Reasonable Reply

Your article Celebrating Good Liturgy, by Nathan D. Mitchell, (5/10) reminded me of a Mass I attended in Costa Rica years ago. During the Mass a barefoot man played My Old Kentucky Home on his violin. I thought it was a strange selection for a Mass.

My brother Neil, military attach at the U.S. Embassy, asked the violinist why he chose that song. He answered that he played that song better than any other song he knew and therefore was the one he wanted to play for God. The reply seemed reasonable to me.

Joseph N. Sweeney

Something Sacred

I want to thank Drew Christiansen, S.J., for his recent Memorial Day reflection (5/24) and to tell him how much his words and thoughts resonated with my eighth-grade students at The American School in London. Though few of our students here at the A.S.L. are British, we are guests in a country that still reveres Wilfred Owen and the soldier poets of World War I. Every one of my students knows Dulce et Decorum Est, and “the old Lie” is hardly lost on these 13-year-olds, whose perceptions of America have been shaken both by the events themselves and by the BBC’s reports of the war during the past year and a half. However, Father Christiansen’s frustration at being denied the right to honor those who have lost their lives during the Iraq war is something our eighth graders here can understand, perhaps in a slightly different way.

We have just returned from a weeklong excursion visiting the American, British and Canadian landing beaches at Normandy. We laid a wreath at St. Laurent Cemetery; each student placed a poppy (the flower still worn on many a lapel each Remembrance Day) on the grave of a soldier from his or her home state. Our Israeli students walked tentatively around the teutonic crosses marking the German soldiers’ graves at LeCambe Cemetery, and a few kids became emotional reading the poetic inscriptions and viewing all the flowers that adorn the graves at the British cemetery.

Many of these young people had never seen or visited a cemetery. Many do not believe in God, let alone the Resurrection. For some of our 132 eighth graders, this was the first time they had ever experienced something sacred: consecrated ground, hallowed by the thousands of young men just a few years older than themselves, who gave their lives so that we might live. This did sink in, and it is comforting to know that even as the number of World War II veterans is thinning, there are young people who are still moved by their stories and their sacrifices. Perhaps this is the “anthem for doomed youth” our students will carry with them.

Susan O’Connell

At the Bedside

In Must We Preserve Life? (4/19), Ronald Hamel and Michael Panicola present a forthright and cogent summation of the church’s traditional teaching on nutrition and hydration, drawing particular attention to the subtle, and now not-so-subtle, attempts of some to restrict this teaching narrowly during the last 20 years.

Must we preserve life? Each human life is sacred, given dignity by the Creator’s hand, and therefore always and everywhere to be preserved as unique and precious.

Central to this dignity, however, is the belief that the same Creator’s hand will raise up this mortal body to new and eternal life. Human life therefore is understood in the continuum of life here and life hereafter. This then becomes the primary context for our ethical analysis and the implications for care of the sick and dying.

There comes a time when the healing process ends and the dying process begins. Unfortunately there is no clear line of demarcation for this. But there iswith best medical judgment, in consultation with a team of holistic health care providers and with respect for the patient’s wishesa way of determining when this shift appears to be happening, and then of appropriately responding with care by either natural or artificial means.

Artificial nutrition support, whether by means of intravenous catheters or by feeding tubes into the gastrointestinal tract, is a medical therapy. The therapy has greatly evolved over the last 40 years and continues to evolve today. But make no mistake, the physical placement and maintenance of such devices, and the provision of refined nutrients, requires a high level of clinical skill in order to initiate this therapy safely and avoid harm to the patient. The choice of which approach is taken is based on the route of administration that will mostly like be assimilated, irrespective of the patient’s condition.

The decision to initiate and/or withdraw nutrition support is a difficult decision, but should be guided by prognosis. Patients with a prognosis for survival of less than three months, for example, might benefit from a nutrition support intervention that provides limited quantities of nutrients, with a principal emphasis on maintaining fluid and electrolyte (sodium, potassium, etc.) balance. For other patients with a somewhat longer or uncertain prognosis, but nonetheless an ultimate terminal outcome, the same approach may be considered. Alternatively, consideration may be given to complete nutritional support in this setting, when the shift from a healing to dying process is not certain. The decision to intervene is not diagnosis-specific, but rather prognosis-specific, and offered in a manner that preserves the dignity and comfort of the patient and significant others. Initiating nutrition support may occur prior to the final prognosis, but should not preclude its subsequent withdrawal.

