Bishops' Schedules: Bishop Robert C. Morlino Thursday, April 21, 2005 2:00 p.m. -- Participate in the fourth Annual International Bioethics Forum, BioPharmaceutical Technology Center, Madison Saturday, April 23, 2005 4:30 p.m. -- Preside and Preach at the Celebration of the Sacrament of Confirmation, St. Thomas Parish, Poynette Sunday, April 24, 2005 4:00 p.m. -- Preside and Preach at the Celebration of the Eucharist, 100th Anniversary of St. James Parish, Madison Tuesday, April 26, 2005 7:00 p.m. -- Preside and Preach at the Celebration of the Sacrament of Confirmation, Holy Mother of Consolation Parish, Oregon Wednesday, April 27, 2005 7:00 p.m. -- Preside and Preach at the Celebration of the Sacrament of Confirmation, SS. Andrew and Thomas Parish, Potosi Thursday, April 28, 2005 5:00 p.m. -- Preside and Preach at the Celebration of the Eucharist, Red Mass, St. Patrick Parish, Madison Bishop William H. Bullock Saturday, April 23, 2005 5:15 p.m. -- Preside and Preach at the Celebration of the Sacrament of Confirmation, St. Peter Parish, Madison Bishop George O. Wirz Saturday, April 23, 2005 5:15 p.m. -- Preside and Preach at the Celebration of the Sacrament of Confirmation, St. Mary of the Lake Parish, Westport

Medical treatment:
Make decisions based
on Catholic teaching

		Under the Gospel Book + Bishop Robert C. Morlino

Dear Friends,

Please allow me to continue with the second installment of a series [read first installment] of reflections concerning the appropriate medical treatment relative to certain life issues.

The recent tragedy which concluded with the death of Terri Schiavo has powerfully raised the question for all of us as to the human dignity of a person who is medically termed to be in a persistent or permanent vegetative state.

Never reduced to a 'vegetable'

In the first place, medical professionals who use this terminology know exactly what they mean by it. But when dealing with those who are not medical professionals, I fear that the connotation is carried that a person is somehow reduced to a vegetable. The fact that a person is gravely ill and disabled could never make that person anything less than a person - such a person should never be treated as a vegetable. So I would prefer to use the terminology which I take from the late great Bishop McHugh, "diagnosed as permanently unconscious" (DPU rather than PVS for those of us who are not medical professionals).

The person who is diagnosed as permanently unconscious, according to the scenario which played out with Terri Schiavo, is not terminally ill, and not close to death. Such a person has no "right to die" any more than any other person because there is no such right. To intend suicide should one ever be found to be diagnosed as permanently unconscious is gravely immoral - to sign a living will ordering one's own death if one were diagnosed as permanently unconscious, but not terminally ill and not close to death, is a mortal sin in other words. It is possible to create a living will that will generate more problems than it solves and contains intentions that are themselves seriously sinful.

The one who is diagnosed as permanently unconscious may not in fact be permanently unconscious - he or she may wake up after 18 to 20 years. In all likelihood future biotechnical advance will allow for greater precision regarding this particular diagnosis.

No one can intend death

In any event when a person is not terminally ill and not close to death, neither that person nor anyone else has the right to intend or perpetrate his/her death. One who is diagnosed as permanently unconscious maintains his or her own dignity, including his or her right to food and water, even when artificially provided.

The fact that food and water are provided by artificial means does not mean that food and water are no longer food and water. This is the clear teaching of our deceased Holy Father John Paul the Great. He taught us by his own death that a very weak and disabled human life ought to be treasured. He accepted for himself the use of the feeding tube and did not choose to starve to death. The right to food and water is one of which the person not terminally ill and not close to death should not be deprived.

If a patient is in fact terminally ill and close to death, then those medical treatments are appropriate which are effective for sustaining life and which are not disproportionately burdensome. For example, if someone is terminally ill and close to death and his or her body is still able to process nourishment, then a feeding tube inserted through the nose (naso-gastric) would generally be appropriate. A feeding tube inserted into the stomach (gastrostomy tube) more directly involves invasive surgery so that this kind of medical treatment might well be disproportionately burdensome for someone who is terminally ill and close to death, whereas the nasal feeding tube generally would not be.

If someone is terminally ill and close to death and the body no longer can process nourishment, that is the inception of food and water have become futile because the body can no longer process them to sustain life, then clearly food and water are not required, but only under these most serious circumstances. If there is any question about a particular medical treatment as appropriate, it should be addressed to an individual with the proper moral training and awareness of the Church's teaching effectively and pastorally to answer the question.

But it must be kept in mind that we are always determining whether a particular medical treatment is proportionate or not, that is whether or not the benefits of the treatment outweigh the burdens. We are making such decisions about medical treatment and not making judgments about the value of the human life of the individual.

Living wills, health care proxy

Lastly, it was commonly said after the death of Terri Schiavo that the lesson society should learn from the tragedy is that one should always have a living will. That in fact is not at all the lesson that anyone should learn, I believe.

In the first place living wills are open to interpretation if the author becomes seriously incapacitated and cannot communicate for himself or herself. Then the interpretation of the living will would be left to others. The best approach to providing advance directives for health care is to designate a health care proxy, that is to give the durable power of attorney for health care decisions to some trusted individual who knows one's wishes.

A good number of years ago, in fact, I designated such a health care proxy and gave those persons such durable power of attorney. They were alerted to my major surgery last September and were present in case they had to exercise their proxy. Thanks be to God for their presence and I am deeply grateful that the Lord chose to give me the gift of a new and energized life.

Summary of Catholic teaching

But if one chooses to sign a living will or to execute a grant of durable power of attorney for health care issues, then one must not simply checkmark boxes on some template. One must be sure that all of the principles of our Catholic teaching are embodied in whatever action we choose to take.

To summarize, those principles are: 1) no one may directly intend death; 2) life sustaining measures are required (food and water are required) as long as the person is not terminally ill and close to death; and 3) for those who are terminally ill and close to death medical treatments which are disproportionately burdensome are never obligatory.

If one keeps these principles in mind when executing living will or durable power of attorney documents, then such documents, especially the designation of a health care proxy, are particularly effective, and this kind of designation ought to be made by every responsible adult.

Reflect on end of Holy Father's life

Lastly, especially in dealing with those who are terminally ill and close to death, every situation is unique. Let us again reflect on the end of our Holy Father's earthly life. He accepted the feeding tube for nourishment in his last days because human dignity required that he be given food and water.

But as he grew closer to death he chose not to return to the hospital because many of the life sustaining measures provided there would have been disproportionately burdensome and therefore were not obligatory. He judged that his time had come. He accepted death from the Lord who gave him life, but he never directly or indirectly caused his own death. Each situation is unique and the presence of competent physicians, counselors, and clergy is irreplaceable.

I hope these reflections will be of help to you at a time when many are downloading living will templates from the Internet and proceeding. Please do look carefully before you leap.

Thank you for reading this. God bless each one of you. Christ is Risen! Indeed He is Risen! Praised be Jesus Christ!