Terri Shiavo did not die from complications of pneumonia. She did not die from a heart attack or stroke. She did not die because of sepsis or kidney failure, nor from any disease or medical condition at all. She died because she was denied food and water.
Terri was severely disabled. But she was not dying.
In health care settings medical professionals, families and individuals are faced with the reality of disease and death every day. The decisions made in end of life care are unique and dependent on the condition of the patient. The value and efficacy of treatments and procedures must be carefully considered. Our Church offers guidance regarding this in the Catechism of the Catholic Church (1997), sections 2278 and 2279:
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. Here one does not will to cause death; one's inability to impede it is merely accepted. The decisions should be made by the patient if he is competent and able or, if not, by those legally entitled to act for the patient, whose reasonable will and legitimate interests must always be respected.
Even if death is thought imminent, the ordinary care owed to a sick person cannot be legitimately interrupted.
How does one define "extraordinary" or "over-zealous" treatment? Those treatments that will not change the inevitable end, those that increase suffering or exacerbate the present condition, are often considered extraordinary. The important concept is that the removal of treatment or therapies must not be done to cause death. As the Catechism teaches, the withdrawal of treatment must be an acceptance of the inability to impede death.
In the case of life support, mechanical ventilation, cardio-pulmonary resuscitation, and other heroic measures are easy to identify as "extraordinary". But what of IV fluids? What of nutrition via feeding tubes? Does this qualify as extraordinary?
Pope John Paul II in 2004 stated: “The administration of water and food, even when provided by artificial means, always represents a natural means of preserving life, not a medical act. Its use, furthermore, should be considered,in principle, ordinary and proportionate, and as such morally obligatory,insofar as and until it is seen to have attained its proper finality, which in the present case consists in providing nourishment to the patient and alleviation of his suffering” (as cited in National Catholic Register,2006).
Again, the key to this principle is not to will the death of the patient, but accept the inevitable. Therefore, if, as in the case of Terri Schiavo, death is not imminent, withholding nutrition and hydration, even if administered via artificial means such as IV's or feeding tubes, is morally unacceptable. Can IV fluids or nutrition fall into the category of "extraordinary"? If the administration of fluids will exacerbate a condition, as in those who suffer from congestive heart failure in which fluids fill the lungs and cause swelling to the extremities, and causes more suffering than it alleviates, then it may in this case and in others like it be seen as extraordinary. Nutrition, for example, may be seen as extraordinary in the case of the patient who is unable to digest or process food because of diseases of the digestive tract, such as blocking tumors or obstructions, where the only end to administration is vomiting, putting the patient's airway at risk.
Even with these guidelines, men and women are dehydrated and starved to death at alarming rates in hospitals and hospices throughout our nation. They are denied the ordinary care that is due to them. Terri Shiavo was not an anomaly; she was a benchmark in the fight for euthanasia. Our brothers and sisters are thirsty. It is time to take a stand.
How can we take a stand? We can protect our wishes by utilizing a Health Care Proxy or Living Will with specific instructions, choosing someone who will make decisions when we cannot who will honor our faith and follow the guidelines of the Church. We can consult trusted clergy and Catholic medical ethicists for assistance and guidance. We can assist with the end-of-life decision making of our family members and friends. We can insist our legislators and leaders honor the necessity of ordinary care for the ill and disabled.
Most especially, we need to pray. Pray for ethical leaders, physicians, nurses, and decision-makers. In this way and in the actions listed above, we can make a difference in the lives of the ill. Our brothers and sisters, even in their suffering, thirst.
St. Camillus, as we pray for the ill who are approaching the throne of God, we pray that those who deliver care and those who decide on the treatments administered may do so with the love of Jesus. May the care given to the dying be marked with compassion and respect the dignity of the human person. We ask all this in the name of the Merciful Jesus. Amen.
Roberts, J. (2006). Is Hospice movement going beyond end-of-life care? National Catholic Register. Feb. 2006.
Catechism of the Catholic Church (1997). Second Edition. Libreria Editrice Vaticana, Vatican City. Page 550.