If you thought the debate over providing a patient food and water had ended with Pope John Paul II’s 2004 address to health care professionals, you are sadly mistaken. The Holy Father clarified Catholic teaching, but even his profound words did not end the ongoing discussions which are taking on more innuendo and less fundamental ethical guidance as time progresses.
Pope John Paul II discussed the provision of nutrition and hydration in the case of patients in a coma, and did so as the Terri Schiavo drama was playing out in Florida. When he addressed the subject, he said that even in the case of a prolonged condition such as “vegetative state,” there is no ethical justification for ending or interrupting “minimal care” for the patient, including nutrition and hydration. Further, “Death by starvation or dehydration is, in fact, the only possible outcome as a result of their withdrawal. In this sense it ends up becoming, if done knowingly and willingly, true and proper euthanasia by omission.” These are strong words and should have had the effect of ending any discussion about removing comfort care—which is really all that nutrition and hydration can provide to the dying.
So it was with considerable shock that I reviewed a brochure forwarded to me by a medical professional who learned of a presentation that will be made in her home state of Missouri. The title of the seminar is “Ethical Considerations for Withholding Nutrition and Hydration: End-of-Life Decisions.” The course director is Denise Dougherty, MA, CCC-SLP, MFT, a speech therapist in private practice in Pennsylvania. Ms. Dougherty earned a master’s degree at St. Louis University, which is a Catholic university.
Upon reviewing the description of the seminar, it disgusted me that seminars such as this—which take place across the country all the time—are being offered at Catholic facilities. One session is being conducted on October 21 at St. Clare Hospital—a Catholic institution located in Fenton, Missouri. The Catholic Church strongly defends the dignity of the human person and that individual’s right to be treated with full respect and care even when dying, yet this type of seminar goes against that teaching.
The seminar’s marketing brochure uses language which unmasks the intent of the discussions that will occur. For example, under nutrition options we find the words “appropriate and inappropriate” as well as “pulling tube.” Under hydration options we find “benefits” and “burdens.” Each of these terms are subjective—meaning that one can apply a sliding scale of ethics depending on who is making the decisions and the ulterior motives that could come into play with a particular patient and his or her family. In other words, there is no such thing when dealing with a dying patient as a “one size fits all” program of care and preparation for death. Each individual presents a unique set of challenges and questions.
This fact brings me to the question the health care professional asked in her email to me: “Are there really ethical considerations for withholding nutrition and hydration from dying patients?”
The answer to this question is a simple one: Not unless the patient’s body is either rejecting the nutrients or the provision of same is causing a high level of pain to the patient. Otherwise, to withhold or remove nutrition is, as the Pope pointed out, “euthanasia by omission.”
This is why the Holy Father encouraged the medical professionals who were in his audience “to guard jealously the principle according to which the true task of medicine is ‘to cure if possible, always to care.’”
What a blessing it would be for those gathered at St. Clare Hospital on October 21 to study and learn the health care principles set forth by Pope John Paul II in his March 20, 2004 address rather than spending a few hours learning how to apply end-of-life principles guided by moral relativism.
We have expressed our concerns about this seminar to the remarkable shepherd, Archbishop Robert J. Carlson, and invite you to pray that he intervenes so that, at the very least, this event is moved to a secular location.