Refuting So-Called
“Catholic” Testimony Heard in The Case of Terri Schiavo
14 October 2002
John M. Dolan, Ph.D.
Morse-Alumni Distinguished Teaching
Professor of Philosophy, University of
Minnesota, former Co-Chair, Program
in Human Rights and Medicine, Medical
School, University of Minnesota
Father Kevin Flannery, S.J., D.Phil.
Dean, The Philosophy Faculty of the
Pontifical Gregorian University, Rome
Introduction
When people struggling with a moral or legal problem raise the question
whether any teachings of the Catholic Church have bearing on their problem, a
Catholic who undertakes to supply an answer assumes a serious responsibility.
The task of stating relevant Church doctrine and explaining how it bears
on a contested case is often a non-trivial matter.
If the person undertaking the task happens to be a Catholic priest, the
obligations accepted are clearly quite stringent.
And, if the context in which the problem arises is a legal proceeding in
which a human life hangs in the balance, then those obligations assume the
utmost stringency.
In the legal proceedings concerning the fate of Theresa Schiavo, a
Catholic priest has undertaken to state relevant Church teachings and to give
their bearing on the case. Some people following the case are convinced that
there are grave flaws in Father Gerard Murphy’s handling of Church teachings.
They invited us to give a sounder account of relevant Catholic doctrine and to
comment on Father Murphy’s testimony. If
a human life were not hanging in the balance, we would be disinclined to accept
the invitation, disinclined to fault the testimony of a Catholic priest.
But, a human life is at stake, so we have accepted the invitation. Upon
examining Father Murphy’s testimony and other materials concerning the Schiavo
case, we have reached the conclusion that
the representations he made are in certain important respects inaccurate.
We record this judgment without in any way calling into question either
the honor or good will of Father Murphy. What
is at issue is a sharp disagreement concerning Church doctrine.
We have no reason to suppose that Father Murphy approached his task with
any less good will or resolve to do right than we bring to our own.
This age has witnessed the wholesale destruction of traditional
protections of human life, and, in the midst of social upheaval and moral
vandalism, the Catholic Church has often served as the last bastion of defense
for the most vulnerable among us: the unborn, the disabled, and the gravely ill.
There are, thus, two important reasons to regret the existence of
misrepresentations of her teachings (however unwitting and well-intentioned)
when those misrepresentations smooth the way to lethal action against a
particular vulnerable person: there
is, first, the regrettable circumstance that the vulnerable person may die as a
direct result of the misrepresentations; but there is also the even graver
danger that the distorted testimony will be cited in future proceedings by
individuals pleased to seize an opportunity to lend the moral authority of the
Catholic Church to efforts to bring about the deaths of other innocent persons.
Since Father Murphy’s testimony is preceded by pages devoted to the
training and experience deemed to qualify him to testify concerning the case, it
will not be amiss for us to devote a paragraph to our own credentials and
experience. One of us (JMD), a
Catholic who holds a doctorate in philosophy from Stanford University, is
Morse-Alumni Distinguished Teaching Professor of Philosophy at the University of
Minnesota and co-founder and former co-chair of a medical ethics program at the
University of Minnesota’s medical school.
Professor Dolan has been involved in medical ethics at both scholarly and
practical levels for three decades. He
served for three years as a member of the
We note at the outset our opinion that the moral considerations and
reflections required to settle the question whether Theresa Schiavo’s food and
water can be cut off are available to any person who calls upon the natural
powers of moral reflection available to us all. Pope John II writes:
The
Gospel of life is not for believers alone: it
is for everyone. The issue of life and its defence and promotion is not a
concern of Christians alone. Although faith provides special light and strength,
this question arises in every human conscience which seeks the truth and which
cares about the future of humanity. Life certainly has a sacred and religious
value, but in no way is that value a concern only of believers. The value at
stake is one which every human being can grasp by the light of reason; thus it
necessarily concerns everyone. Evangelium Vitae,
§ 101, par. 2 (emphasis in original)
We believe that an individual who has never studied the
specific doctrines of the Church is capable of the moral discernment that, with
the exception of an extremely narrow class of special cases, it is always a
grave wrong to cut off the food and water of a person who is severely disabled
and unable to defend herself. We are confident, also, that the light of ordinary
moral reason is sufficient to enable an honest and deliberate moral agent (not
in the thrall of the euthanasiast impulse of the age) to discern that Theresa
Schiavo’s circumstances do not fall into the narrow class of exceptions just
mentioned. But the invitation we have accepted asks us to identify teachings of
the Catholic Church that bear on the case of Theresa Schiavo and to explain
their bearing. And we turn now to
that task.
