Extraordinary means.

The passions of those on either side of the Terri Schiavo tragedy are not hard to understand. Still, whether Michael Schiavo was right to have his wife's feeding tube removed is not a judgment that people outside the family should second-guess too quickly or easily. The choices involved cannot simply be reduced to the slogan "err on the side of life" or to accusations of euthanasia or death by starvation. Contested by Terri Schiavo's parents, Michael Schiavo's decision was rightfully adjudicated in the courts, not in Congress, the Florida governor's office, or the White House.

Given the inherently complex nature, both medically and morally, of Terri Schiavo's persistent vegetative state (PVS), the demagoguery of some of her self-appointed advocates, especially certain elements of the prolife community and the Republican Party, has been appalling. Almost as bad has been the failure of the Catholic hierarchy to present the full depth and subtlety of Catholic teaching on this difficult question.

For Catholics familiar with the church's traditional and very nuanced teaching on end-of-life care, the attempt made by Terri Schiavo's parents to argue in court that the Catholic Church now forbids the removal of nutrition and hydration from PVS patients was misguided and perplexing. True, not a few have claimed that a recent statement by John Paul II clarified Catholic teaching about providing nutrition and hydration to PVS patients, and that it is now morally obligatory to do so. It is doubtful, however, that the pope's statement, made to a group of doctors and ethicists in March 2004, has settled the issue by unilaterally overturning generations of Catholic teaching (see "Allowing to Die," April 23, 2004). A statement on the Schiavo case by the Catholic Health Association of the United States (CHA), for example, reiterates the church's traditional understanding that extraordinary means need not be taken to prolong life futilely: "Within the Catholic tradition, decisions about forgoing life-sustaining treatment are made by assessing the potential burdens of the treatment in proportion to hoped-for benefits relative to the patient's condition and from the patient's perspective."

The notion of "benefit" has traditionally been understood as a moral category, not merely a biological one. In other words, it is not self-evident that sustaining a person in PVS by artificial means is of benefit to that person. The mere prolongation of bodily functions where there is no hope of recovery and where the patient has no ability to realize any human or personal goods, is not obligatory. Some values transcend the mere prolongation of physical existence.

How authoritative the pope's remarks were is much disputed. If it had been John Paul's intention to clarify such a deeply contested question, presumably he would have issued a more formal statement. Given the pope's own declining health, some wonder if he actually wrote the brief paper presented to the conference. The most authoritative Vatican statement on the question remains the 1980 Declaration on Euthanasia by the Congregation for the Doctrine of the Faith. In that document, the CDF confirmed the church's long-held understanding. "One is never obliged to use 'extraordinary' means," the CDF wrote. In making decisions about medical treatment, the risks, costs, likelihood of success, and the patient's "physical and moral resources" can be taken into consideration. Furthermore, advances in technology that needlessly prolong dying can be a threat to human dignity. "It is also permitted, with the patient's consent, to interrupt these means, where the results fall short of expectations."

The CDF declaration also recognizes that while the church exhorts us to lives of heroic virtue, it never imposes an obligation to heroism. By any moral measure, fifteen years in PVS is an "extraordinary"--even heroic--burden for someone to bear. Is keeping someone indefinitely in a vegetative state likely to reflect (to use a phrase of the Catechism [2278]) the "reasonable will and legitimate interests" of the afflicted person? Conscientious Catholics can answer that question differently. Like any sentient person, a PVS patient, through her legal surrogate, has the right to refuse further treatment. In such cases, it has long been the Catholic understanding that the original injury to the brain, not the removal of nutrition and hydration delivered by artificial means, is the cause of death. If that teaching is to change, much more needs to be said by the pope, the bishops, moral theologians, and the medical professionals and lay Catholics who must make these decisions every day. In the meantime, the wisdom of the church's traditional teaching needs to be made more widely known and defended.

March 29, 2005