Academic journal article The Hastings Center Report

Catholic Teaching on Prolonging Life: Setting the Record Straight: Although Many Do Not Seem to Recognize It

Academic journal article The Hastings Center Report

Catholic Teaching on Prolonging Life: Setting the Record Straight: Although Many Do Not Seem to Recognize It

Article excerpt

Catholic teaching on prolonging life: setting the record straight: although many do not seem to recognize it, the half-millenium-old tradition of Catholic teachings on providing care at the end of life offers a nuanced, carefully balanced doctrine, centering on a finely tuned distinction between ordinary and extraordinary care. Given the significant Catholic contribution to the contemporary pluralist debate about end of life care, getting clear on that tradition is important.

Recently there has been a lot of confusion among Catholics regarding the Church's teaching on prolonging life, especially when it comes to prolonging life with medically assisted nutrition and hydration. This was well illustrated in the nationally publicized case of Hugh Finn. a forty-four-year-old former newscaster in Louisville, Kentucky, who in 1995 suffered a ruptured aorta in a car accident near his home. (1) The lack of oxygen to the brain that Finn sustained as a result of the injury left him in a persistent vegetative state.

PVS is characterized by the loss of all higher brain functions with either complete or partial preservation of hypothalamic and brain stem autonomic functions. (2) Given the absence of higher brain activity, patients in a persistent vegetative state are completely unaware of themselves and their environment and are unable to interact with others. Yet because lower brain function is relatively intact, such patients exhibit periodic wakefulness manifested by sleep-wake cycles and have the capacity to achieve a wide range of reflex activities. As happened with Finn, a PVS is frequently caused by an acute incident, either traumatic (such as a gunshot wound to the head) or nontraumatic (such as hypoxic ischermic encephalopathy). Recovery of consciousness is highly unlikely after twelve months for patients in a PVS caused by an acute traumatic incident and after three months for patients in a PVS caused by an acute nontraumatic incident. (3) The life expectancy of such patients is greatly reduced compared with the normal population. The average ranges from two to five years, and survival of ten years is extremely unusual. The length of survival depends in part on how aggressively the complications are treated. Death for patients in a persistent vegetative state is commonly brought on by an infection in the lungs or urinary tract, respiratory failure, or a sudden event of unknown cause. (4)

From the time of the accident, Finn was unconscious and unable to communicate. He was kept alive by a feeding tube medically inserted into his gastrointestinal tract that provided the essential nutrients and fluids to maintain life. After being treated in an acute care facility and two rehabilitation hospitals with no improvement in his overall condition, he was transferred to a nursing home, where he continued to receive medical treatment, including medically assisted nutrition and hydration. Controversy over his care arose when his wife, Michelle, with the support of his sister, sought to remove the feeding tube so that her husband could be allowed to die. Michelle noted that her decision was based on her husband's previously expressed wishes. Finn's parents and his brothers objected, however, and brought a suit to block the removal of the feeding tube. Several Virginia agencies, Virginia Delegate Robert Marshall, and Virginia Governor James Gilmore publicly agreed with the parents and brothers. In a televised address, Governor Gilmore stated that he had an obligation to protect the interests and rights of the state's most vulnerable citizens, including Finn. Yet despite the objections from the various groups and individuals involved in the case, "three different courts, including the Virginia Supreme Court, refused to second-guess Michelle Finn's decision that her husband would not want to be kept alive in a permanent vegetative state." (5) Finn finally died of respiratory failure on 9 October 1998, eight days after the feeding tube was removed. …

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