Relevant Catholic
Doctrine
The first relevant teaching, central to the entire Judeo-Christian
tradition, is the familiar commandment: Thou
shalt do no murder. This is
sometimes mistranslated (e.g., in the King James
version) as “Thou shalt not kill” (leading superficial critics to announce
with glee that traditional religion contradicts itself by holding
simultaneously, first, that all killing is wrong and, second, that the death
penalty and just wars are morally permissible).
But the commandment prohibits murder, not all killing, and the central
core of application of the concept of murder is deliberate lethal action against
an innocent person. The term "innocent" as it figures here, means
simply "not harming." Thus,
someone who is assaulting another person is not
innocent in the relevant sense, and someone found guilty of a capital offense by
due process of law might also not be
innocent in the relevant sense. Persons
who are not innocent are also protected by the prohibition against murder: it is
possible to murder a person who is not innocent. But, the application of the
prohibition to the case of the non-innocent involves complications that have no
relevance to the present deliberations. It remains true that the central core of
application of the concept of “murder” -- the clearest instance of murder --
is the deliberate killing of the innocent. The specific case we are addressing
here, the fate of Theresa Schiavo, concerns a person who is plainly innocent.
The full import and power of the prohibition against murder is spelled
out in numerous official Church documents. Thus,
for example, we find the following formulation in a declaration of the Sacred
Congregation for the Doctrine of the Faith:
No one can make an attempt on the
life of an innocent person without opposing God’s love of that person, without
violating a fundamental right and therefore without committing a crime of utmost
gravity. (Declaration on Euthanasia, 5 May 1980)
Later in the same document, the Congregation is even more
painstakingly explicit on this point.
It is necessary to state firmly
once more that nothing and no one can in any way permit the killing of an
innocent human being, whether a fetus or an embryo, an infant or an adult, an
old person, or one suffering from an incurable disease, or a person who is
dying. (Declaration on Euthanasia, par. 5)
The circumstance that a person is extremely ill or severely
disabled or even dying does not remove that person from the protection of the
commandment against murder. In the “Gospel of Life” and numerous other
writings, the Holy Father has made crystal clear the “absolute
inviolability” of innocent human life.
If such great care must be taken
to respect every life, even that of criminals and unjust aggressors, the
commandment, "You shall not kill" has absolute value when it refers to
the innocent person. And all the more so in the case of the weak and defenseless
human being,... In effect , the absolute inviolability of innocent human life is
a moral truth, clearly taught by Sacred Scriptures, constantly upheld in the
Church's tradition and consistently proposed by her Magisterium." (Evangelium
Vitae, § 57, pars. 1 and 2).
As the extract just quoted makes clear, it is possible to
multiply indefinitely passages in which the teaching in question is asserted.
Another relevant teaching of the Catholic Church is a principle put
forward by St. Thomas Aquinas. In G.
E. M. Anscombe’s concise
paraphrase: "A [harm by
omission] is voluntary ... [if] it
was both possible and necessary for the agent to act and he did not."
("Murder and the Morality of Euthanasia," Euthanasia and Clinical Practice: Trends,
Principles, and Alternatives, Chapter III, The Linacre Centre, 1982)
The extreme compression of this formulation may prevent some readers from
appreciating it. To give a fuller
statement of the content of St. Thomas’s principle and to make clear how it
bears on the specific harm of causing death by omission, we offer the following
more explicit formulation: A deliberate omission that causes death is morally an
act of intentional killing when three conditions are satisfied: (i) It is within
the agent's power to supply what is being withheld,
(ii) The agent has an obligation to supply it.
(iii) The agent understands that withholding what is needed is likely to
cause death.
It is worth considering this principle’s bearing on the case of Theresa
Schiavo. Those responsible for her
care certainly have the capacity to supply nourishment to her.
Her parents and siblings assert (correctly in our judgment) that they
have an obligation to supply nourishment to her.
Finally, every party to the case understands clearly that withholding
nourishment from Theresa Schiavo will certainly result in her death.
It follows that deliberately withholding nourishment from Theresa Schiavo
would count morally as intentionally killing her.
Since the killing in question would be the intentional killing of an
innocent person, it would be murder.
Now the crucial step in this application of Aquinas’s principle to the
case of Theresa Schiavo is the second one, the step at which we endorse her
family’s assertion that her care givers have an obligation to supply her with
nourishment. We endorse this
assertion as in accordance with the consistent teaching of virtually all
traditional Catholic philosophers and theologians, including Thomas Aquinas,
that to give food to a hungry person is an inherently good thing and its
opposite (starvation) an evil [Thomas Aquinas, De malo q.2 a.4 ad 5].
