In the first episode of 2021, Trent addresses a topic requested by many of his patrons and shows how it applies to recent events related to surges of Covid-19.
Welcome to the Council of Trent podcast. A production of Catholic Answers.
The first episode of the Council of Trent Podcast for 2021. Happy New Year everyone. It’s been a week since the New Year started, but I’m excited that it started because I’m excited to be back here with you all to share more episodes of the Council of Trent Podcast. I’m your host, Catholic Answers apologist, and speaker Trent Horn. For those of you who might be new to the podcast, on Tuesdays and Thursdays, we talk apologetics, theology, how to explain and defend our Catholic faith. I might dive into things that are going on in the news or in the church. I might interview a friend of mine who has an expertise in a particular topic. We’ve got some great interviews lined up here in the New Year on a lot of hot topics, including things that our patrons asked about at trenthornpodcast.com. Some of the shows are people interviewing me about these various topics to offer my perspective on them.
We’ve got a few of those lined up as well. I like to share my public dialogues and debates with non-Catholics and people who disagree with the Catholic faith. We have some of those prepared as well. We’re going to do a Catholic economics round table here at the end of the month. Hopefully a debate on abortion and then a debate on the resurrection sometime in Easter. That’d be very appropriate. So we have a lot of great things planned for 2021. And I want to give a big shout out and thanks to our patrons at trenthornpodcast.com. You guys make this possible. You make the debates, the rebuttal videos on YouTube, which I want to do a lot more of this year. So many things possible through your support. So if you want to help us to grow, please consider supporting us at trenthornpodcast.com. For as little as $5 a month, you get bonus content.
I just did an open thread and asked people what show topics do you want me to cover in the new year? And our patrons came through with a lot of great suggestions. You get access to our catechism study series, a half hour video lecture posted every Monday at 8:00 AM. If you’re a silver level subscriber or higher, you get a Council of Trent mug you can keep in your pantry. It’s always a fun thing to do. Lots of great content. So be sure to go and check that out at trenthornpodcast.com or consider leaving a review. If you want to make, add onto your new year’s resolutions; if you want to go to iTunes, Google Play, scroll down to the bottom and leave a review just quick. Rank it with the stars. I would greatly appreciate that. That helps people to know more about the podcast.
So as I said before, I asked our patrons, “What do you want me to talk about?” And I probably got a hundred suggestions, dozens and dozens of answers. And our patrons really came through for me and I appreciate that. And there were a few topics that were mentioned multiple times. So I’m going to cover one of those in today’s episode because it intersects with things that are going on in the news and in current events. So I had a lot of people ask me about end of life issues. Trent, how do you talk about end of life issues? How do we understand end of life issues? I think for a lot of people, if you’re Catholic, beginning of life issues, especially when it comes to the issue of abortion, it’s pretty simple. If you want to go and talk to people about abortion, the thing you worry about the most is how do I handle when the person gets emotional?
It is kind of hard for me. I go and I want to teach people and people have been very receptive to when I’ve taught them effective ways to engage others on the issue of abortion. But I’ve had people who’ve written to me online saying, “I’ve done this for 40 years, I don’t need to hear anything new.” I say, well, there might be a few new ways to approach the issue. The arguments are pretty similar, but our approach just might need to be tailored a bit. But a lot of people, when it comes to abortion, maybe you feel this way, you’ve got the answers, you just worry about someone getting emotional. I find though that for end of life issues, Catholics are a lot more hesitant to want to go out and talk about them to other people. I mean, it’s easy with abortion to say, look, it should be illegal to kill babies.
Abortion kills babies. We shouldn’t be killing babies. People find that to be an easy argument to make and they go out there and they make that argument. But with euthanasia, with assisted suicide, with declining medical care, people start to have doubts. They don’t know how to articulate this. People will say to them, well, why can’t somebody end their own life if they want to? Are you saying people have to be kept alive by machines forever? And they get more hesitant. I’ll never forget when Brittany Maynard, that was probably back in what, 2014. Brittany Maynard was the California young woman. I think she was 29 years old. She was dying from stage four brain cancer. And she traveled to Oregon to avail herself of the state’s assisted suicide program. And it was her decision to do that, that prompted California to pass a bill, the Brittany Maynard’s law, whatever it’s called, to introduce assisted suicide to California.
