Speaker 0 00:00:00 We as Catholics understand that we are not morally required to have every last extensive scientific intervention implemented in the care of us during illness. Yes, yes. We're allowed to discern, uh, the risks and benefits of interventions.
Speaker 2 00:00:25 Welcome to the Catholic Theology Show, sponsored by AV Iria University. I'm your host, Dr. Michael dk, and today I am joined by, uh, Dr. Diane Eckert, who is a staff ethicist and nurse planner with the National Catholic Bioethics Center, as well as a professor of nursing at Avi Marie University. Welcome to the show.
Speaker 0 00:00:49 Thank you, Michael.
Speaker 2 00:00:50 Great. We're so pleased to have you here, and it's just, it's wonderful. Even just in talking about your, uh, title. You, you've both have been a nurse for many years. You are a nursing professor, and you also have graduate degrees in bioethics and have done bioethics consulting and bioethics teaching. Uh, so maybe just to begin for our listeners right, what even is bioethics
Speaker 0 00:01:16 That is about a 10 hour question, <laugh>, right? Yes. So thank you for asking. I I think that bioethics is anytime any of us who work in healthcare mm-hmm. <affirmative>, uh, when we ask the question of moral action, uh, in the everyday things that we do in healthcare. So a lot of us feel as though healthcare is a calling mm-hmm. <affirmative> at end of vocation. Yes. And, and so in that calling and in that vocation, we recognize the intrinsic dignity of each human person mm-hmm. <affirmative>, no matter how small or how old Yeah. Or how sick or how vulnerable mm-hmm. <affirmative>. And so the bioethical question is a question that's a common morality question. Um, but we can go back to that later mm-hmm. <affirmative>, but it's also, um, very intrinsic part of our nature as, as Catholics. Mm-hmm. <affirmative>. And in the vocation of our healthcare profession, we aim to walk in the light that Jesus taught us mm-hmm. <affirmative> in the care of those who are most forgotten.
Speaker 2 00:02:23 Yeah. That's all I'll put in. And in some ways right. In, in any field in which we're working, uh, e you know, the general moral principles kind of have to be applied in the particular aspects of it. And, you know, nursing and medicine are such kind of wonderful, you know, wonderful means of helping people heal and solving problems. Uh, but Right. That also it all, there's also a lot of right power that can be associated with the medical establishment. Uh, could you say a word a little bit about, maybe, you know, how in the last a hundred years, uh, did we maybe discover more, you know, the need for bioethics sometimes to maybe protect patients or protect even nurses and doctors?
Speaker 0 00:03:17 Sure. So the field of bioethics is a relatively new field. It, it was a field that physicians recognized, even in pagan times, as with their hippocratic oath, promising to do no harm Okay. To the patients that they cared for. And then historically, even during those times, there were false doctors, false medicine men mm-hmm. <affirmative>, who, um, preyed upon vulnerabilities of people and sold them potions of sort that had no relevant mm effect in illnesses, but people were so desperate that they were willing to pay for those things. So if we fast forward to our present time, uh, bioethics gave birth, so to speak, after the atrocities of World War II and the medical experimentation of the Nazis during that horrific time. And so when there became a tribunal against the injustices to human beings in that war, committed by doctors and nurses because they were told to by a hierarchical government for e experimentation purposes, man was appalled mm-hmm. <affirmative> mm-hmm. <affirmative>. And there's this intrinsic knowing of when the dignity of man has been so violently violated mm-hmm. <affirmative>, and in, in that event, it made people think, where are individual rights in response to consent or consent for experimentation. So in the atrocities of World War ii, we know that there are many horrific experimentations that were utilized for the wellbeing of science to understand physiological processes, such as how cold can a human being become and not die, or how cold can a human being become before certain physiological manifestations took place.
Speaker 2 00:05:28 Mm-hmm. <affirmative>. So we're using kind of medical science and experimentation not to heal the person in front of us, but we're using it just to like, as kind of raw material to just do tests upon, no matter the harm to the given person in front of us.
Speaker 0 00:05:50 Right. For the benefit of a higher ranking human
Speaker 2 00:05:56 Oh,
Speaker 0 00:05:56 Yeah. With disregard for a human mm-hmm. <affirmative>, who was deemed to be not worthy of the respect. So
Speaker 2 00:06:03 For the sake of learning in that case, maybe specifically learning how to save the Arian race, we would do experimentations on other quote unquote races. Right. In that particular context. But maybe in any time when we are, in order to heal one person, we might do experiments upon a number of other people
Speaker 0 00:06:27 Exactly.
Speaker 2 00:06:28 Violating their dignity and, and actually possibly not only causing them intense pain, but ending their lives Right. In order to save the lives of others. That's maybe when the, the, that's, that's kind of the, the, the, the heart of the, and, and when you see it in that way, it almost looks horrific. Whereas if you just maybe describe it under kind of terms of medical research or of medical progress, it gets kind of, you know, we, we, you know, we forget that kind of, uh, the intense dignity and beauty of each person in front of us.
