Fr. Desmond Daly

On Letting Go, and Letting God……
                                                                     Letting Terri Schiavo go to God.

Published as a bulletin insert in Christ The King Catholic Parish, Fr. Desmond Daly, Pastor 11-3-03

The Schiavo and Schindler families have been experiencing life as one long drawn out nightmare over the past eleven years or so. Our heartfelt prayers go to the families as we see their members inextricably caught up in a surreal battle of wills. The talk show hosts have discovered in this tragedy a gargantuan and serendipitous harvest of material to feed their hungry masses. And in the center of the drama, lies the neither happy nor sad Tern Schiavo. If even the smallest flicker of awareness inhabits what is left other psyche, I hope and pray she has no knowledge of the pain surrounding her. The whole situation is so sad and so unnecessary.

Every day throughout the world, terminally sick or profoundly disabled people enter into the final phase of their earthy lives.  Often these people will signal the immanence of death by declining to take food or drink. If they are fortunate, as my father and mother were they will have their children present to them in this, their greatest time of need. Nature peacefully and gently, takes its course. The greatest need felt by them at that moment is not the need for nourishment.  It is the need for the comfort and peace that obtains in being surrounded by those they love most in this life. Don’t we all pray to have such a death when our time comes?

The mainline religions represented in our society, be they Christian, Jewish, Muslim, Buddhist, Hindu, as well as many others seem to generally agree on withholding medically assisted nutrition from the terminally ill. To be sure, there are those who believe the absolute opposite; that even extraordinary means must be used at all times to treat the terminally ill, as well as those in a vegetative state of existence. This is not the teaching of the Catholic Church.

A recent story in the St Petersburg Times (10-28-03) states: “Several faiths and denominations say God is okay with taking steps toward death when there is no chance of recovery and sustaining life creates an overwhelming burden for family members.

“In point of fact these issues are decided every day by families,” says Sharon Iler, director of the Catholic Diocese of St. Petersburg’s Respect Life office.  “And they have to consider all of the realities of their own unique situation.”

When the patient is Christian the family has assurance that death means their loved one is going to a better place, Iler said. Life on earth is not the end-all or “the highest good,” she said. “Death is looked upon as a passageway to life eternal.”

The article continues: “The case has reached far beyond Tampa Bay , shining light on what other faiths believe.

“The controversial issue is whether in any circumstances such basic needs as food, water and oxygen can be considered extraordinary means,” said David Strand, spokesman for the 2.5 million member Lutheran Church-Missouri Synod.  “We think it’s possible – again, when all hope of recovery is lost and when the doctors and family agree that allowing a dignified death to occur is appropriate – for food, water and air to be considered extraordinary.”

In those cases, he said, it may be best to “let nature take its course.”

But Strand stressed the church believes Christians should “aim always to care, never to kill” and “if we’re going to err on one side or another, we want to err on the side of life rather than death.”

From the United Methodist Church’s Book of Discipline: “The use of medical technologies to prolong terminal illnesses requires responsible judgment about when life-sustaining treatments truly support the goals of life, and when they have reached their limits. There is no moral or religious obligation to use these when they impose undue burdens or only extend the process of dying.”

The Rev Jackson Day, a consultant for the United Methodists’ General Board of Church and Society, said the statement could support either side in the Schiavo case because it refers to “responsible judgment.” The Schindlers say some doctors have said their daughter’s condition might improve with therapy. Other doctors have said she won’t improve, that she is in a permanent vegetative state and her movements are only involuntary reflexes.

“From a theological perspective, what one is doing is attempting to discern the will of God,” Day said.

Would he want Terri Schiavo to hold on or go on to heaven?

“In a situation where there is no apparent ability for a change … where brain function is essentially gone, then I think that the best reasonable interpretation of the will of God is that God has called that person home,” Day said.

The Evangelical Lutheran Church in America detailed its stance in “Allowing Death and Taking Life: Withholding or Withdrawing Artificially Administered Nutrition and Hydration.”

“Food and water are part of our basic human care. Artificially administered nutrition and hydration move beyond basic care to become medical treatment,” the statement says. When doctors determine such treatment won’t help improve the patient’s condition, patients or their legal spokespersons “may consider them unduly burdensome treatment.” In these cases “it may be morally responsible to withhold or withdraw them and allow death to occur.”

The following is excerpt from a document that may be viewed on the official website of the Catholic Church in the United States :

What are the benefits of medically assisted nutrition and hydration?

According to international codes of medical ethics, a physician will see a medical procedure as appropriate “if in his or her judgment it offers hope of saving life, reestablishing health or alleviating suffering. “[18] Nutrition and hydration, whether provided in the usual way or with medical assistance, do not by themselves remedy pathological conditions, except those caused by dietary deficiencies. But patients benefit from them in several ways. First, for all patients who can assimilate them, suitable food and fluids sustain life, and providing them normally expresses loving concern and solidarity with the helpless. Second, for patients being treated with the hope of a cure, appropriate food and fluids are an important element of sound health care. Third, even for patients who are imminently dying and incurable, food and fluids can prevent the suffering that may arise from dehydration, hunger and thirst.

The benefit of sustaining and fostering life is fundamental, because life is our first gift from a loving God and the condition for receiving His other gifts. But sometimes even food and fluids are no longer effective in providing this benefit, because a patient has entered the final stage of a terminal condition. At such times we should make the dying person as comfortable as possible and provide nursing care and proper hygiene as well as companionship and appropriate spiritual aid. Such a person may lose all desire for food and drink and even be unable to ingest them. Initiating medically assisted feeding or intravenous fluids in this case may increase the patient’s discomfort while providing no real benefit; ice chips or sips of water may instead be appropriate to provide comfort and counteract the adverse effects of dehydration. [19] Even in the case of the imminently dying patient, of course, any action or omission that of itself or by intention causes death is to be absolutely rejected.

