Editorial: "The old, old story..."

Issue 23, November 2007

"Many a worker in a factory or shop has had a strange, beautiful and pious youth. But city life sometimes removes the 'early dew of morning.' Even so, the longing for 'the old, old story' remains. What is at the bottom of the heart stays at the bottom of the heart. In one of his books Elliot describes the life of factory workers, etc., who have formed a little community and hold religious services in a chapel in Lantern Yard, and he says of it, 'It is the kingdom of God on earth, no more and no less."

--Vincent van Gogh, Letter to Theo van Gogh 1876

In less than a month we observe the feast of Christmas – a day of pause and rest, a day for family and those in special need – a day to honour and to celebrate, in myriad ways, the birth of the Word made flesh. In the lead up to Christmas it is passé to hear commentary such as how "secular New Zealand has become", what a "commercial racket" Christmas is, and, how "stressful" this time of the year is with so many competing demands on one's valuable time. Thank goodness, it is said, we can all relax until the country "re-opens for work" at the end of January!

These perceptions generate challenges both in appreciating the light and the shadows of city life and because of the manner in which they powerfully reflect the loss of "the early dew of morning." Equally, they underscore the need to communicate insights and wisdom in fresh ways that resonate in the heart where the longing for the old, old story is still most keenly felt. Such is the challenge in theological bioethics whose role is to make the medical, ethical and moral relevant and understandable within specific cultures and according to a faith perspective. In the midst of the very real complexities of city life it is all too easy to react in a pragmatic and limited manner rather than returning, as we all must, to the old, old story of the Word made flesh written in Scripture and to be found deep within every human heart. Such a return may well generate fresh understanding to see that a so-called "secular" perspective may in fact reflect a deeper and existential longing for the old, old story by a different name.

The use and misuse of technology shapes much of our worldviews and many contemporary debates in biomedical ethics, not least our care of the dying. The use of technology in medicine has grown by geometric proportions as have the moral implications of its use. In the care of the terminally ill and the dying the overuse of technology is not only a way of doing things but also reflects a certain way of thinking. When used inappropriately technology can trigger ethical and moral consequences. In such circumstances both medicine and society are not always able to critique the issues that are raised in a comprehensive and life-giving manner. For these reasons we felt it timely to devote this complete issue of The Nathaniel Report to some current end-of-life issues.

Mary Schumacher, Chief Executive Officer of Hospice New Zealand, reflects on the challenges that the New Zealand hospice movement faces nearly thirty years after the first hospices were formally established. In this wide-ranging interview Mary Schumacher observes that within the rapidly changing context of healthcare delivery in New Zealand the boundaries between active curative treatment and palliative medicine have also blurred. Consequently different technical skills are required. Similarly the partnerships between hospice and other healthcare providers have also changed and the role of cooperating with, and working alongside the aged-care community become more critical particularly if all are to have access to quality palliative care.

In August 2007 the Congregation for the Doctrine of the Faith [CDF] published its response to questions concerning the use of artificial nutrition and hydration for patients suffering from the distressing and relatively rare condition of post-coma unresponsiveness [PCU] or the persistent vegetative state [PVS]. We reprint Doctor Ron Hamel's thoughtful and thought provoking response to the CDF's statement.

The teaching of the CDF and subsequent reflections on it from international theologians is a timely reminder that our commitment to the sanctity of life and the stewardship of the gift of life does not equate with the need to use technology at all costs or in every possible situation. Such a technological imperative could readily become vitalism by another name – life at all costs - and prolong the dying process unnecessarily. The Catholic moral tradition, as many notable theologians have reminded us over time, seeks the path of a "via media" – a path that is beautifully encapsulated in the philosophy of the hospice movement, namely, "to neither hasten, nor postpone, death."

Technology is not the primary means for managing or caring for the dying patient even though the judicious use of it is a central focus in ethical palliative care delivery. It has been said that the moral dimension of healthcare is that which leads us deeper into the mystery of our humanity. The care of the dying is a role for the whole community as it seeks to care for each patient in his or her uniqueness before God.