And that’s usually what happens. When laws are passed, when things are changed at the legal level, a lot of times it’s not an argument. It’s not like an argument is put forward to get people’s attention. It’s a person. People are motivated more by stories of individuals than they are by arguments. So that’s why if you want to make a good engagement people on an issue, don’t just give them an argument, give them an argument wrapped in a story. You know what that’s called? A parable. You know who is great at doing that? Our Lord and savior Jesus Christ. So if we can be like him, if you can be like Jesus, you’re not going to go wrong there. That’s why when the issue of abortion comes up, people say, are you saying that kids who grow up and they live in poverty, they live in meth labs and all these other horrible places, you’re just going to let the kids be born into this and grow up in poverty and have horrible lives? Is that what you’re saying?
Now, you can just give an argument saying, well, you can’t kill human beings. These are human beings. You shouldn’t kill them. It may not resonate with people. So that’s why I do trot out the toddler. I’ve always taught people to do trot out the toddler, which is a parable. Say, look, imagine a mother ends up losing her job and she’s plunged into poverty. She ends up becoming a prostitute and she has a two-year-old and there’s drugs around and he’s going to have a horrible life. Do you think she should be able to just kill her two-year-old? Why doesn’t she place him for adoption? Let’s say he’s disabled and people don’t want to adopt him, or maybe she doesn’t want someone else raising the kid.
She just wants to end his life now and just be done with it. Well, no, you can’t do that. Well, why not? Because he’s a human being. So that’s the issue then? Yeah, that there that’s trot out the toddler, which I cover along with how to defend our faith and a lot of other issues in my moral apologetics class by the way. If you want to do beginning of life, end of life issues and everything in between when it comes to the moral life, check out my course, moral apologetics at the School of Apologetics from Catholic Answers at schoolofapologetics.com. So, people are asking about end of life issues. What is the church’s teaching on this and how do we apply it? And then I was reading in the news, people were concerned about this recent surge in COVID cases over the holiday season, over Christmas.
And it’s really like night and day here. By the way, in case you missed it from last year, me and the family, we up and moved. We are now settled in Keller, Texas. Well, we’re getting settled. We still have boxes that have not been unpacked. I’m sure I’m going to find a box in two years from the move that I haven’t opened and it’ll be the last box. But I’m broadcasting to you now from my studio in our home here in Keller, Texas. This is actually a master bedroom closet I’m operating out of. If you’ve seen Catholic Answers, you’ve seen me broadcast from here. I still haven’t gotten all the visual accoutrements up to make it look nice, but it’s sounds good. I’ve got a window. I’m looking out to my neighbors. I’m sure they’re looking through their window, like what’s Horn doing? What is that Horn guy doing in his master bedroom flailing his arms around talking to a microphone? But I love it. My old office at Catholic Answers did not even have a window. I liked it because it was tucked away.
It was in the middle of the building, down a long hallway. It used to be the credit card storage place, where it was locked and they stored credit card information, hard copies of it in there. And then they eventually digitized that and got rid of everything. And they let me have that office when the building got shuffled around. So I was in there, but I did enjoy that it was… Even if it didn’t have a window, it was tucked away, but I did get a little stir-crazy. But having a window, it’s great. My kids, we’ve done the yell test. I’ve told my kids, “Hey guys, can you yell and scream as loud as you can when you’re playing?” And I do it and I can barely hear them.
I need to install some locks though. If you go to Catholic Answers on the YouTube page, a month ago, I did an episode of Catholic Answers live. And I had a BBC moment, where Thomas my three-year-old comes into the room as I’m broadcasting live to Catholic Answers on YouTube and over the radio. And he just comes and sits in my lap and Laura peeks her head around and quietly beckoned for him to come back with her. But all in all I really enjoy it. And it’s so different. It’s so different here compared to California, COVID and non-COVID. One, I’ve had more people say, God bless you and Merry Christmas in the first three weeks I been here than in the three years that I lived in San Diego. There’s a lot of great Catholics in San Diego, but you feel there’s a cultural difference here in Texas.
