Ethical and Religious Directives - Part Five
A recent case involving end of life issues and receiving nation-wide coverage, gives us a helpful scenario for highlighting Part Five of The Ethical and Religious Directives for Catholic Healthcare Services (ERDs). The case and a lucid assessment of the ethical issues involved were recently presented by John J. Paris, S.J., in the October 31 issue of America.
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In brief, you may remember reading about Hugh Finn, a 44-year-old news anchor in Louisville, Ky., who ruptured his aorta in a 1995 traffic accident. The resulting damage to his brain left him irreversibly comatose. And though he was incapable of any conscious activity, a feeding tube inserted through his abdomen supplied life-sustaining nutrition and fluids.
Because he was familiar with end of life issues, Finn had drafted but not yet signed a written statement opposing such life-prolonging measures for himself. After three and a half years, his wife requested that physicians remove the feeding tube and allow her husband to die. Several members of Finn’s side of the family, however, opposed the request and brought suit to block the removal. And they had support:
• The governor held a televised news conference in which he said he was intervening on the side of Finn’s relatives because he had a duty to protect the interests of the state’s most vulnerable citizens. He contended that removing the feeding tube would constitute euthanasia.
• A state representative claimed that disconnecting the feeding tube would not only be illegal but, "would be against the teachings of the Catholic faith...He’s not on life-support. He’s not on a respirator. He’s not brain dead. To me it is active euthanasia."
• Finally, the secretary of education for a nearby diocese contended, "Mr. Finn has not yet reached the point where death is imminent. To withdraw (food and water) now would be homicide, for it is the adoption, by choice, of a proposal to kill him by starvation and dehydration. Such killing can never be morally right and ought never be permitted."
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Given this situation, we might pose two questions:
1. What helpful counsel does Part Five of the ERDs offer the decision makers?
Response: The Directives make it clear that…
• There is a difference between (a) allowing someone to die and (b) an action or omission which by intention causes death in order that all suffering may be eliminated, i.e., euthanasia.
• Euthanasia is abhorrent and never an option.
• Hydration and nutrition are not morally obligatory when they bring no comfort to a person who is imminently dying or when they cannot be assimilated by a person’s body.
• The free and informed judgment of a competent adult patient concerning the use or withdrawal of life-sustaining procedures should always be respected and normally complied with, unless it is contrary to Catholic moral teaching.
• None of us must continue life-preserving measures, including medically assisted nutrition and hydration, that we judge disproportionately burdensome compared to the benefits they provide us.
2. What additional counsel can respected bio-ethicists provide?
Response: Respected bioethicists such as Paris and others point out that…
• The issue of providing artificial nutrition and hydration (ANH) to patients in a persistent vegetative state (PVS) is still disputed by some theologians and unresolved by Church teaching. Many theologians believe there is no moral obligation to provide ANH under circumstances of PVS. Others believe that forgoing ANH in such circumstances is tantamount to euthanasia.
• No remedy (e.g. surgery, chemotherapy, nutrition and hydration, etc.) is obligatory unless it offers a reasonable hope of checking or curing a disease.
• Once a patient is diagnosed as permanently unconscious or terminal, decision-makers might conclude, without contradicting the ERDs, that there is no need to use oxygen and intravenous feeding.
• It is incorrect to describe someone in a persistent vegetative state as being unconscious but not dying. Rather, PVS patients are human beings who are stricken with a lethal pathology which, without artificial nutrition and hydration, will lead to death. To discontinue artificial nutrition and fluids for such individuals is not abandoning them but accepting the fact the person has come to the end of his or her pilgrimage and should not be impeded from taking the final step.
• If the purpose of life cannot be attained, then under those circumstances life-prolonging treatment no longer provides a reasonable hope of benefit; thus, the treatment may be considered disproportionate means, and there is no moral obligation to provide disproportionate means.
• Finally, to quote Paris, "if there is no benefit—physical or spiritual—to be gained from delaying death, traditional Catholic moral theology on the use of artificial means to prolong life would support the Virginia Supreme Court’s ruling in the Finn case: Remove the medically supplied measure to sustain bodily existence and allow the lethal pathology incurred in the tragic automobile accident to progress to its natural end."
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In conclusion, end of life situations can often be cross-filled for everyone involved. Fortunately, in addition to our faith, we also have, in the ERDs, principles to help us make decisions that are compassionate and respectful of human dignity.