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

5. Must We Preserve Life?

฀ 79 5 Must฀We฀Preserve฀Life? Ronald฀Hamel฀ Michael฀Panicola Is฀the฀removal฀of฀a฀feeding฀tube฀that฀supplies฀nutrients฀and฀fluids,฀especially฀ in฀patients฀in฀a฀persistent฀vegetative฀state฀(PVS),฀simply฀a฀means฀of฀killing฀a฀ vulnerable฀person—a฀form฀of฀euthanasia?฀Judging฀from฀some฀of฀the฀responses฀ to฀the฀much-publicized฀Terri฀Schiavo฀case,฀it฀seems฀there฀are฀those฀who฀think฀ so,฀including฀a฀fair฀number฀of฀Catholics.฀(Ms.฀Schiavo,฀a฀thirty-nine-year-old฀ Florida฀resident,฀suffered฀severe฀brain฀damage฀after฀a฀collapse฀in฀1990฀and฀has฀ been฀sustained฀since฀then฀by฀a฀feeding฀tube.฀Her฀husband฀has฀sought฀the฀removal ฀of฀life-sustaining฀equipment.฀This฀is฀opposed฀by฀her฀parents฀and฀family,฀ and฀the฀issue฀has฀been฀litigated฀for฀over฀five฀years.) It฀is฀not฀always฀clear฀whether฀those฀who฀oppose฀removal฀of฀the฀feeding฀tube฀ do฀so฀because฀they฀believe฀it฀is฀killing฀in฀this฀particular฀case฀or฀that฀it฀is฀killing฀ in฀most฀or฀all฀such฀cases.฀In฀any฀event,฀the฀Terri฀Schiavo฀case฀has฀generated฀not฀ only฀enormous฀controversy฀but฀also฀considerable฀confusion฀among฀Catholics฀ and฀others฀regarding฀the฀moral฀justification฀for฀forgoing฀artificial฀nutrition฀and฀ hydration. The฀confusion,฀however,฀did฀not฀originate฀with฀the฀Terri฀Schiavo฀case.฀Reactions ฀to฀other฀high-profile฀feeding-tube฀cases฀over฀the฀last฀twenty฀years฀or฀so฀ have฀also฀contributed฀to฀the฀confusion.฀In฀general,฀this฀confusion฀has฀arisen฀ because฀differing฀viewpoints฀have฀been฀expressed฀by฀church-related฀bodies฀discussing ฀Catholic฀teaching฀on฀the฀duty฀to฀preserve฀life฀by฀providing฀nutrition฀ and฀hydration฀(e.g.,฀statements฀by฀the฀New฀Jersey฀and฀Texas฀bishops).฀More฀ 80฀ ฀ ฀฀฀฀฀ seriously,฀many฀of฀the฀statements฀that฀have฀been฀issued฀since฀the฀Vatican’s฀Declaration ฀on฀Euthanasia฀(1980)฀appear฀to฀revise฀and฀apply฀in฀a฀narrow฀way฀traditional฀ Catholic฀teaching฀on฀the฀matter.฀In฀what฀follows,฀we฀offer฀a฀brief฀sketch฀of฀the฀ tradition,฀then฀consider฀the฀two฀principal฀ways฀in฀which฀the฀tradition฀is฀being฀ revised฀and,฀finally,฀reflect฀on฀the฀implications฀of฀these฀revisions. Traditional฀Catholic฀Teaching The฀Catholic฀tradition฀on฀the฀duty฀to฀preserve฀life฀has฀developed฀over฀the฀course฀ of฀some฀five฀hundred฀years.฀Two฀Jesuit฀moralists,฀John฀J.฀Paris฀and฀the฀late฀Richard ฀A.฀McCormick,฀presented฀an฀excellent฀summary฀of฀this฀tradition฀as฀it฀relates฀ to฀the฀use฀of฀nutrition฀and฀hydration฀(America,฀May฀2,฀1987).฀We฀would฀like฀to฀ highlight฀three฀important฀features฀of฀that฀summary฀for฀background฀purposes. Duty฀to฀preserve฀life.฀The฀bedrock฀for฀the฀traditional฀teaching฀is฀found฀in฀the฀ basic฀Christian฀understanding฀of฀life฀and฀death.฀As฀Christians฀we฀believe฀human ฀life฀is฀a฀great฀good฀that฀has฀been฀given฀to฀us฀freely฀out฀of฀love฀by฀God,฀ and฀through฀life฀we฀are฀able฀to฀enter฀more฀fully฀into฀communion฀with฀God฀by฀ loving฀others.฀We฀therefore฀have฀a฀duty฀to฀protect฀and฀to฀preserve฀our฀lives.฀Yet฀ this฀duty฀is฀not฀absolutely฀binding฀under฀all฀circumstances฀because฀we฀know฀our฀ ultimate฀end฀lies฀in฀eternal฀life฀with฀God.฀Just฀what฀circumstances฀might฀relieve฀ us฀of฀our฀duty฀to฀preserve฀life฀is฀a฀question฀that฀has฀been฀given฀considerable฀attention ฀in฀the฀tradition. It฀has฀been฀widely฀accepted฀among฀Catholic฀moralists฀since฀the฀sixteenth฀ century฀that฀one฀need฀only฀employ฀“ordinary”฀means฀of฀preserving฀life฀but฀not฀ means฀that฀are฀deemed฀“extraordinary”฀by฀which฀is฀meant฀measures฀that฀either฀ fail฀to฀offer฀a฀proportionate฀hope฀of฀benefit฀or฀that฀impose฀an฀excessive฀burden.฀ This฀distinction฀between฀ordinary฀and฀extraordinary฀means฀was฀first฀articulated฀ explicitly฀by฀Dominican฀moralist฀Domingo฀Bañez฀(1528–1604)฀and฀it฀is฀still฀ operative฀today,฀though฀now฀the฀terms฀proportionate฀and฀disproportionate฀are฀ more฀often฀used. The฀relative฀norm.฀There฀has฀been฀a฀shift฀away฀from฀the฀traditional฀terms฀because ฀the฀meaning฀of฀ordinary฀and฀extraordinary฀began฀to฀be฀seriously฀misunderstood ฀as฀medicine฀became฀more฀advanced฀and฀certain฀means฀of฀preserving฀life฀ became฀more฀commonly฀used฀and฀readily฀available.฀As฀a฀consequence,฀the฀moral฀ question฀regarding฀the฀effects฀of฀a฀particular฀therapeutic฀means฀upon฀a฀person฀ in฀terms฀of฀benefits฀or฀burdens฀was฀reduced฀to฀a฀technical฀question฀about฀the฀ means฀itself.฀If฀the฀means,฀without฀respect฀to฀the฀overall฀impact฀on฀the฀person,฀ were฀an฀ordinary฀medical฀procedure฀or฀therapy,฀it฀was฀wrongly฀deemed฀ordinary฀ in฀the฀moral฀sense฀of฀the฀term฀and฀hence฀obligatory.฀For฀the฀traditional฀moralists ,฀however,฀no฀means฀of฀preserving฀life฀could฀be฀considered฀ordinary฀apart฀ from...