most helpless that we will live up to our own God-given dignity.

NOTES

1. The U.S. Conference of Catholic Bishops news release of Sep. 14, 2007, on this development, with links to the CDF's "Responses" and "Commentary," and the USCCB's related Q&A, can be found at www.usccb.org/comm/archives/2007/07-143.shtml. Pope John Paul II's March 20, 2004, address can be found on the Vatican's website.
2. John Hardt and Kevin O'Rourke, "Nutrition and Hydration: The CDF Response, In Perspective," Health Progress , November-December 2007.
3. Hardt and O'Rourke, 45.
4. Congregation for the Doctrine of the Faith, "Declaration on Euthanasia," (May 5, 1980)
5. Congregation for the Doctrine of the Faith, "Commentary." See note one above for link information.
6. Hardt and O'Rourke, 46.
7. U.S. Conference of Catholic Bishops, Ethical and Religious Directives for Catholic Health Care Services , (Washington, D.C.) Fourth Edition, 2001, www.usccb.org/bishops/directives.shtml.
8. See note one above.


THE END

Labels: E-Letters

Source: SPIRIT & LIFE (Human Life International Newsletter), May 23, 2008

Sen. John McCain responded to the news of Sen. Edward Kennedy's brain tumor saying that Ted Kennedy was the "last lion of the Senate." Nice words, but hollow. Clearly Kennedy has been a forty-year force to reckon with in the US Senate, but lionizing him for his headstrong political partisanship over four decades is a little like saying that sticking around for a long time and being opinionated qualifies as a "legacy." That very record of anti-life advocacy is the measure by which his soul will be judged.

While I pray for Sen. Kennedy's recovery from a brain tumor, I pray more for his recovery from the cancerous metastasis of abortion ideology in his soul. Ironically, in the same years in which abortion has become less and less acceptable to the American public, it has become more and more of an obsession for Sen. Kennedy. Prior to Roe v. Wade, Sen. Kennedy had actually held a pro-life view of the sanctity of life. In a letter to a constituent he said,

"While the deep concern of a woman bearing an unwanted child merits consideration and sympathy, it is my personal feeling that the legalization of abortion on demand is not in accordance with the value which our civilization places on human life. Wanted or unwanted, I believe that human life, even at its earliest stages, has certain rights which must be recognized - the right to be born, the right to love, the right to grow old." (See http://www.worldnetdaily.com/index.php?fa=PAGE.view&pageId=31615 )

However, post-Roe, Kennedy's record of recognizing the "value which our civilization places on life" has been, shall we say, less than stellar. In fact, he has a 0% record of voting in favor of life, and there is not one life-related issue in which his vote reflects a concern for the weakest members of our society, let alone the concern that his supposed Catholic faith places on them. Senator Kennedy

• Is rated 100% by NARAL for his pro-choice voting record.
• Voted NO on banning human cloning.
• Voted NO on banning partial birth abortions.
• Voted NO on notifying parents of minors who get out-of-state abortions.
• Voted NO on criminal penalties for harming an unborn child during the commission of another crime.
• Voted NO on maintaining the ban on military base abortions.
• Voted YES on expanding research to more embryonic stem cell lines.
• Voted YES on $100 million to "reduce teen pregnancy" by hedonistic sex education programs and contraceptives.
• Is a sponsor of pending radical legislation in the Senate to promote special protections for homosexuals in the workplace.(See http://www.ontheissues.org/Social/Ted_Kennedy_Abortion.htm)
  

In other words, Kennedy has spent the better part of his long political career promoting the forces that kill and maim and destroy all the things that we hold sacred. What a shocking example of public service for a man who purports to call himself Catholic.

A month to the day after illicitly receiving Communion at the Mass of the Vicar of Christ in our nation's capital, Sen. Kennedy seems to have been given a real wake up call. When all moral voices go unheeded, the prospect of death tends to focus the mind on the truth. Let us all pray for his conversion from a career of abortion advocacy, for his enlightenment and for a peaceful death, something denied to all aborted babies in this country.

