Tuesday, April 24, 2007

Bishop Aymond's Scandal: Baby Emilio

Bishop Gregory Aymond of the Diocese of Austin is creating a scandal by publicly siding with doctors to pull the plug on baby Emilio Gonzales’s ventilator. I’ll briefly go over what has led up to this scandalous stance by Bishop Aymond. Baby Emilio is disabled, suffering from Leigh’s Disease, and will eventually die from it. Currently he is in a coma like state due to the overwhelming amount of drugs that are being used for his symptoms. He wakes up from time to time and can acknowledge his mother, Catarina Gonzales. Baby Gonzales is 17 months old and is currently in intensive care at Austin Children’s Hospital. Leigh's disease is a rare disorder that affects the central nervous system. Unfortunately there is a notorious state law called the Texas-Futile Law concerning those close to death that are only alive due to life support. This Texas law allows the ethics committee at the hospital to pull the plug off life support if the sickly child receives no benefit from such care. The family can be given ten (10) days notice to find another hospital that will accept said child. After that period of time, the hospital can then pull the plug if the child hasn’t been found another hospital to be cared in. Last week Monday a judge postponed a court hearing that would determine whether or not to pull the plug. The hearing will reconvene on May 8. That is where the baby Emilio drama stands. That is until Bishop Gregory Aymond jumped into the fray by publicly stating:
“We have to look at the reality and the ethical dimension and the Catholic moral dimension to the situation,”
Good enough, so we now know that Bishop Aymond so far agrees with Catholic teaching that states (CCC
2276) Those whose lives are diminished or weakened deserve special respect. Sick or handicapped persons should be helped to lead lives as normal as possible. But then Bishop Aymond makes the mistake of publicly making a stand with the ethics committee that creates this scandal by making the following statement:
…while his heart goes out to Emilio’s mother and the difficult decision she’s faced with, he says he believes the Pediatric Ethics Committee at Children’s Hospital has made the right decision to remove Emilio from life support.
Let’s not mince words here; Bishop Aymond said “he believes the Pediatric Ethics Committee at Children’s Hospital has made the right decision to remove Emilio from life support.” Incredible. Though after reading the Catechism of the Catholic Church carefully it seems that Bishop Aymond falls within Catholic teaching, but due to his public stance, has created a scandal because of such a controversial and sensitive subject. According to the Catechism of the Catholic Church (2268) The fifth commandment forbids direct and intentional killing as gravely sinful. The murderer and those who cooperate voluntarily in murder commit a sin that cries out to heaven for vengeance.(Gen 4:10) “…that cries out to heaven for vengeance.” Vengeance is His. Bishop Aymond, assuming he is within Catholic teaching, is treading a very difficult position here. If he is wrong, vengeance is His. Is this morally imputable? Does this exonerate Bishop Aymond? Let’s see what the Catechism says, (2268 cont.) unintentional killing is not morally imputable. But one is not exonerated from grave offense if, without proportionate reasons, he has acted in a way that brings about someones death, even without the intention to do so. Bishop Aymond defends his actions by saying:
“The Catholic Church would teach if there is no possibility of recovery, that extraordinary means can be withdrawn, and it’s not taking the life of a person, but simply allowing them to die naturally and with dignity,”
I beg to differ, the Catechism states (2269) The fifth commandment forbids doing anything with the intention of indirectly bringing about a person's death. The moral law prohibits exposing someone to mortal danger without grave reason, as well as refusing assistance to a person in danger. Baby Emilio's mother represents my own, "shock".
Bishop Aymond says he’s based his moral and ethical decision on the medical reports and consulted with theologians across the world.
Houston's own Dr. Joseph Graham of the University of St. Thomas objects:
“Baby Emilio is not dying in any immediate sense. He will continue to live if he is kept on the ventilator. It is the constant teaching of the Catholic Church that parent[s] have primary responsibility for the welfare of their children – not hospital administrators.”
One more thing, Bishop Aymond pretty much violates the 5th Commandment, 'You shall not kill', if the attempts at saving baby Emilio are ordinary instead of extraordinary circumstances*. I can only assume that Bishop Aymond views the procedures that are prolonging baby Emilio's young life as extraordinary instead of ordinary. To read the article that my posting is commenting on click here. To read about the Catechism of the Catholic Church click here. (Hat Tip: Catholic Report) *[see CCC 2278: Discontinuing medical procedures that are burdensome, dangerous, extraordinary, or disproportionate to the expected outcome can be legitimate; it is the refusal of "over-zealous" treatment. Here one does not will to cause death; one's inability to impede it is merely accepted. The decisions should be made by the patient if he is competent and able or, if not, by those legally entitled to act for the patient, whose reasonable will and legitimate interests must always be respected. (emphasis mine)]

18 comments:

Darwin said...