And then also when it comes to COVID, I mean, people care about it. They wear masks inside buildings, but the restrictions are reasonable. I can take my kid to the park. I can go and eat at a restaurant. They’re doing things in a sensible way. And what gets me is people will say, you need to tighten up your restrictions. Texas is having this surge in COVID cases. Well guess what, everybody’s having a surge. You go to California, when I just left, they banned outdoor dining. They closed the playgrounds again, and they’re still having a surge. So this idea that, well, if we just do these authoritarian rigorous lockdowns, it’s a weird unfalsifiable hypothesis. Even the World Health Organization came out a few months ago and said don’t do broad lockdowns. Don’t just do broad blanket lockdowns. They don’t work. You have to do targeted lockdowns because it doesn’t make sense in California. Then they say, you just need to stay home.
I mean, that worked for two weeks to slow the spread, but you can’t stay home for six months. You can’t stay home for a year. So in LA, when they banned outdoor dining, even the public health director in LA admitted at a news conference, well, outdoor dining doesn’t contribute to the spread of COVID, but we want to send a message that people need to stay home. Dude, it’s not your job to send me a message. You’re not my dad. That’s paternalism. So when they do that, you take away… These are the same people by the way, these health people in California who say… Sorry if I’m getting a little ranty. Who’ll say we’re going to close outdoor parks. We’re going to close outdoor restaurants. Well, they don’t spread COVID. Yeah, but we’re sending a message. You need to stay home. I don’t care. You need to stay home. You need to abstain from going out. You need to practice abstinence.
These are the same people who will tell you, we can’t do abstinence only education for children. That’s unrealistic. We have to teach them how to practice safe sex. Well, it turns out they’re still sharing diseases. Okay, they can’t call it safe sex anymore. In sex ed curriculums, they call it safer sex because they can’t. Because obviously it’s not safe when you’re encouraging kids to go out where they can get sexually transmitted diseases, unintended pregnancies. Not to mention all the spiritual and emotional harms. But my point is, these are the people who tell you that abstinence is unrealistic. Who will tell us that we need to stay home for a year and not leave our house. Not go to the park. Not go to outdoor dining.
Well, it just doesn’t make sense in California where they’re doing this because they say no outdoor dining, parks and playgrounds are closed. Okay, so what are people going to do? They’re going to go over to a friend’s house. They’re going to get takeout. And they’re going to eat a meal at a friend’s house. And their kids are going to play inside of their friend’s house because they can’t be outside and you can’t play outside. You don’t want to get in trouble. And the disease is just going to keep spreading. That’s what I appreciate here in Texas. Yeah, cases are going up and we should pray that they diminish. We should take reasonable, sensible precautions to not spread COVID-19, but we also shouldn’t overdo it with lockdowns and other preventative measures because the surge is still continuing.
And that brings us to the topic of today’s episode, which is, what do you do with end of life issues, especially when it comes to rationing care for people because that’s a concern as ICU capacity fills up in, especially the smaller regional hospitals. What do you do if you have a lot of people who are sick from COVID and you have to decide who gets a ventilator and who doesn’t, which boggles my mind by the way? Remember, when back in last spring it was, we’re going to run out of ventilators. We need two weeks of slow, the spread. And then in California, Governor Newsom gets on the TV saying we are the leaders in California, we have a surplus of ventilators, we’re sending them to other states.
And now you’re running out of ICU space. You’re running out of ventilators. You had a year to build capacity. You wanted two weeks to build capacity and you had a year. What is going on here. As Mugatu would say in Zoolander, “I feel like I’m taking crazy pills.” So this is an article in the Los Angeles Times; LA County Issues Most Dire Coronavirus Warnings Yet, Hospitals in Crisis as Death Toll Surges Toward 10,000. So the article says we’re concerned, the hospitals are going to overwhelmed. We’re putting people in gift shops. We are putting people in hospital corridors. So it said, “The sad reality is that all indicators tell us that our situation may only get worse as we begin 2021, said LA County public health director, Barbara Ferrer. The rate of community transmission remains extraordinarily high. This has taxed our hospital system as more COVID-19 patients continue to stream in on top of the thousands of patients already fighting for their lives.”