The non-prevention of an evil (when such prevention is possible) is
itself evil [Thomas Aquinas, Summa theologiae I-II q.71 a 5]; therefore,
we are obliged to provide nutrition and hydration to people in need of them if
this is within our power (and provided, of course, that administering the
nutrition and hydration would itself not cause lethal harm to the person in
question or be utterly futile). Father
Murphy does not hold this position; he is not alone among
medical ethicists. In this
age of widespread support for assisted suicide and euthanasia,
a number of medical ethicists would concur with Father Murphy’s denial
of step two. One can even find statements by
Church committees that deny step two.
The existence of these statements shows that there is disagreement among
Catholics concerning the application of Catholic doctrine to the present case.
The existence of disagreement does not by itself establish that there is
no clear application of Church teachings to a case. It merely shows that some
Catholics disagree with others. One
can find people who describe themselves as “Catholic” who reject the
teachings of Humanae Vitae concerning sexual
ethics. One can even find people who
describe themselves as “Catholic” who reject the Church’s teaching that
induced abortion is a grave wrong. No
one would conclude from this that there is uncertainty concerning the Church’s
teachings concerning sexual morality or abortion. Before turning to consider
some of the dissenting statements just alluded to, we wish to emphasize two
points concerning these statements. First,
they do not emanate from the most authoritative sources in the Magisterium. They
are issued by state Catholic conferences and individual clerics, not by bodies
as authoritative as the Sacred Congregation for the Doctrine of the Faith or the
Pope himself. Second, these
statements are explicitly contradicted by a number of other statements from
sources at the same level of the Magisterium from which they proceed. Before we
turn to these various statements, we give brief consideration to the question
whether there is an advanced directive relevant to the present deliberations.
Is there an Advance
Directive that has Bearing on this Case?
Three points bear on the answer to this question.
First, Theresa Schiavo left no written advanced directive.
Second, the claim that she left oral instructions which have the force of
a written advance directive rests on thin and dubious evidence.
Third, even if she had left explicit instructions that those responsible
for her care should cut off her food and water in the present circumstances,
there would be large moral obstacles to acting on those instructions.
We take these points up in turn.
The first requires no elaboration. All
parties to the case agree that Theresa left no written advance directives.
Next, the thinness and dubiousness of the evidence concerning her past
expressions of her wishes. Theresa
Schiavo’s husband now states that she said she would not want to be kept alive
if she were dependent on others. Several difficulties attend this claim.
First, he did not make it when proceedings were underway which resulted
in a $700,000 settlement for the purpose of funding her future care. Second, he
is her potential heir and stands to inherits what remains of the settlement at
her death, a circumstance which could possibly color his present recollections
of statements she made years ago. (Very recently, two persons have come forward
to testify that they heard Theresa Schiavo make a statement like the one her
husband says he heard, but these persons waited years before announcing their
news and both are relatives of Theresa’s husband, his sister and
brother-in-law.) Third, even if it
were certain that Theresa Schiavo made a remark to the effect that she would
rather be dead than severely disabled, reasonable questions could be raised as
to whether the remark represented some considered view of hers or was merely a
casual comment to which no weight should be attached.
More than one person has uttered in the course of a particularly bad day
“I wish I were dead!”, but it would be a grave mistake to take such an
outburst seriously, much less to act on it, carrying out steps to bring about
the person’s death. Further, even
if it could be established that Theresa Schiavo’s considered conviction was
that she would prefer death to a life of severe disability, it would not follow
that this Catholic woman wanted others to kill her if she became disabled.
Still less would it follow that she had consented in advance to have
others bring about her death by deliberate dehydration and starvation. It is
improbable that a Catholic would give advance instructions to others to kill her
if she became gravely disabled. It is even more improbable that any rational
agent (whatever his or her beliefs) would ask in advance for a death caused by
dehydration and starvation, a method veterinarians properly refuse to employ
when they are “putting down” non-human animals.
Finally, the important moral obstacles to bringing about a person’s
death by deliberate dehydration and starvation even if the person asked for such
a death. Even if it could be established, contrary to rational expectation, that
Theresa Schiavo’s considered moral view was that she should be denied food and
water if she ever became seriously disabled, it would not follow that anyone has
the authority to bring about her death her by any method. An advanced directive
can be acted on only if the actions it requests are in accord with the dictates
of justice and morality. Plainly, if she asked in advance that a lethal
injection be administered should her quality of life fall below some
predetermined measure of quality of life, it would be neither morally nor
legally permissible to honor her request. But,
is it clear that a request to have one’s death brought about by dehydration
and starvation is any less problematic than a request to have one’s death
brought about by lethal injection?
