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Passive Euthanasia is All About the Bottom Line: Profit

by Fr. Angelo

In my 12 years as a Catholic priest and pastor, and in one year as a full time/on call priest chaplain at a prestigious Protestant hospital with 650 beds, I have been at the side of several dozen people before and during the time of physical death.  In my many years as a pastor I have seen hospice people “get it right” time and again, but there have also been many times that I saw a pro passive euthanasia agenda in those same hospice groups.

In my intensive year of working with a palliative care team, I saw many dying patients and families benefit from palliative care, however, I saw many patients “hurried along” on the path to death by that same palliative care team.  In sum:  A broken clock is correct once a day and once a night, the same seems to be going on with hospice and palliative teams in America.  In spite of themselves, hospice and palliative teams sometimes “get it right,” while the bigger pro passive euthanasia agenda is what primarily informs their methods and decisions.

With medical insurance becoming more and more socialized in America, and since the terminally ill do not “put in” to the system, it makes more dollars and cents to phase them out totally, that is, to expedite their deaths.  It is counterproductive to the bottom line of hospitals and physicians, to keep non revenue generating patients in their rooms, and the only logical way to solve this problem is to solve the problem  with death.

In the report, “Surgeon Contribution to Hospital Bottom Line, Not All are Created Equal,” issued by the US National Library of Medicine National Institutes of Health [ 2004 May;32(5):1207-14. “Critical care medicine as a distinct product line with substantial financial profitability: the role of business planning.”  by Bekes CE, Dellinger RP, Brooks D, Edmondson R, Olivia CT, Parrillo JE. ] tremendous insights are offered as to the services which are financially beneficial as well as non beneficial to physicians as well as to hospitals, this is the REAL phenomenon that informs the pro passive euthanasia people who work within the protection of hospice or palliative care teams:

“Both hospitals and physician practices are suffering as reimbursement continues to fall, costs continue to climb, and the malpractice crisis looms large. Many academic medical centers are struggling financially as a result of the current environment, and if financial conditions do not improve, the traditional academic mission may be forced to change.  From a financial standpoint, options include further reductions in costs or even elimination of certain service lines found to be unprofitable.”  (“Annals of Surgery,” October 2005).

One of the authors from the mentioned report  is an M.D. as well as M.B.A., two of the authors are M.D.’s, and another author is an M.B.A., so there seems to be a strong consensus from highly competent authorities that dollars and cents, at the end of the day, really is the bottom line, and not the hermeneutic of morally right and wrong treatment.  It is true that the bottom line matters if hospitals and physicians are to stay in business, but, rather than an “either/or” approach to solving the dilemma, is there not a “both/and” solution possible instead?  There IS a way to BOTH remain financially viable AND do what is morally right, vis a vis our terminally ill patients, but that solution will never be discovered as long as we continue to allow passive euthanasia to become a increasingly common in our nation and world.

We could spend all day, or a millennia, talking about what is morally right and wrong, in the passive euthanasia debate, and this is exactly what the passive euthanasia people want.  Just as people can engage in pedantics and semantics over what the word “is” means, so too do the pro euthanasia people try to confuse the real issues when addressing end-of-life issues.  The real factor that informs the argument of pro passive euthanasia people is the importance of money, NOT the question of what is morally right or wrong.

It pays handsomely to perform open heart surgeries, it does NOT pay to keep someone alive by feeding tube, while keeping them sedated and/or on pain meds.  Have you ever seen the formulas of profit and loss for floors on a hospital?  If x number of rooms per floor are vacant, then profits go way down.  If x number of rooms are being occupied by unconscious patients with terminal conditions, instead of being occupied by patients who are about to go into heart surgery or hip/knee replacement, then for financial reasons the ratio needs to be flipped so that more rooms are being occupied by these pre surgery patients instead of terminal patients.  Medical insurances will pay a lot of money for a heart surgery and a lot less  for a knee replacement surgery.  If the hospital gets the patient out of the hospital in 3 days, there is more profit, if the hospital gets the patient out in 7 days, then more of the medical insurance money was burned up and less “take home” profit will there be for the hospital.  It is a numbers game of dollars and cents, this is what informs the language of the palliative/hospice/hospital people, the language of morally right or wrong is not the primary language which informs their decisions for a plan of action or treatment.

