Managed Death: New five-part series on Catholic end-of-life ethics
By Susan Brinkmann
CS&T Correspondent
Lance McMahon was only 45 years old when he suffered sudden acute respiratory failure. By the time his sister Pam got the phone call, he was on a respirator in an intensive care unit (ICU) at a hospital several hours away.
The “usual” story began there: long nights, long drives, phone calls at all hours. “Do you want us to resuscitate him if his heart stops before you get here?” a calm voice would ask and Pam would think, “Of course I do. He’s only 45 years old. Why wouldn’t we resuscitate him?” Lance kept surviving each crisis in spite of every expectation to the contrary.
“There began to be a little hope,” Pam said, “if only the ICU could get him off the sedatives long enough to wean him off the respirator. But you can’t wean someone on a respirator off sedatives if they’re in the grip of the ICU psychosis. Every time they tried, he’d wake up just long enough that it took most of the staff to keep him in bed.”
Finally, the staff found the right combination of anti-psychotics, and Lance began to respond “a little.” Riding the crest of a wave of new hope, Pam decided to have him transferred to a hospital closer to home — “a teaching hospital, mind you.”
Instead of finding more sophisticated care for her brother, Pam was introduced to “progressive” care.
When the staff failed to administer the right dose of anti-psychotic medicine one evening, and her husband had a full-blown psychotic episode, the new doctor “ambushed” Pam in the hall to say Lance was going to die anyway, so why not let him “die with dignity.”
The doctor went on to say they could wean Lance off paralytic drugs just long enough for him to breath on his own, then pull his life support. Otherwise, it would be considered murder.
“What ‘dignity’ had to do with somebody suffocating to death, I failed to see,” Pam said.
But she was meek and vulnerable and decided to go home and start calling relatives. Sometime that night, she said, “My brain kicked in, along with a lot of pent-up rage over recent events in the news about Terri Schindler-Schiavo, until I was practically glowing in the dark.”
She got up and wrote a letter to her brother’s new doctor which was delivered by hand the following morning: “If you can make him comfortable enough to die, why can’t you make him comfortable enough to live? We can always kill him later, but we can’t resurrect him.”
The hospital put her brother back on the anti-psychotics, and within a week he was out of the ICU and into intermediate care. “This, of course, meant a whole new string of doctors and the ‘But what will his quality of life be’ business to endure, but it was just tough cookies,” she said.
Lance made steady progress, got off oxygen, had his trach-tube removed, began eating again, and went to physical therapy.
“One January day, lo and behold — he went home. Wobbly, frail, confused, forgetful. But — home. Two months later, he was shopping at Wal Mart.”
This is a true story. Pam and Lance (not their real names) sent their story to the father of the 40-year-old, cognitively disabled Terri Schindler-Schiavo, who is embroiled in yet another version of the same story.
The story, with its many versions, are becoming much too common. Since beginning regular coverage of the Terri Schindler-Schiavo case, The CS&T has heard from readers, doctors and nurses from all over the country who have had the same disturbing experiences.
Instead of fighting to save the lives of young accident victims such as Lance, or Jason Childress of Virginia, families report being pressured to remove life-support systems long before their loved ones have had a chance to recover. Cases involving the withdrawal of feedings tubes from people who are not terminally injursed or ill — those who are merely elderly and disabled — are almost routine. Parents of premature babies have actually been stripped of their parental rights by hospital ethics committees because they’ve refused to allow the hospitals to stop treatment.
Thirty years ago, cases such as these were unthinkable. Today, we can buy books on the subject, such as those written by attorney-author, Wesley J. Smith.
What’s going on?
It’s the same foe, under different guises, that families of the injured and ill now face: the culture of death.
While most of the country is wrangling over beginning-of-life issues such as abortion and stem cell research, the same cold utilitarian ideas about life and death — which so frequently masquerade as ‘compassion’ — are making alarming inroads into American medicine, particularly in its end-of-life care.
Euthanasia comes in a variety of forms. It’s not merely physician-assisted suicide, but an attitude — a core belief — that the disabled like Terri Schiavo, the severely ill like Lance, the elderly, and the inconvenient unborn, have a “duty to die.”
We will explore, in an upcoming series of articles, the way the idea that some people have a duty to die is becoming policy in more and more institutions.
Known as “futile care policies,” some of these policies allow ethics committees to make decisions to withhold treatment from patients of a certain age, or in a certain condition, often against the family’s and even the doctor’s wishes.
Then there’s the “living will,” an invention of the culture of death that originated with the Euthanasia Society of America, as a way of slowly desensitizing the public to euthanasia. Although the phrase has become a “catch-all” for many different kinds of advanced directives, signing the wrong “will” can mean the difference between life and death.
This dark ideology has been slowly infesting another area of medicine — the hospice industry — where the temptation to put profits ahead of compassionate, end-of-life care has resulted in widespread medicare fraud, patient neglect and the overuse of what’s come to be known as “terminal sedation.”
Even further behind the scenes are movements to create a more “nuanced” notion of death, paving the way for policies that will allow people in irreversible comas or persistent vegetative states to be declared dead in order to have their organs “harvested” while they’re still “fresh.”
How could things like this happen in American hospitals? There are a variety of factors involved, but two are of special significance.
The first is the rise of a new, secular, ethical principal that values the quality of life more than the Christian belief in the dignity of life.
The second is the new, “managed care” environment, where keeping costs low too often means cutting back on necessary health care, a scenario that many health care professionals are beginning to call “managed death.”
Next week, The CS&T will begin a five part series that explores the areas where the culture of death has invaded end-of-life health care in America, and provide information about how you can protect yourself and your loved ones.
Contact Susan Brinkmann at fiat723@aol.com or (215) 965-4615.
PART 1 OF 5: Battle between secular and Christian bioethics
PART 2 OF 5: Be certain living will is Catholic
