Death, Dying, Dignity, Intravenous Tubes and Catholic Teachings

I got a call from my son-in-law this morning. My father, who is living in a care facility a few miles away from the new couple, was unable to swallow this morning. It doesn't seem to be a temporary problem: he can't get food or water in any more.

I'm not all that surprised. He's been having increasing trouble that way: on top of stiff lungs that have made breathing an all-consuming task.

My son-in-law's first wife died of cancer: and he's noticed the same progression in my father that he saw in his wife.

We've probably got anywhere from hours to days or weeks before my father dies.

(Last?) Visit, and Preparations

Happily, the family was able to see him, weekend before last. (Through One Dad's Eye, September 14, 2009) That was a good visit.

The family's getting ready as best we can: making sure that we know what funeral arrangements have been made; who to contact; checking to see if there are any last-minute legal procedures that should be done.

I know: it sounds morbid. But we're in better shape to take care of business now than we're likely to be immediately after his death. And given the unpredictable nature of creation, it doesn't do to get 'all set up' too far in advance. Things change.

'All Those Tubes,' Obligations, Emotions, and Common Sense

It's been a while since I heard someone declaim, with passion, a strong disinclination for being kept alive by 'all those tubes.' But I'd guess that there are still people who feel that way: and I think I can understand how they feel. I'm none too fond of intravenous tubes myself. They're awkward, and sometimes painful.

But a few years ago, when my digestive system had been taken offline to repair damage: it was 'those tubes' that helped keep me going. Any food or water I got, had to be fed directly into my blood stream.

An ideal situation? Something I enjoyed? Not particularly. But they made sense in that case. I wasn't expected to die soon, the needles weren't all that uncomfortable, and that particular bit of life support technology gave my GI tract time to heal.

That was then. This is now.

My father's dying. We've had a few false alarms already. He's been dealing with interstitial lung disease - which, I suppose, isn't exactly a disease. It's more of a condition where a person's lungs get stiff. Which makes it very difficult to exchange oxygen and carbon dioxide. It's not what I'd call a pleasant state of affairs.

He hasn't had all that much interest in food for some time. Now, it looks like he's not able to get it past his mouth. Same thing with water.

Time for the Tubes?

He's kept going this long, thanks in part to decades of active, sensible living; and in part to some relatively high-tech breathing equipment and morphine (I think that's it).

I know: morphine - or any industrial-strength painkiller - isn't all that good for you. But, under the circumstances, it made sense to control the pain my father experienced. And he agreed.

Thankfully, he's been alert and able to discuss his care with the facility's staff - who are a great bunch.

About this latest development? I don't think he'll opt for getting hooked up to something that'll bypass his digestive system and feed nutrients directly into his blood.

And I'm okay with that.

Cold, Unfeeling? Hardly

For an hour or so after I got the not-unexpected news this morning, I felt shaky. And was. I had to pay more attention than usual to walking, and my hands wouldn't stay steady.

I do not like the idea of my father dying. Not at all. But, as things are, that's a part of life. Death happens.

Contemporary Medical Technology: A Mixed Blessing

Medical technicians can do amazing things: like giving my digestive system a long vacation; controlling pain to a remarkable extent; replacing worn or damaged parts - joints, particularly.

The ability to keep a body - or substantial parts of it - alive longer than we could a hundred years ago has brought up the question of 'how much is too much?' How hard to we have to try, when it comes to keeping someone from dying?

You guessed it: the Catholic Church has rules about that.

Starving Granny for the Inheritance: A Big No-No

We're not allowed to practice euthanasia (Catechism of the Catholic Church, 2277) - even if granny isn't as chipper as she was, and we're waiting for the inheritance; or little Filbert will never run the Iron Man Marathon, as his father dreamed.

On the other hand, we're not required to do a "Once more unto the breach, dear friends, once more" medical last stand for someone who's dying - and ready to die.

"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."
(Catechism, 2278)

On the other hand, we're required to continue care for the dying, right up to the end. That includes painkillers. Even if using the painkillers will bring death sooner. (2279)

Is it any wonder that some people think Catholic teachings are 'vague' or 'inconsistent?'

The key in these end-of-life situations is, as with so much else, intent. (2277, again)

Which brings up some points: Catholic teachings aren't vague. They're developed for the universal church. A book like the Catechism is written for everybody - so it's heavy on universal principles, and a bit light on nuts-and-bolts details. I'm just glad they got as specific as they did with the paragraphs I quoted.

