Help my brother witnessed/participated in a death

[deb1]

Hello,

This is difficult for me to write. My younger brother is a PA -physicians assistant. Recently, he helped care for a man with lung cancer. My details are sketchy. The mans lung was removed and there was an infection in the other one. He had suffered a long time and had other problems. After talking to the man, the dr in charge agreed to increase the morphine drip to allow the man a quicker death. My brother was in charge of the other aspects of the man’s care and helped carry out the drs orders. So, although it pains me to say this, my brother helped murder the man. My brother called me and explained how awful that he felt. He said that he would never do something like that again. At the same time, he thinks that the dr’s decision to helped speed up the process of death was justified. I don’t know how to handle this situation. My little brother is not Catholic, but Assembly of God. I really want to discuss this with my brother and get through his stubborn resolve that he did nothing wrong.

 

[mercygate]

deb1:

Hello,

This is difficult for me to write. My younger brother is a PA -physicians assistant. Recently, he helped care for a man with lung cancer. My details are sketchy. The mans lung was removed and there was an infection in the other one. He had suffered a long time and had other problems. After talking to the man, the dr in charge agreed to increase the morphine drip to allow the man a quicker death. My brother was in charge of the other aspects of the man’s care and helped carry out the drs orders. So, although it pains me to say this, my brother helped murder the man. My brother called me and explained how awful that he felt. He said that he would never do something like that again. At the same time, he thinks that the dr’s decision to helped speed up the process of death was justified. I don’t know how to handle this situation. My little brother is not Catholic, but Assembly of God. I really want to discuss this with my brother and get through his stubborn resolve that he did nothing wrong.

Ah. The old principle of double effect. The morphine was to control the pain but, secondarily, the death came sooner than it would have without that merciful intervention. This is not murder.

I would find it unfortunate if the doctor actually used the phrase, “to allow the man a quicker death” – as if that were his purpose. Priests for Life has an 800 number. You might want to talk with someone there; they have been helpful to me in the past, especially with sorting out just how much influence I can ethically exert in cases where the issues are less than obvious.

 

[Verbum_Caro]

Deb,

I am so sorry. It must be very difficult for you and for your brother.

You may want to try contacting the National Catholic Bioethics Center. (6399 Drexel Rd, Philadelphia PA 19151; Call : (215) 877-2660). The also have a very good website.

The staff there are very caring and generous with their time. If you call them and explain your situation it is very possible that someone will call you back (an ethicist) who may be able to talk with you and give you some ideas or some comfort.

If you do not feel like calling them, you might want to look at their website.

If you do call them, and they are able to speak with you, it might help you. You will be able to explain the details of the situation, and in cases such as these, details are very important.

I will say a prayer for you and your brother.
God bless you.

ncbcenter.org/home.html

 

[urquhart]

My view is that it might be best to drop it unless your brother brings it up again. He may not have sinned at all in this situation. Euthanasia is certainly a grave matter, but your brother did not have full knowledge of the act’s immorality, and complete consent of his will is dubious under the circumstances… But if you do convince your brother he committed a grave sin, he won’t be able to go to confession, since he’s not Catholic, so then where will he be?

 

[fix]

mercygate:

Ah. The old principle of double effect. The morphine was to control the pain but, secondarily, the death came sooner than it would have without that merciful intervention. This is not murder.

Right, it would only be murder if the intent was to cause death. These issues have been happening for decades in hospitals.

 

[deb1]

fix:

Right, it would only be murder if the intent was to cause death. These issues have been happening for decades in hospitals.

From what my brother said, the intent was to cause the man’s death. This was done with the man’s consent. When I tried to further question my brother he just evaded me by saying that it was done all the time in hospitals. Also, he told me that he feels horrible and doesn’t ever want to participate in such an act. Its like his heart and his head are in two different places.

 

[deb1]

Verbum Caro:

Deb,

I am so sorry. It must be very difficult for you and for your brother.

You may want to try contacting the National Catholic Bioethics Center. (6399 Drexel Rd, Philadelphia PA 19151; Call : (215) 877-2660). The also have a very good website.

The staff there are very caring and generous with their time. If you call them and explain your situation it is very possible that someone will call you back (an ethicist) who may be able to talk with you and give you some ideas or some comfort.

If you do not feel like calling them, you might want to look at their website.

If you do call them, and they are able to speak with you, it might help you. You will be able to explain the details of the situation, and in cases such as these, details are very important.

I will say a prayer for you and your brother.
God bless you.

ncbcenter.org/home.html

Thank you. I will probably wait until Monday to call. That will give me time to pray about this. My brother is coming to my son’s b-day tommorrow. He might talk further with me.

