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About Medicine & Morality
"Pulling the Plug"
conference confronts end-of-life issues
Bill Moyers's five-part documentary series on dying, "On Our Own Terms", made its public television debut on Sunday, September 10, 2000. The series includes episodes urging acceptance of looser assisted suicide laws as an expression of "love". The viewing audience is expected to be large. The matter of when to "pull the plug" is of great concern to many people -- and with good reason.
Just the day before the Moyers show, more than 200 people participated in a St. Louis conference on end-of-life issues, called -- yes -- "Pulling the Plug". Those attending included doctors, lawyers, nurses and others eager to educate themselves about the ramifying issues in end-of-life.
The September 9 conference was co-sponsored by Missouri Nurses for Life, Lawyers for Life, Missouri Right to Life, Missouri Doctors for Life, Women for Faith & Family, and the St. Louis University School of Nursing, and was held at St. Louis University High School. Some participants received continuing education credit from co-sponsoring institutions.
Nancy Valko, President of Missouri Nurses for Life and one of the conference organizers, has been an outspoken and articulate commentator on issues of euthanasia and care of the seriously ill. Her most recent editorial in the St. Louis Post-Dispatch, "Do Hospitals Give Up on Severely Impaired Patients too Soon?". concerns Stephen Becker, a 27-year-old patient at St. John's Mercy Hospital in St. Louis who had been diagnosed as in a "persistent vegetative state" (PVS). Pro-lifers have charged that basic care is being denied him, including routine antibiotics and even such basic care as washing. Responding to Valko in the same issue was Dominican Father Kevin O'Rourke, a prominent St. Louis bio-ethicist, former director of the Center for Health Care Ethics at St. Louis University, and a persistent defender of removing food and fluids from so-called PVS ("persistent vegetative state") patients.
On June 30, St. Louis Archbishop Justin Rigali issued a "Statement of Principles for Health Care Decisions Concerning Assisted Nutrition and Hydration and Related Issues" reiterating the Church's constant teaching that artificial nutrition and hydration (ANH) should never be denied to terminal patients in order to hasten death.
Conference sessions focus the issues
Wesley Smith, a lawyer for the International Anti-Euthanasia Task Force based in Steubenville, Ohio, and long-time advocate for the disabled and at-risk, was the first speaker at Saturday's conference. His topic was "Creating a Caste of Disposable People". Mr. Smith is also the author of a book on assisted suicide, Forced Exit: The Slippery Slope from Assisted Suicide to Legalized Murder. His most recent book is entitled The Culture of Death: The Destruction of Medical Ethics in America.
Jean Brontoli, R.N., Director of Medical Oncology at SSM-St. Mary's Health Center in St. Louis, spoke about pain management (a topic treated at length in the Moyers special). Most observers agree that doctors are undertrained in pain management techniques. Pro-lifers have long argued that better pain management would reduce anxiety among dying patients, and the perceived need for assisted suicide.
Eugene Diamond, M.D., well known to pro-life audiences and the author of five books and more than 200 articles, spoke on food and drink issues for the terminally ill.
Father Edouard Richard, Associate Dean of Academics and Assistant Professor of Moral Theology at Kenrick Seminary in St. Louis, illuminated the issues surrounding so-called "advance directives" and durable power of attorney. In his view, giving a person you can trust your durable power of attorney is more important than whatever your advance directive says.
Nancy Valko concurs, saying that many hospitals have a form with a box to check off for "advance directive". If the box is checked "yes," hospital personnel often assume that means the patients desires less-aggressive care. The document itself will often not be read.
In her address, Mrs. Valko stressed that end-of-life issues go far beyond those that the public commonly associates with assisted suicide and "patient's choice". As an example, she points to the growing practice of hospitals issuing "futility guidelines" that may supersede the wishes of caregivers. The Texas legislature gave legal status to futility guidelines last year. Mrs. Valko worries that the end-of-life care that was once universally regarded as standard practice has now become a privilege, doled out according to ever-shifting guidelines formulated by "God committees" whose members are often secret.
Marcia Buterin, a nurse, pro-life veteran and chairman of the conference committee, remarked that many of the participants had their eyes opened by the talks. "Everything seemed to come together", she said.
Both Marcia Buterin and Nancy Valko are longtime members of Women for Faith & Family in St. Louis. Mrs. Valko is a regular columnist on bioethics issues for WFF's quarterly Voices, as well as for this monthly online journal.
-- David Aaron Murray