Though I live just outside of Austin, I don't necessarily hear a lot of local news (I can't stand the Austin American Statesman, so I don't subscribe) so this is actually the first I've heard of this.

The big problem here, I think, is the law that allows hospital ethics committees to make decisions which should be in the hands of patients or their guardians. In that sense, this is clearly tragic, appauling and wrong. Don't get me wrong there.

However, there's also the moral question of whether, if the right person was making the decision, it would be moral to remove Baby Emilio from life support. Before flinging the catechism at Bishop Aymond, it's probably best to look at things a little more calmly.

Paragraphs 2268 and 2269 of the catechism, which you quote, are dealing with the question of someone who by act or ommision participates in the killing of someone.

However, while it's clearly taught that either performing an act or witholding an act or ordinary care which thus results in the death of a person is considered murder, it's also the case that the Church teaches that the faithful are not required to undergo "exraordinary" measures to prolong or preserve life.

From all the reading I did at the time of Teri Shaivo's murder, I seem to recall that while the Church considers the administration of food and water (even via a feeding tube) to be "ordinary means" it considers the use of a ventilator to be "extraordinary means". Thus, one is not morally required to use, remain on, or keep someone on a ventilator.

Recall that although John Paul the Great used a feeding tube during his final days on this earth, there were several other medical procedures (that would probably have extended his life for some short period of time) which he chose to forgo as extraordinary.

So from what I understand, while it's clearly wrong for the ethics committee to be forcing this on the parents (who should instead be the decision makers about their child) I do not believe that Bishop Aymond is speaking contrary to Catholic doctrine.

I guess I'm a little hesitant to jump to that conclusion, as well, because in the four years I've been in his diocese everything I've seen and heard of Aymond has been fairly solid. If he is a "heterodoxical bishop", it would be the first I'd seen or heard of it.

Tito said...

Darwin,

I too came across that particular CCC passage explaining ordinary and extraordinary. I will admit that I am not 'certain' what falls under which. So I was careful to describe the Bishop's 'actions' as wrong, but tried not to demean the bishop himself since he is a servant of Christ. I did proofread several times ommiting anything that would impuge his character, but I missed that 'heterodox' accusation.

What you said does give the bishop an 'out'. Though I don't believe the comments of his were directed towards the difference between ordinary or extraordinary, but I'm sure if he did state that, it would have been lost on this particular 'secular' reporter; not understanding the finer points of Catholic teaching.

For the record, I will omit the 'heterodox' accusation since I don't believe in such a call at this moment since I too just came across this particular article yesterday on Catholic Report.

Thanks for your input, I learn a lot from these many constructive debates!

God bless,

Tito

As concerns "extraordinary" vs "ordinary"...

Take the aforementioned ventilator as an example. The ventilator is sometimes "ordinary," when the individual needs help breathing during some traumatic experience, until they have recovered enough to do it on their own. It's sometimes "extraordinary," when the individual no longer has any hope of breathing on his/her own. Therefore, it's sometimes permissible to pull the plug, sometimes not.

I'm no moral theologian outside of a couple classes (with more to come), but you can see how this complicates things and possibly exonerates Bishop Aymond. The baby's death is immanent; the drugs will not save the child's life, and he will die without them. If the drugs acted as a kind of temporary ventilator, buying him time to recover, then everyone involved would be ethically obliged to provide treatment, since to do otherwise would be the same as choosing for the child to die. That isn't the case here, though, since nature already chose.

It's still a tragedy and an injustice in my opinion, because it seems to me that ultimately the parents should have the final say as to what treatment their child receives.

Here's a quick article that gives some of the basics on this contemporary issue in light of Terri Schiavo's case, on a Catholic ethicist.

"Kelly writes: “To claim that treatment can be morally extraordinary only when the person’s death is imminent, regardless of whether the treatment is given, is to give biological life itself an absolute value that supercedes all other values.”"

Darwin said...

It sounds like the ordinary/extraordinary issue is what Bishop Aymond is talking about when he said "The Catholic Church would teach if there is no possibility of recovery, that extraordinary means can be withdrawn, and it’s not taking the life of a person, but simply allowing them to die naturally and with dignity"

To that extent, I don't think that I differ with him at all.