The article goes on to say in the LA Times, “In extreme circumstances, hospitals could be forced to ration care, with doctors no longer pulling out all the stops to save a life. And instead strategizing about where to most effectively use resources and equipment. Huntington Hospital in Pasadena is warning of that grim possibility in an information sheet for patients and their families. Should the situation “reach a point where our hospital faces a shortage that will affect our ability to care for all patients”, officials wrote, then a clinical committee, oh great, consisting of doctors, a community member, a bioethicist, a spiritual care provider, and other experts will review the cases of all patients who are critically ill and make necessary decisions about allocating limited medical resources based on the best medical information possible. And we’ll use the same decision criteria that is being used nationally and throughout California on all patient cases.” So what we’re dealing with is rationing care, whether it’s ventilators or ICU beds. And once again, because we didn’t increase capacity, we had a year to do that, so can you do that?
Can you ration care? How do you do that as a Catholic? How do you say, we have this many ICU beds, we have this many ventilators, what should we do in this situation? Well, there’s a great article by my mentor, Father Tad Pacholczyk, who was one of my teachers at the University of Mary, bioethics program. He has a great column called Making Sense of Bioethics. Just look up Father Tad Pacholczyk. Wonderful Polish name that I’m going to have to spell out for you if you want to fully search it. P-A-C-H-O-L-C-Z-Y-K, Pacholczyk. You can also search Father Tad NCBC to get a lot of his writings. But look up Father Tad, Making Sense of Bioethics. He has a wonderful way of breaking down complex issues in bioethics. And they can become complex.
So take for example, end of life issues. What is the Catholic approach on end of life issues? Well, what it does is it strives to find them middle ground between two extreme positions. So I want to talk about that before I get into how to apply that to the rationing of ventilators or ICU beds. So on the one extreme, we’ve those people who think death is actually a good thing for a lot of people. That if you have a suboptimal life, if you’re elderly, if you have an illness, if you have mobility issues, if you have paraplegia, quadriplegia, death may be an excellent remedy for you. So death is not really that bad. And so maybe these people who are sick, like we have ventilators here and we’ve got someone who… They are already a quadriplegic or they’re already on kidney dialysis, look, they don’t have a life worth living.
If you’re going to be really grim, we’re going to have people who use the German phrase, lebensunwertes leben. Sorry if I butchered that. Life unworthy of life. Now, I’m not saying that people who hold this more secular view in bioethics, who are more apt to say, well, we don’t need to give care to people who have these kinds of illnesses or disabilities. I’m not saying they’re Nazis or something like that, but I am saying that in modern contemporary bioethics, there are some scary things. For example, you have Ezekiel Emanuel, he’s the brother of Rahm Emanuel, Obama’s former chief of staff. And he was selected to be part of Joe Biden’s commission on dealing with COVID-19. And I don’t know why he’s picked because he wrote an article in the Atlantic called, Why I Hope to Die at 75. I mean, so he’s not saying we should euthanize everybody over the age of 75, but what he’s saying is he doesn’t want to live past 75. And he’s saying there’s nothing really worthwhile about life after 75, which is super disrespectful to people over the age of 75 who have very meaningful lives that they share, leisure.
He thinks life is only meaningful if you’re engaged in work. As if a life of leisure, recreation, reflection, discernment, or spending time with grandchildren isn’t worthwhile. It’s just too much. But you see this kind of mentality, who think, oh, death might be good for these people, but that’s of course, not what the church teaches. In paragraph 2276 and 2277 in the Catechism, it says, “Those whose lives are diminished or weakened deserve special respect. Sick or handicapped persons should be helped to lead lives as normal as possible. Whatever its motives and means, direct euthanasia consists in putting an end to the lives of handicap, sick or dying persons. It is morally unacceptable, thus an act or omission, which of itself or by intention causes death in order to eliminate suffering, constitutes a murder gravely contrary to the dignity of the human person and to the respect due to living God his Creator.”