Speaker 0 00:07:03 And that disordered hierarchy didn't end with the atrocities of the Holocaust. Hmm. It continued even in this country with the research at Tuskegee into the 1970s. It was a 35 year old, 35 year research on the disease progression, advancement of syphilis being treated or untreated in a subset of African American populations within this country. And then more recently, we've even seen that research, um, harm for women, indigent populations of women in South America with contraception research where atrocities such as increased death and increased blood clots were left unspoken about. And that contraception was indicated to be of good, uh, consequences for women in the control of birth. But then the ill effects of the blood clotting and deaths related to that blood clotting were, were minimally reported mm-hmm. <affirmative>, so not to cause alarm. And so we have this progression of harms and research mm-hmm. <affirmative> that that persists to the present day. And it's why the science of, or the application of bioethical principles should, would, should be so embraced
Speaker 2 00:08:26 Mm-hmm. <affirmative>, and especially in a Right. We have a, like a, uh, kind of like an industrial medical establishment, uh, that is wonderful for creating a lot of maybe new drugs, new processes, new things, but is so, so much money and so much, uh, maybe even kind of like, I mean, this compelling idea that if I could cure, if I could find a cure for this disease, um, you know, both maybe for the financial incentives, but also for the just genuine service to maybe quote unquote humanity that drives this whole thing. Uh, that's, and, and, and yet, right. What happens to the individuals upon which we are experimenting. Right. How do we protect in a way individuals from this, uh, I don't know, this like powerful, this march of progress, quote unquote, which ironically seems potentially at times what I hear you saying almost becomes regress, where humanity ends up descending back into almost barbaric use of other kind of, I mean, it almost reminds me of, you know, like, uh, I mean of where like other peoples are not counted as people because now they become subjects upon which we're experimenting. Right.
Speaker 0 00:09:47 And so the birth of bioethics
Speaker 2 00:09:50 Mm-hmm.
Speaker 0 00:09:50 <affirmative> stemmed from that realization. Wow. And I think it's so important for all of us today to understand that human nature is such that we're vulnerable to making misperceptions in the good. Yeah. And we, we need to have dialogue amongst one another to maintain, um, a source of normalcy or being on track with the good so that we can be open to the dialogue of the discussion of whether or not the true human good actually occurs.
Speaker 2 00:10:21 Yeah. Right. Our, our desire to solve problems, and in a way to heal or almost quote, you know, to cure is so strong that we can then become, you know, we, we've, we've need to talk about that in the public realm because if people as a whole would say, wait a second, but what you're doing here is exploiting like poor people or here what you're doing and are exploiting embryos. Right. All of a sudden, you know, it's like we, we, we can't always trust our instincts because our instinct to solve problems is so great that it may overwhelm, uh, right. The, the, the, the moral truth of the matter.
Speaker 0 00:11:00 So I think it's really important to, to kind of throw out there that yeah, I really believe that intrinsically most all human beings come from that good mm-hmm. <affirmative>. And so most people who come into healthcare desire to do good for others. Yes. Yes. And so secular bioethics, um, speaks about bioethics in terms of autonomy, beneficence, non maleficence and justice. And so Catholic bioethics embraces those concepts as well. Mm-hmm. <affirmative>, so we're not all the way out in left field. We're in with the normal, or what we can call common morality. There's a morality of good within humanity mm-hmm. <affirmative>, and that, uh, morality has for the most part been deemed as an objective truth through the centuries. Mm-hmm. <affirmative>, what we're experiencing today is an insistence that that objective truth can become subjective. So it's really important for us to educate young, new, um, advancing professionals in the language of bioethics so that they can understand feelings of their own personal morality and values mm-hmm. <affirmative>
Speaker 0 00:12:14 So that when something comes in conflict or tension with that, that they can recognize what that conflict intention is and have the power of words mm-hmm. <affirmative> to be able to verbalize the competing tensions. And that sounds like it should be so easy, but it's one of the most difficult things in bioethics. And I think from your mention of a, a new medical or pre-medical student asking that question of what is bioethics? Yeah. And what is Catholic bioethics mm-hmm. <affirmative> and where is my role as a advancing professional Yeah. In, in that, I'm going to say jungle, for lack of better words mm-hmm. <affirmative>, because there's a lot to navigate through mm-hmm. <affirmative>. And we need to teach people how to navigate through all the many circumstances that can occur. We have beginning of life issues. We have, um, procreative issues because of infertility. We have end of life issues. We have organ donation, transplant issues mm-hmm. <affirmative>, we have now advancing science and, um, the ability to produce and replicate humans through all types of potential mm-hmm. <affirmative> advancing technologies. And we need to ask the question just because we can, should we? Yeah. And how do we prepare our youth in the language to be
Speaker 2 00:13:46 Able, and the weird thing is, I think in any other part of our life, we would say that, well, just cuz you can do something doesn't mean you should do something. I mean, you can throw somebody off of a bus, that doesn't mean you should throw somebody off of a bus. You can drive your car into a pol. Right. You know what I mean? We, we, we intuitively get that, but then when we get in the area of like, research or we get in the area of like medicine, then all of a sudden our, our like, again, this native desire to heal and fix gets so overwhelming that, well, if we can do it, we must do it. And it's just, that's obviously, I think, uh, a confusion, but I think it's one that, um, you know, so Right. You know, it's, it's of course gonna be the case that it's gonna be hard to figure out how to navigate these issues. And we need, therefore to really think about it with others who are in the field. Um, you know, now, I I maybe if you could just say a word about you ha were a nurse for many years before you really got interested in studying bioethics full-time. Would you just maybe, uh, give our audience a little bit of your own background, both as maybe your, you know, call to become a nurse and then your call to become a bioethicist?
