Tuesday, March 29, 2011

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).

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About Me

I am an enormously blessed husband and dad. In regard to my Catholic theological background, I have a certificate in social ministry & a master's degree (moral theology concentration), as well as a catechetical diploma from the Vatican's Sacred Congregation for the Clergy (Nope, I am not now - nor have I have ever been - a seminarian, deacon, or priest.). I feel particularly proud to have a mandatum. I also have a doctorate in Christian counseling psychology.

And yup, that's me!

And yup, that's me!
(from page 1 of the NY Sun, 3/22/04)

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12/12/08 Interview with Rev. Tad Pacholczyk, Ph.D. of the National Catholic Bioethics Center

March for Life 2010