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March 27, 2008
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The Holy Fool by Harold Fickett
[Amazon.com]

A Patient in a Vegetative State Is a Human Person: Interview With Dr. Gian Luigi Gigli, of a Catholic Federation
“After the Pope's words, I believe that for a doctor, a nurse or a Catholic health institution, nutrition and hydration may only be interrupted if they no longer achieve their effect, or impose grave burdens on the patient... or family members, something which should not occur in civilized countries, in which basic care should not be a luxury.”  [ZENIT]

A Writer's Faith by Harold Fickett 
In my writing I’ve tried to dream up contemporary characters who are capable of belief, and through having a personal relationship with them, so to speak, believe myself.

Eternity in the Here and Now
The glittering prizes of secularism are vanity, as is life itself without its extension into eternity. On the other hand, the most humble life when seen under the aspect of eternity is invested with an unimaginable glory.

Gay Marriage and the Collective Lie
We are called to love one another, but real love must be grounded in truth. What I would say to Andrew Sullivan then is, I love you, but don't ask me to lie.

Image - A Journal of the Arts and Religion
"...our focus has been on writing and visual artwork that embody a spiritual struggle, that seek to strike a balance between tradition and a profound openness to the world."

Judging ‘Million Dollar Baby’, by Meredith Gould and Ruth Harrigan
For the two of us, going to a movie requires planning. It's hard to be spontaneous when you're in a wheelchair, or trudging along beside one. But nothing was going to keep us from judging Clint Eastwood's controversial new movie for ourselves.

Killing Terri Schiavo, by Rev. Robert Johansen
Terri Schiavo, the cognitively disabled woman whose husband is attempting to have her denied food and fluids, will be starved to death beginning March 18, unless the courts intervene. This is her story.

Lifeissues.net Euthanasia Resources

Our Lady of the Global Village:World Christianity Comes Home
The faith I've had the privilege of encountering in the developing world is vibrant, courageous, and typically transcends the often-petty concerns of the West. World Christianity is coming home, and Christians are about to experience the catholicity of the church in a personal way.

The Christian Response to Suffering
Message of Pope John Paul II For the World Day of the Sick, 2002

U.S. Bishops 1991 statement on Euthanasia

What's Love Got to Do With It? The Ethical Contradictions of Peter Singer, by Peter J. Colosi
Utilitarian philosopher Peter Singer says some humans—particularly fetuses, newborn babies, and elderly people suffering from dementia—should be killed if their deaths will reduce overall suffering. Never mind that Singer broke all of his own rules when his mother became ill with Alzheimer’s disease.

Why the Alliance between Catholics and the Democratic Party Has Broken Down
The presidential candidates are never asked the really tough questions, the ones about religion, philosophy and the meaning of life, because these questions threaten to break open the fault lines dividing American society. 

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Feeding Tubes & Gut Reactions: The Role of the Church in Bioethical Questions

The secular world says that in matters of life and death, the individual should be left alone to make whatever decision he wishes. My own experience with my dying father showed me the "hard cases" prove exactly the opposite.

Harold Fickett


The recent debate about Terry Schiavo's feeding-tub
e caused me to reflect on my own initiation into the culture of death.

Three years ago my father was, in hospital parlance, "actively dying." My elderly mother and I were invited into the nursing home administrator's office. We were told, as we suspected, that unless we wanted a feeding-tube inserted, he would probably die within a short time. The administrator, a woman in her forties, was compassionate and professional. She asked us to consider his quality of life in making this decision.

Six weeks before, my eighty-three year-old dad had undergone a quintuple bypass. He had been suffering from congestive heart failure. Without the surgery, he would probably die in six months to a year and might pass away at any moment.

Still, his local East Texas internist favored doing nothing. "What, you want to live forever?" he asked. This verbal pat on the head was more like a smack across the room. The doctor may have had a point, but he couldn't stop long enough to explain his reasoning to a highly intelligent, if frightened patient.

What the doctor knew was that my father's chances of recovery were exceedingly slim at his age. He might better enjoy the time remaining to him-and have more of it-if he simply took diuretics and let nature take its cruel course.

My dad put his local internist behind him and found a gifted surgeon in Houston who would give him a shot at a new lease on life. That's what he wanted.

Sadly, my dad had only a few lucid moments after the surgery. A week passed before he awoke out of his post-operative coma. During his stay in the intensive care unit, his heart stopped altogether for a few damaging moments. The lack of oxygen during this episode and a series of micro-strokes produced a dementia that would steadily worsen.

When he finally left the ICU, he was mostly unable to respond to the wide variety of therapies offered in a rehabilitation facility.

We brought him back to my parents' house, where we hoped he would gain a greater will to fight. (I'm not sure the doctors had any real hope; they may have been putting a good face on things.) Dad rallied enough to take his meals, and stay awake for about thirty to forty-five minutes within every twenty-four hours. Once he even allowed us to wheel him into the living room to watch a football game with me. But after ten minutes he wanted to go back to bed.