Sincerely Yours in Christ,
Rev. Thomas J. Euteneuer,
President, Human Life International

Labels: Abortion, Politics

The most important question: Are organ donors really dead before their vital organs are removed?

The simple answer is that donors of vital organs cannot be and are not dead. Before organ transplantation was possible, physicians cautiously determined death in order not to treat the living as dead. Today, both “brain death” and “cardiac death” are hastily declared, not for the patient’s welfare, but because removal of vital organs must be done before they begin to deteriorate due to loss of blood circulation. Vital organs are useless if physicians wait the time necessary to determine that a person is certainly dead.

If “brain death” is not death, what is it?

“Brain death” is a legal fiction. This fiction enables surgeons to remove living organs, without legal liability, from patients who are not dead yet, but will be after their organs are excised. Consider these facts:

• A person can be pronounced “brain dead” while he or she has a beating heart, as well as normal pulse, blood pressure, color and temperature. All signs of life.
• “Brain dead” patients’ wounds heal. “Brain dead” children grow. “Brain dead” pregnant women, kept alive for extended periods, gestate and deliver healthy babies and produce milk. All signs of life.
• A “brain dead” donor is given a paralyzing drug to prevent squirming and grimacing when the incision is made to remove organs. Even paralyzed, his or her pulse races and blood pressure shoots up. Dead people don’t react to being cut.

Accounts of patients who have recovered after a firm diagnosis of “brain death” demonstrate that “brain dead” patients are not certainly dead. In some cases they are not even close to it. Take Zack Dunlap’s story. In November 2007, this 21-year-old Oklahoman flipped over on his 4-Wheeler and suffered catastrophic brain injuries. Thirty-six hours later, doctors at United Regional Healthcare System in Wichita Falls, Texas, declared him “brain dead.” Preparations to harvest his organs were underway when friends and relatives gathered to say their final goodbyes. His cousin, a nurse, wanting to make certain, scraped his pocket knife along the bottom of Zack’s foot. Zack jerked his foot away. Just months later, Zack is walking and talking. He recalls hearing the doctor say he was dead and being “mad inside” but unable to move. Now, he’s impatiently moving toward a full recovery.

Recoveries like Zack’s should at least make us wonder: How many potential organ donors are prematurely written off? This is not an unimportant question, particularly if the potential donor is you or your loved one.

Must a person be declared “brain dead” in order to be used as an organ donor?

No. Donor eligibility has been broadened to include another group of people who are not dead yet—patients on ventilators whom doctors label “hopeless” or “vegetative.” New rules were established to permit “donation by cardiac death” (DCD). DCD was proposed because more organs are wanted to satisfy the ever increasing demand and decisions to withdraw life support have become so easy and private.

What is “donation by cardiac death”?

A patient or family can agree to have the ventilator turned off and a “do not resuscitate” order written, then consent to organ donation. The patient is usually taken to an operating room where the ventilator is turned off. If or when the patient becomes pulseless, “cardiac death” is declared. In order to ensure healthy organs, speed is of the essence. The organ retrieval team waits only 2 to 5 minutes before beginning organ removal. The donor may be given an anesthetic just in case the team acts too quickly.

If you go without a pulse for two to five minutes in some hospitals, you’re a dead organ donor. In other places, at two minutes or five minutes or 30 minutes, they’re still trying to revive you. This means that patients in identical states are deemed dead if they are destined to be organ donors or alive when destined for resuscitation attempts.

Conclusion: The thrust of protocols that permit organ donation after “brain death” and “cardiac death” is simply this: “Let’s call them dead so we won’t be accused of murder when we stop their beating hearts and cut out their living organs.” For this reason, transplantation of vital organs taken from “dead” people can not be morally justified.