Speaker 0 00:15:05 Sure. So I graduated high school and went right into nursing school. Mm-hmm. <affirmative>, it was, um, a calling. I knew, um, pretty young that, that that was the professional route that I wanted to take. And I had the, um, always, I say the good fortune of being trained by the Franciscan Sisters of Allegheny in a Catholic diploma, associate degree program in nursing. And so we, we were familiar with the ethical and religious directives at the Catholic church, um, as a document along with the code of nursing ethics, um, back in the early 1980s mm-hmm. <affirmative>, and both of those documents are fluid documents that helped try to guide nursing practice. And we were taught very young to keep those, um, documents in our personal possessions so that if anything happened in the middle of the night and we needed a resource, we had mm-hmm. <affirmative> a, a guide, so to speak. Um, and, and I advanced quickly into working in critical care, um, medicine. I worked, uh, surgical and, and cardiac critical care with adult patients for my first six years. And, and
Speaker 2 00:16:14 Maybe for non, um, people that aren't in the medical field, what exactly is critical care?
Speaker 0 00:16:19 So critical care is an intensive care unit. Mm-hmm. <affirmative>, uh, where we would take care of, um, patients that were, um, on the edge of, of life, so to speak. Wow. They needed advanced surgeries, are advanced cardiac care, and they were at risk for, for death mm-hmm. <affirmative> because of septic shock or because of Yeah. Any other acute mm-hmm. <affirmative>, life-threatening disease state. Uh, and that was, that was challenging. But working in the Catholic hospital, I can't think of any particular, um, bioethical issues that happened because my personal values aligned with the Catholic hospital values mm-hmm. <affirmative>, we respected the intrinsic dignity of the patients that we cared for. We worked in a inner city hospital, um, and we took care of the poor and the marginalized in a, in a way that just seemed natural Yeah. To, to care as Jesus did for those that were, um, ill and sick.
Speaker 0 00:17:21 And, and then I kind of branched out and started to work in pediatric intensive care and neonatal intensive care. And we, we moved out of the state and moved to a different state. So it's a totally different environment. And I enjoyed, um, working with a primary, primarily Catholic, um, healthcare population, maybe at least 40% of the population. And we still practice in adherence with those core principles of respecting the dignity of all life. Um, and then slowly, somewhere in the nineties, um, ethical questions started to rise, things started to happen that previously had not, uh, happened, um, excessive, uh, morphine use for a child prior to organ donation transplantation, uh, slow codes, so to speak, so that we wouldn't, people wouldn't wanna resuscitate someone who was still a full code because their life was, um, not, was a futile care type situation. Mm-hmm. <affirmative>. So language and words started to, to circulate through the healthcare environment that we hadn't previously.
Speaker 2 00:18:31 And those, those would both be cases where you're somewhat, uh, without really having the permission of the people or the families, you're beginning to kind of accelerate death, uh, by excessive means.
Speaker 0 00:18:50 And we began to see that conflicting value, the value of the hierarchy, the hierarchy of the physicians mm-hmm. <affirmative> or the care providers writing orders that as a nurse you might know, weren't exactly in line with what the family had verbalized. Okay. Previously mm-hmm. <affirmative>. Uh, and so this is an essential element of autonomy mm-hmm. <affirmative> and the application of what we call informed consent. So every patient, when they're admitted to the hospital, has the right to express their wants and desires in regard to the medical interventions mm-hmm. <affirmative> that they signed consent for. Okay. And it's our obligation of healthcare providers to provide the information of the treatment interventions mm-hmm. <affirmative> that are at hand, but to also explain treatment interventions that could be alternative treatments and to identify clearly for families and patients, the risks and benefits of both. Sure. And we as Catholics understand that we are not morally required to have every last extensive scientific intervention, um, implemented in the care of us during illness. Yes. Yes. We're allowed to discern, uh, the risks and benefits of interventions, and we are not obligated to have interventions that are deemed extraordinary care.
Speaker 2 00:20:17 Yeah. Yeah. I remember one time I had a, um, was with a, a anyway, a close friend who was, who was older and who was, um, you know, dying and Right. It was that idea that you, you don't need to do things that in a way that are prolonging the dying process that are extraordinary, but that doesn't mean you stop. Right. You know, you stop giving the person food and water. Right. Because feeding a person's, you know, I don't know, is typically not extraordinary. Right. And so that sense in which you, you care for the, the person Right. But you don't need to do anything. I always felt that was a helpful, you know, way of thinking
Speaker 0 00:20:52 About it. And that's an important, um, topic to bring up mm-hmm. <affirmative>. And, and it's a perfect time to also state that just because sometimes in isolation these things happen in healthcare mm-hmm. <affirmative>, it doesn't necessarily mean that it's what happens all the time. So I don't want anyone to become afraid because I do believe in the intrinsic goodness of each healthcare provider. Uh, but we also have to be aware and watchful mm-hmm. <affirmative> of the times that maybe someone's values do not align with our own personal values. And food and hydration is mm-hmm. <affirmative> increasingly becoming such a topic Oh, in, in, in modern healthcare. Yeah. Um, and when we are in the dying process, our ability to tolerate food and water declines Interesting. And so people cannot eat and cannot drink if they are actively dying. Mm-hmm. <affirmative>. And so the misconception is that, uh, if the healthcare providers feel that someone's at the end of their life mm-hmm. <affirmative>,
Speaker 0 00:21:56 And they want to discontinue hydration and feeding mm-hmm. <affirmative>, then it is their obligation as practitioners to implement those orders. But unfortunately, what happens is that sometimes they, the practitioners implement those orders too soon, or we have, um, opposite, uh, requests from family members. Uh, there's a lot of education about bioethics that have never been around previously. And so, uh, we had the experience at a, at a huge nursing conference in, in UCLA about five years ago that we presented it, that we were presented with a case that discussed three sisters who requested that their mother, who was in a long-term care facility and had advancing dementia no longer be fed or provided WA with water. And the question was posed to the 365 nurses that were there mm-hmm. <affirmative> if hydration and food were considered care or medical interventions. Mm. And overwhelmingly and very positively for the rest of the world to know, all of the nurses in that room said, yes, food and water is normal care.
