December 15, 2013
Bernard Hammes, Ph.D.
Director of Medical Humanities and Respecting Choices
Gundersen Health System
1900 South Avenue
La Crosse, WI 54601
Dear Dr. Hammes,
We, the undersigned, members of the Pro-life Healthcare Alliance (PHA) and other concerned individuals who provide or advocate for ethical healthcare, are writing to express our deep concern over the Gundersen Health Care System Respecting Choices advance care planning documents entitled “Tube Feeding: What You Should Know” and “BiPAP and Ventilators: What you should know.”These fact sheets are biased and discourage individuals from employing two specific means to preserve their lives – tube feeding and ventilators. Your statement, “Think about what being alive means to you,” introduces a false “quality of life” argument which is an affront to human adaptability, ingenuity and passion for life. Finally, these documents assault the gift of life.
Chronically disabled individuals lead lives of inestimable worth. Some have made important contributions to society while burdened by chronic disease requiring nutritional or ventilatory support (e.g., Stephen Hawking). Your fact sheets are misleading because of underlying pernicious assumptions: self-worth is a measure of one’s “usefulness” and “usefulness” is essential for a good life. Life is both a gift and a great good even for those who suffer greatly or who bear incredible burdens.
Human dignity is immanent and never fades even among those patients whose circumstances are indeed undignified. In the course of our lives most of us will become disabled for shorter or longer periods (except for those, approximately, 20% of us who will die suddenly). At some point we all will become dependent upon others, needing the assistance of families and communities. Rather than discouraging those who are sick and in need of constant help and support; rather than intimating their lives are worthless, or worth less than others; rather than insinuating they have a duty to die; and, finally, rather than discharging our duty with these most uncharitable fact sheets, we ought to rally support for and remain in solidarity with them, keeping in mind that their plight is, ultimately, our plight.
The PHA’s mission is to ensure that society does not unfairly burden any particular group. A just society would care always and especially for those having the greatest need. Your fact sheets uniformly discourage those “older and weak,” afflicted by disease or by incurable illness from using technology that may serve them and preserve their lives. As such, your approach is both ageistic and prejudicial against the disabled. Furthermore, it is unjust, unfair and unethical. As always, judgments of benefits and burdens should be left to individual patients and their surrogates assisted with medical guidance from physicians and spiritual guidance from their faith tradition.
In summary, the Pro-life Healthcare Alliance and all the undersigned believe that human dignity inheres in each individual person. As such, each is worthy of respect. This is not contingent upon the presence or absence of specific human qualities. There is no defect in the physical or mental domain that would diminish or end our respect for and defense of all human life. We ask you to reconsider your position and to remove these documents from circulation.
Julie Grimstad, Chair
Pro-life Healthcare Alliance
Note to PHA Monthly readers: If you would like a list of the signatories, please contact Julie at email@example.com or Ann at firstname.lastname@example.org.
 Respecting Choices has provided training, consultation, and materials regarding advance (medical) care planning to organizations and communities around the world. Respecting Choices is a primary promoter of the POLST Paradigm Program, educating and certifying POLST “facilitators.” [For information on POLST, see PHA MONTHLY July 19, 2013 and August 27. 2013 at www.prolifehealthcare.org.]
Case in Point
By an Anonymous physician
I first met Fr. Gerard in 1998 while doing a house call for his mother. A brief initial conversation revealed that he was retired and living in a small apartment only a block from my office, and that we shared many Catholic and pro-life interests. Fr. Gerard soon became a close friend, and we met frequently for meals. I assisted him with various tasks around his apartment, and he called me often simply to talk. He got to know my wife and children well and relied on us for help, as his only sibling lived out of state. Fr. Gerard eventually developed Parkinson’s disease. We offered to take him into our home, but knowing the chaos of our homeschooling household he politely declined, and entered a local nursing home. We continued to visit him often and took him out to dine at his favorite restaurants.
In late 2007 and early 2008, Fr. Gerard’s health declined rapidly. He left a voice message on my cell phone late on a Wednesday in April 2008, asking me to stop and visit. By the time I was able to visit him two days later, he had been admitted to a local hospital for aspiration pneumonia, and had been diagnosed as “terminal” by the treating physician. He was transferred to the palliative care unit from the ER and the treating physician insisted that according to his Living Will, Fr. Gerard wanted no “extraordinary care” to prolong his life.
I was shocked that he was receiving no water, food or IV, only Morphine by slow IV drip. His Parkinson’s was certainly advancing and the aspiration pneumonia was a serious crisis (aspiration pneumonia has a 20 to 60% mortality rate), but food and water did not constitute extraordinary care. We were permitted to wet a sponge to moisten his lips, and he would try to suck all the moisture from the sponge, but we were forbidden to give him a drink of water, because of the “risk of further aspiration pneumonia.”
Fr. Gerard had shared with me his opposition to passive euthanasia in the past, and he was trying to talk to me, but he had become so dehydrated that he could not form words. When the attending physician made rounds, I told him my concern that Fr. Gerard was receiving no food or water. The physician asserted that “their hospice rules forbid IVs” as it only “prolonged the process.” He then stated, “The public has a misconception that death by dehydration is torturous, but that’s not true. It’s the most humane way to do this, with the least discomfort. We will control any discomfort with the Morphine. That’s what we’re going to do.”
With that the attending physician, a Catholic father of six, looked me in the eye defiantly, turned on his heels and left. I was speechless. The next day I pleaded with his sibling that Fr. Gerard would never have consented to passive euthanasia by dehydration, explaining that if he died now it would be due to dehydration, not the aspiration pneumonia or the Parkinson’s, but to no avail.
I have always been pro-life. I had even attended pro-life conferences about euthanasia and had sat on the medical ethics committees of two hospitals, both in the mid 1990’s. I had staff privileges at the hospital in question. But in April 2008, in Fr. Gerard’s specific case, I simply did not know what to do. I called four good pro-life priests locally, begging for advice. They all agreed that something must be done but none could offer any specific advice, and because his sibling held power of attorney none could personally intervene to help their fellow priest.
Another priest I consulted recommended I request a medical ethics committee consultation. Late on a Thursday evening, eight days after Fr. Gerard had left the voice message on my cell phone, I spoke with a physician assistant who was on call for the ethics committee. I told her that he was a good priest and a faithful son of the Church who would never agree to being passively euthanized, and I discussed with her the relevant documents from the Vatican, the USCCB and the state bishops’ conference. She asked me to enter these documents in Fr. Gerard’s chart, and the medical ethics committee would be happy to review the case Friday morning on rounds.
Relieved that there was something I could finally do for this good priest, I went to the hospital Friday morning at 7:00am, asked the unit clerk to formally enter the documents into his chart for the ethics committee consultation, and headed down the hall to visit him.
His room was already empty. Fr. Gerard had died of dehydration several hours earlier.