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End-of-Life Ethics: Preparing Now for the Hour of Death – Catholic Update August©2006

Here is another discussion about the end of life for my Catholic friends who are trying to decide whether to support SB 303.

Life, however, is not an absolute good.

Treatment and life support

Questions about the use of medical treatments and life-support systems are distinct from—and yet often associated with—euthanasia. The scriptural insights can be very helpful with these issues, even if they cannot give details. As good stewards, we believe that death is not the final word, that life is not an absolute good. Therefore, we do not have to keep someone alive “at all costs.”

The Catholic tradition helps with the details, providing this guidance: ordinary means must be used; extraordinary means are optional. Ordinary means are medicines or treatments that offer reasonable hope of benefit and can be used without excessive expense, pain or other inconvenience. Extraordinary means do not offer reasonable hope of benefit or include excessive expense, pain, or other inconvenience. What is important to remember is that “ordinary” and “extraordinary” refer not to the technology but to the treatment in relation to the condition of the patient, that is, to the proportion of benefit and burden the treatment provides the patient (see the Vatican’s Declaration on Euthanasia, #IV, 1980).

Many people remember when Cardinal Joseph Bernardin of Chicago decided to stop the treatment for his cancer. The treatment had become extraordinary. He did not kill himself by this choice but did stop efforts that prolonged his dying. He allowed death to occur. (This distinction between allowing to die and killing, as in euthanasia or assisted suicide, is of great significance in the Catholic tradition. The rejection of this distinction by several U.S. courts raises serious concerns.)

Within the Catholic Church, debate still surrounds the question of providing medical nourishment through a feeding tube. Let’s look at two positions.

1) “Life must almost always be sustained.” This position holds that the withdrawal of medically assisted nutrition and hydration cannot be ethically justified except in very rare situations. The fundamental idea for this position is the following: Remaining alive is never rightly regarded as a burden because human bodily life is inherently good, not merely instrumental to other goods. Therefore, it is rarely morally right not to provide adequate food and fluids.

This position acknowledges that means of preserving life may be withheld or withdrawn if the means employed is judged either useless or excessively burdensome. The “useless or excessive burden” criteria can be applied to the person who is imminently dying but not to those who are permanently unconscious or to those who require medically assisted nutrition and hydration as a result of something like Lou Gehrig’s or Alzheimer’s disease. Providing these patients with medical nourishment by means of tubes is not useless because it does bring these patients a great benefit: namely, the preservation of their lives.

2) “Life is a fundamental but not absolute good.” This approach rejects euthanasia, judging deliberate killing a violation of human dignity. On the other hand, while it values life as a great and fundamental good, life is not seen as an absolute (as we saw in the section on scriptural foundations) to be sustained in every situation. Accordingly, in some situations, medically assisted nutrition and hydration may be removed.

This position states that the focus on imminent death may be misplaced. Instead we should ask if a disease or condition that will lead to death (a fatal pathology) is present. For example, a patient in a persistent vegetative state cannot eat enough to live and thus will die of that pathology in a short time unless life-prolonging devices are used. Withholding medically assisted hydration and nutrition from a patient in such a state does not cause a new fatal disease or condition. It simply allows an already existing fatal pathology to take its natural course.

Here, then, is a fundamental idea of this position: If a fatal condition is present, the ethical question we must ask is whether there is a moral obligation to seek to remove or bypass the fatal pathology. But how do we decide either to treat a fatal pathology or to let it take its natural course? Life is a great and fundamental good, a necessary condition for pursuing life’s purposes: happiness, fulfillment, love of God and neighbor.

But does the obligation to prolong life ever cease? Yes, says this view, if prolonging life does not help the person strive for the purposes of life. Pursuing life’s purposes implies some ability to function at the level of reasoning, relating and communicating. If efforts to restore this cognitive-affective function can be judged useless or would result in profound frustration (that is, a severe burden) in pursuing the purposes of life, then the ethical obligation to prolong life is no longer present.

Disagreements in the Church

How are these significantly different positions judged by the Roman Catholic Church? There is no definitive Catholic position regarding these two approaches. Vatican commissions and Catholic bishops’ conferences have come down on both sides of the issue. Likewise, there are Catholic moral theologians on both sides.

via End-of-Life Ethics: Preparing Now for the Hour of Death – Catholic Update August©2006.

Emphasis by underlining is mine. Edited 5/10/13 BBN

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6 thoughts on “End-of-Life Ethics: Preparing Now for the Hour of Death – Catholic Update August©2006

  1. This is only the most superficial and poorly sourced (almost entirely lacking in sources) opinion of a non-Catholic. There is not, as you claim, wide disagreement in the Church. It is very consistent.

