Joint Finance: Political geography

		Eye on the  Capitol  John Huebscher

When Franklin Roosevelt was presented with the chance to select his ninth Supreme Court justice, he settled on Wiley Rutledge of Iowa.

Rutledge was a distinguished though not particularly well known judge. He was also from Iowa and no one on the court at the time was from the Midwest. In telling Rutledge of his good fortune, FDR explained, "Wiley, you have geography."

Political geography

Geography also plays into appointment to the Wisconsin state legislature's biggest plum: the powerful Joint Committee on Finance. Not only does this 16-member panel craft the state budget, but it passes judgment on any other bill that calls for the expenditure of tax dollars.

A seat on "Joint Finance" is sought after. And appointments to the panel shed insights into which legislators have the trust of their colleagues for an important assignment but also to the political geography of our state.

Since each party controls one house of the legislature, Democrats and Republicans will each have eight seats on the committee. The distribution of those seats says something about where the parties enjoy support at this point in time.

Democratic seats

Milwaukee County is Wisconsin's most populous and a long time Democratic stronghold. It is no accident that two of the eight Democrats on the Finance Committee, Sen. Lena Taylor and Rep. Pedro Colon, are from Milwaukee. Dane County also cranks out large majorities for Democratic candidates; its delegation holds two seats: one to Sen. Mark Miller and Rep. Mark Pocan, both of Madison.

The populous Fox River Valley also rates attention and got it with Sen. Dave Hanson of Green Bay. Southeastern Wisconsin is represented with the appointment of newly elected Sen. John Lehman of Racine.

Of course, much of Wisconsin is rural and no party wants to ignore "out state." Central Wisconsin is often seen as a "swing area" and Douglas County, that includes the city of Superior, is a Democratic stronghold. Both are represented on the committee in the persons of the panel's co-chairs: Sen. Russ Decker from Weston in Marathon County and Sen. Bob Jauch from Poplar in Douglas County.

Republican seats

The Republican leadership made similar calculations in selecting their members on the panel. If the city of Milwaukee is reliably Democratic, the suburban communities around it tend to be Republican. Two seats went to lawmakers who represent Milwaukee's suburbs: Sen. Alberta Darling of River Hills (whose district also includes part of GOP vote rich Waukesha County) and Rep. Jeff Stone of Greendale. Southeast Wisconsin also has GOP representation with Rep. Robin Vos of Caledonia in Racine County.

Wisconsin's towns and small cities have been good areas for Republicans over the years and they too are well represented on the committee. Assembly co-chair Kitty Rhoades is from Hudson. Other "out state" Republican members include Rep. Dan Meyer (Eagle River), Rep. Steve Kestell (Elkhart Lake), Rep. Scott Suder (Abbotsford), and Sen. Luther Olsen (Berlin).

The members of the Joint Committee on Finance are among the hardest working in the capitol. It is not a place for people of modest ability. But with only 16 seats and 132 legislators, tie-breaking factors are important. And sometimes, geography is an important "tie breaker."

John Huebscher is executive director of the Wisconsin Catholic Conference in Madison.

Feeding tubes: Are they morally required?

		Making Sense  Out of Bioethics  Fr. Tad  Pacholczyk

One of the very practical concerns that patients face near the end of life involves the question of feeding tubes. How can we discern whether a feeding tube is morally required?

The answer always depends on the particulars of a patient's situation, but there are a few broad considerations that can help in the discernment process.

How we die

As a general rule, we ought to die from a disease or an ailment that claims our life, not from an action (or inaction) by someone that causes our death (for example, withholding hydration). Our death, in other words, should result from the progress of a pathological condition, not from a lack of food or water if it could have been readily offered to provide comfort and support to a patient.

In general, there should be a presumption in favor of providing nutrition and hydration to all patients, including those who require the assistance of a feeding tube. A feeding tube can be conceptualized as a kind of "long spoon" that assists us in feeding someone who has difficulty swallowing.

Providing comfort

The proper starting point for the discussion is the recognition that feeding tubes should be offered to patients because they are likely to provide two benefits: they bring comfort to the patient and alleviate suffering that comes from hunger and dehydration, and they may also serve as a bridge to healing, depending on the disease.

Does this stance imply that feeding tubes must always be used, no matter what? Certainly not. There will be circumstances where feeding tubes will become "disproportionate" or "extraordinary" and will not be morally obligatory.

One very clear example would be the situation in which a feeding tube fails to provide nourishment to the patient. If somebody has advanced cancer of the digestive tract, for instance, so that he lacks a functional stomach or intestines, and cannot absorb nourishment, a feeding tube would not be required, since this would constitute a futile kind of "force feeding."

Causing problems

In some cases, feeding tubes may actually cause significant problems of their own. For example, if someone is very sick and dying, perhaps with partial bowel obstruction, the feeding tube may cause them to vomit repeatedly, with the attendant risk of inhaling their vomit, raising the specter of lung infections and respiratory complications. The feeding tube under these conditions may become disproportionate and unduly burdensome, and therefore non-obligatory.

In some instances, providing drips and naso-gastric feeding tubes can interfere with the natural course of dehydration in a way that causes acute discomfort to the patient near death. When the kidneys have not shut down, the fluids can sharply increase the flow of urine. If patients are extremely weak and have lost bladder control, they may need to have a catheter inserted, which can be distressing to patients and their families.

