We stand at a cultural crossroads, the intersection of the Culture of Life and the Culture of Death. At this critical juncture, the choices we make matter, now and forever. Therefore, the members of Life is Worth Living, a lay apostolate, have chosen to promote the Culture of Life.
Our mission is to strive to affirm -- in thought, word, and deed -- the infinite preciousness of human life; to encourage service to others rather than radical self-interest; and to promote a climate of public opinion that recognizes the right of all human beings to life, respect, compassionate care, appropriate medical treatment, and equality under the law.
Food and Water are Basic Human Rights
posted by Julie Grimstad
Thursday, May 22, 2008
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…nutrition and hydration (whether orally administered or medically assisted) are sometimes withdrawn not because a patient is dying, but precisely because a patient is not dying (or not dying quickly enough) and someone believes it would be better if he or she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.
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
Hospital "Futile Care" Policies- Deciding Who Should Die
posted by Julie Grimstad
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.”
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