Respiration, Nutrition, Hydration, Confusion, & the Good Life

March 31, 2011 marks the sixth anniversary of the cruel death of Terri Schindler Schiavo and a wonderful opportunity to reflect on the truths proclaimed by our Church about end of life issues.

Shortly after her 1954 birth in Scranton, Pennsylvania, Karen Ann was adopted by the Quinlans and raised near Lake Hopatcong, New Jersey. She was the eldest of an intact, Catholic family of three children (i.e., two girls and a boy), which was to be drawn into media and legal frenzies, as the result of medical decisions….

Shortly after her 1963 birth, Terri was brought home by the Schindlers and raised near Philadelphia, Pennsylvania. She was the eldest of an intact, Catholic family of three children (i.e., two girls and a boy), which was to be drawn into media and legal frenzies, as the result of medical decisions…..

Born less than a decade apart and raised less than 75 miles apart, there are striking parallels in the tragic cases of Karen Ann Quinlan and Terri Schindler Schiavo. While both women are known to us because of dramatic medical decisions, there was an insurmountable difference in the character of those decisions. In Karen Ann’s case, the decisions concerned "extraordinary treatment." In Terri’s case, the decisions concerned "ordinary care."

In her memoir, Julia Duane Quinlan (1985) reports that

• [In] the early morning of April 15, 1975…we received a phone call in the middle of the night….‘Mrs. Quinlan, this is the nurse from Newton Memorial Hospital. Your daughter was admitted to the intensive care unit. She is unconscious’….By late May 1975, I faced the reality that there was no medical help for Karen….After many family discussions we asked to have Karen removed from the respirator and the cessation of all extraordinary means to preserve her life….she continued to receive nourishment through her nasal gastric feeding tube” (pp. 37, 41, 44, 50 ).

It was not until June 11, 1985, that Karen Ann Quinlan passed away, but Julia Duane Quinlan maintains that her “beautiful, vivacious daughter died” (p. xv) on April 15, 1975. Since Julia Duane Quinlan’s book was published by St. Anthony Messenger Press and includes a forward by the bishop emeritus of the Diocese of Patterson, New Jersey, one should be able to assume that this book is theologically accurate with regard to end of life issues. Unfortunately, that is not the case. Karen Ann’s mom actually evidences great confusion between what constitutes “extraordinary treatment” and what constitutes “ordinary care.”

In 2006, Julia Duane Quinlan was paired with Michael Schiavo at a bioethics symposium at the University of Pennsylvania.

On the jacket of his book, Michael Schiavo (2006) announces: "Now, I can finally tell you what caused me to conclude that it was time to let her go. And I can also answer the questions that seem to trouble so many people: Why didn't I just divorce Terri and allow her parents to take over as her legal guardians? And how could I be in a relationship with another woman, and have two children with her, while Terri was still alive?" Michael basically contends that Terri’s siblings and parents - particularly Terri’s dad - were horrible, dishonest, money-grubbing people.

By the early 2000s, Michael Schiavo readily acknowledges that he was living with a woman other than his wife and had two children with that woman. As to why Michael did not surrender care to Terri’s parents, the Schindlers - in their book – maintain that Michael did not want to lose control of Terri's estate. As per Terri’s brother, "Okay. Let's for a moment pretend that Dad was the worst person in the world. What bearing does it have on Michael's promise to use the money for rehabilitation and therapy? It doesn't take away the commitment he made to himself and to the jury - and to our family - that he was going to care for Terri for the rest of her life. And what does it have to do with his petitioning the courts to remove her feeding tube? It's as though he was saying, the father is a bad guy, therefore I'm going to kill his daughter" (Schindler, Schindler, Schindler, & Schindler, p. 55).

Way back in 1995, #120 of the Vatican's "Charter Health Care Workers" had stated that "The administration of food and liquids, even artificially, is part of the normal treatment always due to the patient when this is not burdensome for him: their undue suspension could be real and properly so-called euthanasia." Yet Michael Schiavo was able to brag of being backed at a trial by a supposed expert on Catholic medical ethics. When the Schindlers tried to appeal to their bishop, Michael Schiavo apparently cried witness tampering!

Had misunderstanding and confusion about one sentence in the 4th edition of the U.S. Catholic Bishops "Ethical and Religious Directives for Catholic Health Care Services" (2001) fostered confusion about Church teaching? (i.e., "The USCCB Committee on Pro-Life Activities' report...points out the necessary distinctions between questions already resolved by the magisterium and those requiring further reflection, as, for example, the morality of withdrawing medically assisted hydration and nutrition from a person who is in the condition that is recognized by physicians as the 'persistent vegetative state' (PVS).") In his 2004 address to the International Congress on Life-Sustaining Treatments and Vegetative State, it appears that Pope John Paul II was directly intervening to bring clarity to Terri Schiavo's situation:

• "The sick person in a vegetative state, awaiting recovery or a natural end, still has the right to basic health care (nutrition, hydration, cleanliness, warmth, etc.), and to the prevention of complications related to his confinement to bed. He also has the right to appropriate rehabilitative care and to be monitored for clinical signs of eventual recovery ....the administration of water and food, even when provided by artificial means, always represents a natural means of preserving life, not a medical act....The evaluation of probabilities, founded on waning hopes for recovery when the vegetative state is prolonged beyond a year, cannot ethically justify the cessation or interruption of minimal care for the patient, including nutrition and hydration. Death by starvation or dehydration is, in fact, the only possible outcome as a result of their withdrawal."

In response to the Holy Father’s address, Richard Doerflinger, chair of the aforementioned USCCB Committee on Pro-Life Activities stated: "With the Pope's statement, the Church's teaching authority has rejected each aspect of the theory that opposes assisted feeding for patients in a PVS."

