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ABSTRACT Death with Dignity: the Future of Catholic Healthcare In ABSTRACT Death with Dignity: The Future of Catholic Healthcare in Texas Regarding End of Life Policies The Texas Advance Directives Act of 1999 from a Catholic Perspective on Sanctity of Life Ivy Jo Stejskal Director: Bill Neilson, M.D. The Texas Advance Directives Act of 1999 was a law that was created with the intention of adding order to the chaos that surrounded end of life care disputes. This act allows a physician to discontinue life-sustaining treatment if an ethics committee decides that the care of the patient is futile. Futile is termed as pointless or fruitless. The Catholic Church has very strict and set doctrine on how end of life issues should be handled as well as what constitutes a human person. The Catholic Church also has set doctrine on how to preserve the sanctity of a person even in the hours of death. My thesis will assess both the laws in place in Texas as well as the teachings of the Catholic Church regarding end of life care. Through this understanding, we will address certain case studies and how each of these would have been decided using the ERDs, TADA, and a combination of these two documents as a guide. After discussing the relations between politics and religion and how this impacts the delivery of end of life care, I will present the reason behind why an issue like this is important to me as well as my audience. There are faces and names behind all of the data and end of life care statistics. This thesis was designed to advocate for people in their last hours here on earth. APPROVED BY DIRECTOR OF HONORS THESIS: ________________________________________________ Dr. Bill Neilson, Honors Program APPROVED BY THE HONORS PROGRAM: ________________________________________________ Dr. Andrew Wisely, Director DATE: _____________________________ DEATH WITH DIGNITY: THE FUTURE OF CATHOLIC HEALTHCARE IN TEXAS REGARDING END OF LIFE POLICIES THE TEXAS ADVANCE DIRECTIVES ACT OF 1999 FROM A CATHOLIC PERSPECTIVE ON SANCTITY OF LIFE A Thesis Submitted to the Faculty of Baylor University In Partial Fulfillment of the Requirements for the Honors Program By Ivy Jo Stejskal Waco, Texas May 2015 TABLE OF CONTENTS Chapter One: Introduction to Catholicism and Texas Law. 1 Chapter Two: Death and Dying-A Catholic Perspective . 8 Chapter 3: The Texas Advance Directives Act of 1999 . 23 Chapter 4: The Practical Application of Catholic Doctrine Within Hospital Walls . 33 Afterword: Shining Light in the Darkness. 52 Bibliography. 59 ii CHAPTER ONE Introduction to Catholicism and Texas Law “But of that day and hour no one knows, not even the angels of heaven, nor the Son, but the Father alone”1 (New American Standard Bible). No one knows when he will die, nor does he know how he will die. The timing of death is something that is known only to God. Even if one has endured almost 20 years of schooling, dons a freshly starched long white coat, and has a framed medical school diploma, he still does not have this knowledge of the hour of death. Patients die from accidents, cancer, and infections but from a Catholic perspective never should they die by the hand of their physician (Catechism of the Catholic Church). When death, medicine, and religion combine they produce difficult conflicts, but the addition of government, laws, and policies makes healthcare even more challenging. As healthcare is changing, the issues of end of life care come to the forefront of this discussion. The end of life care issues to be discussed in this thesis are only the beginning when it comes to the many medical ethics topics that challenge the beliefs of the Catholic Church. One of the most recent challenges within Catholic healthcare is the Affordable Care Act (ACA). The enactment of this law is going to have a profound effect on Catholic hospitals across the United States and it is going to bring up new areas of concern. These areas of concern within the ACA include but are not limited to conscience laws and their impact on issues such as abortion, euthanasia, sterilizations, federal executions, and birth control. Conscience laws are federal regulations that protect 1 providers if they rightfully refuse to provide a treatment that is against their moral standards (Collins English Dictionary, 2012). Another concern for Catholic healthcare is the loss of Catholic identity. One main reason this is occurring is because Catholic hospitals have lost the prominent positions of religious sisters within the hospital. This decline of nuns in the role of nurses and health professionals can be illustrated by an interview done with Sr. Mary Jean Ryan from St. Louis. When Sr. Mary was a nurse in the 1960s, a nun ran almost every department within the big Catholic Hospital where she worked. Now only 11 nuns remain out of the 22,000 Catholic Hospital employees2 (Kevin Sacks, 2011). Religious orders had been