The Catholic Thing
The Truth about Life-or-Death Decisions Print E-mail
By George J. Marlin   
Wednesday, 10 February 2010

The January 26, 2010 Science section of The New York Times carried an article by St. Louis writer Alicia von Stamwitz titled “An Ill Father, a Life-or-Death Decision,” which described her chilling hospital experience caring for her gravely ill father.

The patient was sixty-nine, suffered from bi-polar alcoholism, had had two open-heart surgeries, several strokes, and couldn’t speak. The attending physician further diagnosed that his liver was severely damaged from taking Lithium, his heart was weak, kidneys were failing, lungs were filling up with liquid, and a tube had to be inserted in his windpipe.

Ms. von Stamwitz was taken aback in a meeting with the doctor. Instead of receiving medical advice, she was asked if her father had a living will and had given her power of attorney. She wrote that when she said, yes, “Visibly relieved, [the doctor] looks me in the eye and gently but pointedly asks: ‘Does your father want us to employ extreme measures. . .knowing that he is not likely to improve?’”

Instead of deciding for her father, she asked him to squeeze her hand if he wanted to be intubated again. The father didn’t squeeze but firmly nodded his head, yes.

The reaction from the attending nurses also shook up von Stamwitz. One nurse, “grunts and rolls her eyes,” and another mutters, “Oh brother, here we go again.”

Ms. von Stamwitz confesses it would have been terribly wrong for her to stop treatments: “I supposed my father’s decision was a mistake. But it was his decision to make, not mine. My role was to support my father no matter what, and to tell the truth, no matter how hard.”

What is most distressing about the von Stamwitz narrative is the behavior of the medical professionals. The attitude they displayed has become common place since the U.S. Supreme Court in Curzan v. Director, Missouri Department of Health (1990) ruled that artificially supplied food and liquids could be denied to patients who had cognitive disabilities regardless of whether they were conscious or unconscious.

To make it easier for doctors to follow the court decision, the American Medical Association revised its canon of ethics to read: “Even if the patient is not terminally ill or permanently unconscious, it is not unethical to discontinue all means of life-sustaining medical treatment [including food and fluids] in accordance with a proper substituted judgment or best interest’s analysis.”

Sadly, many secularists have applauded this death-by-dehydration court decision. In Rethinking Life and Death, Peter Singer jubilantly wrote: “The lives of such patients are of no benefit to them, and so doctors may lawfully stop feeding them to end their lives. With this decision the law has ended its unthinking commitment to the preservation of human life that is a merely biological existence. . . . In doing so they have shifted the boundary between what is and what is not murder. . . . Now, conduct intended to end life is lawful.”

Contrary to claims of the culture-of-death crowd, dehydration is not a “good death.” It’s one of the worst ways to die. Here’s one physician’s description of death by dehydration: “A conscious person would feel it [dehydration] just as you or I would. They will go into seizures. Their skin cracks, their tongue cracks, their lips crack. They may have nosebleeds because of the drying of the mucus membranes, and heaving and vomiting might ensue because of the drying out of the stomach lining. They feel the pangs of hunger and thirst. Imagine going one day without a glass of water! Death by dehydration takes ten to fourteen days. It is an extremely agonizing death.”

Cognizant that many in the field of medicine are abandoning their Hippocratic Oath and recognizing the need to protect human dignity through feeding the sick, Pope John Paul II in March 2004, said the following to an international Congress convened to study the ethics of Life-Sustaining Treatments:

I feel the duty to reaffirm strongly that the intrinsic value and personal dignity of every human being do not change, no matter what the concrete circumstances of his or her life. A man, even if seriously ill or disabled in the exercise of his highest functions, is and always will be a man, and he will never become a “vegetable” or an “animal.

Even our brothers and sisters who find themselves in the clinical condition of a “vegetative state” retain their human dignity in all its fullness. The loving gaze of God the Father continues to fall upon them, acknowledging them as his sons and daughters, especially in need of help.

The Church understands the pressures people like Alicia von Stamwitz encounter in caring for their aging and sickly loved ones. Hence, the Church insists health officials have an obligation to promote and make accessible proper palliative care and should be dedicated to promoting a wide range of programs to improve the state of care for the ill and disabled. The chronically ill have the right to compassionate, humane, and medically indicated treatment and care to live with dignity until the moment of natural death.

George J. Marlin is an editor of
The Quotable Fulton Sheen (Doubleday Image).

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Comments (5)Add Comment
Primum non nocere!
written by Willie, February 11, 2010
The concepts of the Hippocratic Oath have been considerably eroded. I believe medical students have the option these days of not taking the oath or of taking a revised version. It used to be the sworn duty of every physician to do no harm. It was always the aim of the physician to help the patient die, not kill the patient. It should be kept in mind that maintaining food and hydration is not such an extraordinary task. It is sad that the culture of death has invaded such a noble profession!
The Price for Principle
written by William H. Phelan, February 11, 2010
I agree with everything you said in this piece, Mr. Marlin. If you are familiar with the New York City area, you are familiar with the current state of St. Vincent's Hospital. It prided itself in carrying out Catholic Principles every day with every patient. It is $700 million in debt and likely to close as neither the City nor the State has the money to assist it. I confess I don't know the answer to this conundrum.
written by Christopher Manion, February 11, 2010
When Father George Parker was in surgery here in Virginia, he was diagnosed as comatose (but he heard everything). He clearly heard the surgeon say to his team, "This patient will be dead in 24 hours, but we are going to do our work professionally and do it well."

Father Parker lived many more years, God bless him (and that surgeon!), and was a great friend to the Front Royal Catholic community.

His message: ALWAYS assume that your sick loved ones can hear you, because they usually can!
I agree, but...
written by Martin, February 11, 2010
I agree with your essay, but wanted to point out a couple of things. 1. We shouldn't equate artificial ventilation (as in the von Stamwitz case) with providing nutrition and hydration. I think most Catholics agree that ventilation is extraordinary and may ethically be withheld. 2. I agree that the audible reactions of the nurses was inexcusable. However, please remember that ICU (and all) physicians & nurses are exhausted. Their seemingly brusque nature may be due to fatigue.
From "Dying like a Dog"
written by Tom Brennan, February 12, 2010
This firsthand account, from First Things, has stuck with me for years:
"I am a patient ... I am kept alive by very expensive hydration and nutrition ... I can confidently say that hydration is far more pleasant than the opposite. Anyone who doubts this can forgo fluids for a few days or nourishment for a few weeks and experience the reality. And after my experiences with staph infections, I would want antibiotics even if I were dying of cancer." - Nancy Harvey

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