So that’s one extreme, are those who would bracket off the human community to say, some people have life unworthy of life or lives that are really not worth living. And so when we’ve got this care, we’ve got this COVID pandemic, we should reserve the medical supplies that we have for the people whose lives are most worth living. That is completely opposed to Catholic teaching about the dignity of, and respect do to every single individual, simply because they’re made in the image and likeness of God. But on the other extreme though, are people who fear death so much that they want to live forever. These are the transhumanists. These are the people who want to eventually download their minds into computers or find a way to cure death.
I was reading a book recently, but I only made it through about 100 pages because I didn’t feel like it was that great. Everyone tells you, you got to read this book Trent, you got to read this book. It’s by Yuval Noah Harari, Homo Deus. It’s a futurist book, A Brief History of Tomorrow. And he was talking about transhumanism. And he says there are some people who think by the year 2050 we’ll cure death in the sense of not that you’ll be a mortal no matter what. He said that you could always get hit by a car or crushed by something. They think that every 10 years you’ll go in, you’ll have a machine that can regenerate your cells, it will be able to cure the diseases you have.
It’s like that movie Elysium with, what was it, Mark Wahlberg. I think it was Mark Wahlberg in it, where they have this futuristic space station that the rich people go to and you can get your body scanned and all the cancer and bad things taken out of it. But it’s only for the super-rich. And so he says there are some people who think that there are people, the wealthy walking around now who will have access to that and they may be able to live forever, though he himself is skeptical we’ll see that in the 21st century. So you have people and you even have some Catholics who erroneously think you have to do whatever it takes to stay alive. And this is really unfortunate. They think that it’s not pro-life or that it’s murder if you discontinue some medical treatments because they read in that previous paragraph, “An act or a mission which by itself or intention causes death in order to eliminate suffering.” They think omission, that means I can never go off life support then because I’m going to die if I go off life support.
No, there’s a difference between depriving someone of what they have a right to in order to kill them and recognizing that they are dying and not trying to stop the inevitable process of death from going underway. So as a Catholic, we don’t believe that there are some people you should kill because they’re disabled or sick, but we also don’t believe that you should do everything humanly possible to keep people alive because death is a boundary point, a dividing point. Death is bad, but it’s not something that we irrationally fear. It’s something that we have apprehension towards. It’s bad. It was never part of God’s plan for human beings, but it is also the door to eternal life that we walk through when God chooses for us to walk through it. So that’s why the Catechism says in paragraph 2278, “Discontinuing medical procedures that are burdensome, dangerous, extraordinary, or disproportionate to the expected outcome can be legitimate. It is the refusal of over-zealous treatment. Here, one does not will to cause death; one’s inability to impede it is merely accepted. The decisions should be made by the patient if he is competent and able, or if not, like if they’re unconscious, for example, by those legally entitled to act for the patient whose reasonable will and legitimate interests must always be respected.”
Some people have used older vernacular, ordinary care and extraordinary care, but the better terms a bioethicists use would be proportionate care and disproportionate care. And so the question is, what treatments are proportionate and what are disproportionate? There are some cases where it’s very clear cut. Food, water, heat, cooling, being turned in one’s bed, this is proportionate care. I mean, maybe being turned or moved, unless someone had brittle bone disease and moving them could cause their bones to break may not be proportionate. Let’s take food and water for example. You are not justified in depriving someone of food and water because you think they are a hopeless case and you want them to die. That is not withholding medical care. That is murdering someone.
That is what happened to Terri Schiavo. Terry Schiavo was in a persistent vegetative state and was unable to eat food just like my three-month-old cannot eat food by himself, a quadriplegic may not be able to eat, or someone with severe cerebral palsy may not be able to eat their own food. And so they need assistance from others. And we don’t get to decide of the group of people who need assistance from others to eat, which ones deserve food and which ones don’t. It’s always proportionate and it’s always wrong to withhold it from someone in order to kill them. Now, however, there are cases when people are at the very end of their life, this happens a lot in hospice, where, as someone is dying, I mean, they’re dying, they’re going to be dead in 24 or 48 hours let’s say. They will have lost their appetite. Appetite loss is very common near the end of one’s natural life.