 

[fix]

deb1:

From what my brother said, the intent was to cause the man’s death. This was done with the man’s consent. When I tried to further question my brother he just evaded me by saying that it was done all the time in hospitals. Also, he told me that he feels horrible and doesn’t ever want to participate in such an act. Its like his heart and his head are in two different places.

Well, that is another issue. If the intention was to kill, that is certainly a problem and unfortunately does happen all the time. Please continue to pray for all involved and talk to a priest.

 

[mercygate]

deb1:

From what my brother said, the intent was to cause the man’s death. This was done with the man’s consent. When I tried to further question my brother he just evaded me by saying that it was done all the time in hospitals. Also, he told me that he feels horrible and doesn’t ever want to participate in such an act. Its like his heart and his head are in two different places.

Seriously UGLY.

It may seem like a wasted nuance to that Doctor, but just as some people see no difference between NFP and contraception, the “nuance” is NOT trivial. Maybe your brother will be forced by this event to ramp up his “ethical fitness” and become the point person for cases that will arise in the future.

This is an important role for Christians – whether Catholic or Assembly of God; I believe we are all on the same page with this one.

 

[Ani_Ibi]

mercygate:

Ah. The old principle of double effect. The morphine was to control the pain but, secondarily, the death came sooner than it would have without that merciful intervention. This is not murder.

You lost me there. I think we are talking about remote material cooperation which can be permitted, according to the Church, in the presence of proporationate reasons.

****Double effect: The word ‘proportionate’ for a Catholic necessarily conjures the Principle of Double Effect. According to the Principle of Double Effect, for an act to be morally licit all of the following must apply:

a) a) The object of the act must not be intrinsically contradictory to one’s fundamental commitment to God and neighbor (including oneself), that is, it must be a good action judged by its moral object (in other words, the action must not be intrinsically evil). The object of increasing the morphine drip was to decrease the period of suffering. Therefore (a) applies.

b) b) The direct intention of the agent must be to achieve the beneficial effects and to avoid the foreseen harmful effects as far as possible, that is, one must only indirectly intend the harm. The desired beneficial effect was a decreased period of suffering. One cannot say that harm was indirectly intended because the means of decreasing the period of suffering was death. Therefore (b) does not apply.

c) c) The foreseen beneficial effects must not be achieved by the means of the foreseen harmful effects, and no other means of achieving those effects are available. This is where we run into trouble. The decrease in the period of suffering is because death is induced by the increased morphine drip and we know that other means of achieving a decrease in the time of suffering were available. Therefore (c) does not apply.

d) d) The foreseen beneficial effects must be equal to or greater than the foreseen harmful effects (the proportionate judgment). Nothing can compensate for death except Jesus. Therefore (d) does not apply.

e) e) The beneficial effects must follow from the action at least as immediately as do the harmful effects. (e) Applies.

*b,c, and d do not apply. *Therefore there was remote material cooperation. Therefore the action was not licit. This is Catholic doctrine though. I do not know anything about the Assembly of God. You may wish to suggest that the person’s feeling of discomfort may actually be the promptings of conscience. Some reading is: Evangelium Vitae, Humane Vitae, and Dona Vitae at the Vatican website. The person can also go to a priest without being Catholic. Better choose an orthodox priest though. The Centres mentioned above can refer the person to pastoral care.

 

[mercygate]

Ani Ibi:

You lost me there. I think we are talking about remote material cooperation which can be permitted, according to the Church, in the presence of proporationate reasons.

Double effect: The word ‘proportionate’ for a Catholic necessarily conjures the Principle of Double Effect. According to the Principle of Double Effect, for an act to be morally licit all of the following must apply:

a) a) The object of the act must not be intrinsically contradictory to one’s fundamental commitment to God and neighbor (including oneself), that is, it must be a good action judged by its moral object (in other words, the action must not be intrinsically evil). The object of increasing the morphine drip was to decrease the period of suffering. Therefore (a) applies.

b) b) The direct intention of the agent must be to achieve the beneficial effects and to avoid the foreseen harmful effects as far as possible, that is, one must only indirectly intend the harm. The desired beneficial effect was a decreased period of suffering. One cannot say that harm was indirectly intended because the means of decreasing the period of suffering was death. Therefore (b) does not apply.

c) c) The foreseen beneficial effects must not be achieved by the means of the foreseen harmful effects, and no other means of achieving those effects are available. This is where we run into trouble. The decrease in the period of suffering is because death is induced by the increased morphine drip and we know that other means of achieving a decrease in the time of suffering were available. Therefore (c) does not apply.

d) d) The foreseen beneficial effects must be equal to or greater than the foreseen harmful effects (the proportionate judgment). Nothing can compensate for death except Jesus. Therefore (d) does not apply.

e) e) The beneficial effects must follow from the action at least as immediately as do the harmful effects. (e) Applies.

