Artificial Nutrition and Hydration and the Permanently Unconscious Patient: The Catholic Debate

18. Assisted Nutrition and Hydration and the Catholic Tradition

฀ 223 18 Assisted฀Nutrition฀and฀Hydration฀and฀the฀ Catholic฀Tradition Thomas฀A.฀Shannon฀฀ James฀J.฀Walter The฀Terri฀Schiavo฀case฀in฀Florida฀focused฀attention฀on฀a฀variety฀of฀issues฀related฀ to฀the฀end฀of฀life:฀who฀is฀the฀decision฀maker,฀the฀status฀of฀advanced฀directives,฀ the฀role฀of฀family฀members฀with฀respect฀to฀married฀adult฀children,฀and฀issues฀ related฀to฀the฀removal฀of฀life฀support฀systems,฀particularly฀assisted฀nutrition฀and฀ hydration.฀Terri฀Schiavo฀is฀now฀linked฀to฀two฀other฀young฀women฀who฀played฀ a฀critical฀role฀in฀helping฀us฀to฀think฀through฀ethical฀issues฀at฀the฀end฀of฀life.฀ Karen฀Ann฀Quinlan฀and฀her฀family฀raised฀the฀issue฀of฀the฀removal฀of฀a฀ventilator .฀In฀her฀case฀the฀physicians฀were฀reluctant฀to฀do฀this฀because฀they฀feared฀ legal฀repercussions.฀The฀legal฀and฀ethical฀analysis฀concurred฀that฀such฀removal฀ was฀justified฀because฀it฀constituted฀extraordinary฀means฀of฀treatment.฀Nancy฀ Cruzan฀and฀her฀family฀focused฀attention฀on฀the฀removal฀of฀artificial฀nutrition฀ and฀hydration฀(ANH).฀Again฀law฀and฀ethics฀concurred฀that฀such฀removal฀was฀ justified,฀particularly฀because฀people฀testified฀that฀being฀maintained฀in฀such฀circumstances ฀were฀not฀her฀wishes.฀ On฀February฀25,฀1990,฀Terri฀Schiavo฀had฀suffered฀a฀heart฀attack,฀possibly฀ brought฀on฀as฀a฀result฀of฀chemical฀imbalances฀from฀an฀eating฀disorder.฀She฀suffered ฀loss฀of฀oxygen฀to฀her฀brain฀and฀was฀eventually฀diagnosed฀as฀being฀in฀a฀persistent ฀vegetative฀state.฀A฀decade฀later,฀in฀February฀2000,฀her฀husband฀Michael฀ Schiavo฀requested฀that฀her฀feeding฀tube฀be฀removed.฀The฀Circuit฀Court฀judge฀ agreed,฀and฀this฀set฀off฀a฀lengthy฀appeal฀and฀counter-appeal฀process,฀including฀ attempted฀legislative฀initiatives฀from฀the฀state฀of฀Florida฀and฀the฀United฀States฀ Congress฀and฀thirty-seven฀court฀reviews,฀that฀were฀complicated฀by฀increasing฀ family฀acrimony฀and฀public฀commentary฀from฀a฀variety฀of฀sources:฀religious,฀ political,฀ethical,฀and฀legal.฀After฀a฀five-year฀legal฀battle,฀the฀feeding฀tube฀was฀ removed,฀and฀Terri฀Schiavo฀died฀on฀March฀31,฀2005,฀at฀the฀age฀of฀forty-one. ฀ A฀critical฀element฀in฀the฀debate฀was฀the฀ethics฀of฀the฀use฀of฀feeding฀tubes฀ for฀patients฀in฀a฀persistent฀vegetative฀state.฀Several฀bishops,฀particularly฀in฀light฀ of฀the฀papal฀allocation฀on฀feeding฀tubes฀in฀March฀2004,฀argued฀that฀their฀use฀ was฀morally฀obligatory.฀Thus฀Bishop฀Vaga฀of฀Baker,฀Oregon:฀“She฀may฀well฀die฀ in฀the฀future฀from฀an฀inability฀to฀digest฀food฀but฀it฀would฀be฀murder฀to฀cause฀ her฀death฀by฀denying฀her฀the฀food฀she฀still฀has฀the฀ability฀to฀digest฀and฀which฀ continues฀to฀provide฀for฀her฀a฀definite฀benefit—life฀itself.”1 ฀That฀sentiment฀ was฀echoed฀by฀Representative฀Thomas฀DeLay฀of฀Texas฀who฀said:฀ “That฀act฀ of฀barbarism฀can฀be฀and฀must฀be฀prevented.”2 ฀A฀comment฀on฀the฀ethical฀issue฀ underlying฀the฀provision฀of฀ANH฀was฀offered฀by฀Bishop฀Loverde฀of฀Arlington,฀ Virginia,฀who฀said:฀“If฀Mrs.฀Schiavo฀were฀facing฀imminent฀death,฀or฀were฀unable฀ to฀receive฀food฀and฀water฀without฀harm,฀then฀removing฀nutrition฀and฀hydration฀ would฀be฀morally฀permissible.฀It฀is฀however฀never฀permissible฀to฀remove฀food฀ and฀water฀to฀cause฀death.฀Food฀and฀water฀are฀basic฀human฀needs,฀and฀therefore฀ basic฀human฀rights.”3 ฀And฀Richard฀Doerflinger฀of฀the฀United฀States฀Catholic฀ Conference฀of฀Bishops฀was฀reported฀to฀have฀articulated฀the฀normative฀nature฀ of฀this฀position฀in฀an฀interview฀with฀the฀Washington฀Post:฀ Before฀the฀pope฀made฀his฀statement฀about฀feeding-tube฀cases฀at฀a฀conference฀ last฀year฀there฀was฀enough฀uncertainty฀about฀the฀church’s฀position฀that฀Catholics ฀could฀remove฀feeding฀tubes฀without฀fear฀of฀committing฀a฀sin.฀No฀one฀could฀ fairly฀have฀said฀to฀you฀that฀you฀were฀dissenting฀from฀clear฀Catholic฀teaching.฀ Now฀you฀would฀have฀to฀say,฀“Yes,฀you฀are.”4 ฀ The฀issue฀on฀which฀we฀focus฀in฀this฀note฀is฀the฀state฀of฀the฀question฀in฀the฀ Catholic฀tradition฀regarding฀the฀use฀of฀assisted฀nutrition฀and฀hydration,฀an฀issue฀ that฀became฀central฀in฀the฀media฀and฀in฀public฀debate. Our฀position฀is฀that฀there฀have฀been฀four฀unacknowledged฀shifts฀within฀ the฀last฀twenty-five฀years฀from฀the฀traditional฀method฀of฀analyzing฀our฀moral฀ obligations฀during฀illness฀and฀the฀dying฀process.฀The฀first฀of฀these฀is฀a฀shift฀in฀ the฀very฀method฀itself:฀from฀proportionate฀reasoning฀as฀in฀the฀“Declaration฀on฀ Euthanasia”฀from฀the฀Congregation฀for฀the฀Doctrine฀of฀the฀Faith฀in฀1980฀to฀a฀ 224฀ ฀ ฀฀’฀฀฀฀ deontological฀reasoning฀as฀in฀the฀March฀2004฀papal฀allocution฀“Care฀for฀Patients ฀in฀a฀‘Permanent...