Labels: Organ Donation and Transplantation

As a patient advocate and a speaker on medical decision-making, the questions I am most frequently asked concern the withdrawal of food and fluids from persons who are seriously ill or persistently non-responsive (often referred to as being in a persistent vegetative state). If my audience is Catholic, I quote Catholic sources, such as the Catechism of the Catholic Church (CCC) and statements made by Popes and Bishops. If not, my answer is basically the same without naming the source of my wisdom. I get a kick out of non-Catholics who respond enthusiastically. For instance, after I spoke to a Lutherans for Life group, one woman asked, “How did you gain the knowledge and ability to address this confusing issue so clearly?” With a chuckle I confessed to “plagiarizing” the teachings of the Catholic Church.

The Catholic Church, more than any other entity, unambiguously proclaims the truth, very clearly drawing the line between good and evil, right and wrong. Medical decision-making, in particular, calls for such sound moral guidance.

The Church defines euthanasia as “an act or omission which, of itself or by intention, causes death in order to eliminate suffering” and calls it a “murderous act” [CCC, 2277]. Very simply then, if the withdrawal of food and fluids will be or is intended to be the cause of a person’s death, it is a morally unacceptable murderous act. In 1992, the Committee for Pro-Life Activities of the National Council of Catholic Bishops warned:

…nutrition and hydration (whether orally administered or medically assisted) are sometimes withdrawn not because a patient is dying, but precisely because a patient is not dying (or not dying quickly enough) and someone believes it would be better if he or she did, generally because the patient is perceived as having an unacceptably low “quality of life” or as imposing burdens on others.

Promoters of euthanasia call it “death with dignity,” a term that often masks a disdain for those who are weakest and most in need of human kindness. The professional obligation of physicians and nurses is to care for and preserve life where they can, not to preside over the planned deaths of patients whom they or others deem “better off dead”. Nevertheless, widespread legal and medical endorsement for ending lives by dehydration and starvation has misled many people.

On March 20, 2004, Pope John Paul II, for those who would listen, definitively put an end to any confusion about what the Church teaches on this matter. Addressing the International Congress on “Life-Sustaining Treatments and Vegetative State”, the pope said, “I should like particularly 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.” He called their administration “morally obligatory”. Like any seriously ill person, a person in a “vegetative state”, he said, “has the right to basic health care (nutrition, hydration, cleanliness, warmth, etc.).”

In 2005, when the fate of Terri Schiavo was being decided by a Florida court, Archbishop Raymond Burke spoke in defense of her life:

If Mrs. Schiavo were facing imminent death, or were unable to receive food and water without harm, then removing nutrition and hydration would be morally permissible. It is however never permissible to remove food and water to cause death. Food and water are basic human needs, and therefore basic human rights.

Archbishop Burke’s statement is a basic guide for making moral decisions regarding nutrition and hydration. It is also prudent to remember the Pope’s words that provision of food and water, even by artificial means, is not a medical act. Food and fluids do not become “treatment” when they are taken by tube anymore than penicillin or Pepto-Bismol becomes “food” when taken by mouth.

Labels: Euthanasia, Medical Decision Making

December 1, 2007
Over three hundred people from various nations met in Toronto, Ontario for a history-making event, The First International Symposium on Euthanasia and Assisted Suicide: Current Issues, Future Directions. Hosted by the Euthanasia Prevention Coalition of Canada (EPCC), the symposium was co-sponsored by diverse groups from Canada, the United States and the United Kingdom as well as the Archdiocese of Toronto. With one thing in common—opposition to legalization of euthanasia and assisted suicide—disability rights advocates, medical and legal professionals, pro-life activists, people of various religious faiths and atheists came together to learn from the experts, find common ground and strategize

Presenters exposed the new directions and strategies of the movement to legalize euthanasia and assisted suicide. According to Wesley Smith, who is a senior fellow at the Discovery Institute, attorney, international lecturer and author of several books on bioethics (just to name a few of his credentials), “The euthanasia movement has become much more sophisticated in the last few years.” The “crackpot element” is no longer driving the movement. It is now “a professional model” and “an elitist establishment movement” whose pitch is “just a little extra choice for people who are dying.”

