Fr. Cekada and the Terri Schiavo case
#21
OK, but let's stick to what was written and  the theology and not talk about who likes or dislikes Fr. C.  I've already had to heavily edit this thread, and I've edited that portion out of your post.
Reply
#22
Well, how does one defining eating on one's own?  Do they have to chew, or is the stomach's ability to digest considering eating on one's own?

If someone has throat surgery and can only be kept hydrated and alive via an IV, are they eating on their own?  It looks like not, and if not, can we not bother with the IV in the case they are bedridden and can't get it themselves?

Reply
#23
(11-21-2010, 03:39 AM)QuisUtDeus Wrote: Well, how does one defining eating on one's own?  Do they have to chew, or is the stomach's ability to digest considering eating on one's own?

I could be persuaded to your position if it could be shown within Catholic theology no distinction had ever been made between the two.  But even with that, I would like to know in what circumstances you (and those that are anti-Father K's position) would consider 'extraordinary means' vis Terry.  As of now, I dont see that distinction being made. 

Sorry for clouding the debate with my earlier comments, I did not see the earlier thread.
Reply
#24
(11-21-2010, 04:04 AM)Robert De Brus Wrote:
(11-21-2010, 03:39 AM)QuisUtDeus Wrote: Well, how does one defining eating on one's own?  Do they have to chew, or is the stomach's ability to digest considering eating on one's own?

I could be persuaded to your position if it could be shown within Catholic theology no distinction had ever been made between the two. 

Well, here's what the CDF said in 2007, as already quoted:

http://www.vatican.va/roman_curia/congre...sa_en.html

Quote: But even with that, I would like to know in what circumstances you (and those that are anti-Father K's position) would consider 'extraordinary means' vis Terry.  As of now, I dont see that distinction being made. 

For example, the use of a respirator.
Reply
#25
QuisUtDeus Wrote:It's kind of like asking if a spoon is extraordinary means.

A spoon is not normally extraordinary means, but it could be. As Fr. Cekada stated, "in a body that is obviously shutting down for good', that feeding can be extraordinary. This is a person who is in the very definite process of dying. They do refuse food and water (even if they can eat and drink) as their body is shutting down. We do not typically require either force feeding with a spoon or inserting a feeding tube at this point. The lack of food and water does not cause dying, the dying causes the patient to refuse food and water. Of course, this is when the patient receives pallative or comfort care, a type of care that does not refuse food or water, it just does not require it.

Fr. Cekada applies this to Terri Schiavo, who was clearly not in the process of dying until she was refused ALL food and water. A priest who served her, and gave her Holy Communion, said that she received Communion. This is what caused Bishop Sanborn to retreat from his initial support of Fr. Cekada's lonely opinion and his misapplication of the theological principles that should govern our conclusions.
Reply
#26
(11-21-2010, 11:03 AM)lamentabili sane Wrote:
QuisUtDeus Wrote:It's kind of like asking if a spoon is extraordinary means.

A spoon is not normally extraordinary means, but it could be.

I'll split hairs with you here for a minute.  It seems to me extraordinary in the theological sense means either: 1) the patient has to be forced because they have no appetitive desire, or, 2) the means are excessively burdensome.

If that's true, then the problem with the spoon or tube comes it at #1 if the person is conscious.  If a person is unconscious or lacking brain function and can digest, etc., we don't know what the appetitive situation is, and I argue we should assume it's there.  So, then #2 comes into play.  Spoon feeding someone is not excessively burdensome nor is inserting a tube and pumping what is the equivalent of pharmacy grade baby food through them.