And so in that case, withholding food and water, you don’t do it to kill the person. You do that to not inflict unnecessary pain because they are in the process of dying. Withholding food and water is not going to kill them, it’s not going to starve them to death. It’s just going to prevent unnecessary pain. So that would be an example of if someone was on their death bed, they’re going to die in the next 24 hours, eating or drinking may be disproportionate. It provides no benefit to the patient. In fact, it harms the patient. But then there’s going to be other cases where it can be difficult to determine if the care is proportionate or disproportionate. And so we look at two factors. What benefit does it provide the patient and what costs are involved? As a general rule, if it provides very, very little or negligible benefit, and the costs are severe, either physically, emotionally, financially, then the care may be disproportionate.
A clear example of this would be someone who has a massive brain injury and is being kept alive on a heart lung machine, and the prognosis is that they will never regain consciousness and these machines are essentially keeping their body from decomposing. In that case, it’s futile, it’s disproportionate care. It can be withdrawn. But there are other cases where it may be harder to tell. Take kidney dialysis. Kidney dialysis is a very tiring experience, it’s very difficult to undergo. And you may have a case of an 85-year-old who could undergo kidney dialysis and it might keep them alive for another six months. Their organs are already starting to fail and all that it will do is it will make them more tired. It will be very costly to them and their family and there’s a greater likelihood for a secondary infection or something like that.
So you may determine in that case, that it’s disproportionate. But there could be a case with someone who has an acute kidney disease, who is an otherwise healthy 25-year-old, who needs to be on a kidney dialysis regimen for six months, and then they’ll be fine. They’ll be back to near good health. They’ll be at good health in six months and will no longer need it and can live an average life for someone in their mid-twenties. And so in that case, discontinuing it may be rejecting proportionate care. I remember reading a case about a woman in England who wanted to reject kidney dialysis. I think she wrecked her kidneys or her liver through a suicide attempt and she wanted to reject it because she wanted to kill herself still.
It didn’t work first time she wanted to do that. That would be something that would be illicit. So when it comes to these treatments, the ethical and religious directives for Catholic Healthcare Services, paragraph 57, defines disproportionate as disproportionate means… So the disproportionate means those that you can refuse and you’re not committing a sin. You’re not doing something immoral. If you withdraw disproportionate care, you’re not murdering someone. You’re allowing the inevitable process of death to take its natural end. It says, “Disproportionate means are those that in the patient’s judgment do not offer a reasonable hope of benefit or entail an excessive burden or impose excessive expense on the family or the community.” So when we’re deciding whether the care is proportionate or disproportionate, we cannot take the mindset of, oh, well, this life isn’t really worth living. Now, in my case, the example of the 85-year-old man with kidney dialysis, an 85-year-old’s life is certainly worth living.
It was not his age in that example where I said the dialysis may be disproportionate. It’s the fact if he has other comorbidities. If he has other illnesses or symptoms where he is already in the process of dying. And while his kidneys may be getting treatment, if his other major bodily organs are starting to shut down, then it just may end up being futile. It may provide him six months of life. But the costs involved for those six months may just be too much for the patient to want to bear. And so the treatment would be disproportionate. But there are other cases where people will apply a treatment and it’s disproportionate or proportionate, verdict will be rendered solely on whether the patient has a disability and that’s wrong. So, if you have an infant who needs a gastrointestinal surgery. An infant who needs a surgery so they can digest food. Most parents, they say, well, we’ll do the surgery. It’s outpatient. It takes one day. We’ll do it and he will not have any other side effects from this for the rest of his life.
