Column: Decision makers should know your wishes, share your values

by Archbishop Joseph F. Naumann

My grandmother spent the final years of her life at Mother of Good Counsel Home, a skilled nursing facility in St. Louis operated by the Franciscan Sisters of the Martyr St. George.

Mother of Good Counsel Home was located in the parish where I served as pastor. I would frequently go to Mother of Good Counsel to feed my grandmother her supper. The Sisters claimed that I could get my grandmother to eat and to do things that she otherwise resisted.

My grandmother was having a particularly difficult day — not wanting to eat and cooperate in other ways that were important for her care — when one of the Sisters asked her if they wanted her to contact me. My grandmother with her wry sense of humor simply said: “Why contact him? He’s the one who got me into this mess!”

Recently, the Archdiocese sponsored a workshop for priests, doctors, nurses and hospice workers regarding some of the important moral issues involved with the care of the elderly and the severely disabled. In recent years, the church has clarified the application of its teaching regarding assisted (tube or intravenous) feeding for those in a permanent or persistent vegetative state (PVS) or otherwise unable to be fed by mouth. Simply put, food and water — no matter how they are provided — are to be considered basic comfort care, not extraordinary medical interventions.

The highly publicized Terry Schiavo case a few years ago illustrates many
of the important moral issues. Terry was diagnosed as being in a permanent vegetative state. This is a very unfortunate and dehumanizing term, because a human being — no matter how limited our physical or mental capabilities — never becomes a vegetable, never loses our innate human dignity. There actually was a dispute between medical professionals as to whether the PVS diagnosis was accurate for Terry. There is significant video evidence that Terry responded to verbal communications and instructions from her parents and her nurses.

Terry had a feeding tube for many years. Her husband insisted that the nursing facility stop feeding Terry. Terry’s parents sought a court order to give them custody of her so that she would continue to be fed. In the end, her husband won the court battle and Terry died of dehydration and starvation.

Terry already had a feeding tube. Her case did not involve her receiving any new, even minor, surgery. It was simply a case of whether she would be provided food and water by her “caregivers” or whether she would be denied these most fundamental necessities for life. The cessation of feeding in such a case is clearly against Catholic moral teaching.

It is not morally permissible to cause the death of another by denying them palliative (comfort) care. This is, in effect, passive euthanasia, bringing about the death of another by with-holding from them the basics of life.

Father Tad Pacholczyk was one of the presenters at a recent archdiocesan workshop on end-of-life decisions. Father Tad is currently the director of education for the National Catholic Bioethics Center in Philadelphia. He brings an impressive set of expertise to these issues, having received a doctorate in neuroscience from Yale University; four undergraduate degrees in molecular and cellular biology, chemistry, biochemistry and philosophy; as well as two advanced degrees in theology.

Father Tad did an excellent job addressing the many scientific and ethical distinctions that have to be made in evaluating the moral obligations in caring for the aged and severely disabled. For instance, there are times, when an individual is truly near death, that providing food and water is not required or even prudent, as when the body is no longer able to assimilate food. In fact, one may be morally required not to provide food and even water in these cases, because you will only be adding to the individual’s discomfort.

Father Tad also pointed out the limitations of advanced directives, because they are made at a moment when the particular circumstances of some future illness or injury are not known. Advanced directives also cannot anticipate future developments in medical science. Catholics should be especially wary of signing advanced directives that make no distinction between basic comfort care — such as food and water — from medical interventions, such as major surgery.

The best way to provide for future medical decisions, if you are unable to make decisions for yourself, is to appoint a durable power of attorney for health. The person you appoint to serve as your durable power of attorney should know your wishes and share your moral values. They should know your desire for your health care decisions always to be in accord with Catholic moral principles.

One of the most helpful observations that Father Tad made at the workshop did not really draw upon his scientific and theological expertise but just practical wisdom. He spoke about having a conversation with an elderly family member who said, like so many, that he just did not want to be a burden on the family. Father Tad said that when a baby is born, he or she is totally dependent on family, but no one complains that a baby is a burden. The same is true at the end of the life cycle. While caring for a baby or an elderly or sick family member is not easy, it is a privilege and a blessing to be able to love and care for another person. It is just what we do as Christians.

In the Archdiocese we are very fortunate to have Sisters, Servants of Mary who visit the homes of the sick at night in order to allow family members to sleep while the Sisters attend to the sick person. The faith and prayerfulness of the Sisters Servants transform moments of great difficulty for families into occasions of renewed faith and hope in God’s love.

The Sisters, Servants of Mary need more vocations, because there are so many more families that would benefit from their beautiful ministry. I encourage any young woman who wants to serve God and make a real difference in the lives of others to become acquainted with the Sisters, Servants of Mary and their beautiful apostolate.

In the Archdiocese, we are also blessed to have Villa St. Francis in Olathe — a skilled nursing facility operated by the Archdiocese — where we strive to provide residents with the highest quality care that is always in accord with Catholic moral and ethical principles. In the Archdiocese, we also are fortunate to have Catholic Hospice, operated by Catholic Charities, to assist families with the care of the dying in a manner faithful to Catholic teaching.

Today, March 12, would be my grandmother’s 109th birthday. She helped care for me as a child and was a formative influence on my life. I am glad that I had the opportunity to help her in some small ways during her final days in this world.

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