Intravenous fluids also tend to increase respiratory secretions, making it more difficult for patients to catch their breath or cough, and suction may be required. Providing IV hydration can also cause a flare up of fluid accumulation in the abdomen and expand the edema layer around tumors, aggravating symptoms.

Hence the use of IV drips and feeding tubes will always have to be evaluated in terms of the totality of the patient's condition, taking into account any undesirable effects and the likelihood of benefit.

Fear and anxiety

Other circumstances must also be considered. Is the patient suffering from dementia, perhaps due to Alzheimer's or another nervous system ailment? Demented patients present a special challenge, as they may need to be restrained in order for a feeding tube to be inserted and that restraint may need to continue to prevent them from pulling the tube out.

Both the restraint and the presence of the tube can cause fear and anxiety in the demented patient. One must therefore carefully consider whether such a tube would really be proportionate to the patient's health care needs, especially at a point close to death.

Our desire to comfort and palliate those suffering from an end stage disease is an important part of the equation in mapping out the best options for health care treatment. If we have to tie down our loved ones and cause them grave discomfort and uncontrollable anxiety to provide a feeding tube, such a tube may well become disproportionate and non-obligatory.

End of life

These considerations hold most notably for patients who are near death, where it is clear we are not obligated to extend an imminent death, and where the benefits of the feeding tube will be subject to considerable discussion.

It should be emphasized, however, that in weighing the propriety of tube-feeding, we must specifically examine the burden of the technique itself, and not try to make some kind of global assessment about whether we believe that person's life in general is burdensome or "not worth living." Life can be burdensome, but that doesn't provide us with license to shorten it by refusing a standard and effective intervention.

Changing circumstances

Sometimes when families are discussing whether to provide a feeding tube to a loved one who is dying, there may be concern that such a tube, once inserted, can never be ethically removed after it has been put in place.

In point of fact, however, such an understanding would be incorrect. Merely because a feeding tube has been placed does not say anything about whether that tube can later be withdrawn.

If the patient's circumstances change so that a feeding tube has now become a burdensome and extraordinary intervention, that tube can be withdrawn without hesitation or compunction.

We must be concerned first and foremost with providing the best possible health care interventions for our loved ones. Feeding tubes will oftentimes, but not in every circumstance, assist us in exercising proper stewardship over the great gift of human life that each of us has received from God.

Fr. Tadeusz Pacholczyk earned his doctorate in neuroscience from Yale and did post-doctoral work at Harvard. He is a priest of the Diocese of Fall River, Mass., and serves as the director of education at the National Catholic Bioethics Center in Philadelphia, Pa.

Restorative justice:
Bringing reconciliation, peace to Holy Land

	Guest Commentary  Randy Henderson

Christmas is not just a time to welcome Christ, the incarnation of the Word of God into the world, but it is a time to bring renewal and peace into our lives through thoughtful and deliberate living of the Word.

The Word was at the beginning the creative Word of life. New life has begun in the most unlikely of places, the war-torn Holy Land. Some Jews and Muslims are bringing reconciliation, justice, and peace to their homeland, not through the use of force or sanctions, but through discussion and story telling about shared loss, about losing sons and fathers, sisters and mothers.

How they are doing this seems so simple that it couldn't possibly work, but it does. Robi, an Israeli mother robbed of her son, and Ali, a Palestinian whose family suffered much loss at the hands of the Israeli army, shared concrete examples of peace-making at the International Conference on Restorative Justice: Healing From Political Violence held at Marquette's School of Law in November.

Restorative justice

The basic theory of restorative justice is that people who perpetrate acts of violence and those affected by violence are deprived of wholeness. The humanity of each person is diminished or torn apart.

By meeting one-on-one or in groups, victims and perpetrators of crime are able to experience one another as human beings and restore humanity to one another.

Restorative justice has been effective. The cases presented at the conference shared this creative method of dealing with international, national, and personal conflict.

Living in uncertain times

Can there be any doubt that we live in uncertain times? Just open a newspaper, turn on the television and there it is: unrest, division, and death. How do we actively live the Word as Catholics in the United States bringing about the promise of new life, resurrection, and peace?

Not often do the popular media nor our political leaders seek to bring us hope or truth, but often succumb to sensationalism and the propagation of fear.

The story of the infant birth in humble surroundings reminds us of the challenge we each face on our journey of life and death with Christ. We ask, "What is my hope for peace and justice throughout the world? What can I do?"

Applying Catholic teaching

As Catholics we are blessed with a tradition that beckons us to be involved in the world, to bring dignity, justice, and peace through application of Catholic social teaching. As American Catholics we can plead with our media to do a better job promoting stories of hope instead of the endless barrage of blood and bullet stories. We can ask our political leaders to either get out of the way or take the lead in seeking an end to violence that honors the image of God found in each human through models like restorative justice.

Peace begins with prayer. Take time for a restorative conversation with God that will fill you and pour out into the world, to help heal it.

What can you do? If you would like to be involved in promoting restorative justice and peace making in the Middle East, you may join the National Campaign to Promote Peace in the Holy Land that the Diocese of Madison has adopted. Call the Office of Justice and Pastoral Outreach, 608-821-3086. Information on the campaign is at www.usccb.org/sdwp/holylandpeace/

Randy Henderson is director of youth ministry at St. Patrick Parish in Lodi.