|
|
|
|
Death: Our Birth into Eternal life Fr. Joseph Baker |
The following article is the next installment in a series that will appear in the Catholic Herald to offer catechesis and formation concerning end-of-life decisions, dying, death, funerals, and burial of the dead from the Catholic perspective.
Having examined when life-sustaining treatments can be discontinued or forgone, we turn to the issue of food and water.
It must be noted that food and water fundamentally differ from life-sustaining treatments.
Whereas food and water are essentially ordered toward sustaining life, life-sustaining treatments are accidentally ordered toward sustaining life.
This difference is borne out by the fact that everyone requires food and water to stay alive, although not everyone requires life-sustaining treatments to stay alive.
For instance, hemodialysis is only necessary for individuals with some sort of kidney injury, disease, or failure.
Likewise, a ventilator is only necessary for individuals who cannot breathe on their own.
For healthy individuals, hemodialysis and ventilation are completely unnecessary.
In this way, life-sustaining treatments such as hemodialysis and ventilation are accidentally ordered toward sustaining life.
Food and water, on the contrary, are necessary for every individual, regardless of their particular circumstances, to stay alive.
Food and water are essentially ordered toward sustaining life. Eating and drinking are integral parts of normal human physiology.
This essential nature of food and water does not suggest that the benefits of eating and drinking are never diminished or that eating and drinking never become unduly burdensome, but rejects the categorization of oral nutrition and hydration as medical treatments.
As Pope John Paul II stated, food and water each “represents a natural means of preserving life, not a medical act.”
Without an underlying pathophysiological reason why a person cannot eat or drink, the refusal of nutrition and hydration is fundamentally different from the refusal of life-sustaining medical treatments.
Means of preserving life
For this reason, the Congregation for the Doctrine of the Faith has declared that the administration of food and water, even when medically assisted, is, in principle, a proportionate means of preserving life.
It is therefore obligatory to the extent to which, and for as long as, it is shown to hydrate and nourish a person.
Put another way, we generally ought to die from a disease or an ailment that claims our life, not from a lack of food or water.
As such, there is a presumption in favor of providing nutrition and hydration, including when the assistance of a feeding tube is required.
In some exceptional cases, providing food and water by artificial means is not obligatory.
Whenever it would be physically or morally impossible, or when it would truly be disproportionate, medically assisted nutrition and hydration may be forgone or withdrawn.
Medically assisted nutrition and hydration become morally optional when they cannot reasonably be expected to prolong life, when they would be excessively burdensome, or would cause significant physical discomfort.
Especially near the end of life, individuals frequently experience a natural loss of appetite.
In this case, “as a patient draws close to inevitable death from an underlying progressive and fatal condition, certain measures to provide nutrition and hydration may become excessively burdensome and therefore not obligatory in light of their very limited ability to prolong life or provide comfort” (USCCB, Ethical and Religious Directives, #58). Again, in such circumstances, we need not do everything.
Issue of intent
The issue of intent remains important.
The refusal of nutrition and hydration is not merely a refusal of a natural means of preserving one’s life, it can be an intentional act to end a person’s life.
In some cases, it is morally acceptable to withhold or withdraw medical treatments.
This is typically justified when the treatment is futile or excessively burdensome, and the intention is that the treatment should cease.
Take, for example, a person using a ventilator to stay alive.
While initially, the ventilator provides proportionate benefits, following the development of pneumonia, the burdens of continuing to be on a ventilator become disproportionate to its expected benefits.
In this situation, the morally acceptable decision is made to discontinue using this life-sustaining medical treatment.
In making this decision, the intention is solely that the treatment should cease, not that the person should cease.
Therefore, even though the death of the individual might be foreseen, it is not intended.
The intention to stop treatment is fulfilled once the person has been disconnected from the ventilator.
The distinction between intention and foresight is proven by the counterfactual situation — if the individual were able to breathe after withdrawing the ventilator, the intention to discontinue a disproportionate treatment would still be fulfilled.
On the other hand, when food and water are outright refused, the intention is not that this “therapy” should cease, but that the individual should cease.
Death is not caused by the progression of an underlying lethal pathophysiological condition, rather death is caused by dehydration.
Here, nutrition and hydration are forgone or withdrawn not because a person is dying, but precisely because a person is not dying (or not dying quickly).
The intention is not just to forgo a life-sustaining medical treatment, the intention is to introduce a new lethal pathophysiological condition that will kill the person.
While no one likes the idea of needing medically assisted nutrition and hydration, this does not justify us rejecting it outright, or placing arbitrary limitations on it, such as the length of time it can be utilized.
The obligation to provide medically assisted nutrition and hydration for those who cannot take food orally extends to individuals in chronic and presumably irreversible conditions.
So, for example, a person in a persistent vegetative state should be given medically assisted nutrition and hydration, even when this means that they can reasonably be expected to live indefinitely if given such care.
Created in the image and likeness of God, a person never becomes a “vegetable.”
As Pope Saint John Paul II so wonderfully reminds us, “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.”
Our life, even in such circumstances, retains its incomparable and inviolable worth and is due our utmost respect.
Fr. Joseph Baker is the ethicist for the Diocese of Madison and the pastor of Blessed Trinity Parish in Dane and Lodi.