While the Holy Father’s 2004 statement seems immensely clear, the Vatican still provided "Responses to Certain Questions of the USCCB Concerning Artificial Nutrition and Hydration" (2007): "The administration of food and water even by artificial means is, in principle, an ordinary and proportionate means of preserving life. It is therefore obligatory to the extent to which, and for as long as, it is shown to accomplish its proper finality, which is the hydration and nourishment of the patient. In this way suffering and death by starvation and dehydration are prevented....A patient in a 'permanent vegetative state' is a person with fundamental human dignity and must, therefore, receive ordinary and proportionate care which includes, in principle, the administration of water and food even by artificial means."

In its 2009, 5th edition, the U.S. Catholic Bishops "Ethical and Religious Directives for Catholic Health Care Services" also spoke with immense clarity: "In principal, there is a moral obligation to provide patients with food and water, including medically assisted nutrition and hydration, for those who cannot take food orally" (cf., Directive 58).

It is noteworthy that Schindler family attorney David Gibbs maintains that Terri Schiavo was exceedingly more responsive and interactive than the public was led to believe. Even so, her cognitive level should have never determined whether she received food and water! As the Schindlers explain, "We had to argue that Terri wasn't PVS - even though she didn't fall into the PVS criteria - because only then would she be allowed to live. But why did Terri have to prove anything? She's a human being" (p. 230).

As the Schindlers eloquently conclude, "Terri's tragic and needless death, and her life as a disabled woman, have forced us as a society to confront our prejudices against the disabled" (p. 229).

re: "Meanwhile, Population Explosion Ignored" (Courier Times, 3/18/11)

The notion that we are imperiled by the size of the human population has been around since Anglican priest Thomas Malthus first postulated it in the late 18th century. In regard to famine, immorality, war and human misery of all sorts, Malthus maintained that there is "one great cause," preventing "improvement of society," and that is "the constant tendency in all animated life to increase beyond the nourishment prepared for it." If the size of the human population were to go unchecked, Malthus' demographics suggested that people would soon outrun global food supplies. Yup, that tired notion has been around since the 18th century.

Some would suggest that mid-nineteenth century Ireland presented a "laboratory" for the British Empire to experiment with Malthusian concepts. If there are supposedly too many people, some figure that it's OK to weed out the supposedly less desirable and promote the propagation of supposedly more desirable people. It has been said that food remained in British warehouses while the Irish suffered the Great Hunger!

In Ireland and in the other famines since Malthus' time, food experts remind us that the problem has NOT been insufficient food. As per economist Jacqueline R. Kasun, the problem is also NOT overpopulation. While we have enough food, the true problem of famine is inadequate food distribution, which is often linked to good old human selfishness.

For people who buy into the notion of overpopulation (and have you noticed that they often seem to be affluent people like Sir David Attenborough and Bill Gates?), the notion of eugenics can closely follow. Novelist and physician Michael Crichton explained how this notion became popular, more than one hundred years ago:

• "Imagine that there is a new scientific theory that warns of an impending crisis, and points to a way out....The theory of eugenics postulated a crisis of the gene pool leading to the deterioration of the human race....even after the center of the eugenics effort moved to Germany, and involved the gassing of individuals from mental institutions, the Rockefeller Foundation continued to finance German research at a very high level....After World War II, nobody was a eugenicist, and nobody had ever been a eugenicist....Eugenics ceased to be a subject for college classrooms, although some argue that its ideas continue to have currency in disguised form" (State of Fear, 2004, pp. 575 - 577).

I maintain that Bonnie Erbe's dopey tribute to Attenborough, "Meanwhile, Population Explosion Ignored" (Courier Times, 3/18/11) reveals "disguised form" eugenics. As Erbe herself notes, "Attenborough points out what I agree with him has become an 'absurd taboo' on speaking out publicly on human population growth and trying to do something about it."

Evidencing utter ignorance about population demographics (perhaps especially in the historically Catholic countries of Western Europe), Erbe joins Sir David in throwing in some anti-Catholicism for good measure: "Attenborough gets quickly to the point. He compares population growth rates in several developing nations and compares rates in Catholic versus non- Catholic nations and in Catholic countries fertility rates are almost twice as high as in non-Catholic countries."

Erbe parrots Attenborough's hateful bile, which is not even disguised! Why does the Courier Times publish such discriminatory garbage? It would behoove Bonnie Erbe and Sir David to step out of their limos and visit a library.

They would benefit by opening a book once in a while, as there have been many notable ones - AFTER Rachel Carson's Silent Spring.

re: "We Are Sorry" (Catholic Standard & Times, February 2011)

Matthew Gambino, Director & General Mgr
The Catholic Standard and Times
Archdiocese of Philadelphia
222 N. 17th Street
Philadelphia, PA 19103

Dear Mr. Gambino,

In addition to being titled "We Are Sorry," both the first sentence and the last of your recent editorial state: "We are sorry."

The sexual abuse abuse of minors is absolutely criminal; it is abhorent, disgusting, and vulgar. While it flies in the face of crime reports, a bizarre notion has taken hold that sexual abuse is the near exclusive specialty of Catholic priests.

In recent years, "throw under the bus" has become a popular phrase. When criminal charges are not involved, exactly how has the CS& T vetted allegations against priests, before publishing their names as removed from ministry amidst suspicion? In the movie version of "Doubt," there was an incredible image of feathers flying from an open pillow. Even if a priest is subsequently cleared of any wrong doing, how is he to possibly recapture his good name?

If the Archdiocese is guilty of covering up past abuse, this cannot be rectified by overreacting to current situations. Please consider adding a "P.S." to your editorial: "We are sorry to our dear priests with whom we failed to stay awake and whom we denied, during their own agonies and scourgings."

Sincerely,