Medically Assisted Nutrition and Hydration in Medicine and Moral Theology: A Contextualization of its Past and a Direction for its Future

The Thomist 68 (2004): 69-104 MEDICALLY ASSISTED NUTRITION AND HYDRATION IN MEDICINE AND MORAL THEOLOGY: A CONTEXTUALIZATION OF ITS PAST AND A DIRECTION FOR ITS FUTURE1 JOHN BERKMAN The Catholic University ofAmerica Washington, D.C. FOR A SIGNIFICANT PORTION of the 1980s, ethical issues regarding the use of various forms of support to prolong life grabbed newspaper headlines in the United States. Highprofile legal cases over the "right to die," such as those of Karen Ann Quinlan and Nancy Cruzan, became legal landmarks. Other highly publicized cases, such as those ofBrophy, Conroy, Herbert, and Jobes, contributed to making the issue a commonplace part of the news. In the midst of the headlines generated by these and other related cases, many Catholic ethicists attempted to provide analysis and guidance. These cases also elicited frequent formal statements from the Catholic episcopacy, both from individual bishops and from episcopal conferences.2 1 Thanks to Michael Baxter, Bill Mattison, Joyce McClure, Gilbert Meilaender, John Grabowski, and William Barbieri for helpful comments on earlier drafts ofthis paper. Thanks also to Jennifer Moore, M.D., and Heidi White, M.D., for insight on current medical practice with regard to MANH, and to Thomas Bender, M.D., for originally bringing to my attention the Kelly-Donovan debate. Finally, I wish to acknowledge with gratitude the support of the Duke Institute on Care at the End ofLife, where I wasVisiting Scholar in 2001-02, and where much of the research for this paper was conducted. 2 For example, "Guidelines for Legislation on Life-Sustaining Treatment," U.S. bishops' Committee for Pro-life Activities, Origins 14:32 (24 January 1985): 526ff.; "Providing Food and Fluids to Severely Brain-Damaged Patients," friend of the court brief by the New Jersey Catholic Conference in the Nancy Ellen Jobes Case, Origins 16:32 (22January1987):582ff.; "Georgia Man Asks to Turn Off Life-Supporting Ventilator," friend of the court brief by the archdiocese of Atlanta in the case of Larry James McAfee, Origins 19:17 (28 September 69 70 JOHN BERKMAN Of the various ethical dilemmas surrounding decisions regarding the use of life support, none provoked more disagreement among both Catholic ethicists and the Catholic episcopacy than that of the use of medically assisted nutrition and hydration (henceforth MANH). Among the episcopacy, this disagreement gained high profile in statements from the Texas and Pennsylvania bishops, as well as those of other groups of bishops. There were regular if not constant exchanges between Catholic ethicists on this question through the 1980s and early 1990s.3 The literature detailing various arguments for or against the use of MANH in caring for the dying and debilitated is extensive. Yet the thesis of this article is that a large part, if not the main thrust, of the debates over MANH have been inadequate and misguided on a number of different levels. I hope to reorient and redirect the debate by attending to the medical history of MANH (part 1) and recent medical developments with regard to MANH (part 5), examining and contextualizing the earliest debate (i.e., in the 1950s) over MANH among moral theologians (part 2) as well as a more recent debate over MANH involving numerous American Catholic bishops (part 3), and critically evaluating the types of moral arguments that preoccupy many of those who currently write on the ethics of MANH (part 4). The first section-a brief history of nineteenth and twentiethcentury medical practice with regard to MANH-aims to show that inadequate understanding of the medical history, 1989): 273ff.; "The Nancy Cruzan Case," Bishop John Leibrecht, Origins 19:32 (11 January 1990): 525ff.; "Treatment of Dying Patients," bishops of Florida, Origins 19:3 (1 June 1989): 47ff. 3 For examples of such exchanges, see John Connery, "The Clarence Herbert Case: Was Withdrawal ofTreatmentJustified," Hospital Progress (February 1984): 32-35, 70; andJohn Paris, "Withholding orWithdrawingNutrition and Food: What are the Real Issues," Hospital Progress (December 1985): 22££. See also Richard McCormick, S.J., "'Moral Considerations' Ill Considered," America 166 (14 March 1992): 210-14; and Kevin McMahon, "What the Pennsylvania Bishops Really Said," Linacre Quarterly 59 (August 1992): 6-10. For an exchange between William E. May and Kevin O'Rourke, see...