The troublesome quote seems to be something the reporter summarizes as "he believes the Pediatric Ethics Committee at Children’s Hospital has made the right decision to remove Emilio from life support." (I'd be curious to see more of the original article here -- do you have a link that I missed?)

From what I understand, it does seem to me like the actual decision that they reached may be the right decision. The problem is that they have no business making the decision in the first place.

It seems that the injustice here is not in what is being done but in who is making and forcing a decision which is not theirs to make.

I guess I can't help wondering if the reporter is trying to enlight Aymond in support of that, when his actual response had to do with the former.

Tito said...

Darwin,

I tend to agree that is how the decision by Bishop Aymond was made upon. (here's the link)

http://www.kvue.com/news/local/stories/041907kvueemilio-bkm.26766bcb.html

Though, assuming that is correct of our assumption about Bishop Aymond concerning extraordinary instead of ordinary (which can be legitametely debated), why did Bishop Aymond come out so publicly on such a volatile issue?

Tito said...

I've updated my original posting to state that it is Bishop Aymond's 'public' stance that is creating the scandal. Not his interpretation of Catholic teaching, though that door is still open depending on whether baby Emilio is using extraordinary means instead of ordinary means for survival- which IS debateable.

What I find scandalous is the public pronouncements that Bishop Aymond has taken.

Bishop Aymond ahould be defrocked. He has been totally taken over by the politically correct memes, and now he faithfully believes any non-sense coming from them. The poor guy probably thinks that he is very "modern" and does not want to be left behind with the new "fashion".
He has abandoned Catholic teachings and now preaches the culture of death. Shame on him.
Everyone should write to the Pope to complain about this character.

Rolando Bini
http://www.parentsinaction.net

woundedpig said...

I have trouble believing how individuals can indict Bishop Aymond on his statement on Emilio's case.
In Catholic teaching, the focus in end of life decisions is not just the intervention itself, but the circumstances.

A breathing tube and respirator employed to maintain a heartbeat in a terminally ill baby with an irreversible, untreatable disease is the kind of extraordinary care and disproportionate application of medical intervention that is not supported by the Catholic tradition. Feeding, hydration, and pain/syptom relief are being continued. These are ordinary and proportionate interventions. Removing the breathing tube in this instance to allow a peaceful death would not constitute euthanasia. Continuing intensive care support until the heart rate control mechanisms unravel and the heart stops constitutes prolonging death.

Bishop Aymond's reputation and track record are that of a conservative Catholic. He was involved from early on in this case and made his position known after learning and understanding the facts fully.

Adding the Bishop to the list of all the Children's Hospital's nurses and doctors involved in Emilio's care who you indicate are conspiring to deny care to Emilio and harm him is an incredible accusation. Does this really pass the "smell test" to you?

You have only read the "facts" as presented by Jerri Ward, the lawyer. Therefore you do not know all the facts or the truth.

woundedpig said...

The following information is available to you on the web, mostly from a two page clinical summary that Ms Gonzales’ attorney released to the media and blogs (a huge transgression in terms of confidentiality), but also from interviews of physicians and other spokespersons.  There is an obvious incongruity between the mother's story about how Emilio responds to her, grasps her hand, turns his head to her voice, opens his eyes and looks at her, compared with the history that the child has been blind and deaf since birth, prior to the more precipitous degeneration of almost all his cortical structures and brainstem function over the last few months. He is 99.5 % brain dead, has exhibited no higher brain function since late January, and has had absent cough, gag, corneals, dolls eye reflexes since late Jan 2007. Abbreviated apnea tests show no respiratory effort for two minutes. His only response to pain is a faint grimace and slight truncal arching. He has neurogenic bladder requiring catheterizations, and requires considerable invasive efforts to treat severe constipation.
His lungs have shown a tendency to collapse repeatedly, even with a cuffed endotracheal tube in place and management in a critical care setting, making tracheostomy and a chronic respiratory/nursing home environment very problematic.  The respiratory therapy maneuvers required to manage his pulmonary issues are quite vigorous and invasive. This mother and family are incapable of caring for him in a home ventilation environment, even if it were medically possible. Yes, the baby could be subjected to a tracheostomy and G-tube, knowing that these procedures would cause suffering and lead to a more rapid and sudden demise due to worsening respiratory complications.

The emotional and psychological toll on the hospital staff must be huge. People who willingly take care of critically ill children are special individuals, and in my experience, do their utmost to save every child that they possibly can, pulling out all the stops. In a way, they are now being forced into the role of the abuser, parsing their feelings about the interventions and procedures they are forced to employ (in the setting of hopelessness, and prolongation of death) with their more natural and chosen roles as caregiver/advocate.

