Correspondence
Control freaks All praise to John Garvey: He always invites one to think, and his cogent insights regularly deny one's comforting clich6s. He has done it again in "The Seven McCaugheys"...
...In fact, DNR (Do Not Resuscitate) applies only to emergency CPR efforts after a cardiopulmonary arrest...
...Longtime Commonweal readers will recall that the journal has acknowledged and helped to expound Catholic teaching that recognizes a clear distinction between causing death and allowing death to happen...
...The writer replies: As one who claims no expertise in medical matters, I must apologize for the technical error in my reference to the "DNR directive...
...Whether debating euthanasia, assisted suicide, abortion, or any other attack on a life sanctified by God in Christ, we must not be deceived...
...Apparently, however, they failed to tell her that a proxy's first responsibility is not to make decisions based on what she thinks is good for the patient but to convey the patient's wishes whenever they are known...
...First, my mother, whom Devettere describes as "legally competent and cognitively intact," did not "repeatedly" refuse further tests...
...When someone says "ought to" but never follows through, a decision of sorts has already been made...
...Other types of advance directives address other issues, such as respirators and nutrition and hydration...
...14:12...
...It's true, of course, that it was once routine to continue treatment beyond all reason...
...These directives are based on ethical guidelines that have developed in response to the ability of modern medicine to keep patients alive for lengthy periods through the use of extraordinary means...
...My purpose was to describe the course of a health-care crisis on the basis of personal experience...
...He has done it again in "The Seven McCaugheys" [December 19, 1997] by exposing the links among fertility technology, genetic manipulation, the death penalty, abortion, and assisted suicide under the rubric of "control...
...A good intent i o n - t h e desire to save life--does not alone indicate a morally sound decision...
...Because it was my moral responsibility before God...
...Nevertheless, I can imagine other circumstances in which it would have been not merely pointless but destructive of my mother's human dignity to continue invasive technological procedures to preserve a semblance of life...
...A daughter promised, "Don't worry, Mom, they won't...
...We must also be mindful of the salvific power of accepted suffering...
...Given the circumstances of her crisis, even if my mother had insisted she wanted to die and had resisted the initiation of efforts to help her breathe, I would have fought to see her life preserved...
...There is a way that seems right to a man but in the end it leads to death" (Prov...
...Third, the crucial moral question is not whether our actions or omissions play a causal role in someone's death, but whether we have compelling reasons for pursuing actions or omissions when we know death may or will result...
...From that perspective, I am qualified to respond to at least some of Mr...
...Finally, I will add that the "no hope of recovery" theory (Continued on page 29) Commonweal 4" January 30, 1998 gORRESPONDENCI (Continued from page 4) is patently false...
...Goerner's manuscript...
...As this exchange exemplifies, however, applying these guidelines is no simple matter...
...once in a twomonth period hardly constitutes insistence...
...That was not the case in the episode I described, which I believe Mr...
...As should now be clear, Ms...
...First, declining CPR is ultimately a decision for a capable patient, not family, to make...
...No law, no man-made situational ethics can change that...
...Am I my mother's keeper...
...Commonweal 2 9 January 30, 1998...
...When the patient became temporarily confused, physicians appropriately asked her daughter to act as her proxy...
...My mother did not sign the advance directives when her lawyer offered the option...
...No other treatments are affected...
...As a hospice volunteer I have kept watch at the bedsides of several trusted friends...
...For both the living and the dying, obedient perseverance to the end can be a transforming experience (Rom...
...What 'DNR' means The article "You Do Understand about DNR...
...Yes, I am...
...Nor was a woman frightened, disoriented, and oxygen-deprived likely to qualify as "cognitively intact...
...The writer is the author of Practical Decision Making in Health Care Ethics: Cases and Concepts (Georgetown University Press...
...5: 3-4...
...LESLIE GOERNER From the editors: We regret that we failed to note and correct the erroneous description of the "DNR" directive in Ms...
...Devettere, then, I would grant that physical survival is not the highest of all values, while adding that any Christian hierarchy of values must respect and incorporate the Word of God, and therefore the many scriptural injunctions to choose life over death...
...A legally competent and cognitively intact woman stated repeatedly: "No more tests...
...Devettere's concerns...
...While no one not present can make judgments about decisions in a particular story, as long as patients have not lost the capacity to understand the important aspects of their condition and their medical options, and have made their wishes clear, virtue will normally lie in efforts to inform, explain, discuss, recommend, encourage, argue, but never to coerce and to force...
...ROBERT OSTERMANN Tempe, Ariz...
...The author worries that she might have caused her mother's death if she had consented to a DNR order...
...Moral evaluation in this kind of story hinges on whether imposing invasive interventions on a patient when "medical specialists and staff continued to offer no hope of recovery" and the patient herself did not want them is morally reasonable...
...My experience and my reading suggest that the pendulum has now swung in the other direction, so that in serious crises some medical personnel are all too ready to get things over with, and to feel that they've done the right and ethical thing...
...Devettere has misread...
...Goerner was referring to advance directives that authorize withholding or withdrawal of treatment in certain circumstances...
...With Mr...
...Next, it is difficult to comprehend how one human being can make profound life decisions for another on the basis of perceived "wishes...
...This is a terrible worry but morally needless for three reasons...
...Supreme Court decision in Quill v. Vacco have made clear...
...Human freedom is a dangerous reality because sometimes people make poor choices, even about life itself...
...she did not sign when the hospital admissions office gave her the required form...
...Day by day, electronic and print advertising document the melancholy American obsession with controlling/suppressing every random, discomfiting, painful feature of being alive...
...But the Gospels never depict Christ forcing people to accept his way of gaining eternal life: an example families and physicians might consider before forcing anyone to accept their ways of prolonging mortal life...
...The bathroom medicine cabinet tells a similar story, with less effort...
...Yet physicians, with the daughter's permission, continued the invasive tests for weeks...
...It doesn't account for human error or the will of God...
...To suggest that any moral responsibility toward someone else is founded on that person's view of what is right rather than on what God commands in Scripture is to deny the Lord's sovereignty over the life he created...
...November 21, 1997] misrepresents DNR and presents several morally troublesome moves in the medical care of the author's mother...
...As Devettere recognizes, the main issue in this discussion is morality...
...Even after enduring the ordeal I described, my mother never signed such a document...
...One wonders what legal or moral reasons supported the invasion of her body against her wishes...
...We read that a "DNR document" directs caregivers to take no heroic measures, including use of a respirator, and can mandate withdrawal of nutrition and hydration...
...Neither does a happy ending...
...Second, declining CPR and other burdensome tests and treatments is best not conceived as causing death, something the Vatican Declaration on Euthanasia, the AMA Code of Medical Ethics, and the recent U.S...
...poor moral decisions sometimes have good outcomes and good moral decisions sometimes have bad outcomes...
...It's too bad limited space prevented his pointing out how widely the cult of control has extended its power over the American (and Catholic) psyche in matters less mortal but scarcely less destructive...
...RAYMOND J. DEVETFERE Boston, Mass...
...Yet the medical staff made many attempts to convince me that I should sign on her behalf...
Vol. 125 • January 1998 • No. 2