Speaker 0 00:23:13 It is not a medical intervention except one nurse. Right. And so in that dialogue, we, we continued to see the case roll out where when the sisters requested that mom no longer be fed or provided water because she had advancing dementia, and she would not want to live like this. So they were asking the nursing home to discontinue the PO feeding Okay. And provisions of water for their mother. She couldn't feed herself mm-hmm. <affirmative>, but the nursing home staff had videos of where they clearly showed mom being fed and eating food, pureed food and drinking from a straw mm-hmm. <affirmative> during, uh, breakfast, lunch and dinner. Mm-hmm. <affirmative>. And then they clearly showed that she wasn't always excited about her dinner mm-hmm. <affirmative>, but that when she was provided with ice cream as a dessert at the end of the meal, she thoroughly enjoyed receiving the ice cream. Mm-hmm. <affirmative>.
Speaker 0 00:24:10 And they showed the daughters the film clips of your mother eats mm-hmm. <affirmative>, and no, she seems a little disengaged with the mashed peas and the mashed meat, but look how happy she is when she receives the ice cream. And so an ethics committee deliberation was formed with that facility, and they deemed that no, they would not stop feeding, um, these three women's mother because it was normal care. I see. But that they would allow the mother to be discharged at home with the sisters mm-hmm. <affirmative> if they felt that was the care that they wanted to provide. And all three sisters immediately gasped and said, oh, no, we could never do that to mom. Mm-hmm. <affirmative> mm-hmm. <affirmative>. So we have to understand that it's not always healthcare providers. Sometimes family members ask healthcare providers to do things that are intrinsically wrong.
Speaker 2 00:25:07 And sometimes when we can kind of step back, kind of, you know, when you're in the picture, you can't see the picture, when you can step back and you see the situation more clearly. I'm sure this is not always the case, but sometimes people begin to say like, oh, if that's what's going on, then if, yeah. And so, and partly bioethics isn't just kind of like telling people what they can and can't do. It sounds like one of the things you really do is help people to see the situation not in their maybe immediate emotional reaction to it. So, uh, we're gonna take a little break and when we get, when we come back, I want you to tell us a little bit about your work as a bioethics consultant.
Speaker 0 00:25:43 Okay. That sounds wonderful. Thank you.
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Speaker 2 00:26:17 So, Diane, please tell us a little bit about your work as a bioethics consultant. Um, this is work that is, uh, sponsored and coordinated through the National Catholic Bioethics Center. What exactly do you do? Um, can anyone access this, you know, these consultations?
Speaker 0 00:26:38 So Michael? Yes. The National Catholic Bioethics Center has a 24 hour day, seven day a week, uh, bioethics line. Wow. Where anyone, what
Speaker 2 00:26:49 A resource.
Speaker 0 00:26:50 It's Right. That's amazing. So there we have seven ethicists at the National Catholic Bioethics Center. We rotate being on call mm-hmm. <affirmative>. And with consultation duty, we have an emergency consultation service that someone will call the caller immediately back or within a very timely fashion. And then the normal consultation process, we have five bus business days to respond. Okay. To the ethical question. Mm-hmm. <affirmative>, many people do, um, miss that notification. So it's worth saying, if you have an emergency consult where mom or dad are imminently dying and, and you are in distress because of an ethical issue, make sure that you hit the emergent consult line and not the normal consultation line.
Speaker 2 00:27:35 Just as a real, in case there are any listeners, uh, or, or viewers, uh, who might wanna actually take advantage of this. Where would you find specific information about this consulting service?
Speaker 0 00:27:47 So it's easy to access online for the National Catholic Bioethics Center. Mm-hmm. <affirmative>, um, the, and
Speaker 2 00:27:52 What's that website? Is it, it's
Speaker 0 00:27:55 Ncbc ncb center.org.
Speaker 2 00:27:57 Okay. But it's the National Catholic Bioethics Center. You can,
Speaker 0 00:28:00 And if you do a
Speaker 2 00:28:01 Online Got it. Right.
Speaker 0 00:28:02 If you do a Google search for the National Catholic Bioethics Center, you also have access via search, um, capabilities to find out some normal ethical responses in nice short documents, question and answers on cooperation on end of life, on nutrition and hydration.
