Two public deaths

It was, perhaps, no accident, but rather the gentle hand of Divine Providence that both the Pope and Terri Schiavo should die within a few days of each other, that this last great sermon of John Paul II's life might make its point in classic style. After laboring to save the world from the menace of Communism, which treated man as a thing, not a person, the Pope chose again to leave the Papacy as he had entered it, fighting so that human life might be valued as something that belongs to a person, not a thing; that people are not vegetables.

I had thought that it might be more fitting to change the sermon today to be entirely about our Holy Father and his life and work. After having been in Rome for 3 years and having the privilege of being able to see him often, however, I think that he'd rather have this last issue of his life as regards human dignity addressed. John Paul II, popular as he was, was always more concerned with the truth than with the cult of personality; with the good of souls than with oratory and speeches.

And so today we shall take a brief diversion from the normal course of a homily to address a common misperception. I refer to the "painless" death of Terri Schiavo. It is not uncommon to hear people say: "I would rather have food and water pulled if that happens to me. I won't feel a thing." In actuality, removal of artificial nutrition and hydration causes death by dehydration, which would occur from a minimum of 5 days to a maximum of 3 weeks.

Rather than rehash the morals or theology behind the case, instead let us look at common medical practice. It is assumed that everyone knows why the Church opposes the removal of artificial nutrition and hydration; not only is food and water not medicine, but by making someone starve to death, you cause them to die, not their illness. With other forms of life support, it is the disease that brings death, normally; someone who can't breathe without a respirator dies when it is removed because their disease has made them unable to breathe without it. But someone who is denied food and water dies because they are dehydrated, not because some effect of their disease kills them. In essence, we bring about that person's death before their disease can kill them — a clear definition of euthanasia if ever there was one.

But today let us leave that behind, and instead focus on one short sentence from Tuesday's Washington Post: "Schiavo has received two 50-milligram doses of morphine since her feeding tube was removed in response to undisclosed symptoms, which Felos did not describe in detail."
The "undisclosed symptoms" referred to in the article are not unknown symptoms, notice, merely "undisclosed" symptoms. The doctors, and, most likely, Mr. Felos, the husband's attorney, know exactly what the symptoms are, as they are the same symptoms common to everyone who dies by dehydration. So, for the sake of the future medical plans of those here present, let me disclose those symptoms to you that Mr. Felos did not see fit to publish.

Typically, the mouth of such a person dries out and becomes caked with thick material. The lips become parched and cracked. The tongue becomes swollen and the eyes sink back into their orbits. The cheeks become hollow. The lining of the nose begins to crack and bleed. The skin hangs loose on the body and becomes dry and scaly. Urine becomes highly concentrated, causing burning of the bladder due to uric acid buildup. The lining of the stomach dries out, causing dry heaves and vomiting. Then comes hyperthermia, a very high body temperature. The brain cells now begin drying out, causing severe convulsions. The respiratory tract also dries out, giving rise to very thick secretions, which could plug the lungs and cause death by suffocation. Eventually the major organs fail, including the lungs, heart and brain. This causes pain, and therefore morphine or a similar drug is routinely administered. Normal injection dosage for pain is typically 10 mg. Terri had to receive 100 mg — 10 times that much. Hardly a painless death. 100 mg means pain. Real pain.

I am not a doctor, nor do I play one on TV, but I do have bioethical training from my studies in Rome, and I have done consultations for health care facilities in various parts of the country. In my experience, it is nearly universal that people who die from dehydration are given strong drugs to control the pain they undergo. Why, then, is it said in the media by people who are doctors that no pain is felt? Because to admit that actual pain is being felt, they would have to admit that there is a living thing that is capable of feeling pain there. When you pull a vegetable from the garden, you don't give it morphine. When you hook a fish, for that matter, you don't give it morphine. They don't feel pain. Giving something morphine indicates that there is enough consciousness there to be aware of pain; and if we might be dealing with conscious persons, then it will be hard to have legalized euthanasia in this country. The drive to make euthanasia acceptable revolves around the idea that you are avoiding pain, not causing it. But this manner of death is not painless. For example, in 1988 Marcia Gray, a Rhode Island woman, lost 50 pounds and required medication to control seizures during the 15 days it took her to die following removal of her feeding tube. Death by starvation and dehydration is hardly 'death with dignity.'

Additionally, there is a good chance that the patient would be aware that all of this is going on. The British Medical Journal recently reported:
Of the 40 patients referred as being in the vegetative state, 17 (43%) were considered as having been misdiagnosed; seven of these had been presumed to be vegetative for longer than one year, including three for over four years… The vegetative state needs considerable skill to diagnose, requiring assessment over a period of time; diagnosis cannot be made, even by the most experienced clinician, from a bedside assessment. Recognition of awareness is essential if an optimal quality of life is to be achieved and to avoid inappropriate approaches to the courts for a declaration for withdrawal of tube feeding.