We have been concerned in this section with a single question:
“Is there an advance directive that has bearing on the conflict over
Theresa Schiavo’s care?” The meagerness and problematic character of the
evidence that Theresa ever said anything relevant to the present deliberations,
and the moral obstacles to acting on instructions to cause death by deliberate
dehydration and starvation, even if such instructions did exist, make it clear
that the answer to this question is “No.”
Does a State of
Persistent Unconsciousness Relieve One’s Care Givers of The Obligation to
Supply the Normal Care Owed to a Sick Person?
We now take up the task of examining some conflicting views Catholic
theologians have expressed concerning our obligations to the permanently
unconscious. We note, at the outset,
that credible medical testimony has been presented to the court supporting the
clinical judgment that Theresa Schiavo is not
in a state of prolonged unconsciousness. We
were not asked to reach a judgment about the accuracy or inaccuracy of this
testimony or of any competing clinical evaluation before the court.
Our task is say what bearing the teachings of the Catholic Church have on
Theresa Schiavo’s case, and we propose to do so, while operating under the
assumption that the most unfavorable medical diagnosis of her condition is
correct. That is, for the purposes
of the present analysis we adopt the working postulate that Theresa Schiavo is
in a persistent state of unconsciousness from which she will never recover.
Adopting this postulate or stipulation in no way reflects a judgment on
our part concerning the actual medical facts of the case. We are aware of the
uncertainties attending clinical prognostication. We know that a “diagnosis”
which states that a patient will not recover from a state of unconsciousness is
a prognostication, a necessarily uncertain prediction of the future. Our aim is
to spell out the bearing of the Church teachings on Theresa Schiavo’s
circumstances under the assumption that she is in “a persistent vegetative
state.”
We begin our analysis with the observation that there are countless
contexts in which it is entirely licit, fully in accordance with the teachings
of the Catholic Church, to withhold or discontinue a life-sustaining treatment.
Both the Catechism of the Catholic Church
and the Sacred Congregation for the Doctrine of the Faith teach the moral
permissibility of such withholding or withdrawal of treatment. Thus, the Catechism
says:
Discontinuing medical procedures
that are burdensome, dangerous, extraordinary or disproportionate to the
expected outcome can be legitimate. It
is the refusal of “overzealous” treatment.
Here one does not will to cause death; one's inability to impede it is
merely accepted. The decision should be made by the patient if he is competent
and able, or if not, by those legally entitled to act for the patient, whose
reasonable will and legitimate interests must always be respected. (Number 2278)
It is manifestly clear that providing Theresa Schiavo with
nourishment is neither burdensome, dangerous, nor extraordinary.
There are ethicists who would wish to argue that giving her food and
water is “is disproportionate to the expected outcome.”
But the result of giving Theresa food and water is that she is able to
continue to live. The (relatively
modest) effort required to supply her with food and water can be characterized
as “disproportionate to the expected outcome,” namely, her continuing to
live, only by extending implicit
approval of the doctrine that some human lives are unworthy of continued
existence. (The circumstance that the doctrine of “Lebens unwertesleben” was
central to reasoning of Hoche and Binding, who had important influence on Nazi
practice, ought to give pause to any ethicist inclined to claim that giving
Theresa Schiavo food and water is “disproportionate to the expected
outcome.”) “Very often the worst
threat to a good ‘quality of life’ for these people is not the disability
itself, but the prejudicial attitudes of others--attitudes based on the idea
that a life with serious disabilities is not worth living.” (“Nutrition and
Hydration: Moral and Pastoral Reflections,” Resource Paper, Committee for
Pro-Life Activities, United States Conference of Catholic Bishops [formerly
known as the National Conference of Catholic Bishops], 1992)
Concerning the topic of withholding or withdrawing care, the Congregation
for the Doctrine of the Faith offers the following instruction:
When inevitable death is imminent
in spite of the means used, it is permitted in conscience to take the decision
to refuse forms of treatment that would only secure a precarious and burdensome
prolongation of life, so long as the normal care due to the sick person in
similar cases is not interrupted. In such circumstances the doctor has no reason
to reproach himself with failing to help the person in danger. (Declaration
on Euthanasia, 1985)
It is worth making three observations concerning the bearing of this instruction on Theresa Schiavo’s case. First, it allows withholding a specific treatment if it would “only secure a precarious” life. But, all of the medical claims we have seen in this case agree that there is nothing precarious about Theresa Schiavo’s state, that she is in a stable condition, that she is not on the verge of death. Indeed, if her potential heir believed that Theresa were about to die, it is unlikely that he would be engaged in a legal struggle to cut off her food and water. Second, it also allows withdrawing or withholding a treatment if it would secure only “a burdensome prolongation of life,” but on the most gloomy diagnosis of Theresa Schiavo’s situation -- the one under which we are operating -- she is in a peaceful sleep, hardly a burdensome state. Third, the Sacred Congregation allows a treatment to be withheld “so long as the normal care due to the sick person in similar cases is not interrupted,” but it is certainly more reasonable to view the provision of food and water, whether supplied through a tube or not, as “normal care,” rather than medical treatment.