*b,c, and d do not apply. *Therefore there was remote material cooperation. Therefore the action was not licit. This is Catholic doctrine though. I do not know anything about the Assembly of God. You may wish to suggest that the person’s feeling of discomfort may actually be the promptings of conscience. Some reading is: Evangelium Vitae, Humane Vitae, and Dona Vitae at the Vatican website. The person can also go to a priest without being Catholic. Better choose an orthodox priest though. The Centres mentioned above can refer the person to pastoral care.

Great post, as always, Ani. But one could argue that a licit reason for the morphine drip was not to “*decrease the **period ***of suffering” but to decrease the intensity of the suffering.

Walk me through this. Would that not be a significant change to the side of the angels?

 

[Ani_Ibi]

mercygate:

Great post, as always, Ani. But one could argue that a licit reason for the morphine drip was not to “*decrease the **period ***of suffering” but to decrease the intensity of the suffering.

Walk me through this. Would that not be a significant change to the side of the angels?

Change the clause in question and go down the list of requisite criteria for licitness. See what turns up.

 

[fix]

A good example is the case in which a physician considers the possibility of relieving a patient’s physical pain. In order to do so, he would have to administer morphine to the patient. However, administering morphine runs the risk of causing respiratory failure or some other condition that can shorten the patient’s life. The physician finds himself in a genuine moral dilemma. In light of the principle of double effect, the physician:

1. recognizes that there is no alternative to administering morphine for relieving his patient’s physical pain;
2. understands that administering morphine, in and of itself, is a neutral action;
3. would prefer that there be no risk at all in administering the morphine, does not intend the risk, and does not want the risk to become reality;
4. The intended good consequence (relieving his patient’s physical pain) would not be caused by the unintended but possible evil consequence (respiratory failure or any other effect that places the patient’s life at risk). If the possible evil consequence became reality, the intended good consequence could not become reality: relief of pain as intended by the physician presupposes that the patient remains alive and able to experience the relief;
5. discerns with prudence that there is a moral proportion between the intended good and the unintended but possible evil consequence. In other words, he discerns that it is morally justifiable to take the risk of administering morphine.

In short, heretical proportionalism boils down to the teaching that one may do evil in order to accomplish good. The principle of double effect, in contrast, rejects this teaching.

**Answer by Fr.Stephen F. Torraco on 02-07-2003:
ewtn.com/vexperts/showresult.asp?RecNum=291333&Forums=0&Experts=0&Days=2003&Author=&Keyword=morphine&pgnu=1&groupnum=0&record_bookmark=2&ORDER_BY_TXT=ORDER+BY+ReplyDate+DESC&start_at=

**

 

[Ani_Ibi]

Morphine drip as opposed to … ? A couple of the nurses on CA had this discussion a few months ago. The drip, they said, depresses respiration. The inhalor, however, seemed to lessen that risk. So far we have only spoken about morphine. There are many factors to pain. Fear is one. Care and comfort is another. Pastoral care is another. Different medications or combinations thereof is another. Palliative radiation is another. And the list goes on.

I wonder about pain. My mother had none. My good friend had none. Yet they both had advanced cancer which could have been painful had they received different care. One talks in depth about the ‘quality of life’ on this forum yet rarely hears about the ‘quality of care.’ That is what we can be talking about as Catholics.

 

[fix]

Ani Ibi:

Morphine drip as opposed to … ? A couple of the nurses on CA had this discussion a few months ago. The drip, they said, depresses respiration. The inhalor, however, seemed to lessen that risk. So far we have only spoken about morphine. There are many factors to pain. Fear is one. Care and comfort is another. Pastoral care is another. Different medications or combinations thereof is another. Palliative radiation is another. And the list goes on.

I wonder about pain. My mother had none. My good friend had none. Yet they both had advanced cancer which could have been painful had they received different care. One talks in depth about the ‘quality of life’ on this forum yet rarely hears about the ‘quality of care.’ That is what we can be talking about as Catholics.

Morphine depresses respiration as all narcotics do. Drip or not the intention is to lessen the pain. Other factors certainly may be considered, but the patient’s medical history and condition play a pivotal role.

 

[mercygate]

I apologize for the bold type later in this post; I can’t turn it off.
Ani Ibi:

You lost me there. I think we are talking about remote material cooperation which can be permitted, according to the Church, in the presence of proporationate reasons.

Double effect: The word ‘proportionate’ for a Catholic necessarily conjures the Principle of Double Effect. According to the Principle of Double Effect, for an act to be morally licit all of the following must apply:

a) a) The object of the act must not be intrinsically contradictory to one’s fundamental commitment to God and neighbor (including oneself), that is, it must be a good action judged by its moral object (in other words, the action must not be intrinsically evil). The object of increasing the morphine drip was to decrease the [period] intensity of suffering. Therefore (a) applies.

