Do you pray for life or death?

A mother’s coma leaves her daughter with agonizing choices

By RENEE SCHAFER HORTON

When Kathy answered the phone, the 72-hour vigil she’d been keeping by her mother’s bedside was embroidered around the edges of her voice. From the intensive care unit of a Catholic hospital near Houston, my best friend tried to explain how her life was turned inside out and upside down Mother’s Day weekend.

Kathy spoke in hushed tones, not wanting to disturb her mom, even though doctors couldn’t tell if she could hear. I got the Reader’s Digest version of what Kathy’s family currently knew: There was massive damage from an unexpected stroke, almost complete paralysis and no way to determine what part of the brain might be undamaged. The doctors said a previously undiagnosed irregular heartbeat caused the stroke that made the 81-year-old Nash family matriarch collapse against her bathroom wall near midnight on the Friday before Mother’s Day.

The doctors, professionally detached, said other things as well, things that were more challenging and depressing: vegetative state; the best you can expect; probably no hope of recovery.

“I don’t know what to pray for,” Kathy said. Her voice, carrying an equal measure of grief and guilt, beamed to a satellite high above us and bounced down into my bedroom thousands of miles away, where I sat staring at a framed print of St. Ignatius of Loyola’s admonition that “anything turned in the direction of God is prayer.”

Kathy and I are each other’s spiritual touchstones, mothers who met 15 years ago through our then 6-year-old children. We’ve spent 14 of those years physically separated and still managed to stay connected emotionally. When either of us is lost in the Land of Things Too Big to Handle Alone, it is to the other we turn in our doubt and fear, and our long talks bring us back to faithfulness and trust.

“She always said she wouldn’t want to be kept alive like this, wouldn’t want to live as a vegetable,” Kathy explained. “This is her worst nightmare. But we’re getting conflicting information from the doctors -- one says this is the best we can expect, no matter how long she lives. Another says he’s seen people have major breakthroughs and be able to talk. So do I pray that she lives or that God will take her?”

The problem is that Kathy’s mother, who is breathing on her own, was immediately put on a feeding tube upon admission to the hospital. In fact, this is how they discovered she was not completely paralyzed. When the nurses tried to insert the feeding tube, Kathy said, her mother took “her one good arm and tried like hell to yank that thing out. They’ve had to strap that arm down so she won’t pull the tube out.”

This action on her mother’s part, as well as knowing her mother always said she never wanted to be kept alive artificially, leads Kathy’s family to believe they might need to remove the feeding tube.

“Maybe she’s supposed to die and we’re stopping it,” Kathy said, wrestling aloud with the issues her siblings had been discussing around their mother’s bedside. “I just don’t know; it makes it hard to know what to pray for.”

Kathy didn’t say what most of us, especially me, would normally say when faced with a life and death decision, which is, “I don’t know what to do.” My inspirational friend instead said, “I don’t know what to pray for,” acknowledging her helplessness before God and expressing her conviction that God hears us.

It is easy for us to read the church’s teaching regarding euthanasia in the Catechism of the Catholic Church and think we know what we would do when faced with a parent trapped in a body that has turned into her enemy. It is much harder when presented with the issues up close and personal.

In 1952, Pope Pius XII defined “extraordinary means” in regard to end-of-life issues, according to Carmelite Fr. Fred Tillotson, a Tucson moral theologian. “He said if there is no hope of recovering health or well-being by the invasive [medical] procedure, if, essentially, the person is dying, using those extraordinary means prolongs the dying and, in those cases, it is a morally acceptable medical decision to withdraw those means.” But, he said, taking a person off a ventilator is quite black and white, while removal of feeding tubes “is a grayer area.” A person who cannot breathe on his own will quickly die without air forced into his lungs; a person who can breathe but not eat might waste much more slowly toward death.

This issue got more muddled in April when Pope John Paul II announced, in response to the case of a vegetative-state Florida woman who has been kept alive more than a decade via a feeding tube, that feeding tubes are not “a medical act” but “basic care.” He called the removal of the same “euthanasia by omission,” which caused representatives of Catholic hospitals concern, since the hospitals have long viewed taking away the tubes as morally acceptable in certain cases.

For my friend Kathy, the debate over “medical act” or “basic care” isn’t an abstract theological concept. The rubber meets the road in real life and it is there, in the distress and suffering of ailing family members, that church teaching -- which holds up ideals we all should ascribe to -- can sometimes come up wanting.

Perhaps when Kathy told me she didn’t know what to pray for, I should have replied, “Pray for God’s will.” But it seemed too trite, even if it is deeply true. So I just listened to her agony and promised myself I would stand in the gap and pray for her, asking that whatever God’s will is, and whatever decision Kathy’s family makes, God’s mercy and grace will accompany them and bring them peace.

Renee Schafer Horton writes from Tucson, Ariz.

National Catholic Reporter, September 24, 2004