Now the question before us in the present section is whether prolonged
unconsciousness constitutes a disability so extreme that one’s care givers are
relieved of their obligation to supply the normal care owed to a sick person. As
we have noted, Catholic bodies less authoritative than the Sacred Congregation
for the Doctrine of the Faith and the Pope have addressed the specific case of
prolonged unconsciousness. Some have arrived at conclusions we find entirely in
accordance with the Church’s teachings concerning respect for innocent human
life. Others have come up with conclusions that strike us as at odds with Church
teachings. We turn now to
consideration of claims and judgments put forward by these bodies.
We note, first, a directive put forward by the United States Conference
of Catholic Bishops. It is directive 58 in the most recent edition of their
“Ethical and Religious Directives for Catholic Health Care Services”:
58. There should be a presumption
in favor of providing nutrition and hydration to all patients, including
patients who require medically assisted nutrition and hydration, as long as this
is of sufficient benefit to outweigh the burdens involved to the patient.
(“Ethical and Religious Directives for Catholic Health Care Ser-vices,”
Fourth Edition, 2001)
It is a merit of this formulation that it confines the
“burdens” to be taken into account to those borne by the patient.
We have already noted that Theresa Schiavo is, on the most pessimistic
assessment of her condition, in a state of peaceful sleep and, thus, bears no
burdens as a result of continued nourishment.
This directive is plainly in full accordance with the teachings of bodies
higher in the Magisterium.
In another document from the United States Conference of Catholic
Bishops, the 1992 “Resource Paper” we quoted above, we find the following
question and response:
6.
Do persistently unconscious patients represent a special case?
Even Catholics who accept the same
basic moral principles may strongly disagree on how to apply them to patients
who appear to be persistently unconscious -- that is, those who are in a
permanent coma or a "persistent vegetative state" (PVS). ... Some
moral questions in this area have not been explicitly resolved by the Church's
teaching authority. (“Nutrition and Hydration: Moral and Pastoral
Reflections,” hereafter N&H)
There is disagreement in some quarters concerning the
proper moral response to persons who are “persistently unconscious.”
We have already registered our opinion that the mere existence of such
disagreement does not by itself preclude there being a moral response dictated
by the teachings of the Church. We
do not quarrel with the further observation by the committee members that
“Some moral questions in this area have not been explicitly resolved by the
Church's teaching authority.” The very wording chosen “not ... explicitly
resolved” is an acknowledgment that the questions may be already implicitly
answered by the authority of the Church. The absence of an explicit resolution
is entirely consistent with the existence of an implicit resolution dictated by
the “Church’s teaching authority,” much as theorems are dictated by the
axioms of a formal theory.
The committee members claim “wide agreement among Catholic
theologians” for two additional
points concerning patients in a state of chronic unconsciousness. The first of
these reads as follows:
1. An unconscious patient must be
treated as a living human person with inherent dignity and value. Direct killing
of such a patient is as morally reprehensible as the direct killing of anyone
else. Even the medical terminology used to describe these patients as
"vegetative" unfortunately tends to obscure this vitally important
point, inviting speculation that a patient in
this state is a "vegetable" or a subhuman animal. (N&H)
There is undoubtedly widespread agreement among Catholic
theologians and moral philosophers on this point (including the valuable
observation about the term ‘vegetative”).
But, reasonable doubts can be recorded concerning the second point for
which the committee members claim widespread agreement:
2. The area of legitimate
controversy does not concern patients with conditions like mental retardation,
senility, dementia or even temporary unconsciousness. Where serious disagreement
begins is with the patient who has been diagnosed as completely and permanently
unconscious after careful testing over a period of weeks or months.
