A Catholic Citizen in America

I’ve been completing a Health Care Directive. It will probably be this week’s least-favorite task. The form’s nine pages let me outline how I see medical decisions. And who I’d like to make those decisions for me if I can’t.

Picking my primary and secondary health care agents was the easy part, thanks to my being part of a close-knit family.

Making choices about organ donation, autopsy and what to do with my body after I’m dead wasn’t difficult.¹ But it didn’t brighten my day.

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Changing Times: Coffins, Cholera and Care for the Sick

Options of Yesteryear

My options would have been different in the 19th century. Different, but still unsettling.

The era’s health care tech and assorted epidemics encouraged skittishness when examining possibly-contagious corpses.

Waking up in a coffin was a real possibility.

My guess is that odds for waking up in a body bag are lower these days.

I’ve got mixed feelings about death.

Ideally, “…life is Christ, and death is gain.” But I’m not in Paul’s league. There’s also my particular judgment, and I’ve wandered off-topic.²

Where was I? Health care agents. Family. Autopsy. Death. Right.

Reapers and Disease

(From Robert Seymour, via Wikimedia Commons, used w/o permission.)
(Robert Seymour’s 1831 impression of a cholera epidemic.)

Folks who figured that old ways are good ways probably didn’t like the 19th century. Or the 20th. Or the 21st to date.

Scything and gathering grain gave way to mechanical reapers.

We lost an ancient tradition, but harvested more food in less time.

I figure that helped folks sidestep famines.

I’ve also read that famines declined because capitalism replaced feudalism. And that bigger bureaucracies led to better food distribution. Then there’s the British Agricultural Revolution and Green Revolution.³

There’s probably a grain of truth in those assertions. And that’s another topic. Topics.

As far as I know, nobody blamed the first cholera epidemic on Fulton’s steamboats or the Louisiana Purchase. Maybe because it didn’t spread beyond China and the Mediterranean.

All of which happened shortly before 1817.

Folks living in Bengal fingered Ola Bibi and Kali as being responsible.

British troops got blamed for the Bundelkhand outbreak.

Seems they slaughtered and ate cattle, which offended Hindu beliefs. On top of that, the incident took place in a grove sacred to Hurdoul La.

My view is that blaming a deity for death, disasters and disease isn’t unique to my culture. (February 23, 2019; September 17, 2018)

John Snow’s 1849 essay showed that tainted water carried cholera. The powers that be promptly ignored the idea. (July 1, 2018; July 21, 2017)

By 1896, we’d had the first through fifth cholera pandemics.

Doctors and scientists eventually learned that humorism and miasma theory didn’t match observable phenomena. That was happening during the late 19th century.

Well-established customs die hard, so bloodletting was an accepted medical practice until the early 20th century. That may help explain why American life expectancy didn’t get much above 70 until well into the 20th century.⁴

Surgical Successes in the Sixties

Fast-forward to the 1960s.

The ‘old ways are good ways’ set were having conniptions.

No cherished belief or institution seemed safe from scrutiny.

• European colonies became nations
• Eugenics laws were repealed
• Miscegenation was decriminalized
• Prefrontal lobotomies were becoming unfashionable

It was the end of civilization as we knew it. I’m not happy about every change, but on the whole I think we’re living in a (slightly) better world.

Brouhaha over drug-resistant microbes, genetics and other bioethical issues — I’ll get back to that.

A 1962 accident severed a boy’s arm. Folks got him and his arm to a hospital. Surgeons tried, successfully, to reattach his arm.

Christiaan Barnard’s 1967 heart transplant operation was successful. The patient survived 18 days.

Organ transplants are less lethal these days, which I think is a good thing.⁵

It’d be nice if everyone was perfectly healthy and weren’t missing any parts.

That’s not the way it is.

We’ve been using artificial limbs for millennia. (February 24, 2017)

Maybe that’s why I haven’t run across someone denouncing “Satanic” wooden legs.

Human-to-human organ transplants aren’t just new. They involve trickier bioethics.

Wanting to extend someone’s life by replacing a defective heart seems like a good idea. Problem is, whoever donates a heart won’t survive.

Here’s where it gets tricky.

Bioethics

Let’s say that one of my kids needs a new heart. I know a surgeon, hospital and suppliers with flexible ethics.⁶

They can locate and drygulch a suitable donor, extract marketable organs, and save my kid’s life.

And everyone lives happily ever after. Except whoever got broken down for parts.

That doesn’t mean organ transplants are basically wrong.

They’re okay if expected benefits outweigh the risks. Donating organs after death “…is a noble and meritorious act….” But killing someone to help another person is a bad idea. (Catechism of the Catholic Church, 2296)

Let’s look at another happily-hypothetical situation. What if one of my kids was in constant and unavoidable pain?

Not so hypothetical, now that I think of it. Surgery left my son with an unpleasant mix of numbness and pain.

Let’s up the ante, and say that he’s also crippled: not enjoying a “quality lifestyle,” as some said in my youth. Would administering a lethal dose of painkiller be compassionate?