Passive euthanasia is supremely easy to inflict, inasmuch as the palliative agenda people are working with loving family members who are in an extremely emotional and vulnerable condition.  When a hospice care doctor or palliative care doctor tells the wife of a dying patient that her husband will suffer more and longer, as a result of continuing to provide nutrition and hydration, she is left to feel cruel and selfish for choosing the feeding tube instead of an expedited “natural death.”

It must be remembered that, in the 21st century, the Catholic Church does not consider a feeding tube “extraordinary means” or “heroic measures.”  It is easy for pro passive euthanasia doctors to persuade emotionally vulnerable family members to expedite their loved one’s death, especially when they say it is only “letting nature take its course.”

In the 21st century, it is “natural” care to provide nutrition and hydration to a dying patient, as taught us by the Magisterium of the Catholic Church.  To TRULY let nature take its course, nutrition and hydration must be supplied to the patient.  There are times when an imminent death (“immanent” means minutes or hours, as opposed to “terminal” which can mean days or months) can dispense the need for nutrition and hydration, inasmuch a healthy person does not constantly eat and drink throughout the entire day and night.

In his 2004 Address, “LIFE-SUSTAINING TREATMENTS AND VEGETATIVE STATE: SCIENTIFIC ADVANCES AND ETHICAL DILEMMAS,” Pope John Paul II made it clear that nutrition and hydration is considered “ordinary means,” not extraordinary, and he also made it clear that nutrition and hydration should even be given even when patients are in a “persistent vegetative state” :

“I feel the duty to reaffirm strongly that the intrinsic value and personal dignity of every human being do not change, no matter what the concrete circumstances of his or her life. A man, even if seriously ill or disabled in the exercise of his highest functions, is and always will be a man, and he will never become a “vegetable” or an “animal”.  Even our brothers and sisters who find themselves in the clinical condition of a “vegetative state” retain their human dignity in all its fullness.”   (#3)

“I should like particularly to underline how the administration of water and food, even when provided by artificial means, always represents a natural means of preserving life, not a medical act. Its use, furthermore, should be considered, in principle, ordinary and proportionate, and as such morally obligatory, insofar as and until it is seen to have attained its proper finality….”    (#4).

Pope John Paul II’s address falls under the category of faith and morals, and is therefore binding on Catholics who wish to adhere to Mother Church’s Magisterium.  “Quality of life” language is often misleading, and is frequently used maliciously by those who would promote passive euthanasia:

I once had the privilege of ministering to an elderly lady who suffered from Alzheimer’s disease, with complications from a stroke and ongoing pneumonia.  After two days of being unconscious, the hospice doctor encouraged the seven adult children to cease nutrition and hydration, inasmuch as it would be “cruel” to keep her alive in such a condition.  The doctor made the usual palliative care argument that such was merely “existing,” and not “living.”  The doctor went on to use the usual argument:  “Are you keeping her alive for HER good, or for YOUR good?  We have to ask ourselves if keeping her alive is selfish on our parts.  By choosing the feeding tube, you choose to keep her suffering for longer, and it isn’t even living.”
All the adult children, except for one, agreed to take their mom off the feeding tube.  I pointed out the treacherous errors with “quality of life” language, vis a vis the human dignity and image of God positions.  Showing bioethical documents of the Church to these adult children seemed not to help at all.  On the third day, the oldest son who was the leader of all the adult children snapped out of his grief, and he said to the hospice doctor and in front of the other siblings:  “Hey doc!  You keep saying that our mom won’t suffer from death by dehydration.  Tell me something doc, how do you know?  Have you ever been deprived of water?  Have you ever been killed by dehydration?  No you haven’t, so you don’t know!  Get out of here doctor!”

