Is a Do-Not-Resuscitate Killing?

Is a Do-Not-Resuscitate Killing? January 31, 2019

It’s been more than eight days since the fiasco at the March for Life.

It’s about time I actually said something about life issues right now.  And there’s plenty to say.

What I have to say first of all should not be controversial, but apparently it is: a Do-not-Resuscitate, or DNR, is not killing. It’s ordinary, palliative care, and is not against Catholic teaching depending on the circumstances.

Yes, I’m sure of this.  I studied graduate level bioethics courses at Franciscan University of Steubenville. We covered end-of-life issues. Boy howdy did we ever cover end-of-life issues. And I am certain that the teaching of the Catholic Church is that we must administer ordinary, proportionate care to the dying, but it’s perfectly within the rights of the patient (or the person making decisions for the patient of the patient can’t do it themselves) to refuse extraordinary, disproportionate care.

Remember, the Catholic church teaches that it is morally impermissible to directly kill someone, either as an end or a means to an end. But we’re sometimes allowed to pursue a good end in such a way that death might result from a side effect if we don’t have any better ways to pursue it.

According to our Catholic faith, I may not murder my next door neighbor by throwing him out a second-story window. But if my next-door neighbor is breaking in my second-story window screaming “I’ll kill you” and I push him away from me because it’s the only way to buy myself time to escape, and he falls to his death– that’s not direct killing, it’s self-defense, and it’s ethical. I ought not attempt to commit suicide by hugging a hand grenade to my chest. But if someone throws a hand grenade into a crowd and I jump on top of it to prevent the shrapnel from piercing anybody else, and die as a result– that’s not suicide, it’s protecting my friends at the expense of my own safety. It’s not only reasonable, but a good deed. I ought not take an abortion pill in order to kill my unborn baby. But if I have cancer and the doctor prescribes a cancer-killing medicine that stands a good chance of also killing my baby– it’s my choice whether I want to take that medicine or not, and either way I do not sin. I could also choose to put off taking my medicine to give my baby a chance at life, and that might be a heroic self-sacrifice, because I’m not acting to kill myself– I am acting to save a life, knowing that I might die myself.

And that teaching holds true for the severely ill and the dying as well: according to Catholic teaching, we ought never to kill people, either by acting to end their lives or by neglecting their health so that they die. But it is licit and right to refuse extraordinary treatment to extend a life that is ending quickly anyway, if the reason is to limit suffering rather than to make that person die faster. It would be evil to euthanize my dying relative by injecting her with poison or by starving her to death. It would certainly be obscene to murder my physically or mentally disabled relative who might live a long life otherwise by denying them whatever special medical care they need to keep breathing.  But if my dying relative is on the way out no matter what, can’t swallow any more, and can’t stand the thought of a painful feeding tube– it’s irrational and cruel to force her to get a feeding tube to prolong her life a few days more. If she’s dying and her heart has just stopped, I don’t need to keep trying to restart it indefinitely. There’s no moral imperative to do everything conceivably possible, no matter how painful, to stretch out a terminally ill person’s life to the last possible minute. That’s not what “thou shalt not kill” means.

Is resuscitation extraordinary means?

Well, not for everybody. If a healthy swimmer hit his head in the pool and drowned, resuscitating that person might stand a very good chance of saving his life and he could go on to live normally for years. If a person in the ER awaiting emergency surgery stops breathing and the nurse resuscitates her so she’ll last long enough to get the livesaving operation, that’s totally reasonable. If a person who is quadriplegic stops breathing because his ventilator breaks and I perform CPR on him until the medics get there with a new one, that’s not extraordinary. But if someone is terminal, they’re slipping away, there’s no known way to save them, and their heart stops, it might well be extraordinary to try to resuscitate them. And for that person, a DNR might well be a perfectly reasonable part of palliative care.

I think that when we imagine “resuscitation,” we imagine some scene from a movie where a pretty lifeguard drags an unconscious man up out of the water onto the beach, nervously gives his sternum five little taps with her palms, breathes into his mouth once like a kiss, and then he sits up coughing– and then she laughs and kisses him for real this time, and everything is all right. That’s how it’s portrayed. But in real life, resuscitation doesn’t look like that. It’s a painful and rough, traumatic procedure. If you’re administering CPR correctly, you are probably going to break more than one of that person’s ribs. If that person is conscious, it’s going to hurt them worse than you can imagine. It’s not over with in a few seconds; you could potentially be wailing away painfully on their chest for a very long time. If you do manage to get them to live a little longer, they may well be alive but in terrible pain with brain damage from the oxygen deprivation to boot. It’s not necessary to put a loved one through that kind of agony in order to prolong their life by a few hours or days, then do it again the next time their heart stops, and so on indefinitely. That’s extraordinary means, it’s torture, and refusing it is not killing.

Why am I bringing this up?

Because the other day, the governor of Virginia was discussing a bill that would allow abortion up to the moment of birth– and I am pro-life and against abortion, for the record. Abortion is killing and that’s not okay. But when they were discussing the bill, Governor Northam was asked what would happen to a child that was born alive with “severe deformities” that made it unlikely they were viable. The governor answered, “If a mother is in labor, I can tell you exactly what would happen. The infant would be delivered. The infant would be kept comfortable. The infant would be resuscitated if that’s what the mother and the family desired, and then a discussion would ensue between the physicians and the mother.” 

And people are acting like Governor Northam just spoke in favor of infanticide. Whole articles have been published claiming that a mother choosing not to resuscitate a terminally ill baby is the same as “leaving infants to die after birth.

It isn’t.

Choosing not to resuscitate or prolong the life of a severely ill infant who is certainly dying, even if that infant has just been born, is NOT infanticide. It’s not abortion. It’s not abandoning an infant to die of exposure. We are not required to use extraordinary, painful means to stretch out a dying baby’s life by a couple of hours or days. A DNR for a terminally ill person, whether that person is 100 years old or just now clearing the birth canal, is not killing, and it’s not cruel.

I hope to God I never have to make the decision whether or not to resuscitate a dying newborn. I can’t imagine the horror. But a mother who chooses not to, is not killing anyone. What she’s already suffering is bad enough. We do not need to add that false guilt to a grieving mother’s burden. There is no moral obligation to sit there listening to her son or daughter’s bones break again and again, knowing it’s causing horrible agony,  in order to drag out the baby’s suffering a little longer. She’s allowed to choose normal palliative care, including a DNR, to make that baby’s short life a little less painful.

(image via Pixabay)


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