The cost may be burdensome, but I'm not convinced it's the cost of the feeding tube as much as the cost of the additional care around it.
Reply
#27
Here's more material to talk about:

THE TERRI SCHIAVO CASE:
A PRIEST RESPONDS TO A DOCTOR’S CRITIQUE
Rev. Anthony Cekada, www.sgg.org
Note: This letter was written in response to “The Terri Schiavo Case: A Catholic Neurologist’s Perspective” by James M. Gebel Jr., MD, MS, FAHA, which was posted on FreeRepublic.com and a number of other web-sites.
Dear Dr. Gebel,
Someone forwarded to me your comments about my articles on the Schiavo case.
A number of other people involved in health care have written to me about the medical aspects of the case.
I not qualified to decide whether your medical opinion or other conflicting medical opinions about PVS, therapy, etc. are more in accord with the principles of medical science.
But common sense tells me that the method you used to arrive at your opinion -- reviewing CT images, watching  a video and reviewing “summary/excerpts regarding testimony given in deposition transcripts” -- is no substitute for examining a live patient.
Unlike other doctors directly involved in the case, moreover, you have not been cross-examined on either your methods or your conclusions.
Be that as it may, I am qualified to speak about the moral issues in the case, and indeed, I am also obliged to do so.
If what you seem to be claiming is true and Terri Schiavo was somehow able to eat and drink by natural means, there is no dispute that those who cared for her would have been obliged to provide her with food and drink. To have withheld these would have been a mortal sin (unjust direct homicide) against the Fifth Commandment.
However, my writings on the Schiavo case centered on something else: the principles that Catholic moral theology would apply to removing a feeding tube.
I do not want my parishioners to be left with the impression -- due to the high emotions and bitter controversy fanned by the morally bankrupt media and by various lay and clerical grandstanders -- that something is a mortal sin when it is not.
Who knows when any one of my flock may be called upon to deal with the issue of a feeding tube for himself or a family member?
Here, put very bluntly, are the two essential questions in moral theology that I have sought to resolve:
(1) Does the Fifth Commandment under pain of mortal sin ALWAYS REQUIRE a sick person who is unable to eat or drink by natural means to have a doctor shove a tube into his nose or poke a hole into his stomach in order to provide food and water?
(2) Does the Fifth Commandment under pain of mortal sin then ALWAYS FORBID such a person to have these tubes removed, no matter what grave burdens -- pain, revulsion, depression, expense, etc. -- their continued use may impose on him or another?
The answer to both questions is no.
Having a hole poked in you, a tube shoved in and then having to eat and drink that way would be burdensome for any normal man.
Like the IV drip mentioned by the moral theologian McFadden (whom I quoted elsewhere), one could maintain this procedure would be morally compulsory “as a TEMPORARY means of carrying a person through a critical period.”
“Surely,” however, “any effort to sustain life PERMANENTLY in this fashion would constitute a grave hardship.” (Medical Ethics, 1958, p.269.)
(Perhaps some priest, layman or doctor who rejects this conclusion could get his own feeding tube inserted, live that way for fifteen years, and let us all know in 2020 whether the experience was a grave hardship or not. Any takers?)
Insisting (as some have done in the Schiavo case) that one is bound to this UNDER PAIN OF MORTAL SIN (otherwise, euthanasia! murder!) contradicts Pius XII’s teaching  that one is bound only to use “ordinary means,” which he defined as those “that do not involve any grave burdens for oneself or another.”
Imposing “a more strict obligation,” the pontiff warned, “would be too burdensome for most people and would render the attainment of a higher, more important good too difficult.”
So, even though as a doctor you may well consider poking holes into people and inserting permanent feeding tubes “by no logical measure extraordinary or unduly burdensome by any reasonable standard, moral, medical or economic,” Catholics must nevertheless draw their understanding of extraordinary means from the Church’s moral teachings -- rather than from the practices and pronouncements of the medical-industrial complex.
In sum, by the standards of Catholic moral theology, the permanent use of a feeding tube constitutes extraordinary means and is therefore NOT obligatory. Like all such means, however, one is free to use it, “as long as one does not fail in some more serious duty.” (Pius XII)
But one cannot maintain that a Catholic is always bound to use a feeding tube under pain of mortal sin — still less, that the refusal to do so constitutes “murder.”
Don’t try to invent a mortal sin where there is none.
In Christ,
The Rev. Anthony Cekada