Not that the church neglects the practical details. That's part of what the bishops are for - teaching their people how Catholic teachings apply in that particular culture. For a Catholic living in America, the United States Conference of Catholic Bishops (USCCB) shows how my faith applies to the opportunities and limitations that come with this particular cultural, technical, and economic situation.

I'm running out of time, so I'm putting a couple of USCCB resources in the "Background" section, below.

Religious People Hate Technology, Right?

I grew up in America, and think I know where folks can get the idea that 'those religious people' don't like technology, education, or just about anything that wasn't invented before around 1850. As the decades passed, I heard and read how television was the work of the devil, then as people who'd grown up with television started getting inspired, if that's the word, with the idea that the Internet was an affront to God.

Earlier ages had the same sort of difficulty with lightning rods, I understand.

I think a good deal of that sort of Luddite feeling comes from a confusion of cultural norms with religious teaching: something I've been writing about, off and on, for about two years now in another blog. (See "Islam, Christianity, Culture, and Kooks," Another War-on-Terror Blog (November 26, 2007))

The Catholic Church may seem 'old fashioned.' I think that's what happens, when you teach love, respect, obedience, kindness, and compassion - even if that teaching doesn't line up exactly with some cherished local cultural values.

Autopsies? Cremation? Sure, Why Not?

When it's for legal investigations or scientific research, autopsies are morally acceptable. (Catechism, 2301) Which is just as well, since my father's instructions include handing his body over for scientific study after he's dead. And then cremating what's left.

Cremation?! Isn't that a sin?!

Cremation used to be forbidden to Catholics. Something to do with a heresy, I understand, where people were denying the possibility of resurrection. That's heresy's gone now (it'll be back, I'm pretty sure - these things seem to run in cycles), and cremation is both a cultural norm in quite a few places - and good common sense in many more.

So, the Church allows cremation. "...provided that it does not demonstrate a denial of faith in the resurrection of the body." (Catechism, 2301) Intention counts, again.

And no, this isn't a matter of the Church 'changing its mind' about a basic doctrine. The cremation ban was, I'm told, more of a procedural rule: the sort of rule that's recognized as being dependent on some temporary situation from the get-go.

Organ Transplants? Yeah: That's A Good Idea

From the Catechism, again:

"Organ transplants are in conformity with the moral law if the physical and psychological dangers and risks to the donor are proportionate to the good that is sought for the recipient. Organ donation after death is a noble and meritorous act and is to be encouraged as an expression of generous solidarity. It is not morally acceptable if the donor or his proxy has not given explicit consent. Moreover, it is not morally admissible directly to bring about the disabling mutilation or death of a human being, even in order to delay the death of other persons."
(2296)

Again with the conditions - but Catholic teachings deal with human beings, and that's the way it is.

I still don't feel good about my father's impending death. I don't expect to. But he's made good decisions, and I can hope with some reason that he will experience what has been called a "happy death." A few prayers at this end wouldn't hurt.

Related posts:

• "Medical Procedures, Imminent Death, Decisions, and Catholic Teachings"
  (May 21, 2009)
• "My Father's Life: Another Milestone Passed"
  Through One Dad's Eye (May 21, 2009)
• "Daniel Hauser and Mother Fleeing Chemo"
  (May 20, 2009)
  Particularly
  • What the Catholic Church Says About Health, Drugs, and Today's Medicine
• "Stiff Upper Lip? Imperturbable? Ha!"
  Through One Dad's Eye (May 8, 2008)
• "'Hand of Hope' Spinal Bifida Case - Eugenics, Ersatz Compassion, and Life"
  (May 6, 2009)
• "Face Transplant: We Can Do it, But is it Right?"
  (May 6, 2009)
• "Human Clones Possible: Don't Worry, They're Just for Parts and Research"
  (February 2, 2009)

Background:

• "John Paul II: Dying with Dignity"
  Rev. J. Daniel Mindling, O.F.M. Cap.
  (From www.usccb.org/issues-and-action/human-life-and-dignity/end-of-life/euthanasia/john-paul-ii-dying-with-dignity.cfm)
• "Nutrition and Hydration: Moral and Pastoral Reflections"
  A Statement of the NCCB Committee for Pro-Life Activities (April 1992) (From www.priestsforlife.org/magisterium/bishops/92-04nutritionandhydrationnccbprolifecommittee.htm)