    You mention one Vatican document on euthanasia that does not address artificially administered nutrition and hydration but then you go on to discuss it w/o reference to Church teaching.

    You fail to discuss Blessed Pope John Paul II who addressed this issue very clearly in 2005. I do not see that very critical Address here.

    In addition, the Congregation for the Doctrine of the Faith also addressed the issue of artificially administered food and nutrition:

    Please note that while some rely on the commentary here, it cannot be used w/o the careful prerequisites outlined in the very carefully, specifically, narrowly worded question.

    There is NOTHING in these two documents that supports SB 303. There is nothing in these two documents that allow for a doctor or hospital “ethics” committee to determine whether one lives or dies. There is nothing in Church teaching that provides for that. Indeed, such would be a violation of the Principle of Subsidiarity, which I see you also fail to address.

    I discussed these teachings in light of SB 303 in detail here: (link deleted – no advertisement for other blogs, here. BBN)

    Proponents of SB 303 rely on the Texas Conference of Catholic Bishops for support, indeed you have publicly as well. One letter proponents champion is a letter by the TCC chastising a pro-life organization for discussing Catholic doctrine, although it has been hard to find where that was actually done. But at least that group is run by Catholics. You do the same thing here that the TCC criticized a Catholic for doing. You are out of your depth here.

    But again, you continue to make a case for being able to withdraw nutrition and hydration, among other treatments, for a patient over their objections. The motivations behind SB 303 are clear. They are anything but protective of life. They are anything but promoting patient’s rights.

    Posted by Kassi Marks | May 10, 2013, 9:40 PM
    • I’m afraid you didn’t read the source, much less the content of the articles. Both address the Bishop’s Conference and the Pope’s statements. Both are found at the “American Catholic” blog. One, from the “Saint Anthony Messenger,” was written by Daniel P. Sulmasy, O.F.M., M.D., Ph.D., a Franciscan physician and ethicist. The other, the “Catholic Update,” was written by Kenneth R. Overberg, S,J., who is a Ph.D and professor of theology at Xavier University in Cincinnati.

      As I’ve written before, this is about the duty of the physician to do no harm, which is primary to a patient’s demand for a given medical intervention at the hand of that doctor.

      In addition, if SB303 doesn’t pass, the law will continue its silence on notification about DNR orders for two more years. Patients and their families will not have the legal right to any medical records, to have help at the medical ethics committee meeting, and will only have 2 days’ notice before the meeting and 10 days to find an alternate doctor to take over care of the patient.

      BTW, I don’t allow commenter’s to link to their blogs on WingRight unless they are relevant enough for me to write a post on them. I have eliminated the offending link and will block further comments with links to your blog.

      Posted by bnuckols | May 10, 2013, 9:58 PM
  2. Both the link at the top of your piece and the one at immediately at the bottom go to the same post by Overberg, dated August 2006, which does not discuss either the Address by Bl. Pope JPII (only mentioned in passing and dismissed) or the document from the Congregation for the Doctrine of the Faith Q&A to the USCCB.

    The CDF response to the USCCB was dated August 1, 2007. Therefore, Overberg could not have cited to the CDF document that was written the year AFTER his post. YOU failed to discuss either in YOUR post, which is what I was addressing. Your copy and paste of someone else’s work did not include even the dismissive reference to the Address, but as I mentioned, that post does not “discuss” the Papal Address, only quickly dismisses it as being far from certain according to various unnamed, uncited “commentators.” The USCCB “Directives” document (which was not a directive re. drafting legislation) you all rely upon cites both of these documents however, in par. 58, footnotes 40 and 41. It takes them out of context, but they are there.

    Only now did I realize that the other piece you cite is in a link under your name and bio. When I clicked on that it went to another blog piece of yours, where only then could I find the actual link. (Again, your sourcing needs some work.) But that blog post also does not discuss the Papal Address’s actual language in detail, nor is it quoted very much at all. One small quote and then onto what others say about it. Those others and what they write do not trump that Address. Their commentary is not held at the same high level as a statement from the Vatican itself.

    The Overberg blog you cite does not trump documents and teachings from the Vatican. Moreover, when you discuss nutrition and hydration, you cannot ignore those two very recent Vatican documents that specifically address that issue and refer to a more general Vatican document on euthanasia. No physician or ethicist’s writings on a blog trump official Church documents. You can delete my blog post, that’s fine. The blog is not mine, it is that of Bishop Emeritus Gracida from Corpus Christi, another opponent of SB 303. It was for the purposes of making a point already written discussing those two Vatican documents, not advertisement. People will see your act for what it is. (I took a screenshot of it, so all is not lost. Will do the same here, too.)