(N&H)
Characterizing the debate over permanently unconscious”
patients as an “area of legitimate controversy” reveals the committee’s
impression that the teaching authority of the Church leaves open the question
whether or not it is permissible to cut off the food and water of a person
judged permanently unconscious. They proceed to quote a rather astonishing
argument in favor of withholding care from the unconscious:
Some moral theologians argue that
a particular form of care or treatment is morally obligatory only when its
benefits outweigh its burdens to a patient or the care providers. In weighing
burdens, they say, the total burden of a procedure and the consequent
requirements of care must be taken into account. If no benefit can be
demonstrated, the procedure, whatever its burdens, cannot be obligatory. These
moralists also hold that the chief criterion to determine the benefit of a
procedure cannot be merely that it prolongs physical life, since physical life
is not an absolute good but is relative to the spiritual good of the person.
They assert that the spiritual good of the person is union with God, which can
be advanced only by human acts, i.e., conscious, free acts. Since the best
current medical opinion holds that persons in the persistent vegetative state (PVS)
are incapable now or in the future of conscious, free human acts, these
moralists conclude that, when careful diagnosis verifies this condition, it is
not obligatory to prolong life by such interventions as a respirator,
antibiotics, or medically assisted hydration and nutrition. To decide to omit
non-obligatory care, therefore, is not to intend the patient's death, but only
to avoid the burden of the procedure. Hence, though foreseen, the patient's
death is to be attributed to the patient's pathological condition and not to the
omission of care. Therefore, these theologians conclude, while it is always
wrong directly to intend or cause the death of such patients, the natural dying
process which would have occurred without these interventions may be permitted
to proceed. (N&H)
It is clear that this argument is unsound.
First, the result of a sizable number of persons taking its reasoning
seriously and acting on it would be moral catastrophe.
Permanently unconscious persons are not the only human beings incapable
of “conscious, free acts” which advance our union with God. Patients who
have undergone massive strokes, Alzheimer’s patients, victims of severe head
injuries, persons suffering from extreme congenital mental retardation, and many
other conscious persons are similarly incapacitated. If the reasoning just
quoted were sound, all of these other persons would join the permanently
unconscious as legitimate targets of deliberate lethal neglect. Secondly, if in
the cases described in the argument food and hydration are withdrawn, it is not
true that “though foreseen, the patient's death is to be attributed to the
patient's pathological condition and not to the omission of care.”
Withdrawal of food and hydration (i.e., “omission of care”) creates
new pathologies not present before that action, to wit: starvation and
dehydration. Yet, surprisingly, all
the committee members say about this very bad argument is that “it is not
theologically conclusive and we are not persuaded by it.”
They proceed to paraphrase sounder reasoning put forward by Catholic
moral theologians who argue:
... that while particular
treatments can be judged useless or burden-some, it is morally questionable and
would create a dangerous precedent to imply that any human life is not a
positive good or "benefit." They emphasize that while life is not the
highest good, it is always and everywhere a basic good of the human person and
not merely a means to other goods. They further assert that if the
"burden" one is trying to relieve by discontinuing medically assisted
nutrition and hydration is the burden of remaining alive in the allegedly
undignified condition of PVS, such a decision is unacceptable, because one's
intent is only achieved by deliberately ensuring the patient's death from
malnutrition or dehydration. Finally, these moralists suggest that PVS is best
seen as an extreme form of mental and physical disability -- one whose causes,
nature and prognosis are as yet imperfectly understood -- and not as a terminal
illness or fatal pathology from which patients should generally be allowed to
die. Because the patient's life can often be sustained indefinitely by medically
assisted nutrition and hydration that is not unreasonably risky or burdensome
for that patient, they say, we are not dealing here with a case where
"inevitable death is imminent in spite of the means used."... Rather,
because the patient will die in a few days if medically assisted nutrition and
hydration are discontinued,... but can often live a long time if they are
provided, the inherent dignity and worth of the human person obligates us to
provide this patient with care and support. (N&H)
This reasoning strikes us as fully in accord with
traditional Catholic teaching concerning proper responses to persons who are
sick or severely disabled. Its
conclusion rings true as a characteristic Catholic moral instruction: “the
inherent dignity and worth of the human person obligates us to provide this
patient with care and support.”