Usually he was sleeping or simply "out," and unable to respond to a loving hand-squeeze or a kiss on the cheek. While at home, he experienced another episode of cardiac arrest while being moved from his bed to a wheelchair. For a moment or two, we thought he had died.

Then a fever spike sent him to the emergency room one night. I watched beside his bed, not knowing whether he would see the morning. When his condition appeared to deteriorate further, I asked the doctor whether I should call the house and awaken my mother. She would want to be there if he was going to die that night.

"I do not know who is going to live and die," he said. "I cannot say anything to this question."

The strong antibiotics used that night brought my father's temperature back to normal. He came home again. But another near-death incident convinced me that round-the-clock home care from poorly trained care-givers wasn't enough. We took him to a convalescent home, where trained nurses could come running when needed.

Each time we would arrive in the nursing home, we could hear my father coughing at the farthest end of the hallway. An explosive, punishing cough. For a long time I didn't want to know why he was coughing so much. Finally, I asked.

"He's lost most of his ability to swallow," the nurse told me. "His saliva builds up and starts to strangle him."

I learned that swallowing, which healthy people take for granted, demands a high degree of neurological function. Dementia, whether caused by Alzheimer's, stroke, or the post-operative complications my dad suffered, robs a person of the ability to swallow. Eventually the person cannot eat or drink enough to sustain life, even when being tirelessly spoon and bottle fed.

That's when the feeding tube question enters into the picture. That's when hospital administrators start talking about quality of life, and whether the patient's standing orders should be changed to DNR: Do Not Resuscitate.

I'm a pro-life Catholic, so when someone-anyone-starts talking about "quality of life," I know that the discussion has moved onto false ground. My family surely had a tough decision to make. Would we ask that a feeding tube be inserted? I wasn't listening seriously to the administrator's reasons for not inserting the tube. As kind and compassionate as her manner was, I knew that she believed my father's life was no longer worth the time and trouble it was taking the medical community.

My family knew that my father did not want to be kept on a ventilator until kingdom come. But what were his wishes in this situation, and, in a certain sense, did his wishes even count? My dad certainly had not foreseen these exact circumstances. Even if he had, the actual experience is so different from any imagining that ultimately the people entrusted with the decision must simply prove trustworthy.

The only thing worse than watching my father die would have been to experience it at a distance. The reason I've narrated what happened is to convey the profound confusion I faced when considering whether to insert a feeding-tube.

I knew a couple of things. I knew that as Catholics we are not obliged to employ heroic measures to extend the lives of elderly people who are without hope of recovery. I also knew that providing food and water cannot be considered a heroic measure. I thought that we should probably have the feeding tube inserted, but I wasn't sure.

My mother asked the hospital administrator a smart question. Could we see any patients on feeding tubes?

The administrator took us into the room of two men: a short, wiry old man who for some reason looked to me like an old railroad engineer, and a buttery-skinned black man who could have been anything from a teacher to a waiter in his active life. They sat in their wheelchairs. They were by appearance in fairly good health. But the TV in their room was on, and they were not watching it or anything else. I could not tell if they were aware of our presence. Their open eyes did not track our movements as we came into the room, moved closer to them, and then backed away and left. The two men appeared to be living in a perpetual twilight.

Did we want such a twilight for my father? My mother did not.

It was her decision, but I suspected that I could change her mind. My moral responsibility in this situation was not at an end.

I am the only Catholic in a family of devout Protestants. I have thought more about bioethical issues. I was better prepared to see that the "quality of life" arguments of the hospital administrator, and some of my father's doctors, were wrong. The other family members heard it, I guessed, just as the way people talk these days.

Still, at a moment like this, what anyone needs is not a backlog of study. What's needed is the immediate reaction of a sufficiently informed conscience. Should I tell a lie? No. Should I betray a friend? No. Should I have a feeding tube be inserted in my dying father's stomach? Well...

I wasn't sure. And because I wasn't, I knew I had an obligation to seek the advice of someone wise and uninvolved in the situation. Someone whose moral instincts were directly contrary to the quality of life advocates. I called a friend and former pastor of mine, Father Dan, a pro-life priest.

He wasn't sure either. He saw the dilemma. Was a feeding-tube in this situation an unnecessary heroic measure or simply the provision of food and water? Would we be feeding my dad or force-feeding him?

My friend Father Dan did some research. He found what he considered a reliable Catholic authority on bioethics, who thought that in cases like my father's, inserting feeding-tubes should be considered heroic and therefore unnecessary.

If that was the case, then I felt that I should support my mother's decision.  We decided not to have the feeding tubes inserted.

My father passed away three weeks later.

I'm still not sure I did the right thing. I may well be complicit in my father's starving to death. I'm glad I took the steps I did, but because this particular situation hasn't been fully addressed by Catholic teaching-at least to my knowledge-I live in doubt about my decision. I don't know where I'd be if I hadn't been able to consult with Father Dan, and through him, with Catholic teaching as a whole.

The reason that Catholic teaching on faith and morals is so important is that it represents the only informed conscience adequate to humankind's most difficult moral dilemmas-questions like whether to insert feeding tubes into our dying parents. The settled mind of the Church presents Christ's answer to many questions that leave the individual at a loss. In cases where we do not have the immediate answer that conscience demands, we need to be able to "look it up": to consult the Magisterium.