The thread running through all the presentations was the urgent need to establish a common response to this world-wide threat. Many of the speakers were key participants in coalitions that defeated pro-euthanasia and assisted suicide legislation in the US and UK. They outlined the lessons they’ve learned.

Use the Right Language
One lesson learned is that “all social engineering is preceded by verbal engineering,” stated Rita Marker, attorney and executive director of the International Task Force on Euthanasia and Assisted Suicide. “The words used in a debate often determine the outcome of the debate.” Assisted suicide activists blame their failures on the use of the word “suicide” and insist on using what they call “value-neutral” terms. Marker advised symposium participants to always use the term “assisted suicide,” never terms such as “assisted dying” or “aid-in-dying.” The “s” word is powerful.

Dr. Peter Saunders, of Care Not Killing Alliance in the UK, helped defeat the “Joffe” bill, an assisted suicide measure. As an example of effective use of language, he cited a disabled person’s sound bite: “We don’t want assisted dying. We want assisted living!”

Dr. Paul Byrne, a neonatologist and Clinical Professor of Pediatrics at Medical University of Ohio, insisted that the term “euthanasia,” which literally means “good death,” should not be used. The term “imposed death,” he said, is more accurate

Emphasize Bad Consequences
Dr. Saunders, as well as the disability rights advocates who spoke, pointed out that changing the law will put pressure on vulnerable people to choose death rather than be “a burden” on others. Also, euthanasia and physician-assisted suicide (PAS) will be used to contain healthcare costs. Oregon pays for PAS as “comfort care” while refusing to pay for certain types of medical care for cancer patients.

In 2007, Dr. Robert Orr helped defeat a bill that would have legalized PAS in Vermont for persons with a life-expectancy of less than six months. “Inaccuracy of diagnosis,” he said, should be emphasized. He cited Art Buchwald, who was suffering from kidney failure and refused dialysis. He entered hospice in February 2006 expecting to die, but checked himself out several months later. Buchwald lived for nearly a year and wrote a book entitled “Too Soon to Say Goodbye.”

Dr. Orr outlined how, once legalized, euthanasia in the Netherlands slowly expanded from being permitted for patients who are competent and suffering to being imposed on “patients with no free will” and even infants with disabilities. The slippery slope is real.

Cheryl Eckstein, founder of Compassionate Healthcare Network (Canada) gave a rundown of Canadian “mercy-killing” cases. She said that the notion of “‘compassionate homicide’ is about as nonsensical as ‘loving rape.’” And Dr. Bill Toffler, national director of Physicians for Compassionate Care, lamented that his beautiful state of Oregon has “sadly become known for something that is deeply disordered.”

Personal Stories
As one participant said, “The shortest distance between a person and the truth is a story.”

Soft-spoken Alison Davis, representing No Less Human, a disability rights group in England, told her story. Because of her disability, she has constant pain and is dependent on morphine for relief. She told of times when she had wanted to die due to suffering and depression. If the UK had allowed assisted suicide, she expressed doubt that she would be here today. Davis emphasized the danger of legalizing euthanasia and assisted suicide: “Pain control is available, but it takes time and effort. Why bother if killing the patient is equally acceptable?”

Henk Reitsema, an articulate young man from the Netherlands representing Cry for Life, told the compelling story of his grandfather’s death by involuntary euthanasia in a Dutch nursing home. He said, “The way my grandfather died might be described as ‘palliation with the side effect of death,’” which is a common way of imposed death in his country. We “seem to have made the suffering of pain the only crime worth punishing with the death penalty,” declared Reitsema.