May 18, 2005
Dear X,
Thank you for your letter.
How MEDICAL SCIENCE defines “extraordinary means” is different from how Pius XII and Catholic MORAL THEOLOGY define it.
I would have said nothing about Dr. Gebel’s article had he not stated in #9  that tube-feeding was not extraordinary means or unduly burdensome by any “MORAL” standard.
I am not going to give a doctor a free pass once he steps into the realm of theology — i.e., by presuming to tell Catholics what is not extraordinary or burdensome by a “MORAL” standard.
As for some of the other issues you mention:
(1) I’ve said very clearly that, had Terri Schiavo indeed been able to eat and drink by natural means, those caring for her would have been obliged to provide her with food and drink.
(2) I’ve also said publicly several times that those who wish to employ long-term tube feeding (or indeed any extraordinary means) are free to do according to the principles Pius XII laid down.
What I have repeatedly sought to refute is the widely-held but utterly false notion that the use of a feeding tube is ALWAYS OBLIGATORY UNDER PAIN OF MORTAL SIN (otherwise, “murder,” “euthanasia,” etc.).
No matter how high emotions have run in the Schiavo case, Catholics must not be left with the impression that something is a mortal sin when, according to the principles of Catholic theology, it is NOT.
In this matter as in others (such as that of the Iraq War, where I believe you agreed with my analysis), it is my duty as a priest to lay out the principles and show how they apply  — no matter how unpopular I may become.
In Christ,
Fr. Cekada
Reply
#28
I think tube feeding can be extraordinary means...but in a place like America it is less so than in a developing country; however, once a feeding tube has been placed, and if the person is thriving due to its delivery of nourishment...it seems to me that it is wrong to remove it, especially if the intent is to cause death by starvation. 
Reply
#29
Fr. Cekada Wrote:As for some of the other issues you mention:

(1) I’ve said very clearly that, had Terri Schiavo indeed been able to eat and drink by natural means, those caring for her would have been obliged to provide her with food and drink.

(2) I’ve also said publicly several times that those who wish to employ long-term tube feeding (or indeed any extraordinary means) are free to do according to the principles Pius XII laid down.

What I have repeatedly sought to refute is the widely-held but utterly false notion that the use of a feeding tube is ALWAYS OBLIGATORY UNDER PAIN OF MORTAL SIN (otherwise, “murder,” “euthanasia,” etc.).

The feeding tube can be obligatory at times. The ventilator can be obligatory at times. It is important to remember that providing food and hydration is not a medical treatment. Notice that Fr. Cekada assumes tube-feeding is extraordinary means in the bolded section.
Reply
#30
Here's the letter Fr. Cekada was replying to above:

Quote:Dr. James Gebel, Jr. Issues a Report
In Response to Fr. Cekada

THE TERRI SCHIAVO CASE:
A CATHOLIC NEUROLOGIST'S PERSPECTIVE

Over the past several weeks, it has come to my attention that significant debate has developed regarding the Terri Schiavo case. I have read various e-mail messages between Cathy Seal, Father Cekada, Father Dardis, Bishop Sanborn, and two letters appearing in the St. Gertrude the Great Church bulletin.

Let me begin by stating that I do not feel I have either the theological expertise (mine is limited to a minor in theology at Xavier University, a Jesuit college in Cincinnati) or moral authority to adequately address the theological aspects of this case. However, I do feel that my background as a neurologist with additional specialized "fellowship" training in both neurological critical care (the subspecialty of neurology which deals with patients in comas and other critical neurological illnesses) and stroke, at the Cleveland Clinic and University of Cincinnati respectively, put me in a position to contribute some thoughts on the medical aspects of her case. Since
Completing medical school, I have over 15 years of experience training, practicing,  and doing research in these areas. I have also had the opportunity as the result of my training and expertise in these areas to testify as an expert witness in such matters in medical malpractice and pharmacological product liability lawsuits. I state the above not to be prideful, but to give you some tangible appreciation of the fact that, simply speaking, there are few people in the country with any better training background or practical expertise to understand in detail the scientific and medical aspects of the care of patients like Terri Schiavo, whom I deal with on literally an almost daily basis.