It should be apparent that Emilio is no Schiavo or Christopher Reeve. Schiavo’s case involved a patient who did not have a terminal disease, had modest care requirements, and had a true, but severe disability. She was fed with a feeding tube. The Schiavo case = euthanasia to me. Emilio is dying from a rapidly evolving, fatal disease without any treatment possibilities, even experimental. Emilio’s brain has been destroyed. He is a beating-heart preparation. Saying he is “disabled” is like saying a 767 airliner full of fuel crashing into a mountain is a “malfunction.” The careproviders are being forced to witness the painful, inexorable march of the natural history of this fatal incurable disease.
The cases of individuals such as Christopher Reeve are not relevant to this case at all- the need for mechanical ventilaton due to spinal cord disease or a primary muscle disease is entirely different from requiring a respirator because of lack of cortical and brainstem function. Mr. Reeve was never asked to give up his ventilator because he was neurologically impaired- he had completely normal and full cognitive function and was making his own choices.

People need to stop referring to 6+ years of life expectancy for Emilio- babies with genetic neurodegenerative diseases that present fulminantly in infancy die much earlier in life. Emilio’s disease trajectory has been rapidly progressive and destructive. (see http://www.wesleyjsmith.com/blog/2007/04/baby-emilio-hearing-postponed.html). Dr Doody’s perseveration about word definitions (dead vs dying) is truly pathetic. If you were out walking and a three ton meteor struck you, it would make no sense to argue whether the outcome could have been different if the meteor were iron core vs a ball of ice. Emilio’s diseae is like that meteor. Dr Doody has taken it upon himself to redefine the Catholic Church’s position of end of life care.

For those interested in the truth vs fabrications, there are several sources of information on the church’s position, expanding on the brief description in the Cathechism.
See the National Catholic Bioethics Center at http://www.ncbcenter.org. and The Center for Bioethics & Human Dignity (a Christian bioethicis site) at http://www.cbhd.org/. See   http://www.ewtn.com/expert/answers/end_of_life_decisions.htm also.

A breathing tube and respirator employed to maintaini a heartbeat in a terminally ill baby with an irreversible, untreatable disease is the kind of extraordinary care and disproportionate application of medical intervention that is not supported by the Catholic tradition. Feeding, hydration, and pain/syptom relief are being continued. These are ordinary and proportionate interventions. Removing the breathing tube in this instance to allow a peaceful death would not constitute euthanasia. Continuing intensive care support until the heart rate control mechanisms unravel and the heart stops constitutes prolonging death.
 
The Texas futility statute requires the hospital to assist the family in finding physician(s) and an institution willing to care for the patient after an ethics committee has determined the care of the patient to be futile.  The statute requires ten days for this process, but the actual timeline actually allows about 16-17 days for the purpose of locating alternative care. If you had looked at information available on the web, you would have seen that the physicians caring for Emilio obtained three separate "second opinions" from other prominent Children's Hospitals regarding his diagnosis, treatment, and prognosis prior to the first Ethics Committee meeting. All concurred with the medical decision making and agreed that care was futile. The hospital started the process of trying to locate a willing receiving institution in mid February and contacted ≥ 30 different Children's Hospitals, all declining to accept Emilio on medical grounds. The futility statute has been rarely utilized in cases involving infants and children in Texas- I know of only 2-3.
 
Harsh comments about funding status and the medical/ethical stance of the hospital have been cruel, uninformed, and misguided. Ironically, the financial burden to the hospital would be relieved by preparing the baby for chronic care and then sending him home to his inevitable and rapid demise. But, their decisions are obviously not driven by financial considerations.  Children's Hospital of Austin is part of a not-for-profit Catholic health care network, whose guiding principles came from the Daughters of Charity order, which began in France in the 1600's with the first organized hospitals in existence. They take care of all patients, regardless of their ability to pay.
In response to questions by local media regarding the actual cost of providing care to Emilio since late Dec 2006, the estimate was > $1.5 million. Over half of the patients in most pediatric ICU’s have no insurance coverage. Children's Hospital of Austin coordinates and participates in medical missions to third world countries to provide care, including basic medical care as well as surgical procedures. A foundation was set up to bring in patients from all over the world to correct congenital heart defects in patients who would otherwise die in infancy and early childhood.
 