Needless to say, the mom was given nutrition and hydration anew.  A week later, the mother was able to gain consciousness and say kind “I love you’s” to her children, and two weeks after that, she died naturally and beautifully.  Best of all, no one sinned against this lady’s dignity, and none of the children would ever have to live with the guilt of knowing that they killed their mother by starvation and dehydration.
On another occasion I ministered to a gentleman who was dying from Bovine spongiform encephalopathy, better known as “mad cow disease.”  At first I was in shock that this disease even existed in our hemisphere, since like most Americans, I thought that this disease never reached American soil.  Working 24/7 in a large prestigious hospital, on call most of those days and nights, can be very eye opening.  It is amazing what “we the people” are not told about the inner workings of hospitals and the medical system in general.
The palliative care team explained to the wife and adult children that their husband and dad would probably die in three weeks if given the “feeding tube,” whereas the suffering for their loved one would be much less acute, for fewer days, and less intense, if he were to forego the feeding tube.  The patient had a nasopharyngeal airway installed for breathing purposes, and the palliative doctor used this “visual aid” to persuade the family that their loved one was probably very uncomfortable.  The loving wife and children decided to “not be selfish” and let their husband/dad die the “natural way,” by denying him nutrition and hydration.  They were in a very emotionally vulnerable state when the palliative doctor used emotions and hype to brainwash the family.  The palliative team told the family that their husband/dad would probably die within five days.  On days five and six, the palliative nurses and doctor expressed their exasperation to me, “their chaplain,” inasmuch as the patient was taking so long to die.  When the gentleman died at the end of day six, the relief and satisfaction for the palliative team was very apparent.  Days later, the wife and children would share with me how their consciences were torturing them, for killing their husband/dad by dehydration and starvation.

Three years ago my own wonderful dad was there in the hospital, in a terminal condition.  My dad was in and out of consciousness, and in pain.  My mom broke down and shared with me the most difficult decision of her life, and while doing so she handed me a page of advanced directives which were signed by my dad before his condition became terminal.  My mom showed me where my dad chose the DNR (do not resuscitate) option on the advanced directive.  After showing me dad’s choice, my mom then explained what the hospice doctor told her, that denial of nutrition and hydration is what is meant by “DNR.”  I knew with all of my trained intellect, as well as my heart, that my mother was being misinformed and brainwashed by the hospice doctor.  I showed my mom various medical documents which proved that DNR did not mean withholding of nutrition and hydration, but her emotional state prevented her from understanding.  My mom only understood that the hospice doctor advised against nutrition and hydration, since such is what is meant by “DNR.”  The doctor also brainwashed my mom into believing that giving nutrition and hydration to my dad would be selfish on her part, and it would only give my dad more suffering for longer.

On the second day of not receiving nutrition and hydration, I was there at the side of dad’s bed, talking with mom and my sister.  At one point, I was playfully teasing my little sister, and then she playfully said to my unconscious dad:  “Dad, Angelo is picking on me and you aren’t even protecting me, your only daughter! Why aren’t you protecting me Daddy?”  To the shock of all of us in the room, my dad opened his eyes and spoke coherently for the first time in days:  “Sugar, Daddy can’t help you because he is too weak.  I am fighting for my own life Sugar, they are trying to kill me, please forgive me.”  Needless to say, my mother found the hospice doctor immediately, and in a matter of thirty minutes my dad was back on nutrition and hydration.  Dad passed away one month later, naturally, and it was a God filled experience with family in the room.  After dad died, none of us would have to feel guilty or BE guilty of killing their loved one, as the hospice team would have preferred.

As one who has actively provided ministry and sacraments to dying people for many years, and as one who studied bioethics with enthusiasm before priesthood and during,  one of the big question on my mind for the last several years has been:  “How can we, as a people, purge the pro passive euthanasia agenda, as it is found in many or most palliative and hospice teams?”  It is my contention that, as long as there are medical teams which are specialized in giving treatment to end of life/terminal patients ONLY (palliative care “says” it is not for terminal patients only, but in praxis, it is), who do not also spend equal amounts of time providing medical assistance to the “young and beautiful,” the passive euthanasia agenda will eternally recur.

The passive euthanasia agenda will always recur within teams which cater specifically and solely to terminal patients, as long as it is the only viable way to go when the language of dollars and cents is spoken.  If we can find a way to overhaul the way hospitals, doctors, and insurance companies are paid and reimbursed, in a way that does not create inordinate financial burdens vis a vis terminal patients, then we will be on the first step towards getting hospitals and physicians to place morality first when it comes to the terminally ill.