in charge of healthcare delivery and medicine long before the government had a role in healthcare financing. St. Elizabeth of Hungary and the Franciscan monks felt it was in their vocation as religious officials to care for the sick, dying, needy, and hungry. The monks and nuns felt that they needed to be the hands and feet of Christ especially to the poor and vulnerable3 (Thomas Nairm, 2010). Catholic hospitals were built with this mission of helping the underserved and maintaining Catholic doctrine in the 13th century. Catholic hospitals came to the United States in the 1700s and today there are over 400 Catholic hospitals4 (James Walsh). Currently, this Catholic mission is being tested by outside influences such as the ACA and non-religious leadership. For some of the Catholic hospitals, the only thing that makes them Catholic is that they have the word ‘Saint’ in their name or they may have a priest living in residence. Some Catholic hospitals are now having a harder time honoring their original mission of serving the underserved and providing quality healthcare to the needy (Lilly Fowler, 2015). A large percentage of Catholic hospitals are more concerned 2 with making money than upholding Catholic doctrine and caring for the disadvantaged5 (Alan Zuckerman, 2005). This concern with money over mission is a natural trend that may have happened because Catholic hospitals are forced to compete with other large hospital systems. Catholic hospitals are now hiring CEOs based upon their ability to run a business regardless of whether they are Catholic or not6 (Andrew Agwunobi, 2013). The seven issues presented in the chart below are issues of particular concern with Catholic healthcare providers as of 2005. The scales on the chart range from 1 (strongly disagree with the statement) to 7 (strongly agree with the statement). As can be seen by this chart, Q23 states that financial skills in a CEO are on the same level as upholding Catholic values. Q23 is almost a 6 on the scale of 1-7 meaning that out of the 175 Catholic healthcare providers surveyed, most of them strongly agreed with the statement in Q23. Also in the chart below, Q24 is a huge concern that suggests that Catholic hospitals could lose their original vision. Q24 states that a majority of the providers surveyed agree with the statement that it may be necessary to close programs for the poor in order to keep Catholic hospitals open. Catholic hospitals were originally created to help the poor and needy and this chart implies that Catholic hospitals may need to close their programs for the poor (Alan Zuckerman, 2005). Q23 and Q24 are at the core of what makes up a Catholic hospital: a mission to uphold Catholic doctrine and help the poor. The data presented in this survey shows that money and financial concerns have consumed the mind of Catholic healthcare administrators and the Catholic identity of the hospitals may end up lost because of this. 3 Figure 1: Issues Within a Catholic Hospital The Affordable Care Act (ACA) is going to greatly affect the future of Catholic healthcare. If Catholic hospitals work to regain their original purpose, these hospitals offer an alternative to what could become government run healthcare. The ACA will challenge Catholic beliefs on conscience issues such as abortion, euthanasia, sterilizations, and contraception among other issues. An interview with Leonard J. Nelson III, a professor at the Cumberland School of Law at Samford University and author of a book addressing the future of Catholic healthcare, said that if a Catholic hospital were forced by ACA to provide abortions or abortion referrals, it would either be shut down for refusing this service or taken over by non-Catholic facilities7 (Leonard Nelson, 2013). Jesuit Father John Haughey, a research fellow at Georgetown University’s Woodstock Theological Center, focuses on the role of Catholic healthcare as a way to imitate Christ’s healing ministry. He had these words to say on the future of Catholic 4 healthcare: What people should experience through Catholic healthcare is ‘more than competence, though that, more than efficiency, though that too, more than professionalism, though that too. It is people giving of themselves, emptying themselves to serve their brothers and sisters. … If that is what is experienced in your facility,’ he said, ‘you are extending Christ’s healing mission in that facility at this time’8 (John Haughey, 2012). Even with outside influence impacting Catholic healthcare providers, it is still possible to be a doctor and a devout Catholic. The future of Catholic healthcare seems uncertain under the ACA, but in a narrower sense, end of life care is also an area that needs to be given great thought as it pertains to governmental regulation. The Catholic Church has very strict and set doctrine that went into the formation of the Ethical and Religious Directives (ERDs).
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