The current environment of consumerism, egocentrism, and focus on personal rights vs personal/parental duty and responsibility has led to the trumping of the integrity and moral/ethical foundations of medicine by the autonomy of the patient/family. I need no lecture about the moral/ethical problems of the paternalistic era of health care.  I trained during those times and witnessed decisions allowing patients with trisomy 21/duodenal atresia, and myelomeningocele to die. I saw many children with chromosomal defects die of Eisenmenger's syndrome following decisions to withhold corrective heart surgery. If parental autonomy always prevailed, we would be in trouble. A number of times I have experienced the situation in which a parent has asked/demanded that care be withdrawn when no physician or consultant involved in the case felt that this was appropriate.
It might interest you to know that the largest (by far) right-to-life coalition in Texas actually supports the Texas futility statute and was at the table when the law was written and passed. The smaller, more radical, vocal, and extreme groups in Texas seem interested in driving patient autonomy to the point that even euthanasia could be demanded of the medical profession. Moderate right-to-life advocates are so concerned about this that they have allied with the state’s hospital and physician organizations in support of the Texas futility statute.   

A well established ethical principle supports the medical profession in declining to provide treatments that are not beneficial or therapeutic. Stating that the parent's choice should always outweigh the physicians’ medical/ethical/moral stance is a quite dangerous position- indeed, one that you should recognize as representing another treacherous slippery slope that society should approach very carefully. There is considerable concern by ethicists and the medical community that the pendulum has swung too far toward patient autonomy. There are numerous “physician conscience” laws on the books now across the US that are intended to defend the integrity and moral stance of care providers.
See “Health Care Providers' Right of Conscience” at http://www.cbhd.org/resources/healthcare/collett_2004-04-27.htm
Only if yours is an extreme right-to-life position (keep the heart beating at all costs) could you fail to see the danger of unchecked patient autonomy.
Did you know that in mid February the mother had picked out Emilio's burial clothes and funds were obtained by the family for a Catholic burial?  Then somehow the extreme right-to-life groups got involved, and Emilio became the pawn of the political agendas of these groups. This sequence of events is so unfortunate- where is your moral/ethical justification for such a cruel objectification and politicization of a human life?
 
The cost of medical care in the US is ~ 16 % of the GNP, with a huge fraction of that cost being devoted to true end-of-life care. There is broad consensus that end of life pain and symptom relief are suboptimal and that hospice care options are underutilized.  This is where economics does come into play on a societal level. How many patients like Emilio are there? Say there are 100 in Texas alone in a year's time. 100 X 1.5 million = 150 million dollars. What could society do with extra funds of that magnitude to improve health care access?
 
It is dangerous to make uninformed statements about such a volatile and sensitive issue, especially one in which the family and her lawyers are out parading their version of the story with its gross inaccuracies in the media, while the hospital and medical profession has remained circumspect and responsibly restrained out of concern for family confidentiality and privacy and staff privacy and safety.




A Catholic physician

woundedpig said...

I suggest you read the following article from the National Catholic Reporter regarding the Schiavo situation and its impact on the current debate.

http://ncronline.org/NCR_Online/archives2/2005c/070105/070105i.htm

The discussion of the use of the ethic of reciprocity/application of the Golden Rule is quite telling. I tried to find another essay on the web that is also quite relevant here- an analysis of end of life decisions and human attachments, but could not find the reference. It speaks to the extreme difficulty some individuals have in allowing their loved ones have a peaceful demise. The essay uses the concept of pathologic/selfish/egocentric attachment vs a loving attachment and relates the family/spouse/parent's difficulty in making end of life decisions to the types and proportions of attachments at play.

The article from the National Catholic Reporter about the Golden Rule says this:

"...Finally, he suggested applying the Golden Rule and asking: “What would reasonable people think should be done or what would I want done if I were in a similar condition? Maybe all we have left is the ethic of reciprocity or the Golden Rule,” said Rosell, an ordained American Baptist minister and an associate professor of pastoral theology -- ethics and ministry praxis -- at Central Baptist Theological Seminary in Kansas City, Kan.
Rosell noted that several hundred people have been given “the Golden Rule” test, including many of his family members and students. Despite professing vehement support for the continuation of life supports in the case of patients in a persistent vegetative state, Rosell said he has yet to find a single person who has volunteered to have tubes and a respirator attached to themselves in order to prolong their life were they to become permanently incapacitated with no prospects of improvement."


Jerri Waard refers to "Emilio's nurse" in some of her posts. This nurse, who gives the glowing report about Emilio's alertness and purposeful movements, is a nurse "planted' by Jerri as a visitor who has chosen to disgrace herself and her profession by reporting this misinformation. To take this nurse's word over that of a dozen or more independent pediatric sub-specialist physicians and many more critical care nurse's skilled observations is a true stretch and one of the tragedies of this case. To choose to believe this operative of Jerri’s also involves accepting the paranoid and incredible belief that the entire hospital, all its physicians, and nurses are together conspiring to deceive the public and do harm to Emilio. Does this really pass the "smell test" to you?

