ARTICLES

End of Life at Mercy Hospital

Would Terri Schiavo Have Fared Better at San Diego's Catholic Hospital?

BY STANFORD ESPEDAL

In the wake of Terri Schiavo's court-ordered death by starvation and dehydration, questions have been raised about the policies of health care facilities on "termination of life." In particular, are Catholic medical centers, such as San Diego's Scripps Mercy Hospital committed to a defense of individual lives, which would have made a difference for the late Terri Schiavo?

In an attempt to answer this question I contacted Mercy board member Dan Mulvihill. He returned my call but referred me to Sister Josiel Young, stating that she would be able to answer my questions. Sister Josiel returned my call and explained that any request for an interview with her would have to be authorized by Ty Kennon, director of marketing and communications for Scripps-Mercy. Kennon did not grant an interview or arrange an interview with any staff members as I had requested but did supply written answers to a few preliminary questions.

What are Scripps' policies on "termination of life? We'd like a complete outline, please.

We do not euthanize patients. In conjunction with the Ethical and Religious Directives for Catholic Health Care Services (published by the United States Conference of Catholic Bishops, Washington, D.C.), Scripps Mercy Hospital's policy is "to respect the rights of patients or their surrogate decision makers to make informed decisions, with the assistance of their physicians, regarding the withholding or withdrawal of life-sustaining medical treatment." (Refer to the Directives section, pp. 30-32 of the Ethical and Religious Directives for Catholic Health Care Services). In some instances we discontinue medical treatment (such as ventilation, pressors, feeding tubes and hydration) when it is determined by physicians (who are treating the patient) and in agreement with the decision maker (i.e., the spouse, adult children of the patient and siblings) that there is not a realistic chance of providing an effect that the patient would ever have the capacity to appreciate as a benefit or that requires significant pain, suffering, harm or burden to occur to the patient with no realistic chance of benefit. We never compromise a patient's dignity in these instances. They are always treated with respect, and their comfort is the goal.

What allowance does Scripps make for distinctly Catholic ethical guidelines at Scripps Mercy Hospital as a Catholic facility?

When needed, an addendum strictly for Scripps Mercy Hospital can be placed within any Scripps policy.

Does Scripps Mercy Hospital put Catholic Church norms above any contrary Scripps policies? Or does Scripps Mercy follow Scripps' guidelines totally?

The contract with Scripps Health clearly states that Scripps Mercy Hospital will always maintain its Catholic identity, thus necessitating that we would follow the Catholic Church's directives (i.e., Ethical and Religious Directives for Catholic Health Services).

If Terri Schiavo had been at Mercy would hospital authorities have heroically resisted ending her life? Or permitted her starvation in obedience to her husband and a judge?

Within the Catholic tradition, decisions about forgoing life-sustaining treatment are made by assessing the potential burdens of the treatment in proportion to hoped-for benefits relative to the patient's condition and from the patient's perspective. In the matter of medically administered nutrition and hydration, Directive 58 of the Ethical and Religious Directives for Catholic Health Care Services calls for a presumption in favor of their use. However, as Cardinal William H. Keeler, chairman of the United States Conference of Catholic Bishops' Committee for Pro-Life Activities, recently stated, and as stipulated in the Directives, "there are times when even such basic means may cease to be morally obligatory, because they have become useless or unduly burdensome for the patient." Removing them, however, with the intent to cause the patient's death, is always morally unacceptable.

Mrs. Schiavo's situation also underscores the importance of completing written advance directives, even given their limitations, and a durable power of attorney for health care. Our prayers go out to Mrs. Schiavo's family and loved ones through this difficult time.

What provision does Scripps Mercy Hospital make for a priest to visit the dying? Is the effort made in all cases or only upon specific request?

For all patients — not only those who are dying. Every effort is made to have a chaplain visit the patient shortly after their admission. If the patient is Catholic, then arrangements would be made for a priest to visit the patient.

TOP