If That Ever Happens to Me: Making Life and Death Decisions after Terri Schiavo

8 Feeding

 feedIng 8 Throughout this book, artificial nutrition and hydration has been referred to as “life support” or “life-sustaining treatment ” or a “life-prolonging procedure” that might be refused under the same rules as other forms of medical treatment. This reflects an ethical and legal consensus that has existed for at least two decades or more. But for many people, artificial nutrition and hydration is different. Some of thosewho protested the removal of Terri Schiavo’s feeding tube did so not because they believed that Michael Schiavo was misrepresenting her wishes or that Terri had some degree of consciousness but because they believed that food or water should never be withheld from anyone. To fail to feed is to fail to care, in this view, and is an unacceptable way for human beings to treat one another. Pope John Paul II made a statement on this issue in the spring of 2004 that substantially elevated attention to the ethical questions involved and challenged the consensus view. The pope’s address to participants in the International Congress on Life-Sustaining Treatments and Vegetative State included the following: The sick person in a vegetative state, awaiting recoveryora natural end, still has the right to basic health care (nutrition, hydration, cleanliness, warmth, etc.), and to the prevention of complications related to his confinement to bed. He also has the right to appropriate rehabilitative care and to be monitored for clinical signs of eventual recovery. I should like particularly to underline how the administration of water and food, even when provided by artificial means, always represents a natural means of preserving life, not a medical act. Its  f e e d I n g use, furthermore, should be considered, in principle, ordinary and proportionate, and as such morally obligatory.1 At the time, the policy of many Catholic hospitals in the United States had been to allow family members more discretion than this statement suggested with respect to the withdrawal of artificial nutrition and hydration—both for patients in a permanent vegetative state and for other patients. Withdrawal was permitted under the general church policy that artificial nutrition and hydration, like other forms of life support, can be withdrawn from incompetent patients when continued treatment is disproportionately burdensome to the patient or—in contrast to most U.S. law, which does not allow explicit consideration of the interests of the family—disproportionately burdensome to the patient’s family. The pope’s statement called these prevailing practices into question, and U.S.Catholic organizations scrambled to understand what it should mean for them. Because of this uncertainty—and the claim of some scholars and theologians that the pope’s statement was a departure from past church doctrine—the U.S. Conference of Bishops asked for clarification from the Vatican. The response, approved in August 2007 by Pope Benedict XVI (the successor to Pope John Paul II, who died in 2005), confirmed the earlier pope’s 2004 statement. “Question: Was the administration of artificial nutrition and hydration to a patient in a ‘vegetative state’ morally obligatory? Answer: Yes. . . . Question: May it be discontinued when competent physicians determine that the patient will never recover consciousness? Answer: No.”2 These sentiments, expressed at the height of national debate over Terri Schiavo’s fate and then confirmed one and a half years later, have had more of an influence in framing the discussions about artificial nutrition and hydration than we might expect in a pluralistic society that, as a constitutional matter, honors the principle of separation of church and state.There are a number of reasons for this unusual influence. For one, the Catholic Church—more so than other dominant religious organizations—has for years been at the fore-  f e e d I n g front of and deeply involved in sophisticated discussion and writing about end-of-life treatment decisions and bioethics generally. Second, the Schindlers are Catholic and so was Terri Schiavo, even if she was not a regular churchgoer. Finally, the pope seemed to say, at just the right time during the Schiavo controversy, from a position of some moral authority and in accessible and unambiguous terms, what a lot of the American public found troubling about the Schiavo case.The statement that artificial nutrition and hydration was “basic care” had a simple emotional and moral appeal. What arewe to make of the argument that feeding is basic care and should be subject...