Speaker 2 00:28:20 And I saw, by the way, that it's actually the 50th anniversary of the National Catholic Bioethics Center. So it was 1972 to, to 2022
Speaker 0 00:28:29 Excitingly.
Speaker 2 00:28:30 So 50 years of, uh, that, that work they've been doing. And so maybe just give an example of, um, obviously conf, you know, with, without the, any specifics, but what are, you know, what's, what's a consultation that you've had, uh, that you know, uh, that you think are, might, might, might help our, you know, help people understand how I, I, I think one of the goals I really want to do in discussing Catholic bioethics on this show is showing how this is an aid, it's an assistance, it's helpful, um, right. The difficulties of navigating decisions in, in healthcare don't go away because you don't have bioethics or something. It's not like it's actually No. When it's like Catholic bioethics is kind of a guide how to navigate these difficult issues in a way that helps us to honor our highest commitments Right. To life. So, right.
Speaker 2 00:29:27 It, it's, you know, the, the, it's, it's not like these are not things in a way that restrict us and limit us, but instead they're things that actually free us to become more human through what is often a very distressing Right. And debilitating time as we go through rights, great. Suffering in ourselves or in our loved ones. So that's kind of just so you know, a little bit of what I'd love to, you know, see a little bit about how, you know, Catholic bioethics can actually be helpful and be that kind of light unto our path that our Lord promises us.
Speaker 0 00:30:04 And, and the Catholic church and Catholic bioethics is a beautiful light that many people, uh, think as a strict guidance of what we are allowed to do and what we are not allowed to do. Mm-hmm. <affirmative>. But the, the beauty of Catholic bioethics is that it does exactly that. It, it makes those difficult moments in life a moment where the theological virtues can shine through, that we can help provide people with, um, that hope, that peace and the love that was intended for each of us. Mm-hmm. <affirmative>, and I've witnessed many deaths and witnessed mar very many births and witnessed a lot of suffering. And when humans pull together in that compassion and love and support mm-hmm. <affirmative>, those moments become sacred moments where you can truly feel God's presence. And that's what we hope to provide for people with the ethics consultation process. Mm-hmm. <affirmative>, uh, within this past year, our consultation director, John d Camillo, has, uh, dedicated the consultation services to the sacred heart of Jesus. Mm. And and it's such a beautiful, um, consecration because it, it clearly embraces the great love and mercy that God has for each of us as we travel through life's.
Speaker 2 00:31:27 Yeah. And, and one thing maybe for, uh, for, for people, right. The sacred heart of Jesus, when we talk about that, right. Uh, within the Catholic tradition, we're thinking about Jesus Christ being fully God and fully man. So he has a full human heart, but that human heart at the same time is, you know, uh, kind of revelatory of the divine love. So in Jesus's human heart, in his human love, we see the divine love. Uh, and it's also the case that the sacred heart, right, as we know from the gospel of John, was pierced by a sword. So the human heart of Jesus entered into the full depth of suffering and death, so that there's nothing in our suffering and death that is ultimately meaningless or hopeless because Christ has entered into it. And we can think about that. Not only was his physical heart pierced by a sword through the side, but Right.
Speaker 2 00:32:36 His psychological heart was pierced at the, the betrayal of everyone, almost except for his mother and a few faithful women, and John, and even his intellectual heart, so to speak, in which he saw and knew, uh, you know, that, that the people that he came to save had actually would not receive him. Right. And so they, you know, anyway, all these different elements, but I think it's a, it's really powerful to dedicate a bioethics center to the sacred heart of Jesus where we see God's love revealed in suffering. Right. You know, God redeems suffering, uh, by redeeming us through suffering.
Speaker 0 00:33:17 And the world doesn't recognize that value. And so I think that's another beautiful distinction that secular bioethics can't enter into. Hmm.
Speaker 2 00:33:26 And right. Not only, so secular bioethics is don't do things against the patient's consent, don't do things that violate the patient's autonomy. Right. But Catholic's bioethics also adds that, well, there's some things of course, to which I can't actually consent to, um, you know, like, just cuz it's not, it's not in my nature. I can't consent to destroy myself or something along those lines. Um, but also the fact that Right. That, that our suffering, that that, that God meets us in our suffering, that God has entered into our suffering, and so now our suffering, um, is not in vain, is not empty. Is that something that you, but
Speaker 0 00:34:08 Which then makes the sacred ground of the interesting experiences mm-hmm. <affirmative> that, that patients individually go through. And so we have a lot of bioethical issues, but every person's experience and every person's circumstance is uniquely their own. Okay. So we get a lot of consults where people ask a specific or a general question, and they want to know the, is this always wrong or is this always right? Okay. And so to enter into that consultation with patients mm-hmm. <affirmative>, sometimes it's a daughter, a son asking about questions of end of life for an aging parent mm-hmm. <affirmative>, or it's a mother and a father with fertility questions mm-hmm. <affirmative> or a poor prenatal diagnosis questions. And so the consultation is an entering into those experiences, those sacred experiences that people go through the struggles and the suffering. And one of the first things I always say, and we have a disclosure, is I, I'm not a priest.