Changing the word “period” to “intensity,” (a) still applies. Right?

---

b) b)

*** The direct intention of the agent must be to achieve the beneficial effects and to avoid the foreseen harmful effects as far as possible, that is, one must only indirectly intend the harm. The desired beneficial effect was a decreased [period] intensity of suffering. One **can **not] say that harm was indirectly intended because the means of decreasing the [period] **intensity **of suffering was [death] administering a greater dose of palliative medication. Therefore (b) **does **not] apply.
Again, changing “period” to “intensity” renders the harm less directly associated with the intent, so (b) would now apply – no?

---

c) c)

*** The foreseen beneficial effects must not be achieved by the means of the foreseen harmful effects, and no other means of achieving those effects are available. This is where we run into trouble. Agreed.

The decrease in the period of suffering is because

death is induced by the increased morphine drip and we know that other means of achieving a decrease in the time of suffering were available. Do we know that?*

Therefore (c) does not apply.

*If other means were available, then, of course, this is correct. But if morphine were the most effective means of pain management, then (c) would apply, wouldn’t it?

---

d) d)

*** The foreseen beneficial effects must be equal to or greater than the foreseen harmful effects (the proportionate judgment). In a case like this, what are the parameters of proportiontality? (You must think I am a blockhead – and I probably am . . .)

• Nothing can compensate for death except Jesus. Therefore (d) does not apply.* I think I need a diagram on this one; words of one syllable or less. The idea of “compensation” seems too pedestrian given the life-and-death stakes . . .

---

e) e)

*** The beneficial effects must follow from the action at least as immediately as do the harmful effects. (e) Applies. In other words, the relief of pain comes before death, so we’re OK at this point.

Need to go now. Hope I haven’t left this so un-thought out that it is tiresome.

 

[Ani_Ibi]

fix:

Drip or not the intention is to lessen the pain.

But the effects are different, according to whether drip or inhalor is used. What about the other routes mentioned? My mum always used to tell me that pain is a signal that something is wrong. In the case of terminal illness, I suspect it is because an incorrect pain protocol is being used. The worry raised is that morphine drip is being used to shorten stays in hospital.

My friend died at home while being cared for by a palliative home care team. There are options. I have no problem saying that doctors and nurses should be allowed to do what they are trained to do. But that doesn’t mean the rest of us should shut up. My hospital is Women’s College Hospital. In our culture, decisions are made mutually among the health care team and the patient. The patient is not treated like a thing. The patient is treated like a human being.

The price of freedom is eternal vigilance. Democracy does not mean handing over power carte blanche to some one else. It means allowing people to do their jobs with a system of checks and balances in place. Freedom is not absolute in democracies. There are limits on every freedom.

 

[Ani_Ibi]

mercygate:

Need to go now. Hope I haven’t left this so un-thought out that it is tiresome.

It takes a bit of practice. Catch ya later.

I think we can reduce the discussion to ‘other means available’ and ‘compensate for death.’

 

[2heartsaz1]

As an RN, and as a Catholic who has inlaws entirely non-Catholic Christian…

In the future when speaking with your brother, just in conversations, mention here and there the concept of God’s will, seeking to know and do God’s will, etc. Of course the Commandments are part of God’s will and protecting our bodies and taking care of our souls are part of the “Thou shall not kill” (I don’t mention number 5 because our Protestant brothers and sisters have different order) …

Murdering the innocent is what is forbidden. Comforting the sick and ailing is also included within the instructions of this commandment, though unwritten, in the typical Hebrew manner of writing.

God is the giver and taker of life- and your brother, from Assemblies of God, should be very familiar with Bible verses such as those Old Testament verses.

God disciplines us (another Old Testament verse) and suffering is part of that discipline.

Having compassion on the suffering involves caring for the person, body and soul.

One question I have, when the morphine was increased, what provisions for the man were made to care for his immortal soul?

God bless you- these are truly difficult times but the Truth will set us free!

Your brother is not alone and thank God he has a conscience.
Because other hospitals are ‘doing these kinds of things’ doesn’t make them acceptable to God. That they have been doing these things for a long time doesn’t indicate that they are moral or immoral. Humans have been sinning for a long time too.

Hope I haven’t been sounding like a gong.
Spoken in love as a parent and teacher would do while in the midst of continuing to study and learn :+)

 

[Lilyofthevalley]

Using a morphine drip to lessen pain is not murder, it’s called pain management. When my dad was dying, painfully, there were flakes in the medical field who did not want to give him too much pain medication so he would’nt be “out of it”. I had to MAKE these flakes give him more to manage his pain properly.