Both of us, a clinical researcher and a chaplain, stand on the side of the bed holding not only the technology to assist in the healing or dying, but also the hand of the one we are helping in their healing or dying. Both of us are concerned with the physical and spiritual sustenance the person needs either to gain strength toward healing or to provide comfort in dying.

When we are in a healing process, nutrition and hydration can be physically administered in such a way as to strengthen the person toward recovery. Similarly, out of our sacramental tradition, we administer the Eucharist as food to strengthen the person and fortify him or her spiritually in the journey toward healing.

But when we are in the dying process, nutrition and hydration, whether administered artificially or in the normal course of attentive care, is offered in such a way as to bring comfort to the persona different kind of carein the last part of their journey. In like manner, we administer the Eucharist as the last sacrament, known as viaticumlikewise a different kind of care: food for the journey to the life hereafter.

Prior to the technological advances that have proved to be both benefit and burden, human beings in the home setting naturally followed the process of caring and being cared for, in being nurtured back to health or being nurtured through their dying. As history shows, there were always ethical concerns. But it seems there was a fundamental respect for the difference between the healing process and the dying process. Food and water were given and received in both instances, but always with careand with the appropriate means.

David F. Driscoll

Satisfactory Return

I read Michael McGreevy’s letter (5/3) about the editorial Trading Jobs (4/5), and I think the mind-set expressed by Mr. McGreevy is outrageous. It is, however, typical of investment bankers and lawyers.

Those of us who manage a business in manufacturing, as well as our friends who manage a service business that renders a genuine service, really do not feel that our function in running a business is primarily to make a profit and to provide this profit to the investor. Our prime responsibility is to manufacture a good product or supply good service and to provide constructive and satisfying careers.

Clearly everyone, whether owner, manager, salaried employee or hourly employee, recognizes that we must make a profit to maintain and grow our business, but I challenge Mr. McGreevy and those in their ivory towers with similar mind-sets to go onto the shop floor and ask the individuals there whether they feel the primary purpose of their career is to make a satisfactory return for the investor.

Carl C. Landegger

Means to Solidarity

How is it possible that so few Americans are aware of the horror in northern Uganda: since 1988, nearly 20,000 children abducted, more than one million civilians living away from their homes in squalid camps? Thank you for trying to inform them (Child Soldiers and the Lord’s Resistance Army, 3/29).

Thanks too for Rwanda Ten Years Later (4/19) and your editorial urging the need for the American public to be better informed about African politics. The U.S. bishops argued for such self-education and involvement in public policy in their November 2001 A Call to Solidarity with Africa. Unfortunately, very few American Catholics, even professionals in ministry, seem to have heard of this. A student in our Jesuit school in Bukavu, Congo, recently asked me, Why do your people know so little about us, when we know so much about America?

To counterbalance the usual bad news, your authors also highlight the hopeful antidotesso many beautiful, faith-filled people here who struggle daily to combat the heavy forces against them (including, too often, some from the civilized world). I long for the day when Africa begins to get the good attention that so many Americans gave to Latin America in the 1980’s. Africa also has heroic witnesses to the faith, even martyrs worthy of canonization. At a recent Mass in Rwanda, I heard the large, mostly young adult congregation singing, You are at the center of our lives; you are alive. Immediately after the genocide in 1994, the Africa bishops proclaimed, The Risen Christ Is Our Hope.

The U.S. bishops remind us of the power of prayer but go on to advocate more diocesan/parish twinning (including Catholic schools and retreat houses). For those to whom it applies, they call for more corporate responsibility and responsible investment. Could my company/investment somehow be making things even worse for those who are already poor? What about my country?

Finally, I have come to learn that there is no better means to solidarity than personal contact, trying to get to know some Africans in the United States or, even better, somewhere here.

Tony Wach, S.J.

cartoon by pat byrnes

Natural Method

I was exceedingly pleased to read in Signs of the Times (4/5) that Pope John Paul II said, The administration of water and food, even when delivered using artificial means, always represents a natural method of preserving life and not a medical act. What a relief. All these years I thought the church held that things artificial were not naturalas in artificial birth control.

Michael Ducar