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Code words: Comfort care

Via Wesley J. Smith comes a story that you need to hear, because knowledge is power. In this case it may be a power that will save the life of someone you love. Put this phrase in your mind. Note it down:

Comfort care

It doesn't mean what you think it means. (See also "palliative care," which means the same thing.)

In Texas, Terry Mace was only 43 years old when he went into cardiac arrest and fell at his home. He and his wife had been estranged for five years, but that didn't prevent her from showing up and ordering, on March 22, that his nutrition and hydration be removed. (Mace was evidently unconscious and unable to eat and drink on his own.) Mace's parents went to court promptly, and the court blocked her decisions (March 24) and granted guardianship to Mace's father on March 27. Victory! Well, not quite.

On March 29, the hospital (a Catholic hospital, by the way) got "permission" (scare quotes deliberate) from Mace's now-guardian family to put him on comfort care. They neglected to tell them that this meant the removal of the food and water that the family had just gone to court to have reinstated! (Ya' think that might have been a relevant thing to mention in a case where nutrition and hydration was obviously what the family wanted?)

On Monday, March 31, the family lawyer went to see Mace in the hospital and discovered that the feeding tube had been withdrawn. So, in addition to what looks like two to five days at the outset (depending on what the court's "blocking the wife's decisions" meant), Mace had now been without food and water for two days over the weekend. The hospital reinstated tube feeding, which allows them to say that they "cooperated with the family." Nice cooperation there. Mace died on April 1. When he would have died if he had consistently received nutrition and hydration since his heart attack is anyone's guess.

Sad failure of clear communication. What a shame.

Smith opines, probably correctly, that a lawsuit is not in the family's best interests and that a jury would probably refuse to make any award.

It's easy enough to say that the hospital staff were deliberately unclear, but to my mind it's almost worse if they weren't. That is to say, it's almost worse if Mace was surrounded by (in one sense) well-intentioned nurses and doctors who were just talking their lingo and to whom it never occurred that the family didn't know what "comfort care" meant. It's worse, because it means that, if your loved one is in the hospital, you shouldn't infer from, "This doctor or nurse seems like a nice person" or even "This doctor or nurse is a Christian" that "This doctor or nurse would voluntarily and explicitly tell me if the proposal is to remove food and hydration from my loved one. I can trust the rhetorical sound of what this doctor or nurse proposes to me." You can't. You can't trust it. And you certainly cannot infer that such a good person in a medical role would never recommend leaving someone without food or water until death. They might very well recommend what amounts to just that, though they wouldn't put it that way.

The training of even the best medical people today is pro-dehydration. I'm sorry to have to put it that bluntly, but it is true. In fact, they are trained to associate tube feeding with forced feeding. When they use a phrase like "palliative care" or "comfort care," they really believe that is best, and they are motivated to talk about it in a way that inclines you to accept it. This doesn't make them evil people, but it does mean that, if you disagree with them about leaving your loved ones for days with no food and fluids, you can't trust the rhetoric, and you have to know the code.

Addendum: A Facebook friend shares the following story about her son, now six, who was born with a serious health condition. She was pressured to put him on "comfort care" when he was a newborn:

It's very loaded how they present the options. I still remember the way the staff worded it: "Do you want us to do everything possible or do you want to make him as comfortable as possible? Do you want him to be comfortable?" Obviously, we were meant to take "doing everything possible" as being the opposite of being comfortable. It's easy to see how parents and family members could be tricked/guilt-tripped into something without fully comprehending to what they just agreed[.]

Comments (17)

Wording from the "end of life" section in the living will presented to my wife by her employer as part of a "free legal services" package:

"Here is where you express your basic end-of-life decision: do you wish to be kept alive as long as reasonably possible regardless of how hopeless your prognosis is or do you wish to withdraw or withhold life-sustaining treatments so you can be allowed to die."

Nothing loaded about that description. Not at all.

Wow Sage. It might as well just read:

"Here is where you express your basic end-of-life decision: do you wish to be kept alive as long as reasonably possible regardless of how hopeless your prognosis is, how much financial burden it places on family members, or how many tears Lady Liberty sheds as you selfishly gobble up the nation's valuable resources, or do you wish to withdraw or withhold life-sustaining treatments so you can be allowed to die and restore peace, harmony, and balance to the universe."

No false dichotomies offered to Mrs McL, are there?

On a note utterly unrelated to this case, Seton, Austin's own 'angel of death' Catholic hospital chain is being abandoned by its religious congregation due to a dearth--a death-- of vocations. Nope, no connections can possibly be drawn between a religious order presiding over its own euthanasia, so to speak, and that religious order promulgating care=death language in its hospitals.


Scott/David, I'm glad you were impressed in the same way we were by that language.

Another problem was that it just seemed so crude (CHECK THE BOX THAT APPLIES TO YOU: ___ ___ ).

I was surprised that, given the tremendous complexities that can arise, this was supposed to serve as a dispositive legal document. It felt like being passed a little hand-written note that read, "DO YOU LIKE ME? YES ___ NO___ ".

That's scandalous conduct from the hospital. Unless it was evident that he was going to die before suffering the ill effects of hunger or dehydration or the sustenance was actually impairing his condition, it was unambiguously evil to remove his feeding apparatus in that manner. If the hospital is still subject to the oversight of the local ordinary (is this the one in Austin, or a different Seton?), it should be promptly subjected to a severe remedial sanction or stripped of its identification as a Catholic hospital.

Most of the old-line hospitaller orders in the U.S. have become something of an embarrassment.

And no, never use one of those "check the box" living wills. Sheesh.