The familiar story of Terri Schindler-Schiavo’s dehydration death in a Florida hospice was related by her brother Bobby Schindler. There was not a dry eye in the room as he described Terri’s last days and the suffering her family endured and continues to endure because of her cruel death.

Dr. Paul Byrne’s topic was “brain death.” He told of several cases that compelled him to begin evaluating whether “brain death” is true death, or not. The first was in 1975. Joseph, a premature infant, had been on a ventilator for six weeks and an EEG was interpreted as “consistent with cerebral death.” Dr. Byrne did not turn off the ventilator; rather, he continued treatment. Joseph is now married with children and works as a fireman and paramedic.

Get Involved
Euthanasia and physician-assisted suicide are now “medical treatment” in the Netherlands and Belgium. Switzerland does not penalize assisted suicide so long as it is not done for selfish motives, but physicians cannot be involved. In the U.S., PAS is legal only in Oregon. Opposition coalitions have defeated 89 efforts to legalize it in other states.

Compassion & Choices, the U.S. organization leading efforts to legalize PAS, has adopted the slogan “Oregon Plus One.” PAS promoters are determined to legalize assisted suicide in at least one more state in 2008. They are targeting Washington State in particular. Booth Gardner, popular former governor of Washington who now has Parkinson’s disease, is putting his popularity and considerable fortune behind the campaign to gather the 225,000 signatures needed by July to place a PAS initiative on next November’s ballot.

Rita Marker warned, “Any place that assisted suicide passes will affect the whole world.” Everyone who opposes assisted suicide, she said, “is a Washingtonian for the next year. You are important. Get involved.”

Conclusion
The sponsors and organizers, in particular Alex Schadenberg, executive director of the EPCC, deserve hearty congratulations for the shining success of this first of its kind symposium.

Labels: Euthanasia, Physician-Assisted Suicide

Physician-assisted suicide (PAS) was legalized in Oregon in 1994. That law permits a doctor to prescribe a lethal dose of drugs at the request of a patient who is expected to die within six months. Thus far, every other state has resisted similar legislation thanks to the efforts of organizations and individuals opposed to PAS, including the Catholic Church. While the very public push to legalize assisted suicide diverted our attention, some ethicists and doctors quietly proposed a legal, but just as lethal, alternative – terminal sedation – and incorporated it into the practice of palliative medicine.

The word “palliative” describes care that comforts and relieves or moderates pain and suffering, such as the care provided by a hospice. “Terminal sedation” is a term recently added to the stock of medical phrases most people do not understand. But it is vitally important that people do understand this controversial, increasingly common method of permanently ending a person’s suffering.

“Terminal sedation” (TS) essentially means that a patient is given a sufficient amount of drugs to render and keep him unconscious until he dies, usually days or weeks later. No further active treatment is done and nutrition and hydration are often withheld. TS is also referred to as “palliative sedation” or “total sedation”. The National Hospice and Palliative Care Organization (NHPCO) presses hospice agencies to adopt TS and make it “a comfortable addition to the palliative care repertoire” (Goldstein-Shirley and Fine, “Ethics of Total Sedation”, NHPCO Ethics Committee). The claim is made that TS is aimed at relieving pain and suffering, not the intentional death of the patient. That claim is misleading. One might wonder if it is an intentional half-truth, but it is impossible to know another’s intention. Facts, on the other hand, can be examined to discern whether or not TS is, in any given case, mercy or murder.

Sedation is an important medical intervention for some patients who are near the end of life and have symptoms—pain, difficulty breathing, agitation, etc.—that have become progressively more difficult to manage and when nothing else will work. Sedation should only be used to relieve severe physical distress and never to intentionally shorten life. When used for medically and morally appropriate reasons, sedation is merciful.