The mother was ready to bury Emilio in February, having picked out his clothes, and repeatedly expressed the desire to not let him suffer or be kept alive by machines, and refused surgical procedures that would have prolonged the dying process. Then the third parties came into play, like the legislator (with proposed legislation to pith the state futility statute) who crashed the first ethics committee, not identifying who he was, pretending to be representing the family. For the forces that are "handling" Ms Gonzales, Emilio's plight has been lost and forgotten in their maneuvering. He became an abstraction and a pawn of the political agendas of others.

The economic argument is a hard one, I grant you. I do not believe that economics should play a deciding role in end of life decisions from the individual patient's point of view. But to deny that there is a huge societal question of social justice here is to truly be like the ostrich with its head in the sand or the monkey who covers his ears. Continued blind application of unfruitful, burdensome, non-efficacious medical interventions do nothing other than prolong the death of an individual, while offering no hope of changing the outcome. This is expensive. You are no doubt aware of the huge number of uninsured children in Texas, the huge number of unvaccinated kids. You probably know that children with no primary/preventative care make up a disproportionately high % of hospitalized and ICU patients, have a disproportionately higher risk of dying, and have significantly longer length of stay. What is your answer to this dilemma, when 16% of the nation's domestic product is already going to health care?
Doesn't the 1.5 million dollar bill for Emilio's care when multiplied over time feel a little different when you look at the health of society as a whole?

We often talk about natural death and not wanting to take the decision out of God's hands. From first hand experience over many years, I know with certainty that medicine is able to take the decision out of God's hands for a while- to postpone God's decision.

Back to the NCR article for a second:

"Rosell hopes to practice what he preaches. “As a Christian I lived my life and will die with regret that I have not sufficiently shared my resources,” he said. So out of a sense of “distributive justice,” he does not want his caregivers to expand services beyond those that will keep him comfortable in the last stages of his life.
Rosell and other ethicists pointed to the example of Pope John Paul who in the final week of his life chose to die at home without any infusions for his heart or the use of a heart pump or ventilator.
In her gerontology practice, Thibault has seen patients who were “detained from union with God” because of the needs of the caregivers. She recalled a woman who wanted to keep alive her 80-year-old husband, who was in a vegetative state, because she was dependent on his pension, which would stop at his death.
Thibault thought the issue of keeping a loved one alive at any cost will become “significant as baby boomers age.” But she also noted that sometimes people need a little more time to hold on to their loved one to come to terms with their loss, especially if the cause of brain death has been sudden -- as opposed to death by dementia."


For a moment, put yourself in the shoes of the pediatric ICU nurse at Emilio's bedside during her 12 hour shift, watching him suffer with no hope of recovery, experiencing his loss of dignity as he must have his bladder catheterized or his stool extracted.

Also, in a careful, deliberate, and honest manner, apply the golden rule as suggested by Dr Rosell as you contemplate the manner of your own death and its impact on your loved ones. Will you apply the same rules and values to yourself as you seem willing to impose on others?

It is an exercise that all of us should experience for ourselves as we go thru life, so that our loved ones are well aware of our wishes at the end of life.

woundedpig said...

The legal team handling Emilio's mother has seen that public opinion and media coverage has not gone their way. Though Emilio's clinical status has been misrepresented to the public by their legal team, there are enough inconstencies in family statements and press releases {e.g., turning and fixing vision on family and turning to a sound while at the same time being blind and deaf since birth) that the general public knows that the baby's condition is much worse than represented. Responses to American Statesman articles are almost unanimously in favor of a peaceful end to Emilio's suffering.

Though Bishop Aymond has been attacked by zealots claiming his participation in a conspiracy, all but a few recognize that the Bishop is a Christian man of unquestioned integrity who is unlikely to have made such strong statements in favor of the hospital and physicians's views on Emilio's care unless he was sure of the facts and the theology. The family has rebuffed repeated offers by the Bishop to meet with them to discus the family's plight.
Jerri's crew wanted to postpone the probate court hearing till after the legislative session because of their fear of the outcome of the hearing. Emilio has not become the true poster child that they had hoped. The public has realized that Emilio is no Schiavo- Emilio is no elderly person being euthanized by family members inconvenienced by the responsibility of caring for their family member. Emilio is a critically ill patient on ICU life support in a nearly brain dead state- a baby with a terminal disease facing imminent death who is being maintained on life support with no hope of recovery or leaving the hospital. All this and many other inconvenient facts about Jerri's case would have come out in a court hearing with huge media coverage and in the public record.
At this point, the main goal of the extreme political interests in this case is simply that Emilio die on a respirator, however long that takes, as that would seem to be a victory or at least save face for them.
As was indicated in previous news reports, there is a hearing scheduled for May 8th

Tito said...

