November 07, 2024
Column

Death of the pope – a doctor’s perspective

God called in his gift of Pope John Paul II to the world last month, bringing home the Polish pontiff who inspired so many by the grace of his common touch, the power of his faith, and the tradition of the Catholic Church. An overwhelming infection took him to death’s door, and the pope walked peacefully through it to his God, unshorn of the IV lines, heart- monitor wires and other miracles that aggressive medical care could have used to tether him a while longer to this world.

In the global bedside vigil held for the pope during his fatal illness, however, there were few who complained about his obvious decision to forgo aggressive medical treatment in his final days. In the plethora of prayers – probably more than have ever been said for another human being – there were probably few who prayed he would go to the hospital and get more aggressive care.

Despite fighting a severe infection – sepsis, in medical terminology – the pope stayed out of the hospital and therefore almost certainly did not get the powerful anti-sepsis drug Xygris that has been shown to decrease the risk of death due to sepsis. Despite fighting low blood pressure and kidney failure the pope almost certainly did not get intravenous dopamine, which might have raised his blood pressure and helped his kidneys work, or dialysis to clear accumulating toxins from his blood. It’s doubtful his lungs were kept going by a ventilator, despite the “shallow breathing” described by the Vatican.

The pope almost certainly died sooner than he otherwise would have because he did not get the full treatment for infection that would have been available in a hospital. While sepsis in the frail elderly is often lethal, with aggressive treatment he would certainly have lived days longer, and he might have even survived the infection to live months longer. The pope died early for lack of aggressive care, although not for lack of loving care, probably because he knew before he developed the infection that he was terminally ill with end stage Parkinson’s disease. When the infection developed his decision to stay home suggests he must have decided that this was his time.

The silence in America on the issue of the pope’s “comfort measures only” care at the end stands in sharp contrast to the national shouting match and political seizure that scarred the last days of Terri Schiavo’s life. Despite the obvious withholding of potentially life-saving treatment from the Pope, newspaper columns and talk show hosts calling for ‘saving’ the pope were nowhere to be found. The U.S. Congress did not try to subpoena the dying pontiff and his doctors to testify. U.S. Senate Majority Leader Dr. Bill Frist did not diagnose the pope’s condition from afar and suggest the pope’s doctors were making the wrong diagnosis. U.S. Rep. Tom DeLay did not suggest that the pope’s caregivers were killing the patient pontiff, or that we should intervene with the therapeutic cavalry because the pope was lying there wanting to be saved but unable to say so. President Bush flew in only to the funeral, not to the rescue. The most beloved man on earth died without all the care he could have had and no one sued anyone.

One could argue the difference between the pope and Schiavo was that he was old and she was young, a valid point at least partially countered by the simple fact that Schiavo was physiologically old if chronologically young. Most patients in her condition do not survive more than 15 to 20 years, and 15 years into her injury Schiavo was approaching her “old age.” Most patients in her condition die, as the Pope did, of an overwhelming infection.

One might argue that the difference between them was that her care (the feeding tube) was withdrawn, and no care was withdrawn from the pope because aggressive care for him was not started in the first place. Legally and ethically, however, acts of commission (such as pulling out a tube) and acts of omission (not starting aggressive treatments, or putting in a feeding tube), are the same. To omit a treatment is to willfully decide to withhold it, and that willful decision to withhold is an act of commission as much as the pulling out of a tube. Withholding a feeding tube is really no different than withdrawing a feeding tube; it may seem different, and it may be an easier decision for some to make, but the distinction dies under close inspection of the moral and ethical issues involved.

The distinction between the pope and Schiavo turns primarily on whether each got the care they wanted. It is clear the pope did; it’s doubtful he would have stayed at in his Vatican home to the end against his will. Whether Schiavo really said she would not have wanted to live the way she ended up is an issue on which many others will never agree. Courts from Florida to Washington, with judges from conservative to liberal, believed she did.

If the passing of Schiavo has left wounds to heal then perhaps this thought can be a “balm of hurt minds”; she might be up there now, standing in the window of her father’s house, held close at the side of a kindly old Polish priest with a smile that could warm stone. And they might be talking, the way new friends would after finding each other in a new place.

They might talk about those they left behind, and agree that any who want to honor the legacy of a loving pope or a beloved family member should pass up the opportunity to sew bitterness and reap revenge, for the road to their heaven is only open to those who forgive and are forgiven. They might agree that none of us would want our dying held up to the microscope of courts or Congress, because such intrusive inspection magnifies every difference in a family’s opinion about care, and thereby pulls apart the fabric of the acceptance of death that allows a family to come together at the end.

The two new friends might agree that the body can become an inhospitable home to the human soul, and that after hard lives of progressive illness and dwindling independence “letting slip the surly bonds of earth and kissing the face of God” was not such a bad thing, even if many others were not ready for them to take flight.

So rest in peace, Terri Schaivo and John Paul II. In the days ahead let us apply the lessons of forgiveness in the pope’s life and faith to the controversies around Schiavo’s life and death. Then let us make this a better world than the one they left behind, that they would look down upon us and be proud.

Erik Steele, D.O., a physician in Bangor, is chief medical officer of Eastern Maine Healthcare Systems and is on the staff of several hospital emergency rooms in the region.


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