“At one and the same time Christ has taught man to do good by his suffering and to do good to those who suffer. In this double aspect he has completely revealed the meaning of suffering.”
~ Pope St. John Paul II
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“A man must be certain of his morality for the simple reason
that he has to suffer for it.”
~ G.K. Chesterton
Several months ago, I heard an ad that got me muttering. It was for a non-profit Alzheimer’s research fund. “The first person to survive Alzheimer’s disease is out there,” said the lady in the voiceover. “Wait – what?” I asked out loud. “Everybody survives Alzheimer’s!”
It’s true. Alzheimer’s itself is a devastating disease but it does not directly attack vital bodily functions. Instead, its progressive and inexorable assault on nerve connections in the brain leads to cognitive deterioration, which makes it progressively difficult for those suffering from Alzheimer’s to care for themselves or safely perform what healthcare workers call “activities of daily living.” Folks with advancing Alzheimer’s are more prone to falls and other injuries and, when they become less mobile, they’ll be more susceptible to skin breakdown and lung infections. They’re especially at risk for swallowing problems – which can lead to a deadly aspiration pneumonia when food or fluids go down the wrong pipe and into the lungs.
So, there’s no question that Alzheimer’s, the most common form of chronic dementia, truly has a terminal trajectory. In fact, Alzheimer’s is considered the sixth leading cause of death for adults in the USA – and some researchers suggest that more accurate data would put it in third place. Yet, no matter the disease’s official mortality rank, the fact remains that Alzheimer’s is in the running only as an “underlying cause of death” – something the World Health Organization and the Centers for Disease Control define as “the disease or injury which initiated the train of events leading directly to death.”
In other words, despite the radio ad’s rhetoric, everyone survives Alzheimer’s itself – unless we kill them on account of it before they die of something else.
Does that sound harsh? Maybe, but what is really harsh is the silent killing that has become pretty routine in dementia care. It rarely makes the news because it is perfectly legal and, frankly, most don’t even think of it as killing. I’m talking about the intentional removal of nutrients and fluids from those who can no longer feed themselves safely or the discontinuation of feedings administered through a tube. Although there are situations in which such deferrals of food and fluids may be morally acceptable (e.g., when certain gastrointestinal diseases make it impossible for a person’s body to digest nutrients), most such deferrals hasten the dying process with no legitimate ethical justification.
The rationalization of this common practice takes a variety of forms – such as assertions that an individual should not be allowed to eat or drink because of aspiration risks and that the autonomy of the person suffering dementia should be respected when he refuses meals and water – but they all lead to the same result: death by dehydration within a matter of days. Those who defend this practice even argue that it’s a comfortable way to go, and so it’s actually compassionate to remove food and fluids when Alzheimer’s advances.
Wrong. Death by dehydration is a horrendous, agonizing process, no matter how much we gussy it up in medical lingo and references to compassion. Besides, when anything is done with knowledge that it will hasten death, it is killing, pure and simple.
The bottom line is that we should be making the necessary sacrifices to genuinely care for those who suffer from Alzheimer’s, especially when the disease takes away memory and cognitive abilities. We should keep them clean and warm; help them move about to avoid skin problems; monitor them for infections and give them antibiotics when they get sick; and, yes, feed them safely – and gladly, especially when we consider the admonition of the Lord in Matthew 25: “When you did it to one of the least of these, you did it to me.”
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A version of this article originally appeared in The HALO Voice, a publication of the Healthcare Advocacy and Leadership Organization. For more information about HALO’s critically important work, follow this link.
“Love each other with genuine affection,
and take delight in honoring each other” (Rom 12.10).
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“Women are the only realists; their whole object in life is to pit their realism against the extravagant, excessive, and occasionally drunken idealism of men.”
~ G.K. Chesterton
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At its core, nursing is care, and caring is a dance, with ups and downs, rhythms and reels — balance, that is, and harmony.
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“The Christian who seeks to purify himself of his sin
and to become holy with the help of God’s grace
is not alone” (CCC 1474).
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“Fasting is the helm of human life and governs the whole ship of our body” (St. Peter Chrysologus).
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“That I may love her with the perfect love of a perfectly whole heart, cause me to love Thee more than her and most of all. Amen. Amen” (Temple Gairdner).____________________________________