Wounded Pig,

I assume your posting are for the other posters on this article, not to Darwin or myself (Tito).

I argued that Bishop Aymond is correct. I didn't say he was incorrect. What I did say was that he probably shouldn't have taken a 'public' stance on the issue due to the volatility of the issue. Bishop Aymond opened himself up to observation and commentary.

Living in an age of apostocy where bishops have no spines and those that do take stands they do only in their self-interest on 'politicaly correct' stances.

But I'm here to help, not to preach.

You have four points that don't help your argument.

1. You argue about costs. The costs should be irrelevant concerning the life of a human being. In this case a vulnerable and innocent child.

2. You use ad hominem attacks to paint those that practice their faith as 'right wing extremists'. False attacks such as yours only shows that you yourself are a cafeteria Catholic. There is only Catholics and cafeteria-Catholics. Catholics follow their faith. Cafeteria-Catholics pick and choose what they want to believe. Whenever Catholics are attacked such as your ad hominem makes you look bad, not I (or us).

3. You quote the National Catholic Reporter. Everyone knows, except probably cafeteria-Catholics, that the NCR is a heterodoxical newspaper wanting to push the agenda of the 'Spirit of VAtican II' crowd. You do yourself no favors when quoting from the NCR.

4. We're talking about someone's life.

I agree with most of what you wrote, though you should really adhere to the four points I have made to you.

In Him,

Tito

woundedpig said...

1. To me , it is inexcusable to refuse to consider the cost of providing health care to all, especially the safety net needed to protect the vulnerable of society. It is a question of social justice at a societal level. Resources are not unlimited, either human or capital. I said that I do not believe that we should make decisions on individual patients that are based on cost of care. The Catholic Church's position on end of life care includes economics as a variable in end of life decisions. Perhaps the reality of the economics are lost on you. With as much as 3-4 % of the US GDP devoted to end of life care, there are many holes in the safety net.

2. You are wrong here. I am a recent Catholic convert and quite conservative. I find it interesting that Catholics who choose to go beyond the teaching of the Church on a particular issue, such as end of life, consider those who disagree with their extremism to be incomplete, cafeteria Catholics.

3. It doesn't matter where my quote comes from. The views are vital and relevant. Do you read only from sites/sources that you agree with? You're probably in an uproar over the Bishop's testimony yesterday concerning the church's position on end of life issues and support for the amended version of the Texas futility statute. Are you waiting for Pope Benedict to slap the Texas bishops down? It won't happen.

4. Yes, we're talking about someone's life and their intense effort to arrive into the arms of Jesus and become whole.

woundedpig said...

"Baby Emilio is disabled, suffering from Leigh’s Disease, and will eventually die from it. Currently he is in a coma like state due to the overwhelming amount of drugs that are being used for his symptoms. He wakes up from time to time and can acknowledge his mother, Catarina Gonzales."

The above is completely and utterly false. He has lost all higher brain function due to the melting away of nearly all his brain tissue. He has no respiratory effort. He has no brainstem reflexes. He is almost brain dead. He is on low levels of pain medicine, not in coma due to them. He has to be catheterized to drain urine because of neurogenic bladder. He has to have his stool extracted at times to treat his constipation.

You should not blindly accept as truth the information released by zealot lawyers motivated to rally the true believers to the cause.

Anonymous said...

This case is very complicated. I agree that the fundamental issue is that the decision lies with the mother. No one can take that right away from her if they follow church teaching. Think about what it would be like for the mother if she had to agree to an act that would take extinguish the life of her own child. As a mother myself, it is unthinkable unless I saw that the procedure itself was causing agony for the child with no measureable benefit. Bishop Aymond does not believe in church teaching on the fundamental rights of parents. Call the superintendant of schools in Austin and verify whether or not they believe that parents have the right, as public school parents do, to opt their kids out of human sexuality classes if they feel it is not appropriate for their child. Ask if they inform the parents before presenting children with interviews of child molestors and have the children perform sexual role plays of molestor/victim in their safe environment programs. They don't ask the parents. In fact they do everyting they can to ensure 100% attendance to satisfy their liability insurers. I believe that Bishop Aymond is orthodox in any other area I know of except for parental rights. Then, I frankly believe that his actions can appear tyrranical.