However, TS is not limited to patients who are so near death that further treatment and/or food and fluids will no longer sustain their lives. Sometimes TS and withdrawal of nutrition and hydration are combined to introduce a cause of death—dehydration—unrelated to the patient’s illness. Sedation is used to keep the patient unaware as dehydration ravages his/her body. Death by sedation and dehydration can take up to two weeks or longer. For this reason, TS is sometimes called “slow euthanasia”. The Catechism of the Catholic Church defines “euthanasia” as “an act or omission which, of itself or by intention, causes death in order to eliminate suffering” and calls it a “murderous act”.

Sedation combined with dehydration is the treatment of choice for some patients who are not dying quickly enough to suit themselves or others. Regardless of who makes the decision, it is wrong. And, even though it may be legal, it is evil to deny food and water to anyone unless they will make the person’s condition worse or will no longer sustain life.

Regrettably, medical ethics and practice have largely degenerated from concern for doing what is right to merely doing what is legal. Obviously, what is legal is not always right.

Labels: Euthanasia, Hospice/Palliative Care

A euphemism is language that softens or masks an unpleasant truth. In City of God, St. Augustine wrote, “God’s command, ‘Thou shalt not kill,’ is to be taken as forbidding self-destruction — anyone who kills a human being, himself or another, is guilty of murder.” That is a plain, hard truth. Promoters of euthanasia and assisted suicide call killing a human being who is sick or disabled “death with dignity.” That is a euphemism.

Oregon’s Death With Dignity Act, the only law of its kind in the nation, permits a physician to prescribe a fatal drug dose upon the request of a person who is expected to die within six months. Willfully taking a mouthful of pills in order to end one’s life is suicide, but “right to die” activists dislike such honest and direct language. Their polling data revealed that when a softer term such as “physician-aid-in-dying” was used instead of “physician-assisted suicide” to describe exactly the same proposal, the proposal garnered significantly more support. So, they demanded a change in language, believing that not calling suicide what it is would help legalize physician-assisted suicide (PAS) in other states.

In 2006, each and every assisted-suicide measure failed even though PAS activists thought they were going to taste victory in many states. They blamed their failures on the media for using the word “suicide” to describe these measures. But the death marketers never give up, they just craft a new advertising campaign. Already in 2007, several states have PAS proposals before their legislatures—Vermont, for instance. Dr. David Babbott, who supports that state’s “Death With Dignity” bill, declared, “We believe that ‘S’ word is an inflammatory word and we don’t use it.” (Darren Perron, Channel 3 News, Montpelier, VT, 1/12/07)

Compassion & Choices—a group formed by the merger of End of Life Choices (formerly the Hemlock Society) and Compassion In Dying—has helped facilitate the deaths of about three-quarters of the Oregonians who have requested PAS. George Eighmey, director of Compassion & Choices of Oregon, claims they often hear from people who want to avail themselves of the law, but who find the term “physician-assisted suicide” offensive. (The Oregonian, 11/11/06) Obviously, the social stigma and religious prohibitions attached to the act of killing oneself make the word “suicide” a powerful deterrent. And, just as obviously, Eighmey and his colleagues don’t want anyone to be deterred from committing suicide under the law. Therefore, last year, his group lobbied Oregon’s Department of Human Services (DHS) to adopt “value-neutral language.” Not wanting a court battle, the agency capitulated. DHS now blandly refers to patients who ask physicians to help them commit suicide as "persons who use the Oregon Death With Dignity Act."

Following suit, the American Public Health Association (APHA), which represents more than 50,000 members, has rejected the term “assisted suicide” in favor of “aid-in-dying” or “patient-directed dying.” APHA’s Governing Council adopted an interim resolution in November that advises reporters, educators, public policy makers and medical personnel to use these “value-neutral terms.” Compassion & Choices is banking on many of us being gullible enough to believe that suicide isn’t really suicide when medical professionals say it isn’t.

The plan of action of “right to die” activists is and always has been to work on society in order to bring about new attitudes favorable to euthanasia and assisted suicide. Do not be seduced by the death marketers’ spin. Even the high-sounding title of their “Death With Dignity” measures is a lie. Where is the dignity in self-destruction? Where is the honor in helping another commit suicide?

