Life, Death and Politics in the U.S.

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— Money — in the form of cost containment for hospitals and insurance companies — plays a role in the right-to-die ethos. The Register’s series on trends in end-of-life care continues. BY PAUL A. BARRAREGISTER CORRESPONDENT This is the second part of the Register’s three-part series on end-of-life issues. In Part 1, we discussed a case in Houston where a hospice apparently tried to hasten a man’s death by withholding medicines, food and water from him and we cited examples of the apparent mainstreaming of such actions, showing connections between some hospice and palliative care communities and the right-to-die movement. A North Carolina pro-life organization called LifeTree claims that a subtle campaign in the medical community and right-to-die groups seeks to change people’s mindset about end-of-life issues, to manipulate us into "death-acceptance." That’s a term LifeTree uses to mean resignation to ending our own lives or those of loved ones when the end is near. This campaign is paired with the more overt one to legalize physician-assisted suicide in state legislatures. "We contend that, while the public has been watching the more outrageous aspects of the right-to-die people, the Dr. [Jack] Kevorkians, the bills in state legislatures and the lawsuits, very quietly social engineering efforts are going on," said LifeTree’s chief researcher, Ione Whitlock. "Their main motivation is that they have a grand vision, which says, ‘We’re going to bring everyone a choice in dying, just as we have brought them a choice in abortion.’" A policy statement passed at last November’s annual meeting of the American Public Health Association, the nation’s oldest and largest member organization for public health professionals, may illustrate implementation of that vision. The statement still needs final approval, according to Donald Hoppert, director of government relations, but it seeks to change the meaning of suicide, to make it more palatable to the general populace. It urges people to "recognize that the choice of a mentally competent, terminally ill person to choose to self-administer medications to bring about a peaceful death is not ‘suicide.’" Similarly, the Illinois-based American Academy of Hospice and Palliative Care, the largest physician organization of its kind, this year changed its wording of physician-assisted-suicide to "physician-assisted-death" and withdrew its opposition to it. Chuck Ceronsky is the ethicist and chaplain at Fairview Health Services in Minneapolis, the 2006 winner of the American Hospital Association’s Circle of Life award that "honors innovation in palliative and end-of-life care." He’s a Catholic with a master’s degree in theology and he is as fearful as LifeTree is of what he calls the slippery slope that leads to euthanasia. Even so, he said, it is only a subset of the pro-life leadership that wants to limit a hospice’s right to withhold food and water from a dying patient, and they want to do it for political reasons. Hardly any Catholics, Ceronsky said, follow the magisterium on this issue. "Only stupid pro-lifers who still believe that Terri Schiavo was responsive to people around her and whatever else they wanted to claim … believe that this is one spot to slow down the movement toward mercy killing," Ceronsky said. "Individual Catholics and families are not getting in line with the Vatican and the bishops anymore than they’re getting in line on artificial birth control vs. natural means." Ceronsky claimed that the Church is beginning to shift to the position that tube feeding a terminal patient is not like bottle feeding an infant. He thinks a feeding tube is as much an artificial life support mechanism as a respirator or dialysis machine. His attitude is what Whitlock refers to as "soft euthanasia." "The choice to die is becoming the duty to die," she said. Ceronsky’s wife is Lyn Ceronsky, director of hospice at Fairview. She is mentored by a colleague of Dr. Ronald Cranford, a notorious right-to-die advocate. Cranford wrote an op-ed piece for the Minneapolis-St. Paul Star Tribune in 1997, calling for the starvation of Alzheimer’s patients. Lyn Ceronsky is also a presenter at Palliative Care Leadership Center training seminars where withholding food and water is pushed as normative care. Changing the Culture This kind of war of words makes Betty Wickham, executive director of LifeTree, worry about the future. She thinks that these subtle changes in culture are catching much of the Church unawares. "This nuanced approach has got a lot of Catholics hoodwinked," Wickham said. That fear is evidenced by the public position of Dr. Glen Komatsu, director of palliative care at Little Company of Mary Hospital, a Catholic institution in the suburbs of Los Angeles. Komatsu is apparently beginning to favor killing dying patients. Witness his 2005 review of the pro-euthanasia book Physician Assisted Dying: "I find myself wondering if the option of physician-assisted dying would have helped my patients. I find the rationales in this book persuasive and compelling." The Hastings Center’s 2005 report Improving End of Life Care delineates some of the obstacles to changing the American culture of death and dying to accommodate people like Komatsu. Much of what the report contains seems to be a good and estimable agenda of reducing pain and fear at the end of life, improving palliative care medical training and taking control of dying away from hospitals and giving it to the patient and his family. The trouble is, the report authors believe that only "religious conservatives and disability advocates" think that human life is sacred. "Those who believe in the sanctity of life object in principle to decisions that may hasten death (and especially the discontinuation of artificial nutrition and hydration)," write Thomas Murray and Bruce Jennings. The Hastings Center’s report was funded by the Robert Wood Johnson Foundation. Money — in the form of cost containment for hospitals and insurance companies — also plays a role in the right-to-die ethos, according to Dr. John Shea, a member of the board of the Catholic Bioethics Institute of Canada. Shea said: "Doctors and next of kin are beginning to ask themselves: Is this treatment futile in the financial sense?" Some hospitals have futile care guidelines in place, which allow doctors to withhold food and water from a terminal patient if they think there is no hope of curing the patient, even against the wishes of the patient or his next of kin. Two states, Texas and Virginia, even have futile care laws on the books. (In the middle of all these conflicting opinions and confusion, Catholics have the advantage of Church teaching to guide them. In the next and final article of our series on end-of-life issues, we will look at those teachings and how they pertain to real-life cases.) Paul A. Barra writes from Reidville, South Carolina. http://www.ncregister.com/site/article/bodies_minds_protestants_and_sacraments/