Anonymous said...

I am a hospital-based pediatric physician and have experienced many situations over 25+ years that put a dagger in your argument that parental autonomy should always trump the position of the physicians involved and the carefully considered conclusions and recommendations of an independent, multidisciplinary ethics committee.

I will share some of them with you:

1.A father asked that support be withdrawn in the case of his 8 month old infant who presented in shock, coma and soon developed multi-system failure. He eventually developed kidney failure. Family was reticent to consent to dialysis if he was "just goint to turn out to be a vegetable." The physicians were not comfortable with this and pressed for the dialysis. Consent was obtained with some difficulty and dialysis was started, which turned things around, saving the baby's life. The final diagnosis was intentional poisoning with ethylene glycol (antifreeze). The father received (only) a 40 year prison sentence. The baby had a normal outcome.

2. A mother wanted to give alternative medicine therapy to her child who had a form of leukemia with a 95% long term cure. While this was being negotiated with the attending physician, the mother took the child out AMA (against medical advice) and went to Mexico to get Laetrile therapy (a peach/apricot pit extract which is poisonous.)The child had a leukemic crisis, almost died before being found and returned to the US to receive appropriate therapy, which resulted in a cure.

3. A 2 year old boy of an Asian family was having refractory seizures requiring therapeutic drug coma. A number of attempts to bring him out of the coma led to recurrence of seizures. It appeared that the boy would be left with significant brain damage. The family asked, then demanded that care be withdrawn. The physician staff resisted, and recommended that more time be given. The father relented, and eventually the child went home with a hemiparesis and occasional recurrent mild seizures. The child received poor followup, was neglected and eventually went into foster care. It was then revealed that this child was the male heir and, in the fanily's culture/custom, "had to be perfect" according to the family.

4. A robust and precocious (in terms of development) 11 month old girl had a cardiac arrest out of the blue and suffered severe brain damage. The biologic father, a minister in training who did not live with the mother, asked a number of times early on in the course whether it could be determined by autopsy whether the child was smothered. His influence on the mother contributed to a conflict with the physicians regarding end of life decisions. The baby met all criteria for brain death except for respiratory effort which appeared after 5 minutes (!!!) off the ventilator. The physician staff and ethics committee recommended that ICU life support be withdrawn. The family refused. The baby received a trach and Gtube eventually and went home on a ventilator. There was other evidence of foul play, but not enough for arrest/indictment.

You get the picture. I have experienced only one situation in my professional life like the Emilio case in Texas. I attribute this to the skills, compassion, and communication abilities of my colleagues and I, and to the love and compassion of the parents making those difficult decisions.

I have experienced several other situations like this in which the family's wishes were resisted, sometimes with involvement of Child Protective Services.

Compassionate staff in children's hospitals are tremendously skilled at helping families arrive at end of life decisions. I have established the practice of meeting with families weeks after the decision is made to withdraw life support. I always ask how families feel about the decision that was made. All say that it was a terrible difficult decision, but that they are at peace with it. Not one has ever said that they had made the wrong decision. A number of times the family expressed worry and regret that they may have allowed their child to suffer longer that necessary. I always reassure/remind them that all efforts were made to treat pain and discomfort.

The pendulum has swung too far toward parent autonomy. There are now laws on the books in several states that are referred to as "physician conscience" laws- intended to protect and give relief to physicians being requested/forced to intervene medically in situations that violate their integrity, ethics, and oath as physicians. This is why futility statutes like the Texas law are needed. The Texas law may not be perfect- it is being revised at this moment and will go to the Senate for vote next week. It is an improvement over the 1999 law.

Anonymous said...

SHAME , SHAME, BISHOP GREG DON''T YOU BELIEVE IN PROLIFE??? WHATS THE DIFFERANCE HERE???A LIFE IS A LIFE...BABY EMILIO WILL "RETURN TO THE LORD" WHEN GOD IS READY TO TAKE HIM...I AM SURPRISED BY YOUR DOUBLE TALK...IT IS STILL A SIN TO KILL ISN'T IT ??? SHAME ON YOU

Anonymous said...

In response to the post with a violent image of a dagger being put in my argument about respect for parents rights, I did not make the statement that parental autonomy always trumps what doctors think. In cases where abusive, neglectful behavior on the part of the parents, then of course the child should be protected. Try to address the issue of Catholic church teaching regarding the principle of subsidiarity. That is what I am referring to.

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