This communal role takes us necessarily into the spiritual realm without excluding the medical dimension of healthcare.

Good communication is the lifeblood of relationships and its lack can readily lead to a sense of loss and disconnection with the old, old story. Good communication is essential if family and healthcare providers are to honour the wishes of a particular patient, especially the terminally ill. Health and Disability Commissioner for New Zealand, Mr Ron Paterson, provides a timely reminder of the value of Advance Directives and their place in decision making at the end of life.

Sue Seconi's poignant reflection on a ten-year journey with her mother who was suffering from Alzheimer's disease reveals how she became aware of the gift of life and the giver of life at an even deeper level despite all appearances to the contrary. Hers, and similar stories of families caring for loved ones at the end of life, embody the core meaning of the old, old story of God among us – a story which fundamentally speaks of self-giving and presence especially in the midst of suffering.

Rev Michael McCabe, PhD
The Nathaniel Centre

An Interview with Mary Schumacher

Issue 23, November 2007 

New Zealand's first hospices Mary Potter Hospice in Wellington, Te Omanga in Lower Hutt and Saint Joseph's (now Mercy) Hospice in Auckland, were opened in 1979. With over thirty hospices nationwide there is now widespread recognition and awareness of the hospice movement and of the need for, and availability of, palliative care for the terminally ill.

On 25 October 2007 I interviewed Mary Schumacher, Chief Executive Officer of Hospice New Zealand, and asked her about the remarkable growth of the hospice movement in New Zealand and the challenges that such growth presents.


Statement on Artificial Nutrition and Hydration

Congregation for the Doctrine of the Faith
Issue 23, November 2007


Responses to certain questions of the United States Conference of Catholic Bishops concerning artificial nutrition and hydration

First question: Is the administration of food and water (whether by natural or artificial means) to a patient in a "vegetative state" morally obligatory except when they cannot be assimilated by the patient's body or cannot be administered to the patient without causing significant physical discomfort?

Response: Yes. The administration of food and water even by artificial means is, in principle, an ordinary and proportionate means of preserving life. It is therefore obligatory to the extent to which, and for as long as, it is shown to accomplish its proper finality, which is the hydration and nourishment of the patient. In this way suffering and death by starvation and dehydration are prevented.

Second question: When nutrition and hydration are being supplied by artificial means to a patient in a "permanent vegetative state", may they be discontinued when competent physicians judge with moral certainty that the patient will never recover consciousness?

Response: No. A patient in a "permanent vegetative state" is a person with fundamental human dignity and must, therefore, receive ordinary and proportionate care which includes, in principle, the administration of water and food even by artificial means.


The Supreme Pontiff Benedict XVI, at the Audience granted to the undersigned Cardinal Prefect of the Congregation for the Doctrine of the Faith, approved these Responses, adopted in the Ordinary Session of the Congregation, and ordered their publication.

Rome, from the Offices of the Congregation for the Doctrine of the Faith, August 1, 2007.

William Cardinal Levada
Angelo Amato, S.D.B.
Titular Archbishop of Sila

The CDF Statement on Artificial Nutrition and Hydration: What Should We Make of It?

Issue 23, November 2007

Over the past few weeks, there has been much conversation within the Catholic health care community and among theologians and ethicists, both within and outside of Catholic health care, about the meaning of the most recent statement from the Vatican's Congregation for the Doctrine of the Faith (CDF) on artificial nutrition and hydration. The statement (or "Responses" to two specific questions posed by U.S. bishops) and an accompanying "Commentary", intended to clarify the meaning of the March 2004 allocution of John Paul II,[1] has actually generated a range of interpretations and a number of questions. In this short essay, I wish to try to sort out a) what seems to be clear in the statement and commentary, b) what seems less clear, and c) what is puzzling.