If John Paul needed that, otherwise he was going to die because he can’t digest food, I would obviously give him that surgery. But you had cases in the 1980s of babies who were born with down syndrome who also had this stomach blockage that prevented them from digesting food and their parents refused to give them care. The most famous example of this was the 1982 Baby Doe case. So it says here, in 1982, Baby Doe, his real name was never released, was born in Bloomington, Indiana with down syndrome and a birth defect requiring surgery. The parents refused the surgery because of the child’s down syndrome. Hospital officials had a guardian appointed by the Indiana Juvenile Court to determine whether the surgery should be done. The court ruled in favor of the parents and thus against the surgery and the Indiana Supreme Court refused to hear the case. The baby died later in 1982. Due to the baby’s death, there could be no appeal to the United States Supreme Court. And when this case came out, I remember reading newspaper articles about it.
This broke to the news. It broke and people were saying that there’s this baby at this hospital and the parents are not going to give him surgery so he can live and he’s going to starve to death. And what happened, a dozen families came forward and said we will adopt this baby. Please don’t do this. So don’t you dare give me that garbage, that slander. Not you. I don’t think you believe that, but you hear it. You’re pro-life, you only care about life after birth. That’s my Dave Ramsey when he makes fun of people, he uses that voice. It’s basically Kermit the Frog. You only care about life after birth. Any child, an infant in this country, there is an adoption wait list of five to 10 years. Any infant in this country can be placed with a loving family. A dozen families came forward; we will adopt this baby. And the baby starved to death.
And so this resulted in the passage of Baby Doe laws in 1984, saying here that states that receive federal money for child abuse programs have to develop procedures to report medical neglect, which the law defines as the withholding of treatment, unless a baby is irreversibly comatose or the treatment for the newborn survival is virtually futile. So here, I mean, in this case you would give this surgery to any child, but you decide, oh, you have down syndrome, you have a life not worth living. It’s so, so disrespectful and offensive. And I remember, in my debate with Dr. Malcolm Potts, the abortion provider and professor at UC Berkeley, one of the students asked about, what about abortion in the case of down syndrome? And Dr. Potts twisted himself into a pretzel to say, “Well, I love people with down syndrome. I understand it’s a difficult diagnosis, but women have a right to choose.” And I just said, “You know what? If someone here had down syndrome or knows someone with down syndrome, that was a very offensive and uncomfortable answer to hear that your life isn’t worth protecting?
So that brings us back to the question of rationing COVID-19 care. We don’t want to be in a situation where we withhold care, just because somebody has a “lower quality of life” like in these horrible down syndrome cases. That’s why I recommend this article, Thinking Through the Rationing of Ventilators by Father Tad Pacholczyk in the March 2020 issue of Making Sense of Bioethics. This was back when we were really worried about shortages. That might not be the shortages that will take place. And the hospitals may not be overwhelmed. The surge may subside, but if it is the case or in a future illness, something else that happens in the future, we need to be prepared for these kinds of situations when they arise. So the principle of rationing ventilators can also be applied to rationing ICU beds and other kinds of specialized treatment for COVID-19, if you have these surges, especially in smaller hospitals.
So this is what he says about ventilators, but it could apply to all other kinds of treatment. He says ventilators should not be rationed based on categorical exclusions, such as a patient’s age, disability, or other secondary traits, but rather… So you wouldn’t say, oh, you have down syndrome or you’re older anyways. I mean, how many years do you have left as it is? You’re over 75, Ezekiel Emanuel would say. Is your life really worth living? You can’t do that.
But it is based. It’s not purely random either. When you have the ability to designate among people on a waiting list, it says it should be made on the basis of clinical data, including likelihood of survival, organ function and other clinically relevant medical data or test results. So it should be evenly applied across the board of who is going to benefit from this. Some people who are disabled may do very well on a ventilator regardless. And some people who are not disabled may have some other kind of co-morbidity or a secondary infection that they may not do well on a ventilator as is and it may be better to allocate that to someone else. So it says various medical scoring tools can be used to objectively evaluate this information about a patient’s status and to make comparisons among patients.
Number two, if two clinically similar patients arrive at the emergency room, the allocation of a ventilator to one over the other can be done on first come first serve or a lottery basis. Once again, you don’t say, oh, we got two people of similar health who both need a ventilator. Well, this guy has more money so we’re going to help him. Or this person is of a disadvantaged race and so we should practice anti-racist justice, whatever the mindset may be. No, you should just apply something randomized in this situation or first come first served.