If it takes false advertising to sell a law, you can bet your life there’s something wrong with it.

Labels: Physician-Assisted Suicide

Visiting the sick is a Christian work of mercy. Mercy is similar to compassion, which means “to suffer with” another, but it is more challenging than mere compassion. Mercy is putting our kindly inclinations—which we are often tempted to resist—into practice through readiness to assist.

A relative or volunteer advocate who accompanies a medically vulnerable person to doctor appointments or stays with the person when hospitalized contributes immeasurably to his or her well-being. The term “patient advocate,” as used here, means a person who strives to safeguard the welfare of a patient in the health care system. Particularly in need of patient advocates are persons whose lives are devalued—the mentally impaired, physically disabled, chronically ill, incurable, elderly and/or poor. In light of society’s growing willingness to abbreviate the lives of unwanted persons (both pre-born and born) patient advocates truly may be the last line of defense for some patients’ lives.

One essential role of the patient advocate is to facilitate communication between patient and physician. Before a visit with a doctor (in office or hospital), the advocate compiles a list of the patient’s symptoms, concerns and questions. During the visit, the advocate makes certain that all of these matters are satisfactorily addressed. The advocate also takes notes or tapes the conversation so the doctor’s advice can be reviewed later with the patient. This will help prevent misunderstandings and hopefully ensure compliance when the doctor prescribes medications or treatments.

Some hospitalized patients become disoriented in unfamiliar surroundings. They may feel acutely cut off from others and betrayed by their own bodies. A familiar face helps orient the patient and prevents loneliness, isolation, fear and despair. Rest is essential to recovery, but often difficult to get in a hospital. A patient may need someone he trusts by the bedside in order to feel secure enough to go to sleep. An advocate can minimize noise, light and other distractions by closing the door while with the patient. Particularly vulnerable patients need a caring person with them 24/7. Recruiting and scheduling family members, friends and volunteers to fill all the hours is another important role of the patient advocate.

Many hospitals are short-staffed and every hospital has times when the staff is extremely busy. (This also applies to nursing homes.) These problems can translate into less attentive care and even life-threatening situations. Busy medical personnel may overuse tranquilizers and physical restraints for patients who are restless or demanding. Feeding tubes are sometimes used for patients who are able to swallow simply because the staff does not have time to spoon-feed them. Call bells may be ignored when help is urgently needed. The advocate is able to soothe the restless patient, prevent him from pulling out tubes or falling out of bed, assist with meals, offer drinks of water, go for help in an emergency, etc. Whatever the advocate does to improve the patient’s welfare also positively influences others’ attitudes toward the patient. Some medical personnel perceive certain patients as being of “low value” and therefore give them less care or even think they would be “better off dead.” The advocate’s watchful presence is apt to induce such staff members to be more attentive to the patient’s needs.

Possibly the most important role the patient advocate plays is being a visible ally of the patient—a sign to the world that this patient is valued and that caring for and protecting this patient is a commendable moral act. A work of mercy, indeed.

If you would like to become a patient advocate or want more information on this subject, I recommend reading: A Guideline on Protecting the Health and Lives of Patients in Hospitals, Especially if the Patient is a Member of a Societally Devalued Class (106 pages), Second Edition (2005), by Wolf Wolfensberger. Available from Syracuse University Training Institute, 800 South Wilbur Avenue, Suite 3B1, Syracuse, New York 13204; telephone 1-315-473-2978.

Labels: Patient Advocacy

Imagine visiting your 75-year-old mother in the hospital after she has had a disabling stroke. She is unable to speak or swallow. Her immediate needs include artificially provided food and fluids (tube-feeding) and antibiotics to fight an infection. If she survives, nursing home care as well as physical and speech therapy will be required to help her recover. Your mother chose you to be her health care decision-maker (agent) and told you that, no matter what, she wants to live. Nevertheless, her attending physician refuses to provide further “life-sustaining treatment”—including tube-feeding. When you object, the doctor explains that this is what he thinks is best for your mother. You are stunned.