    The refusal to point to accurate, actual Church teaching, as well as refusal to discuss actual bill language is consistent with the modus operandi of the proponents of SB 303. I assure you, this attempt to silence the truth speaks louder than any words. People are noticing.

    You will not post it, but I did an in-depth analysis of how SB 303 still allows for secret DNRs. And, even if they are discovered, they will still not be removed if the ethics panel agrees with it. That right to determine treatment is also taken away from the patient.

    I did an in-depth analysis of how this bill would allow for the withdrawal of food and hydration even during an extended time period to find a new facility. As an appellate attorney, I went into great detail using my skills and expertise.

    Withdrawal of food and hydration are harms. Those choices are not yours to make. Moreover, why are you doctors so determined to limit a patient’s time to find another facility and to be hydrated and supplied with nutrition while they search for a new facility? That says it all. You complain about the 10 day time limit. That is the best the pro-life groups could get the Texas Medical Association to agree with. They did not want to give a patient time. So, any complaint you have about the current time limit is due to the TMA dictating the law.

    Even with more time given, there are so many flaws in this bill there is not a net gain to the patient in any provision in SB 303. The patient is still at the mercy of the hospital ethics committee w/ no final recourse to court to challenge the ultimate underlying decision. You can give a little more time, but the end result and who gets to make that decision is left as it was before. Again, there is no net gain for the patient.

    This bill is neither pro-life nor a boon to patient’s rights. It does nothing to remedy the problems with the current law, about which I note the TMA says on their website: “TADA was a good law when passed; it remains a good law today.” I’d post a link, but no free advertising. You can google it. I’m sure you’re a member of the TMA. Why, by the way, are you all wanting to “reform” this most excellent legislation that you drafted back in 1999? It wouldn’t seem like an organization that thinks it’s so great would want to reform it then. I question those motivations. So do others.

    I, and others, also question any doctor who believes that it is so necessary to have enshrined in law an ability to withdraw care from a patient rather than just say, “I don’t want to treat you, here’s a referral to another doctor.” You assume all doctors would have the same opinion.* Instead of that, you would further set into our law and insist on A (as in ONE) treating physician having the RIGHT according to CONSCIENCE to determine DENIAL of any further care for that patient and have a hospital “ethics” committee rubber stamp that after a kangaroo court. It simply makes no sense and makes a mockery out of any claim to “do no harm.”

    Do not promote SB 303 by referring to Catholic doctrine you neither understand nor live, by reference to those who are not in positions of authority who do not rely upon, accurately represent, or fully present authoritative teaching on the matter. You rely on ethicists, and for your purposes here, Catholic ones, as if they are infallible. They are not. I remind you that Peter Singer is an ethicist. I’d provide a link, but no free advertising. You can google that, too. I also note that not all ethicists are in agreement. Wesley J. Smith is certainly not in agreement with SB 303 and addresses it specifically by citing its language. He appears to have far more practical expertise in this area than the two individuals you cite. He testified about SB 303. Google it.

    (*In terms of the language of SB 303, the family can get a second opinion if they so desire, at their expense, to try to make their case before the committee; but the point here is that the assumption on the part of the treating physician is that he is infallible and his decision is correct and based on nothing more that that, he should determine life and death for this patient. The committee process is only if the patient disagrees; so there is no automatic oversight of this doctor.)

    Posted by Kassi Marks | May 10, 2013, 11:50 PM
  3. I gave those two links in my first post. They are the definitive teachings. In neither does one find support for the proposition that a doctor or hospital ethics committee makes these final decisions for a patient which is the fundamental (though hardly the only) problem with BOTH the status quo AND SB 303.

    If SB 303 does not pass, the status quo remains, yes. If SB 303 passes, the situation becomes dramatically WORSE. It does not address problems in the current law and it adds new problems. Change for the sake of change is not necessarily good change. If this passes, not only will it make the situation dramatically worse, it will eliminate any momentum to go back and fix the problems so obvious in SB 303.

    You seem to be distancing yourself from the TMA on this, which is understandable, but they are pushing these so-called “reforms” as hard as anyone at the same time they say this is a good law as it is. That contradiction indicates that this is not about reform for the sake of the patient; but the biggest indicator this is not about reform for the sake of patient is the plain language of the bill itself.

    A list of endorsements is fine, there are plenty who do NOT endorse SB 303. Indeed, the list is quite a bit longer. I’d give a link, but, well, you know. One can find it online quite easily.

    But no list of endorsements takes away from the fact that SB 303 is a deeply flawed bill that does not give more protection to patients (more process with the same final outcome does not equal more protection), does not promote life, and violates Catholic teaching. It does not improve current law. So expending this effort on a bill that will do so much damage is a waste. The energy should be spent on a better bill.

    Posted by Kassi Marks | May 11, 2013, 9:16 AM

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