I have reviewed the CT scan images of Terri Schiavo's brain, watched the video of her taken by her family members, and also reviewed some summary comments/ excerpts regarding testimony given in deposition transcripts in her medical malpractice case. These again are all things I do on a very frequent basis. They are, to be frank, part of how I make my living.  Having clarified the context in which I share my thoughts with you, I offer the following thoughts on this matter:

I) Terri Schiavo was NOT in a persistent vegetative state. The video taken of her clearly and unequivocally demonstrates that, at least at times, she is in a minimally conscious state and capable of interacting in a rudimentary way with her family and environment, which by definition excludes her from being medically classified as comatose or in a persistent vegetative state.

2) The parts of Terri Schiavo's brain which would allow her to perceive pain, her thalami, were clearly intact and visible on her CT scan images shown by her husband, Michael Schiavo, on national television (which I rarely watch, and by the way, I have never voluntarily watched "Oprah'')

3) The parts of Terri Schiavo's brain which would allow her to perform complex cognitive function, or which would enable her to speak or understand speech, were clearly damaged.

4) The parts of Terri Schiavo's brain which would allow her to swallow on her own were intact and, in fact, she did not suffer from medically significant dysphagia (swallowing difficulty). If she had, she would have been dead long ago from a condition known as aspiration pneumonia, an infection in the lung;; which is the result of inhaling one's own saliva.

5) The parts of Terri Schiavo's brain which would allow her to move her arms and hands to feed or hydrate herself were clearly damaged.

6) The parts of Terri Schiavo's brain which would allow her to experience discomfort and/or pain due to hunger were undamaged.

7) Other tests were available to better clarity the full extent of Terri Schiavo's awareness or lack thereof, such as MR1 scanning of her brain ( a more detailed picture of the brain than a CT (CAT) scan, EEG (a brainwave test), and evoked potential studies, which could decipher the extent to which she could hear or see. These studies were refused by her husband, Michael Schiavo.

8  ) Terri Schiavo did not receive or require intravenous hydration or nutrition (so-called "TPN'') or total parenteral nutrition.

9) Oral or stomach tube feeding via an "NG" (nasogastric tube) (a tube put down one's throat to the stomach) or (more commonly) via a "G-tube" are routinely used to feed stroke victims, both temporarily and indefinitely in patients with stroke or other brain injuries who cannot feed themselves, whether due to swallowing problems (which occur at least temporarily in most stroke victims). Such feeding and hydration are by modem medical standards considered as ordinary and unburdensome as eating and drinking on one's own. Such feedings are, in fact, less expensive than what an average American spends on food and water, and are easily administered a few times a day by a family member, requiring much less effort than cooking three meals a day. Terri Schiavo's husband, parents, or siblings could easily administer such feedings. They are by no logical measure extraordinary or unduly burdensome by any reasonable standard (moral, medical, or economic).

10) Terri Schiavo could have been cared for at home with some home health care assistance at modest to at most moderate expense which would not by any common sense standard be deemed economically burdensome.

11) Terri Schiavo's stomach and intestines were fully functional and capable of digesting food, even normal food if it was placed in her G-tube.

12) Terri Schiavo could have received sequential neurostimulation therapy to her throat muscles, which may have further improved her swallowing function to the point that she may have been able to chew or swallow at least some types of normal food and/or liquid if placed in her mouth. This and other similar available measures were denied to her by her husband.

13) Terri Schiavo's brain, while severely damaged, had not "failed". When someone's brain "fails," i.e. is irreparably and totally damaged, they are, by definition, dead. While we can keep people alive when other vital organs such as the liver, kidneys, lungs, and even heart fail (via dialysis, organ transplantation, etc.), not even 2005 era medicine can keep one alive if one's brain has failed, because all other organs shut down within 5 days when this occurs, even when every maximal effort possible is made.

14) Terri Schiavo did not require, nor to the best of my knowledge did she ever receive intravenous nutrition (TPN), as was suggested in one of Father Cekada's e-mail messages. Lifelong TPN, in contrast to tube feeds, is widely considered to be an extraordinary, burdensome, and expensive means of prolonging life, and are comparable to a respirator in that regard.

15) Terri Schiavo's doctors did, in my opinion, probably commit malpractice by failing to order routine pre- procedure labs which would have disclosed severe electrolyte disturbances secondary to her bulimia.