The committee members themselves proceed to make the
following point:
On the one hand, there is a
concern that patients and families should not be subjected to unnecessary
burdens, ineffective treatments and indignities when death is approaching. On
the other hand, it is important to ensure that the inherent dignity of human
persons, even those who are persistently unconscious, is respected, and that no
one is deprived of nutrition and hydration with the intent of bringing on his or
her death. (N&H)
They add an observation about patients judged to be
permanently unconscious:
We do know that many of these
patients have a good prognosis for long-term survival when given medically
assisted nutrition and hydration, and a certain prognosis for death otherwise --
and we know that many in our society view such an early death as a positive good
for a patient in this condition. Therefore we are gravely concerned about
current attitudes and policy trends in our society that would too easily dismiss
patients without apparent mental faculties as non-persons or as undeserving of
human care and concern. (N&H)
The committee members are led by their reflections to the
following general conclusion concerning patients experiencing prolonged
unconsciousness:
... it is our considered judgment
that while legitimate Catholic moral debate continues, decisions about these
patients should be guided by a presumption in favor of medically assisted
nutrition and hydration. A decision to discontinue such measures should be made
in light of a careful assessment of the burdens and benefits of nutrition and
hydration for the individual patient and his or her family and community. Such
measures must not be withdrawn in order to cause death, but they may be
withdrawn if they offer no reasonable hope of sustaining life or pose excessive
risks or burdens. We also believe that social and health care policies should be
carefully framed so that these patients are not routinely classified as
"terminal" or as prime candidates for the discontinuance of even
minimal means of life support. (N&H)
Thus, the upshot of the “Resource Paper,” the considered judgment of
its authors, is that one can cut off food and water only when “they offer no
reasonable hope of sustaining life or pose excessive risks or burdens.” We
have already noted that Theresa is not terminally ill, that supplying her with
food and water will sustain her life. None
of the parties to the case claims that feeding Theresa will expose her to
“excessive risks.” (Indeed, it
is clear that the risks all lie on the other side:
withholding her food and water will cause her death.) Further, it is
clear that continuing Theresa’s food and water will impose no burden on her or
anyone else. Not on her, because on the hypothesis that she is unconscious she
is not experiencing any pain. Not on her family, because a substantial sum of
money has been set aside for her long-term care and because her mother and
father and brother and sister have registered in the strongest terms their
passionate desire for Theresa’s feeding to continue. Note that both documents
we have been examining state strict standards which would forbid cutting off
Theresa Schiavo’s food and water.
Thus, though one of the two documents from the United States Conference
of Catholic Bishops, calls disagreement over the feeding of the permanently
unconscious “legitimate,” both defend criteria for withholding food and
water that forbid cutting off Theresa Schiavo’s food and water.
The Resource Paper on “Nutrition and Hydration” considers an argument
in favor of cutting off the food and water, but rejects it as
“inconclusive.” This
characterization of the argument as excessively gentle. The argument, whose
adoption would have lethal consequences not only for the unconscious but also
for countless disabled persons who are conscious, is deeply flawed.
Though neither of the documents constitutes official church teaching,
both reach conclusions that protect Theresa Schiavo.
Father Murphy testifies that it would be “consistent” with Church
teachings to remove Theresa’s feeding tube in the present circumstances. If
the authors of the 1992 Resource Paper were right to hold their belief that
there is “legitimate debate” over our obligation to feed permanently
unconscious persons, then Father Murphy’s testimony would be correct, not in
the sense that the Church would, in that case, be teaching that it is
permissible to deny food and water to the unconscious, but rather in the weaker
sense that the Church, under the hypothesis in question, would not have
expressly forbidden such denials. But it important to note that, even though the
Resource Paper authors deem the question of feeding the unconscious not
explicitly resolved by Church teachings, they themselves offer strict standards
for withholding nourishment from the unconscious, standards which forbid the
denial of food to Theresa Schiavo. In fact, as one reviews the literature
concerning the feeding of the unconscious, one discovers again and again
conclusions like those advanced in the two documents from the United States
Conference of Catholic Bishops. A
few sources, like the authors of the Resource Paper, view the question as one
not explicitly settled by official Church teachings, but, almost invariably,
those same sources conclude that denial of food and water to the unconscious is
wrong.
It is interesting to observe that the protective findings of the two
documents from the United States Conference of Catholic Bishops are in agreement
with the conclusions of groups advising the Holy See. These groups also defend
the ethical judgment that permanently unconscious patients should be fed.