We also have to remember that medical science still knows little about how the mind actually works. The New York Times recently ran an article on persons who were in a vegetative state who were shown by the Sloan-Kettering Institute and Cornell Medical School to have brain activity MRI results no different from a fully aware human being's when they were exposed to the voices of family and friends, even though they were unable to respond. This was a great surprise to the medical world when it was discovered this past year. However, it is still extremely rare for PVS patients to have such MRI scans done, so there is little knowledge as to how many people who were actually aware of their surroundings periodically were judged brain dead and allowed — or caused — to die, merely because science had assumed that they were dead to the outside world and only recently discovered that they were not.

One person who can talk about it is Kate Adamson, who collapsed at 33 from a devastating stroke. She was diagnosed as likely to develop a persistent vegetative state but she later recovered fully. At one point, however, she was removed from food and given minimal water for 8 days. She writes of this: "When the feeding tube was turned off for eight days, I thought I was going insane. I was screaming out in my mind, "Don't you know I need to eat?" …the hunger pains overrode every thought I had." She continued to say that she was administered inadequate anesthesia during her bowel-obstruction surgery. Yet, as painful as that was, it was not as bad as the suffering caused by being denied nourishment: "The agony of going without food," she says, "was a constant pain that lasted not several hours like my operation did, but several days. You have to endure the physical pain and on top of that you have to endure the emotional pain. Your whole body cries out, "Feed me. I am alive and a person, don't let me die…Somebody feed me." Moreover, although she was not deliberately dehydrated—she was constantly on an IV saline solution—she still had horrible thirst.

All this is easily verifiable medical fact, which is perhaps why, besides the usual pro-life voices in and outside the Church, others such as Ralph Nader, Jesse Jackson, atheist Nat Hentoff and others joined the fight. Who is a person and who is not? What makes someone's life valuable? These are the issues at hand here, and it is unfortunate that the people the media cited, by and large, made such an important issue seem like a trivial one about which there was really no room for contention, when in reality medicine is far from united on all these issues.

Now, what does all this have to do with the Gospel? Well, today is Divine Mercy Sunday. There are two contrary notions of mercy here, one that says suffering is the greatest evil and sin is acceptable to avoid it, and another which says that sin is the greatest evil, and suffering is acceptable to avoid it. One says that denying food and water is mercy, and one says that two of the works of mercy are to feed the hungry and give drink to the thirsty. The readings today speak about the sacrament of Confession, and it is there that we find true mercy, and freedom from death — both death of the body, through sharing in Christ's Resurrection, and the death of the soul which is caused by sin, which is by far the worse of the two. As horrible as death by dehydration is, it is nothing compared to the horrors of sin, especially in the next life, should we die unrepentant. And we know that because God loves us so much, and because His mercy is so great, that if we confess humbly we can be sure of forgiveness, no matter how horrible a deed we have done. With confession, all our sins can be reversed in an instant.

But a living will is not so flexible, and once it has been written, it is difficult to reverse it if you cannot talk. It is said that many people are revising their living wills in response to the Terri Schiavo case to express their wishes should such a fate happen to them. The diocese provides some solid Catholic advance medical directives that we have here in stock at St Mary's that are highly recommended, and which allow for someone to make legitimate decisions about the end of their lives while still remaining within the teaching of the Catholic Church.

However, there still may be those who think that removing food and water is better than the alternative, most likely because they are afraid of pain — and nobody likes pain — and of the loss of self-control and dignity. Hopefully, by now it should be apparent that having food and water removed only increases these problems; it does not solve them. But also, I think, it is to just such people that the Holy Father directed the last message of his life. To those afraid of the loss of self-control and of dignity, the leader of the largest religion in the world, the very vicar of Christ Himself, did not shrink from displaying his infirmities and weaknesses openly, to everyone, including his foes and detractors. The Pope who charmed the world by his athleticism was not hesitant to stand at his window, unable to speak and semi-crippled, even as people shook their heads and recalled when he used to ski on vacations. They may have been embarrassed for him; he was not embarrassed.

But most of all, this Pope who opened his papacy by crying in his strong voice, "Be not afraid," ended it by crying out the same silently with his very life to those who fear the pain and suffering of being like Terri Schiavo. Be not afraid, his appearance said, of the ravages of illness and old age. Be not afraid of the suffering that comes with the Cross in every age of life. Be not afraid to do what is right even in the face of indignities and pain. Open wide the doors of your hearts to Christ, and let Him be your strength. These things he could not say, because his voice had left him, but his last days shouted them as if from all the housetops of the world.

And so, to those who are yet timid at the thought of their last hours, and ponder what to do in their future plans, I say to you, in not my words but the Holy Father's, his last message: Be. Not. Afraid.