Number three, it is generally immoral to take away without consent, the ventilator of a patient still in need of it in order to give it to another patient who may die without it. So even if someone is not doing well on a ventilator and you feel like, oh, I wish I could give the ventilator to that guy over there. You can’t take it away from that person without their consent or the consent of their healthcare proxy, which is where point 4 comes in. Father Tad says, in situations where a patient on a ventilator is clearly deteriorating and where COVID-19 and its complications can reasonably be expected to cause the patient’s death, even with continued ventilator support… I mean, ventilators are not magic. Ventilators are meant to keep oxygen in your bloodstream and assist in the functioning of the lungs either to replace or in many cases, assist in lung function. The body still needs to be able to heal. If it can’t do that, we can’t do ventilators indefinitely. So it says dialogue should be initiated with the patient or his designated healthcare agent to obtain consent to remove the ventilator.
If it’s not because you want to necessarily save this other person, but you would pretend, let’s say that other guy didn’t even exist. And look, the ventilator is not helping. The prognosis is poor. It looks like this person is not going to survive. So there, removing the ventilator would not be removing proportionate care, it would be removing disproportionate care because it’s not providing a benefit to the patient. They’re not getting better and they may even be getting worse. It goes on to say a scoring tools can be used to decide which patient’s health care agent should be approached first. That’s why it’s always important to have a healthcare proxy. Don’t just get a living will. Your mind can change later in the future. Designate someone you trust, who shares your values to be a healthcare proxy. I’m sure they have information on that at the National Catholic Bioethics Center. Check them out. Fill that out. Have it set aside so someone you trust can make those decisions for you if you’re incapacitated.
Number five, patients who relinquish a ventilator in triage situations or who cannot be given a ventilator due to the lack of availability should receive not only suitable alternative forms of medical treatment. And there may be cases of people who would give up ventilators. I heard stories of priests who said, if I got COVID-19 and there was a crowd of the hospital, I would give up my ventilator they said. Which is heroic. He said they should receive not only suitable alternative forms of medical treatment and palliative measures, i.e. painkilling measures to manage their discomfort, but also spiritual support rooted in their particular religious tradition. So that’s why one of the biggest tragedies of this is people have died cut off from human contact. They can’t even have someone with them, not even a priest with them for confession or last rites.
I think it’s the saddest thing. These hospitals, I mean, can’t we do something to give these people a hazmat suit, like in that movie, Andromeda Strain? I mean, if I was in charge. But seriously, if I was in charge, I’d invest to give priests those hazmat suits and I would send them into the hospitals as much as possible. Our mission in this life is to prepare for the next life. That’s what this life is for, to prepare for the next life. And the way we prepare for that is by holding close to our Lord and savior through the sacraments. The sacraments of a communion, of confession that he’s given to us. And there’s ways to adapt them for these situations. During the black death, the bubonic plague in 14th century Europe, priests were given permission to apply the anointing of the sick with a metal spatula so they wouldn’t have to touch a plague victims forehead, for example.
So adaptations can be made. But we should always be working to bring people to the sacraments or the very least to pray for them and to pray for people who’ve been cut off from family and cut off from the sacraments and pray for them to have a good death and when they can have a good death, to at least have a good after life and that their souls will find rest in our Lord and savior Jesus Christ. So I hope this is helpful for you to learn more about bioethics, end of life issues. Good resources on this. National Catholic Bioethics Center is awesome. If you have a personal issue, like you have a question about a family member in the hospital, call them. They got ethicist on the line that can help you. Good books on this. William May, Catholic Bioethics and Gift of Human Life. Excellent book I would recommend. I also cover some of this in my course for moral apologetics at the School of Apologetics. So hey, thank you guys so much. Our first episode back for 2021. I hope you enjoyed it. Be sure to leave a review at iTunes and Google Play. And I hope that you all have a very blessed day.
If you liked today’s episode, become a premium subscriber at our Patreon page and get access to member only content. For more information, visit trenthornpodcast.com.