This is the Seton of the central Texas area; the religious order is dying, but the chain of Seton hospitals continues to sprawl- Wmson Co/Round Rock is just northern a extension of Austin/Travis County.

The local ordinary was first appointed to the episcopacy as an auxiliary to Cardinal DiNardo. DiNardo's signature appears on a strongly-worded letter issued recently by the TCC-Texas Catholic Conference, the official lobbying voice of the state's bishops- condemning Texas Right to Life and all the other groups which found the recent legislative 'fix' to the end of life legislation that was the product of earlier bishop-approved compromises worse than leaving things alone.

What is interesting about all this is at least twofold, in that Texas is notionally a conservative state firmly under notionally conservative Republican control, and Cardinal DiNardo is in the lineup to run the USCCB.

It sickening and appalling to see how bishops - and cardinals, no less - cannot be trusted to simply toe the standard, straightforward Catholic line on what is a fairly simple moral issue. If there is one thing I have in complaint against JPII, and even Benedict (though less so) it is this apparent willingness to rubber-stamp the selections of whatever committees at the bishops' conferences and other bureaucracy aiming to forward pencil-pushers into the ranks of bishops and cardinals. Virtually every single bishop and cardinal now in the ranks were made that way by one of these 2 popes, and the outcome seems hardly better than simple chance coin tossing. From Cardinals Bernardin to Mahoney to Law to McCarrick to Kasper to DiNardo, (and that's just in the American red hat territory) is it really true that the Church cannot find better men, better priests than these to run things? No, it is not really true, and so those responsible for selecting these men made some pretty big mistakes.

"Mistakes" is a generous way of putting it, Tony. But maybe I should be more generous, I don't know.

Sage, I was using the term to cover both the simple errors of estimating the validity of various facts, and also errors in judgment - judgment of whether to accept poor quality X versus poor quality Y, or neither, for example: Do we accept someone who has been trained poorly in theology (unfortunately, about 75% to 90% of them), someone who is too laissez faire on liturgical disturbances, someone who is willing to wink and nod at sexual abuse, someone whose own spiritual development is badly truncated? Accepting these in priests means, inevitably, accepting them also in bishops and cardinals - so bishops and cardinals who permit them to go on in their dioceses are setting us up for a future of the same. So, to put it bluntly,

Why the hell didn't John Paul II tell every bishop who asked for girl altar boys "not only don't you get that, but now I know not to take a single priest from your diocese and raise him up to be a bishop"

According to Wesley J. Smith, the Catholic Hospital Association supports futile care theory and has therefore opposed attempts to reform a law in Texas that has been allowing hospitals to cut off life-sustaining "treatment" of various kinds. Now, to be fair, the case in the o.p. was a case where the legal battle had been won and where the hospital simply used coded terminology in talking with the family and stopped nutrition and hydration. That could easily happen even after a legal fix. Nonetheless, there are families that would have been helped by the proposed legal fix, and it is scandalous that it is the CHA that has opposed it.

What I mean to say, Tony, is that the word mistakes carries the implication of something unintentional, as though the revolution carried out in the Church was an unfortunate and unforeseen "oopsie." But that's a subject for another thread, so I should just shut up about it.

Two observations: 1) It is sad but true that some Catholic hospitals are becoming/have become "catholic-lite". 2) Bishops still are not all-knowing, and the local bishop is probably not aware of this particular case.

It is the local bishop, who has jurisdiction of the particular Catholic hospital, and not Cardinal DiNardo unless the hospital in question is within the borders of the Archdiocese of Houston. The cardinal's interest would lie in his work on the pro-life committee.

The local bishop should be made aware of this. Like the bishop of Phoenix, who evaluated a case of a terminated pregnancy, the local bishop should evaluate this case. In Phoenix, the hospital lost its Catholic affiliation.

The local ordinary is Bishop Joe Vasquez.

I can find nothing about this on the diocesan website, nor on the Seton website. The closest thing is a document on the Texas Catholic Conference website, http://txcatholic.org/images/docs/Advance_Directives_Reform.pdf , which indicates that hydration and nutrition are normative for "all" patients. Perhaps as this is simply a desideratum, the Catholic hospital felt that it was okey dokey to ignore it.

If the TCC were to apply its arguments in favor of opening the borders, eliminating the death penalty, and that sort of thing, to the hospitals which fall under the influence of the bishops comprising the Conference, then we would not have a situation in which it looks and feels like the Catholic Church carried out a deliberate execution of an innocent man.

"Comfort care" unequivocally means "hurry up and die already": euthanasia by dehydration. They tried that routine on an in-law of mine and had the family convinced, until I asked a few questions and got the proposal translated into honest language. This has been standard practice in medicine for decades: to offer to kill loved ones by dehydration in the most conciliatory, ambiguous, this-is-what-all-compassionate-people-do tones.

I was communicating with a young Christian nurse recently, a young man, as it happens, and it was interesting to see how his training has made him quite comfortable with giving no nutrition and hydration by tube while at the same time he doesn't want to mislead or confuse the family. I asked him what "palliative care" meant, stating that if I ever had a power of attorney for health care and were offered "palliative care" for the patient, I would want to know the meaning. He _strongly_ encouraged me to ask questions and was quite pleased about the thoroughness of the information that he would give if asked such questions. There was clearly no intent to deceive on his part, personally. But at the same time...I got the impression in a way that was difficult to quantify that the training was strongly in favor of the "no food or water except for swabbing the mouth" if the person could not eat and drink on his own.

You have to ask the right questions, and bluntly, or you will be led down the garden path to execution by "comfort care."

I agree. And good for you for having asked the right questions.

I believe that the system corrupts everyone in it. This is a reason why I am not sure how or if one could advise a Christian young person considering entering the medical profession.

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