Faith, ethics help many in agonizing dilemma
Bill Gothmann listened quietly last week when a fellow member of Sunrise Church of Christ stood in front of the congregation and called Michael Schiavo a “snake.”
He’s heard politicians and pundits make stronger remarks in recent weeks, labeling the husband of the brain-damaged Florida woman Terri Schiavo a “murderer.” No matter what the name, Gothmann has the same reaction each time: The words feel like a knife stabbing his heart.
“I guess I take it personally,” the Spokane Valley resident said. “If he’s killing his wife, I guess I killed my mother. That hurts to be labeled a killer.”
Last summer, Gothmann declined when the staff caring for his mother, Donna “June” Horton, asked if he wanted a feeding tube inserted to prolong her life. More than 20 years ago, Horton had told paramedics not to revive her husband as his battle with cancer ended. A few years later, she regretted having a feeding tube inserted in her own mother, who spent the rest of her life curled up in a ball on her bed.
Although Alzheimer’s disease had crippled Horton’s ability to talk with her son, those experiences convinced Gothmann he was honoring his mother’s wishes.
While the national spotlight is illuminating the Schiavo family’s end-of-life decisions in the East, Inland Northwest families, like Gothmann’s, quietly cope with similar ethical dilemmas closer to home. Ethicists, caregivers and many others are wrestling with the heart-wrenching questions: When is it morally acceptable to end a life? Who has the right to decide?
Diane Hermanson, Hospice of Spokane’s director of social services, said a few times each week her organization works with a family that’s considering whether to remove a feeding tube.
“There comes a point when hydration and nutrition becomes more of a discomfort” because of a body’s inability to eliminate it, she said.
The body goes through stages when nutrients and fluids are removed. Within three or four days, a patient’s mouth begins to dry. Then breathing becomes irregular, and during the final days, the kidneys start to fail, toxins build up in the body and organ systems shut down.
Hermanson said that as a patient’s life fades once a tube is removed, “Our experience is it is not uncomfortable; it is not painful.”
Gothmann’s experience with his mother would indicate the same. In her final days, his mother would whimper and moan when she was moved because her bones were deteriorating, but she never made those sounds of pain otherwise, as her organs failed, he said.
At Hospice of Spokane, when a patient dies after a tube is removed, the cause of death isn’t starvation, Hermanson said.
“The cause of death is the (disease) that robs the body of the ability to sustain life,” she said.
Respecting life and death
Yet the debate is more complicated than semantics. There’s disagreement over Schiavo’s condition and whether she is truly “brain dead” – as well as whether that even matters.
For J. Michael Stebbins, director of the Gonzaga Institute of Ethics, how we treat Schiavo reflects the value we place on human life.
“I don’t want human beings to take each other’s lives, even in the name of humanity,” he said.
Refusing to feed a person isn’t respecting that individual’s dignity, said Stebbins, who worked as a registered nurse on the Advanced Care Unit at Children’s Hospital in Seattle before becoming a theologian.
“This is a person who isn’t dying, as far as we can tell,” he said. “Why is she still here? I don’t know. But I’m not going to take away her food and water.”
A human life also shouldn’t have certain characteristics for it to have value, he said. And the value of that life should also never be calculated by the cost of medical care or how long a person has lived. It wouldn’t matter if Schiavo were 80 years old, he said.
“The dignity of a human person is an absolute – it doesn’t increase or diminish depending on the quality of a person’s life or the length of life,” he said. “You enjoy the same dignity.”
Schiavo’s life is still meaningful, not only for her family, but for those who care for her and the rest of us, he said.
“There’s more mystery to the meaning of human life than many people acknowledge,” Stebbins said. “We respect that mystery. We can’t always offer a complete explanation. … It just makes us better people to care for others that way.”
To Spokane psychologist Rob Neils, respecting someone’s life also means respecting their right to die.
“Aren’t you playing God when you pull the plug? No, you’re playing God when you put it in,” he said.
Neils founded the local chapter of the Final Exit Network, a right-to-die organization formerly called the Hemlock Society of Eastern Washington State. At chapter meetings, the group teaches how to write advanced directives – documents that say how you want to be treated if you’re unable to make your wishes known – and how to “hasten death,” or commit suicide in a way that causes the least pain for the person dying as well as to those he or she leaves behind.
A terminally ill person doesn’t choose whether they’re going to die but should be able to determine how they’ll die, he said. He compared that way of thinking to the choice made by the people who jumped off the World Trade Center after the Sept. 11, 2001, terrorist attacks set the twin towers ablaze.
Neils is upset with President Bush and Congress for passing a measure Monday that allowed a federal review of the Schiavo case. He thinks conservative Christian politicians pushed their religious beliefs into the law and into the private matters of one family.
“George Bush fights fundamentalism (in the Middle East) without realizing he’s doing the same thing here,” Neils said.
Even more atrocious, he said, was that Democrats didn’t fight harder – and in some cases didn’t even vote – to stop the legislation.
Hospice of Spokane opposes assisted suicide. To work in hospice care is “to be able to listen to someone’s despair and not want to jump in and fix it for them or discount it, none of which are particularly helpful,” Hermanson said.
Bill Gothmann also opposes assisted suicide. To him, it is an “artificial shortening of life.” In his mother’s situation, he feels his family “turned her case over to God.”
A matter of faith
Gothmann, who attends church twice every Sunday, thinks his views on the Schiavo case are the minority opinion at his congregation. But he doesn’t feel his beliefs are in opposition to his faith.
“I draw from my faith. I don’t try to suppress it,” Gothmann said.
Maureen Kirby draws from her faith, too, but it leads her to a different conclusion.
A registered nurse, a mother of four and a devout Roman Catholic, the Spokane woman doesn’t understand why anyone would deprive another human being of food and water.
“Starvation is an agonizing death,” she said, her voice filled with sadness and frustration. “They have chosen to kill an innocent human being in such a brutal fashion.”
A year ago, Pope John Paul II affirmed the teachings of the Catholic Church: Providing food and water to a patient in a “vegetative” state is a moral obligation – even if nourishment is administered through artificial means.
But opinions vary among Catholics, as they vary among people of other denominations and religious beliefs. Some have argued that because Schiavo cannot feed herself, then a feeding tube is indeed an “extraordinary means” to keep her alive since it only prolongs her inevitable death.
For the Rev. Darrin Connall, a priest with the Diocese of Spokane, there is something “gravely disturbing” about taking food and water away from someone who is able to survive without being hooked up to a respirator or any other machine.
“If we’re going to make a mistake, we should always err on the side of human life,” said Connall, rector of Bishop White Seminary.
Given the complexity of Schiavo’s case, many national religious organizations have provided resources for their congregations as they debate end-of-life issues.
The Rev. Scott Starbuck, pastor of Manito Presbyterian Church, has provided spiritual guidance to parishioners working on living wills, funeral plans and other decisions that will inevitably affect their families when they die.
“We can never really know if we’re doing the right thing,” said Starbuck, who focuses on pastoral care. “How we make the decisions is more important, even though these are gut-wrenching, life-changing, awful decisions. … I hate to see families torn up over this.”
Gothmann acknowledged the difficult nature of such decisions and said he empathizes with both sides of Terri Schiavo’s family.
But his support for her right to die comes from his understanding of what death is, he said.
“Americans have come to think of death as an absolute total tragedy. It’s a passage from one place to another,” Gothmann said. “It’s a terrible time to go through, but it is not a tragedy.”
He added, “If I were to die today, and I’m ready to die, I would know the grief it would bring to my family. Yet, at same time, they can rejoice and know that I’m back home with my Holy Father.”