Pro-Life Even At the End of Life
By Simcha Fisher
“Technology runs amok without ethics,” says Tammy Ruiz, a Catholic nurse who provides end-of-life care for newborns. “Making sure ethics keeps up with technology is one of the major focuses of my world.”
How do Catholics like Ruiz honor the life and dignity of patients, without playing God—either by giving too much care, or not enough?
Cathy Adamkiewicz had to find that balance when she signed the papers to remove her four-month-old daughter from life support. The child’s bodily systems were failing, and she would not have survived the heart transplant she needed. She had been sedated and on a respirator for most of her life. Off the machines, Adamkiewicz says, “She died peacefully in my husband’s arms. It was a joyful day.”
“To be pro-life,” Adamkiewicz explains, “does not mean you have to extend life forever, push it, or give every type of treatment.”
Many believe that the Church teaches we must prolong human life by any means available, but this is not so. According to the Catechism of the Catholic Church, “Discontinuing medical procedures that are burdensome, dangerous, extraordinary, or disproportionate to the expected outcome can be legitimate; it is the refusal of “over-zealous” treatment” (CCC, 2278).
Does this mean that the Church accepts euthanasia or physician-assisted suicide—that we may end a life to relieve suffering or because we think someone’s “quality of life” is too poor? No. The Catechism continues: “One does not will to cause death; one’s inability to impede it is merely accepted” (CCC, 2278).
Richard Doerflinger, associate director of Pro-Life Activities at the USCCB, explains that caregivers must ask, “What good can this treatment do for this person I love? What harm can it do to him or her? This is what Catholic theology calls ‘weighing the benefits and burdens of a treatment.’ If the benefit outweighs the burden, in your judgment, you should request the treatment; otherwise, it would be seen as morally optional.”
Palliative care is also legitimate, even if it may hasten death—as long as the goal is to alleviate suffering.
But how are we to judge when the burdens outweigh the benefits?
Some decisions are black and white: We must not do anything, or fail to do anything, with the goal of bringing about or hastening death. “An act or omission which, of itself or by intention, causes death in order to eliminate suffering constitutes a murder gravely contrary to the dignity of the human person and to the respect due to the living God, his Creator (CCC, 2277).
The dehydration death of Terry Schiavo in 2005 was murder, because Schiavo was not dying. Withdrawing food and water had the direct goal of killing her.
But if a man is dying of inoperable cancer and no longer wishes to eat or drink, or his body can no longer process nutrition, withdrawing food and water from him might be ethical and merciful. He is already moving toward death, and there is no reason to prolong his suffering.
Our moral obligations are not always obvious. Laura Malnight struggled with doubt and fear as she contemplated the future of her tiny newborn quadruplets. Two of them had pneumonia.
“It was horrible to watch them go through what they had to go through to live, being resuscitated over and over again,” Malnight says.
One baby was especially sick and had suffered brain damage. The doctors who had pushed her to do “selective reduction” while she was pregnant now urged her to stop trying to keep her son alive. “They said we were making a horrible mistake, and they painted a terrible picture of what his life would be like in an institution,” Malnight says.
Exhausted and overwhelmed, Malnight was not able to get a clear answer about the most ethical choice for her children.
Everyone told her, “The baby will declare himself,” signaling whether he’s meant to live or die. “But,” says Malnight, “my only experience with motherhood was with these babies, in their isolettes. The thing was, we would put our hands over our son and he would open his eyes, his breathing would calm.”
“We just kind of muddled through,” she says. Her quadruplets are now 13 years old, and her son, while blind and brain-damaged, is a delightful and irreplaceable child.
Doerflinger acknowledges Malnight’s struggle: “Often there is no one right or wrong answer, but just an answer you think is best for your loved one in this particular situation, taking into account that patient’s own perspective and his or her ability to tolerate the burdens of treatment.”
The key, says Cathy Adamkiewicz, is “not to put our human parameters on the purpose of a human life.”
When she got her infant daughter’s prognosis from the neurologist, she told him, “You look at her as a dying system. I see a human being. Her life has value, not because of how much she can offer, but there is value in her life.”
“Our value,” Cathy says, “is not in our doing, but in our being.” Doerflinger agrees, and emphasizes that “every life is a gift. Particular treatments may be a burden; no one’s life should be dismissed as a burden.”
He says that human life is “a great good, worthy of respect. At the same time, it is not our ultimate good, which lies in our union with God and each other in eternity. We owe to all our loved ones the kind of care that fully respects their dignity as persons, without insisting on every possible means for prolonging life even if it may impose serious risks and burdens on a dying patient. Within these basic guidelines, there is a great deal of room for making personal decisions we think are best for those we love.”
Because of this latitude, a living will is not recommended for Catholics. Legal documents of this kind cannot take into account specific, unpredictable circumstances that may occur. Instead, Catholic ethicists recommend drawing up an advance directive with a durable power of attorney or healthcare proxy (see sidebar). A trusted spokesman is appointed to make medical decisions that adhere to Church teaching.
Caregivers should do their best to get as much information as possible from doctors and consult any priests, ethicists, or theologians available—and then to give over care to the doctors, praying that God will guide their hearts and hands.
Terri Duhon found relief in submitting to the guidance of the Church when a sudden stroke caused her mother to choke. Several delays left her on a ventilator, with no brain activity. “My husband and I couldn’t stand the thought of taking her off those machines. We wanted there to be a chance,” she says. But as the night wore on, she says, “We reached a point where it was an affront to her dignity to keep her on the machines.”
Duhon’s words can resonate with caregivers who make the choice either to extend life or to allow it to go: “I felt thankful that even though all of my emotion was against it, I had solid footing from the Church’s moral teaching. At least I wasn’t making the decision on my own.”
Adamkiewicz agrees. “It’s so terrifying and frustrating in a hospital,” she remembers. “I can’t imagine going through it without having our faith as our touchstone during those moments of fear.”
End of life resources
NCBCenter.org provides samples of an advance directive with durable power of attorney or healthcare proxy.