Thus, for example, in the
mid-eighties a study group of the Pontifical Academy of Sciences concluded:
"If the patient is in a permanent, irreversible coma, as far as can be
foreseen, treatment is not required, but all care should be lavished on him,
including feeding." ("The Artificial Prolongation of Life,"
Pontifical Academy of Sciences, Origins,
Volume 15 [
We have seen that, while there are no documents bearing the full teaching
authority of the Church that contain the literal phrases “persistent
vegetative state” or “prolonged unconsciousness,” the language of many
documents that do have the full authority of the Church carry the powerful
suggestion that persons who are unconscious deserve the same respect as any
other human being. We have already seen that the Sacred Congregation for the
Doctrine of the Faith teaches us that:
... nothing and no one can in any
way permit the killing of an innocent human being, whether a fetus or an embryo,
an infant or an adult, an old person, or one suffering from an incurable
disease, or a person who is dying.
We can ask ourselves which of the two following extensions
of this passage better accords with its purport:
... nothing and no one can in any
way permit the killing of an innocent human being, whether a fetus or an embryo,
an infant or an adult, an old person, or one suffering from an incurable
disease, or a person who is dying, or a person
judged permanently unconscious.
... nothing and no one can in any
way permit the killing of an innocent human being, whether a fetus or an embryo,
an infant or an adult, an old person, or one suffering from an incurable
disease, or a person who is dying, but, of
course, a person judged permanently unconscious is not protected by this
prohibition.
It is clear that the first extension of the original
passage accords better with its purport. We have also recalled Pope John II’s
powerful statement in Evangelium Vitae that
“the absolute inviolability of innocent human life is a moral truth, clearly
taught by Sacred Scriptures, constantly upheld in the Church's tradition and
consistently proposed by her Magisterium.”
Moreover, we have seen that bodies advising the Vatican have explicitly
discussed persistently unconscious patients and recommended that, while it is
permissible to withhold “medical treatment” from such a person, “all care
should be lavished on him, including feeding.”
Though these recommendations do not have the full authority of Church
teaching, their source within the Church requires us to accord them great
weight. Further, we have seen that, while individual clerics
offer a different view of our responsibility to unconscious patients, two
documents produced by the United States Conference of Catholic Bishops advance
standards of care for patients in prolonged unconsciousness which expressly
forbid cutting off food and water from a patient in Theresa Schiavo’s
circumstances.
In light of all these facts, it is, to say the least, highly misleading
to assert that it would be in accord with the teachings of the Catholic Church
to cut off Theresa Schiavo’s food and water.
The very most that could possibly be claimed is that the Church has not
expressly and explicitly forbidden cutting off the food and water of a patient
judged permanently unconscious. This
assertion would allow the possibility that such a denial of food and water is,
nonetheless, in violation of the Church’s moral instructions concerning our
obligations towards innocent human life. We
are convinced that this is the case.
We can summarize a few of the other principal points of our analysis with
a series of questions and answers. On
what ground could one possibly justify denying food and water to Theresa Schiavo?
On the ground that she cannot digest and metabolize the food?
If that were the case she would be on the verge of death.
But she is not terminally ill, and she is fully capable of digesting and
metabolizing the nourishment given her. On
the ground that the life sustained is a burden to her?
But those arguing for the denial of food are claiming that she is
permanently unconscious and we are adopting their claim as a working hypothesis.
On that hypothesis, Theresa is in a peaceful sleep and her life is no burden to
her. On the ground that continuing her feeding is a burden on her family?
But some funds remain from the substantial sum that was set aside for her
care and her parents and siblings have expressed in unmistakable and moving
terms their passionate desire that she be allowed to live. On the ground that
the expected outcome of the continued feeding would be disproportionate to the
effort involved in the feeding? But
the judgment that sustaining the life of someone as severely disabled as Theresa
is not worth the effort of feeding her is a special case of the dangerous and
immoral doctrine that some human lives are not worth living, a doctrine that had
its natural home and practice in Nazi Germany.
We have already expressed our judgment that it is immensely “improbable
that any rational agent (whatever his or her beliefs) would ask in advance for a
death caused by dehydration and starvation, a method veterinarians properly
refuse to employ when they are ‘putting down’ non-human animals.”
It is also clear to us that such a death could not possibly be in
anyone’s “best interests.” (“They that die by famine die by inches.”)
For two thousand years the Church has consistently, unambiguously, and
uncompromisingly insisted that the value of a human life is not conditioned by
standards of fitness or competence, that every human life, however injured or
compromised, possesses incalculable and inviolable worth and dignity.
The life of Theresa Schiavo possesses incalculable and inviolable worth
and dignity. An attempt to cut off
her food and water would be attempted murder.
In the words of the Catholic moral theologians cited in the 1992 Resource
Paper of the United States Conference of Catholic Bishops, “the inherent
dignity and worth of the human person obligates us to provide this patient with
care and support.”