Speaker 0 00:35:14 I can't provide absolution. I I will help guide you utilizing the principles of rational understanding of the natural law and how we can navigate through those with the complexities of your situation. Mm-hmm. <affirmative>, um, but I can't always say what is right or wrong. We deliberate through intentions of action mm-hmm. <affirmative>, and even though someone verbalizes to us a scenario, we don't always know what the intentions are. Mm-hmm. <affirmative>, nor can we judge what those intentions are. Mm-hmm. <affirmative>. So we, we do the best that we can to provide resources if it's an end of life question. Mm-hmm. <affirmative>, we help explain the difference between ordinary and extraordinary care. Okay.
Speaker 2 00:35:58 We, maybe if you were just, could you, I mean, I think that issue you, you raised, uh, you mentioned like a prenatal diagnosis, uh, so this would be Right. Somebody who's pregnant, uh, they go probably through routine screening, they're informed of something. Could you just
Speaker 0 00:36:16 Sure.
Speaker 2 00:36:16 This is, discuss the scenario so that we could actually kind of see what's happening.
Speaker 0 00:36:20 This is a relatively new and quickly advancing ethical mm-hmm. <affirmative> dilemma for many young couples. Um, technology is advanced so that it about 10 weeks of gestation, uh, couples can, they're asked the question of, do you wanna know what biological sex your baby is? And everybody's all excited. They wanna know if they have a boy or a girl. We no longer have to wait for an advanced ultrasound mm-hmm. <affirmative> where we can see genitalia. So everyone's really excited. But during the reveal of gender, there's also, um, consent for screening for genetic abnormalities that takes place. And depending upon the practitioner, that additional information is either explained well or skirted over, or people are so excited that they're gonna be able to find out if they're having a boy or a girl. They don't hear what the practitioner is saying about the genetic screening. And so the genetic screening can provide an early, um, presupposition that there might be something wrong with the baby genetically or chromosomally. Uh, and I say presupposition because it's a screening test, not a diagnostic test. And that's, what's that,
Speaker 2 00:37:41 What's that different?
Speaker 0 00:37:42 That's a big difference. So for a non nurse, for, for a layperson, even for some nurses, um, a screening tool will let the practitioner know that there's a likelihood that there could be an abnormality with the pregnancy. Wow. Mm-hmm. <affirmative>, but it's not diagnostic meaning it's not confirmatory. Okay. Well, so with that screening tool comes the need for additional diagnostic testing mm-hmm.
Speaker 2 00:38:09 <affirmative>,
Speaker 0 00:38:10 And many times, because of the abortion laws within the country, uh, positive screening test might be, uh, followed by, uh, an expression of the practitioner to end the pregnancy, uh, because of gestational age. Wow. And to start all over again with a clean slate, so to speak, or
Speaker 2 00:38:36 Really even before diag even like, let alone the, like, the morality of that. But even just from a scientific perspective, it's not even confirmed. Sometimes you're saying that people are choosing to abort
Speaker 0 00:38:50 Because of the screening tests. Wow. And so there are really good practitioners who will nicely explain that and then request diagnostic testing mm-hmm. <affirmative>. Um, so I don't want everybody to be under the assumption mm-hmm. <affirmative>, that that's always the trajectory. But I think with great knowledge comes great responsibility, and what young people need to be further educated on is that when they give consent for gender reveals mm-hmm. They need to specifically ask questions about screening, uh, tests that may also be implemented in conjunction with those gender reveals. And to be able to verbalize to the healthcare providers that yes, we wanna know biological sex, but maybe we don't wanna know about the screening results because we as Catholic parents will never choose to eliminate our child or eliminate the pregnancy. Mm-hmm. <affirmative>, we need to be careful because a lot of practitioners aren't using the term abortion. Mm. They're talking about something's wrong with a pregnancy, and the only, uh, intervention that we have, uh, in, in this regard is to terminate the pregnancy, or, or they use some other words. Mm-hmm. <affirmative>, or they'll utilize more strong words that with the screening tool, it has been, um, identified that your baby could have a condition that's incompatible with life. And if any new parent hears their, you're just
Speaker 2 00:40:15 Hearing terms, hearing the words incompatible
Speaker 0 00:40:17 With lies,
Speaker 2 00:40:18 You're lost, you're vulnerable
Speaker 0 00:40:21 Perhaps. And what does that mean exactly. And then if they hit you suddenly with the pregnancy needs to be terminated, there's nothing that we can do for you people in a state of stress response. And they're not thinking clearly, and they may be asked to hurry up and make a decision because your window of being able to terminate the pregnancy is, is
Speaker 2 00:40:41 Small. Mm-hmm.
Speaker 0 00:40:41 <affirmative>. Uh, so the language that is being utilized also needs to be disseminated maybe in pre-Cana classes when people get married, so that they can understand some of these dangers that the world is, um, projecting upon them. I'm
Speaker 2 00:40:56 Saying some of this have been around for a long time. Um mm-hmm. <affirmative>, I remember, uh, my mother telling me the story she has, I don't remember her blood type, but anyway, her blood type was deemed incompatible with my blood type. And the doctors said that, um, you know, I might have severe like neurological, developmental delays and I'm, I'm sure my, uh, wife and children would say I have plenty of neurological disabilities. Uh, but, but it is, and it was interesting. I was actually born right after Roe v Wade, so, um, you know, it's, it's kind of, it is a, you know, and it, anyway, just it is and, and now like we have so much more kind of, so to speak, technology and medical knowledge that now when medicine tells you, you know, you kind of, you could just imagine that overwhelming. And, and in my mind, you know, too, one of the things that I would, you know, just ask. So as you know, people of course, maybe if, if they are committed to, you know, not ending the life right. Of the baby, uh, in the womb, what do you do to kind of help them navigate, uh, the uncertainty, the fear, the loss, maybe Right. Which perhaps may be nothing also as you point out, because it may not even be confirmed.