Maybe, from some viewpoints. But euthanasia is not a good idea. (Catechism, 2277)

The same would apply to self-administered euthanasia. Whatever it’s called, that’s suicide: and a bad idea. (Catechism, 2280–2283)

On the other hand, I’m not obliged to continue ‘over-zealous’ medical treatment if I’m dying and ready to die. “Ordinary care” is another matter: and is an obligation. (Catechism, 2278–2279)

That can include painkillers, even if they’ll shorten life. The idea is that the goal is easing the patient’s pain: not killing the patient. “Palliative care is a special form of disinterested charity….” (Catechism, 2279)

I’m over-simplifying the situation.

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A Task (Nearly) Done

Death and Signatures

My father died about 10 years ago. My father-in-law died last year.

I’ll die, too, sooner or later. That thought’s been inching its way toward the front of my mind, partly due to last year’s transient ischemic attack.

Contemplating my death isn’t among my favorite pastimes. Putting it mildly.

That’s made filling out my Health Care Directive a less-than-pleasant task.

But now it’s done. Apart from witness signatures and getting the thing notarized.

There’s more to say about life, health and death.⁷ But that’ll wait for another day.

Somewhat-related posts:

• “Sickness, Death, God, Love and Questions”
  (February 23, 2019)
• “Death, Funerals — and Life”
  (September 30, 2018)
• “Transient Ischemic Attack?”
  (August 12, 2018)
• “The Magi, Meds and Me”
  (January 7, 2018)
• “Different Sorts of ‘Dead’”
  (November 11, 2016)

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¹ Planning and principles:

• MN Department of Health
  • Advance Care Planning
  • Federal Law Regarding Advance Directives
  • Questions and Answers About Health Care Directives
• Life, death, health and transplants: my take
  • “Face Transplant at Mayo” (February 24, 2017)
    • Replacement Parts: Current and In Development

² Life, death and safety coffins:

• “…death is gain.”
  • Philippians 1:21
• Wikipedia
  • Premature burial
• Australian Museum
  • Safety Coffins
• United States Patent and Trademark Office, Patent Full-Text Databases
  • Patent Database Search Results: CCL/27/31 in US Patent Collection
• My take
  • “Death, Funerals — and Life” (September 30, 2018)
    • Life and Expectations
    • Looking Past “These Few Years”
  • “Different Sorts of ‘Dead’” (November 11, 2016)
    • Presumed Dead
  • “Miscarriage, Stillbirth, and Hope” (October 9, 2016)
    • Death is Certain, Life is Eternal

³ Agriculture and technology:

• Wikipedia
  • British Agricultural Revolution
  • Famine
    • Decline of famine
    • Attempts at famine alleviation
  • Green Revolution
  • List of famines
  • Reaper

⁴ Health care and humorism, mostly:

• Wikipedia
  • Bloodletting
  • Germ theory of disease
  • Humorism
  • Life expectancy
  • List of epidemics
  • Louisiana Purchase
  • Pandemic
  • Robert Fulton
  • Miasma theory
  • Academics
    • “A Dreadful Scourge: Cholera in Early Nineteenth-Century India“

⁵ New medical options and bioethics

• Wikipedia
  • Christiaan Barnard
    • First human-to-human heart transplant
  • Drug resistance
  • Eugenics
  • List of former European colonies
  • Lobotomy
  • Miscegenation
  • Ronald A. Malt
    • First Successful Replantation of a Severed Limb (Everett Knowles)
  • Miasma theory
• My take
  • “Where Have All the People Gone?” (November 23, 2018)
    • Viewpoints
  • “Face Transplant at Mayo” (February 24, 2017)
    • Remembering Everett ‘Red’ Knowles
    • Life, Health, and a Severed Arm

⁶ Organ trafficking:

• “Protection of Human Beings Trafficked for the Purpose of Organ Removal: Recommendations”
  Assya Pascalev, Kristof Van Assche, Judit Sándor, Natalia Codreanu, Anwar Naqvi, Martin Gunnarson, Mihaela Frunza, Jordan Yankov; Transplant Direct; via PMC/NCBI (Published online January 4, 2016)
• “Trafficking in Persons for the Purpose of Organ Removal”
  Assessment Toolkit, UNDOC (United Nations Office on Drugs and Crime) (2015)
• “The state of the international organ trade: a provisional picture based on integration of available information”
  Yosuke Shimazono, Bulletin of the World Health Organization (World Health Organization) (December 2007)

⁷ Background:

• “John Paul II: Dying with Dignity”
  Rev. J. Daniel Mindling, O.F.M. Cap.
  (From www.usccb.org/issues-and-action/human-life-and-dignity/end-of-life/euthanasia/john-paul-ii-dying-with-dignity.cfm)
• “Nutrition and Hydration: Moral and Pastoral Reflections”
  A Statement of the NCCB Committee for Pro-Life Activities (April 1992) (From www.priestsforlife.org/magisterium/bishops/92-04nutritionandhydrationnccbprolifecommittee.htm)