16) Medical malpractice care awards/settlements are often grossly overinflated due to plaintiff’s attorneys hiring so-called "life care planners" who add up every conceivable convenience and treatment imaginable as "necessary" for the rest of the patient's life. Their overestimates are typically further compounded by overestimating the patient's life expectancy. Furthermore, all the money is paid in advance at today's dollars, meaning the real money value of the award is much higher than the actual cost of such care in the vast majority of such cases. Terri Schiavo's true care needs would certainly be far less than $750,000 or $1,000,000 dollars.

17) Attorneys representing patients and defendants in medical malpractice and other medical matters often "shop around" for expert witnesses until they find experts who will give an opinion which suits their client's needs. Thus, it is no surprise that George Felos, a well-connected euthanasia advocate, was able to find three physicians to testify that Mrs. Schiavo was in a persistent vegetative state. In fairness, likewise it is no surprise that Terri Schiavo's parents and siblings' attorneys found expert witnesses who testified that she was not. One should certainly be suspect of the testimony of an expert witness who has spoken to the Hemlock Society and concludes that Terri Schiavo is in a persistent vegetative state.

18) Terri Schiavo died of dehydration, not starvation. Dehydration kills one much faster than starvation, barring the exception of extreme malnourishment, which was not the case here.

19) Terri Schiavo had an average life expectancy despite her brain injury, and would not have died were it not for her being deprived of nutrition and hydration. The proximate legal and medical cause of her death in my opinion was dehydration.

20) Laws regarding who has legal authority over health care decisions vary greatly by state. In Pennsylvania, for instance, children and siblings have as much right to make medical decisions as spouses, unless a pre-specified durable power of attorney designating one of them pre- exists the illness, or unless a living will was written by the patient. Other states require a durable power of attorney to be obtained no matter what. Ex- spouses, unless they are made durable power of attorney, have no legal right to make medical care decisions in any state.

21) Discontinuation of tube feeds or any form of food in general causes intense hunger pains for 2-3 days, which Terri Schiavo would have had the capacity to feel and suffer.

22) Death by dehydration occurs slowly, eventually causing hyperosmolarity often resulting in shriveling cracking and bleeding of the mucous membranes. This causes pain, nosebleeds, and as consciousness begins to wane, patients often begin aspirating blood from the nosebleeds, thickened, mucus or saliva, or both, causing aspiration pneumonitis. The aspiration along with accumulation of secreted organic acids results in progressive shortness of breath which further compounds the mucus membrane injury. Observing this struggling to breathe and choking is often very disconcerting to family members as well as potentially painful and discomforting to the patient. This is why such patients are often administered morphine, which both relieves pain and suppresses this so- called "air hunger." This is also I suspect why the judge in the Terri Schiavo case barred pictures or video of her being taken while she dehydrated and starved. Much as those who are pro- abortion most detest the one thing which actually shows people what happens in the case of abortion (pictures of aborted babies), euthanasia advocates do not want people to see the visible suffering which often occurs in cases like Terri Schiavo's.

23) Cases like Terri Schiavo's are, thankfully, rare. This is why when they occur and ultimately result in legal battles, we hear about them on the media Collectively, even if one were to assume each and every one of them were to result in a lifetime of tube feedings, would be far less of an economic burden on society than a new football stadium. Cases like Terri Schiavo's understandably evoke a wide range of emotional responses and theological arguments. Unfortunately, the Catholic Church, theologians, and bioethicists in general lag far behind in their scientific understanding of the rapid and increasingly complex advances in medical care, which often occur literally even prior to our ever having the opportunity to contemplate their moral and theological implications. It is in the spirit of attempting to help simplify and clarify some of the medical aspects of the Schiavo case that I share the above thoughts with those who are inclined to read them. Finally, I would advise each and every person to prepare a living will as you would a normal will so that your families might be spared the pain and anguish of having to decide what care measures you would want should a grave or terminal illness occur. Had Terri Schiavo done so, her family and many others would have been spared from the bitter, divisive, and expensive series of legal battles which followed, which were the real extraordinary burden to society in her case.

Respectfully,
James M. Gebel, Jr., M.D., M.S., F.A.H.A.
Reply




Users browsing this thread: 1 Guest(s)