Speaker 0 00:42:10 And in that ethics consultation process that we engage with Yeah. With, with people, we have the opportunity to educate and to provide them with alternative confidence to be able to question in light of what is seemingly a hierarchical power imbalance. The physician is the all knowing the, the physician who knows the scientific mm-hmm. <affirmative>, uh, language who may have the control over being able to dialogue with you and interpret complex diagnostic information. Okay. And one of the most valuable things that we provide for families in our consultation processes, even with end of life issues mm-hmm. <affirmative>, is that permission for all of us exposed in those traumatic moments or those moments of unex unexpected news Okay. To be able to call a timeout, so to speak. Mm. Mm-hmm. <affirmative> to say, thank you very much for providing me with this information, but I think my husband and I, or my family and I need to further discuss and dialogue all of the information that you have provided for us mm-hmm. <affirmative>.
Speaker 0 00:43:20 And we will not be making a decision based upon your, your expression of concern and urgency in us making a decision. We believe that we have time to pray. Yeah. And we believe that we have time to go speak to some consultants within our family mm-hmm. <affirmative> before we make a decision such as that. Yeah. And it's powerful because a lot of people will respond, I'm allowed to tell the doctor that I want more time Interesting. Mm-hmm. <affirmative> because of this perception of, of them having mm-hmm. <affirmative> some sort of medical knowledge that's higher than our own knowledge that we must respond to an urgency when sometimes we can ask for a timeout Yeah. And consult our spiritual directors. Mm-hmm. <affirmative>, our confessors, our priests, and the National Catholic Bioethics Center. <laugh>. Yeah.
Speaker 2 00:44:12 Well, and, and I certainly think if you transition to, you know, end of life questions or the dying process and all of that, that is often such a, uh, like, you know, a lot of people don't go through it a lot. You go through it. No, we don't. You only get to go through it and it's like all of a sudden you're going through it and it's like, it's your mom or you know, you're going through it and it's like, and all the kids are, are in disagreement and stuff like that. And sometimes you're right, maybe just waiting for 48 hours, giving people time to talk to process, and then also to say, wait a second, this sounds like you're doing this and you wanna say no. You know, beginning hospice care is not ending the person's life. Beginning hospice care is trying to make sure that the person is, is comfortable, which is a duty we have in just, it's hard to believe that you even have to call that hospice care.
Speaker 2 00:44:59 I don't know that, you know what I mean? That you don't always care about the comfort of the, you know, like, but it, it, I think like some of those things, I think that's just a wonderful idea that we can kind of pause, maybe pray, and then proceed, uh, in a variety of these situations so that we don't end up with that kind of rushed thing and that feeling of regret. Um, because other, these things are just going to be painful and difficult. You know, death is, you know, I mean, I think it's important to remember that in the biblical conception, in the book of wisdom, it describes, right. God did not make man for death. He created us for immortality, but death entered the world through the envy of the devil. And that in some ways, right. It's because of sin, uh, that now we live in death.
Speaker 2 00:45:44 And so we do kind of, there's part of us that hates death. And death is kind of, I mean, we, we, we, we do somehow fight it. And it's hard. And so to somehow this way that we can navigate it with saying, Hey, we did the best we could with the skills and knowledge we had at the time. We asked the right questions, you know, we got the right direction, and now we're ready to, you know, we're ready in a way to let the process unfold. Um, without kind of that sense in which, wait a second, I, I don't know how to put it. Like, I, I jumped the gun because I got impatient. I didn't want to see suffering, so I ended someone's life. Because those are the things that you hear, um, you know, like where away at people's consciences.
Speaker 0 00:46:33 And I think you bring up some very valuable points. And it, it reminded me of my grandmother who was born in the late 18 hundreds, where she had the experience growing up of witnessing childbirth and childbirth, death, witnessing loss of loved ones, and where funerals and caring for those who were dying occurred in the home. Yes. And so, with the advances in the last century, we've institutionalized these difficult moments Mm. And we've kind of given the power to the hierarchy of the medical mm-hmm, mm-hmm. Scientists community. Mm-hmm. And maybe it's time we regained that, that we could institute spirituality back into the care of the dialing, dying and spirituality back into our understanding of complications before birth.
Speaker 2 00:47:22 Yeah. And, and in a way, right. The, the, the medical communities we have it right now, is not trained to deal with those sorts of proc. Their, I mean, the training is more acute. Here's a condition, here's a treatment, here's an injury, here's a treatment. It's more, you know, um, it's not as though we, they were meant to be the, um, you know, the ones that usher families and individuals through the portals of death. Right. You know, that's not what they were trained to do. And now all of a sudden that's happening and great, that creates a real, um, uh, it's interesting, even back in Tolstoy's book, which is around the end of the 19th century, uh, the death of Ivan Iage talks about, um, right. That it in some ways, uh, I don't know, you know, the, the, the doctors would somehow are supposed to promise life, promise healing and not really address just the reality of the situation, which is, death is coming, let's get you prepared.