Sound far-fetched? It’s not. Similar scenes are playing out all over the country in hospitals which have quietly adopted “futile care policies.” These policies are based on the theory that a physician is entitled to refuse life-sustaining treatment when he/she believes the quality of a patient’s life is too low or the cost is too high to justify further treatment. Such policies permit so-called “futile care” to be stopped, not because the care or treatment won’t sustain the patient’s life, but precisely because it will. If the patient, family or agent objects, the case is referred to the hospital ethics committee for the final decision.

A hard question needs to be asked. Is it advisable, or even legal, for doctors and hospital ethics committees to have this kind of power?

In 1998, I was interviewed for an article entitled “Medical Futility: Who has the power to decide?” which appeared in Nurse Week and Health Week. I said then that I believe medical futility policies are designed for one reason: cost-containment. And, I say it again. The high-sounding motive of “doing what is best for the patient” is simply camouflage.

Most people assume that they will have the right to make their own medical decisions. Insistence, against a patient’s wishes, that every means be used to postpone death would be senseless and inhumane. (While we have a moral obligation to use ordinary means to preserve our lives, treatments that are extremely burdensome, overly zealous or otherwise extraordinary are optional.) However, it is just as cruel to refuse available and potentially effective treatment to a patient who wants it. If a person wants to fight for every last moment of life, this is his or her right. There is absolutely no concern for the rights of patients in “futile care” policies.

Not only do these policies permit the wishes of a patient’s family and even a patient’s advance directive (Living Will or Power of Attorney for Health Care) to be ignored, they also allow doctors to override the medical decisions of a patient who is conscious and asserting the desire to live! The essence of any “futile care” policy is involuntary euthanasia by omission. [Catechism of the Catholic Church (CCC), 2277-2278]

“Futile care” policies make people with disabilities extremely nervous. Diane Coleman, president of the disability rights group Not Dead Yet, says, “It’s not news to us that health professionals judge our quality of life to be far less than how we judge it ourselves. The view that our lives are futile is frightening, no matter who holds it.” (“A Duty to Die” by Karla Dial, Citizen magazine, 2/04.)

“Quality of life” judgments are extremely unsettling. Based on the notion that certain lives are not worth living, they are totally incompatible with the fundamental Christian principle that “human life is sacred.” [CCC, 2258] Part of the spiritual war being waged between the Culture of Life and the Culture of Death is the ethical battle between the Sanctity of Life Ethic and the Quality of Life Ethic. We all have a stake in the outcome. If the Quality of Life Ethic prevails, hospitals may as well post signs warning patients, “We reserve the right to refuse treatment to anyone.”

Labels: Medical Decision Making

As we, the pilgrim people, the people of life and for life, make our way in confidence towards "a new heaven and a new earth" (Rev 21:1), we look to her who is for us "a sign of sure hope and solace."

O Mary, bright dawn of the new world, Mother of the living, to you do we entrust the cause of life. Look down, O Mother, upon the vast numbers of babies not allowed to be born, of the poor whose lives are made difficult, of men and women who are victims of brutal violence, of the elderly and the sick killed by indifference or out of misguided mercy. Grant that all who believe in your Son may proclaim the Gospel of life with honesty and love to the people of our time. Obtain for them the grace to accept that Gospel as a gift ever new, the joy of celebrating it with gratitude throughout their lives and the courage to bear witness to it resolutely, in order to build, together with all people of good will, the civilization of truth and love, to the praise and glory of God, the Creator and lover of life.

This prayer closes Evangelium Vitae, given in Rome, at Saint Peter's, on 25 March, the Solemnity of the Annunciation of the Lord, in the year 1995, the seventeenth of the Pontificate of John Paul II.