The cool reflection of the whole Church together, guided by the Holy Spirit, constantly extends divine wisdom in addressing civilization's new questions. That reflection will be needed more than ever in the coming century as new discoveries in biology and medicine present humanity with new and difficult choices.

The "hard cases" are usually used to vanquish any dependence on traditional wisdom. "This is such a complicated matter that the individual should be left to make whatever decision he wishes," says secular reasoning.

I have my own reasons to know that the "hard cases" prove exactly the opposite point: when I was in an emotional and cognitive muddle, what I needed was a dependable, objective authority.

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November 12, 2003

Harold Fickett is a contributing editor of GodSpy. He can be reached at [email protected]

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READER COMMENTS
05.04.04   alexander caughey says:
If the life of the parent, in question, were ended suddenly, would the debate on life extension of a human life, in the process of dying, be a subject of discussion? Of course not, for the life in question was extinguished and our willingness to discuss life in the process of dying, more a question for those of us who consider life in the dying process, as an end to enable a beginning. So why in heaven's name do we focus so much attention on extending an existence which clearly is no longer a life?Could it be fear of our willingness to accept the reality of death, be it in a parent or family member?Even for us believers in life continuation, at the death of the human body, there is an unwillingness to accept the departure of a loved-one for a happier life in eternal bliss. Our sentiments intervene, where our beliefs should be paramount. This is a human frailty, not to be condemned or ridiculed, rather we should enable ourselves to accept that human life is but the beginning of life in eternal life.That reference should be made to current ethical understandings, emanating from Rome, is to ignore the teachings of the one who grants us eternal life, Christ, who taught that life is but us in the process of growth and this growth cannot be extinguished by death of the human body. This self same Christ, died and rose in to eternal life, to prove that all he had received from His Father, would be granted to us and even more. So why the need to refer to contemporary bio-ethical ideas, when the Master made it all very clear?

02.09.04   human33 says:
Dear John, I am grateful you are able to look at this poignant matter in a continued clear-headed way, for all our sakes...I would add that the issue is not so much that the nutrients supplied would be"put to good use", as in bringing about a recovery or better quality of life (secondary possible gifts) as that they are successful in the very simple object of their use - absorbtion, the object of their use - absorbtion, period, unless the absorbtion then causes extreme burdensome results to the patient; and this result may not be defined as kept- alive -with- low quality of life...that is not the object of the nutrients, to provide a higher quality of life.It would, however, seem that if his digestive system were partially breaking down, the nutrients supplied could be called extremely burdensome...the doctors should have helped with this clarification.... God bless, LK

02.09.04   John Martin says:
Dear Human and Sem, Thanks for your follow-up. This is the author speaking. You ask a question Human whose answer I am partly unsure of. I know my dad was not making much use of the nutrients he was being given. His digestive system was breaking down to a degree. Whether a feeding tube would have supplied enough nutrients for this process to be reversed was unknown but doubtful. In some of this I'm guessing because the doctors supplied very little specific information for our decision. We were being counseled mostly by hospital administrators. The doctors had pretty much thrown up their hands. What? You want him to live forever? was their collective attitude. The point you bring up is terribly valuable, because it presents a reasonable dividing line for the decision. In cases where the nutrients can be put to good use, then by all means use feeding tubes; in cases where the digestive system itself is failing, then feeding tubes would simply introduce nutrients that could have little beneficial effect. How difficult it is to make such a determination only the physicians among us would know. But if it's possible to know this with a reasonable degree of accuracy, then it's precisely the kind of information people in my family's situation should have. It would also supply an objective standard upon which everyone could stand. Thanks for both notes. Harold

01.24.04   sem says:
Human33,Hey, I just wanted to thank you for having the guts to ask the really tough question. I was hoping the author would respond with words of wisdom and consolation, : \ because I like happy endings. However, lack of response by the author could mean anything. We'll never know.Prayers to you, the author, and to everyone who has been, is, or will be in that type of situation.Peace,sem

01.14.04   human33 says:
There's not enough information here to understand: were the vital functions of this man's body shutting down, including his digestive system, so he was actually already dying and would not have been able to absorb nutrients (nor have an appetite for them if he were awake and such was the case)?If not, then this man was, forgive me, not let to die, but caused to die. And had it been my situation, I would now turn a wrong into a right by fighting for more protection of the dying (as opposed to the imminently dying, with proven checks for digestive systems shutting down on their own), and disabled.I have heard from professionals that there are ways to ascertain if painful complications arise after a patient stops eating on his own...presumably because his digestive system is shutting down - and attend to them as best as possible. I also presume doctors would certainly know if the body is absorbing nutrients provided to it...as is unquestionably the case of Terri Schiavo, and is the question I have in cases like the author's in this poignant, disturbing article.

11.12.03   Godspy says:
The secular world says that in matters of life and death, the individual should be left alone to make whatever decision he wishes. My own experience with my dying father showed me the "hard cases" prove exactly the opposite.

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