Speaker 2 00:48:27 What do we need to do? You know? Um, but even then when medical invention was limited, there was still this kind of, again, we, we, we put this unrealistic hope, uh, in, in, in, as though doctors could bring life to the dying. But, you know, I, I'd just like to kind of, um, maybe in, in closing, uh, just I wanna ask you a few questions and, and I wanna also just, I remember reading, uh, John Paul ii, uh, in cyclical on the Christian meaning of suffering, uh, Sal Dolores, and he speaks in there of the gospel of suffering and this idea that since God redeemed us through suffering, now suffering itself is redeemed. And, and, and I think that is such a, just a, that's kind of a theme that I, I hear from your description of not just giving people guidance, which they need, but also that this sense that in these moments of our extremities, of our own dying and then also of watching other people dying and having loved ones dying and are grieving, those are moments in a way in which, right, it's, it's in that moment of our suffering that in a way God is, uh, very present to us.
Speaker 2 00:49:38 And that suffering either becomes redemptive in which we grow closer to who we truly are, loved children of God, whose only hope ultimately is in God. Or if we don't move into that redemptive thing, we move into the kind of the resentment and the, um, you know, this, this fearful mode. Uh, I think that just giving into fear and resentment is kind of so dominant today and kind of trying to recover and restore the gospel of suffering that the certain sense that we can, our suffering can have, meaning our lives in way can have meaning. But, um, and, and again, I appreciate so much your sharing, uh, the consultation service, uh, that you provide. And thank you for your service. That's such a, a beautiful thing. Uh, so I have, uh, three questions I'd like to ask you and, uh, just partly so our read, our listeners, uh, can get a little better sense for you. Why don't you, uh, tell us of a book? What's a book you're reading?
Speaker 0 00:50:35 Oh, so, um, my husband and I are, are reading Mayor Christianity for CS Lewis.
Speaker 2 00:50:42 Oh, wonderful.
Speaker 0 00:50:43 One of my favorites. And it's something that we haven't read in a very long time, so it's always nice to go back to the classics. Oh, that's great. And, uh, we just celebrated our 35th wedding anniversary and we Oh,
Speaker 2 00:50:52 Congratulations.
Speaker 0 00:50:53 We, um, actually started to do that just recently this
Speaker 2 00:50:57 Week. Oh, that's great. That's great. Um, what's a daily practice you do to, you know, find meaning?
Speaker 0 00:51:04 So that's a, a beautiful question. Um, with, with time permitting, um, we, we love to go to Daily Mass mm-hmm. <affirmative>, um, and, and as a family, we say prayers with one another. My husband and I have continued that, um, daily rosaries and, um, consecration mm-hmm. <affirmative> to St. Joseph in the Holy Family has been a meaningful practice for us and our families. Um, and it's, it's important to keep Christ in the center of our lives and to pray for his guidance and, um, sustaining through the work that we do. Mm-hmm.
Speaker 2 00:51:42 <affirmative>, and I'm sure especially right at Right. As a nurse and witnessing that suffering, staying close to Christ is, uh, so, so helpful. Uh, and then last question, what's a falsehood about God maybe that you believed or were under, and what was the truth? You discovered?
Speaker 0 00:51:59 The falsehood of God,
Speaker 2 00:52:02 A false belief about God,
Speaker 0 00:52:03 A false belief about God. Um, I think, um, very young in my early, uh, career, um, having an unrealistic expectation that, that we could satisfactorily meet the needs of every human that we tried to care for mm-hmm. <affirmative>. Um, and that I think that can cause a lot of moral distress for healthcare providers. Yeah. Uh, and it, it took me 20 years of searching and 20 years of working in the middle of the night, um, having personal conversations with God in relation to that struggle. Mm-hmm. <affirmative>. Um, and, and so for the new healthcare providers that are beginning in their careers, they're so energetic and they're so excited about this mission and the work that they're embarking on. Um, and, and you try to invoke those moments of hoping that they don't despair mm-hmm. <affirmative>, uh, when you see so much suffering and you see so much death, um, little by little without even knowing you're at risk of your faith fading away into this world of darkness. I think I lived in a world of darkness because I worked midnight shifts mm-hmm. <affirmative>, and, and you wake up at some point thinking that you've lost a piece of yourself. Hmm. And as, as a healthcare provider, it's so important that we don't lose an understanding of who we are and where we've come from. And that Christ has preceded us in understanding humanity, suffering, and that we need to give that back to Christ mm-hmm. <affirmative> because we can't shoulder it all by ourselves.
Speaker 2 00:53:48 Christ, Christ is the universal savior. Right. Right. I am
Speaker 0 00:53:52 Not. I am not for sure. That's
Speaker 2 00:53:54 Beautifully put. Well, uh, Dr. Ere, thank you so much, uh, for being with us on our show today.
Speaker 0 00:54:00 Thank you for inviting me. It's been enjoyable. Thank you. Thank you.
Speaker 3 00:54:05 Thank you so much for joining us for this podcast. If you like this episode, please write and review it on your favorite podcast app to help others find the show. And if you want to take the next step, please consider joining our Annunciation Circle so we can continue to bring you more free content. We'll see you next time on the Catholic Theology Show.