As Christians who trust in the promise of eternal life, we recognize that death does not have the final word. Accordingly we need not always prevent death until the last possible moment; but we should never intentionally cause death or abandon the dying person as though he or she were unworthy of care and respect.

What are the burdens of medically assisted nutrition and hydration?

Our tradition does not demand heroic measures in fulfilling the obligation to sustain life. A person may legitimately refuse even procedures that effectively prolong life, if he or she believes they would impose excessively grave burdens on himself or herself, or on his or her family and community. Catholic theologians have traditionally viewed medical treatment as excessively burdensome if it is “too painful, too damaging to the patient’s bodily self and functioning, too psychologically repugnant to the patient, too restrictive of the patient’s liberty and preferred activities, too suppressive of the patient’s mental life, or too expensive. “[20]

Because assessment of these burdens necessarily involves some subjective judgments, a conscious and competent patient is generally the best judge of whether a particular burden or risk is too grave to be tolerated in his or her own case. But because of the serious consequences of withdrawing all nutrition and hydration, patients and those helping them make decisions should assess such burdens or risks with special care.

Here we offer some brief reflections and cautions regarding the kinds of burdens sometimes associated with medically assisted nutrition and hydration.

Physical risks and burdens

The risks and objective complications of medically assisted nutrition and hydration will depend on the procedure used and the condition of the patient. In a given case a feeding procedure may become harmful or even life-threatening. (These medical data are discussed at length in an Appendix to this paper.)  If the risks and burdens of a particular feeding procedure are deemed serious enough to warrant withdrawing it, we should not automatically deprive the patient of all nutrition and hydration but should ask whether another procedure is feasible that would be less burdensome. We say this because some helpless patients, including some in a “persistent vegetative state,” receive tube feedings not because they cannot swallow food at all but because tube feeding is less costly and difficult for health care personnel. [21]

Moreover, because burdens are assessed in relation to benefits, we should ask whether the risks and discomfort of a feeding procedure are really excessive as compared with the adverse effects of dehydration or malnutrition.

Psychological burdens on the patient

Many people see feeding tubes as frightening or even as bodily violations. Assessments of such burdens are necessarily subjective; they should not be dismissed on that account, but we offer some practical cautions to help prevent abuse.

First, in keeping with our moral teaching against the intentional causing of death by omission, one should distinguish between repugnance to a particular procedure and repugnance to life itself. The latter may occur when a patient views a life of helplessness and dependency on others as itself a heavy burden, leading him or her to wish or even to pray for death. Especially in our achievement-oriented society, the burden of living in such a condition may seem to outweigh any possible benefit of medical treatment and even lead a person to despair. But we should not assume that the burdens in such a case always outweigh the benefits; for the sufferer, given good counseling and spiritual support, may be brought again to appreciate the precious gift of life.

Second, our tradition recognizes that when treatment decisions are made, “account will have to be taken of the reasonable wishes of the patient and the patient’s family, as also of the advice of the doctors who are specially competent in the matter.”[22] The word “reasonable” is important here. Good health care providers will try to help patients assess psychological burdens with full information and without undue fear of unfamiliar procedures. [23] A well-trained and compassionate hospital chaplain can provide valuable personal and spiritual support to patients and families facing these difficult situations.

Third, we should not assume that a feeding procedure is inherently repugnant to all patients without specific evidence. In contrast to Americans’ general distaste for the idea of being supported by “tubes and machines,” some studies indicate surprisingly favorable views of medically assisted nutrition and hydration among patients and families with actual experience of such procedures. [24]

A Pro-Life Pastor Living in an Age of Theological and Technological Complexities

I like the majority of our Bishops and the majority of my colleagues in parish ministry, all of us sworn to uphold our Church’s teaching regarding life, I unhesitatingtly pass on these teachings to every family that seeks my pastoral counsel to help them make life and death decisions regarding their loved ones. This is always in the context of the following realities:

We are all passionate about our respect for life in all its conditions and phases.

We are NOT pro-euthanasia., but we fully understand the pain of those who stand by as their loved ones linger in sometimes abominable conditions of health.

We stand profoundly against abortion, but have great compassion and sacramental mercy for those unfortunates who have had an abortion and who struggle with the agonies of this reality.

We are firmly against the death penalty. Terrible injustices have been and continue to be done in our nation in its often unfair administration of capital punishment.

I believe that many of our own Catholic people today, including some members of the clergy, for whatever reason, are not as merciful and compassionate towards their neighbors as our Mother the Church is in her laws.

I also believe as Sharon Iler, our Diocesan Respect Life Director so beautifully put in her newspaper interview, “Iler, with the Catholic diocese said Christians partner with God in the sense that he grants free will and autonomy over their bodies.”

This is why believers must make decisions based on their individual circumstances. “It’s what is in the heart,” Iler said.

“We may face a situation at the end of our lives where we say, “I don’t want anymore chemotherapy- or “I don’t want to put my family through a heart transplant.”

Family members may decide to stop efforts that prolong a loved one’s life.

That’s all right with God, she says.

“Everyone’s life is precious,” she said. “Even after the patient expires, we still consider the life to be precious even though the person has moved from this life on our journey to be with God.

Bottom Line:

I hope and pray that very soon the two families involved in Tern’s case, with good medical and pastoral counseling will have the wisdom and strength to let go and let God draw Terri into the next phase of life, eternity. Isn’t that what we are called to?