Hospitals and “Choice”

They keep moving the goal posts, re-defining life and death and disability and what constitutes care.

Let’s look at this full-page article the Chicago Tribune ran today on Catholic hospitals and choice, as they put it. The centerpiece of the story is the bishops’ directives on the care of impaired human beings while they still have life.

“U.S. bishops have decided that it is not permissible to remove a feeding tube from someone who is unconscious but not dying, except in a few circumstances.

“People in a persistent vegetative state, the bishops say, must be given food and water indefinitely by natural or artificial means as long as they are otherwise healthy. The new directive, which is more definitive than previous church teachings, also appears to apply broadly to any patient with a chronic illness who has lost the ability to eat or drink, including victims of strokes and people with advanced dementia.

“Catholic medical institutions…are bound to honor the bishops’ directive, issued late last year, as they do church teachings on abortion and birth control. Officials are weighing how to interpret the guideline in various circumstances.

“What happens, for example, if a patient’s advance directive, which expresses that individual’s end-of-life wishes, conflicts with a Catholic medical center’s religious obligations?”

The Tribune cited one woman who called the directives “authoritarian”, complaining that people should have the “autonomy” of deciding for themselves when to let go of life. Which is a common complaint of Catholics who resent Church teaching that interferes with their cultural sense of self-determined rights.

But the Church has these guidelines because under and beyond the particulars of each patient’s case, there’s a universal human right to life and dignity that no one has the ‘right’ to violate or relativize. Stories like this always come back to the case of Terri Schiavo…

“The guideline addresses the cases of people like Terri Schiavo, a Catholic woman who lived in a persistent vegetative state for 15 years, without consciousness of her surroundings. In a case that inspired a national uproar, Schiavo died five years ago, after her husband won a court battle to have her feeding tube removed, over the objections of her parents.”

First of all, Popes John Paul II and Benedict XVI have specifically addressed the PVS designation as de-humanizing, even when doctors apply it to patients with no detectable cognitive awareness. But Terri wasn’t PVS.

Every account in the press of her story is a set of un-truths lifted from other reporting that never got it right in the first place. Which is a separate conversation from the PVS diagnosis and the Tribune article and care for the disabled…..but this is the baseline story for the cultural shift since Terri died, and understanding it is essential to reclaiming the truth.

She was a patient whose brain was deprived of oxygen long enough for her to become cognitivily impaired (for very dubious reasons, but that’s another story…). But in the initial weeks and months of her hospitalization, she was cared for and improving and very aware and responsive to her caregivers.

“In 1991, the rehabilitation center recorded notes indicating Terri was speaking during physical therapy sessions, saying things such as “No”, “Stop” and “Mommy.”

She was eating jello and ice cream, enjoying outings to the mall, and improving with physical therapy. After her husband won a lawsuit with a bundle of money allegedly for her care, he ordered all therapy to be stopped and shunted her off to a hospice, depriving her of medical care and even human comforts. Of course she deteriorated. Put a plant in a dark closet and leave it, and it will die.

Back to the Tribune story…

“I think many (people) will have difficulty understanding how prolonging the life of someone in a persistent or permanent vegetative state respects the patient’s dignity,” said Dr. Joel Frader, head of academic pediatrics at Children’s Memorial Hospital in Chicago and professor of medical humanities at Northwestern University’s Feinberg School of Medicine.”

The difficulty is in understanding how ending the life of someone in an impaired state respects their dignity.

“Church members should steer away from advance directives that make blanket statements such as “I don’t want any tubes or lifesaving measures,” said the Rev. Tadeusz Pacholczyk, director of education for the National Catholic Bioethics Center in Philadelphia.

“Pope John Paul II articulated the principle in a 2004 speech, and the Congregation for the Doctrine of the Faith, an arm of the Vatican, expanded on it in a 2007 statement. The new guideline incorporates those positions in Directive 58 of the U.S. bishops’ Ethical and Religious Directives for Catholic Health Care Services.”

Here’s a takeaway, the pull quote from the piece, something said by Erica Laethem, director of clinical ethics at Resurrection Health Care, Chicago’s largest Catholic health care system:

“I have never seen an advance directive that says, ‘If I am in a persistent vegetative state, I ask that you withdraw food and water…'”

(See this story also at Sheila Reports.)