Disabled Texas woman will not be denied food and water — for now — after judge’s order

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CNA Staff, Aug 2, 2024 / 11:00 am (CNA).

A disabled Texas woman will continue to receive food and water after a Texas attorney filed an emergency petition last month to keep her parents, who are Catholic, from ending her life by starvation.

Margaret “Margo” Naranjo, 28, suffered severe brain damage in a 2020 car accident. Though not technically on “life support” and able to breathe without the use of a ventilator, she is today profoundly disabled and not able to speak, eat, or drink on her own.

Naranjo’s parents, Mike and Cathy, are Catholic and have frequently called for prayers for Margo’s healing and for their family since the car accident. But in a now-deleted Facebook livestream, Cathy announced on July 7 that she and Mike — in accordance with what they believe to be Margo’s pre-accident wishes — had decided to allow Margo to die by starvation in hospice.

Naranjo’s situation has drawn comparisons to that of Terri Schiavo, a Florida woman who was left severely brain damaged from oxygen deprivation amid a heart attack and lived for a decade and a half in a persistent vegetative state.

In 2005, she died of starvation after her husband insisted he was complying with her wishes by removing her feeding tube, despite a protracted and very public court battle and the pleading of her family.

Cathy, Margo’s mother, said in the July 7 video that Margo had told her and Mike before her accident that she was “very clear” that she “would not want to be kept alive by machines” if she were ever incapacitated.

“I feel 100% certain that she knew what she was saying,” Cathy said, while noting that although Margo’s statements were never written down, “we want to honor and respect her wishes.”

Cathy said she and Mike had already scheduled Margo’s funeral for Aug. 2 at their local Catholic parish — despite Margo still being alive, and sitting next to her — as well as a “celebration of life” party to be held the next day, Aug. 3.

“Margo believes in heaven … and that’s where we’re going to let her go,” Cathy said in the video. 

Concerned for Margo’s safety, a local attorney, Courtland Kristoferson, filed an emergency application July 19 with the Denton County Probate Court. The application states that home health workers taking care of Margo report that she is in “good condition and that her health has not declined or deteriorated to the point hospice treatment is necessary.” 

The application also says that the home health care workers devised a communication system based on Margo turning her head left or right to indicate yes or no. The application says her carers asked Margo if she wanted to have her food and water stopped, and she answered no. (Kristoferson, the attorney, did not respond to requests for comment from CNA for this story.)

Court records show that Denton County Probate Court Judge David W. Jahn appointed a temporary guardian for Margo and issued a temporary restraining order against her parents on July 19, precluding them from stopping her food and water. A hearing on the temporary restraining order was scheduled to take place Aug. 1.

The Diocese of Dallas, on behalf of St. Ann’s Parish in Coppell, Texas, confirmed to CNA this week that there is no longer any scheduled funeral at the parish for Margo. Spokeswoman Katy Kiser told CNA that upon learning that Margo was still alive, the parish “reached out and spoke to the family and prayed for Margo.”

CNA reached out to Mike and Cathy Naranjo to ask if they are still resolved to end Margo’s life and to give them an opportunity to explain but did not receive a response. In a social media post, Mike indicated that they are cooperating with Margo’s temporary new guardian. 

In a recent livestreamed prayer video, posted after receiving the restraining order, Mike insisted that he understands the Church’s teaching on end-of-life care and that his and Cathy’s decision was not related to difficulties they have had in caring for Margo. 

“I want to assure you I am well-versed, probably more than most, on the teaching of the Church on this matter. So no one has to warn me, you don’t have to post the doctrine, I think we all get where the Catholic Church stands on this, but I appreciate the concern,” he said, with Margo seated at his side.

What does the Catholic Church teach about withdrawing food and water?

The Catholic Church teaches that human life must be protected from conception until death and says in No. 2277 of the catechism that it is immoral to take actions to hasten a person’s death, even if the person does not appear to have a good quality of life. 

The catechism notes that discontinuing medical procedures that are “burdensome, dangerous, extraordinary, or disproportionate to the expected outcome” and allowing a patient to die naturally can be legitimate. But Church leaders have stressed over the years that basic food and water are not extraordinary forms of care. 

Jozef Zalot, a staff ethicist at the National Catholic Bioethics Center, indicated to CNA that Church leaders at the Vatican and in the U.S. have specifically addressed the question of denying food and water to a patient who is in a vegetative state, especially since Terri Schiavo’s court battle and eventual death in 2005. 

In a 2004 address given amid the debate surrounding the Schiavo court case, St. John Paul II clarified the Church’s teaching that “the administration of water and food, even when provided by artificial means, always represents a natural means of preserving life, not a medical act.” 

“Even our brothers and sisters who find themselves in the clinical condition of a ‘vegetative state’ retain their human dignity in all its fullness. The loving gaze of God the Father continues to fall upon them, acknowledging them as his sons and daughters, especially in need of help,” the saint noted. 

The pope explained that “waning hopes” that a person in a vegetative state will recover “cannot ethically justify the cessation or interruption of minimal care for the patient, including nutrition and hydration.”

“Death by starvation or dehydration is, in fact, the only possible outcome as a result of their withdrawal. In this sense it ends up becoming, if done knowingly and willingly, true and proper euthanasia by omission,” John Paul II said. 

Zalot also pointed to a 2007 set of responses from the Vatican’s Congregation (now Dicastery) for the Doctrine of the Faith, which addressed two follow-up questions from the U.S. bishops about whether a patient in a “vegetative state” can ever be denied food and water. 

The congregation, under Pope Benedict XVI, clearly affirmed that a person in a vegetative state must be supplied with food and water even if they seem to have no chance of recovery. 

“A patient in a ‘permanent vegetative state’ is a person with fundamental human dignity and must, therefore, receive ordinary and proportionate care which includes, in principle, the administration of water and food even by artificial means,” the congregation wrote. 

Zalot said those responses helped to craft a 2009 revision to the U.S. bishops’ Ethical and Religious Directives for Catholic Health Care Services, which state in Directive 58 that “there is an obligation to provide patients with food and water” at Catholic hospitals, an obligation that “extends to patients in chronic and presumably irreversible conditions.”

The directives leave room for the patient to choose to reject extraordinary means, however. 

“Medically assisted nutrition and hydration become morally optional when they cannot reasonably be expected to prolong life or when they would be ‘excessively burdensome for the patient or [would] cause significant physical discomfort, for example resulting from complications in the use of the means employed,’” Directive 58 continues.

“For instance, as a patient draws close to inevitable death from an underlying progressive and fatal condition, certain measures to provide nutrition and hydration may become excessively burdensome and therefore not obligatory in light of their very limited ability to prolong life or provide comfort.”

Jennifer Allmon, executive director of the Texas Catholic Conference, told CNA that under Texas law, artificially administered nutrition and hydration (AANH) must be provided to a patient unless the AANH would cause the patient harm, or the patient has a “clearly documented desire not to receive artificially administered nutrition or hydration.”

Allmon said Catholics in Texas can make use of a conscience formation guide on end-of-life care provided by the Texas Catholic Conference, which recommends that Catholics make it abundantly clear in their advance directives that they do not want to be denied food and water if they are incapacitated unless it is actively causing them harm.

“Catholics [should] make explicitly clear that their nutrition and hydration requests comply with Catholic teaching, given that the law is not fully compliant with Catholic teaching,” Allmon said.