Schiavo & double effect.

Paul Lauritzen is right to point out that those who argue that Terri Schiavo was killed by the removal of her feeding tube are proposing a profound change in Catholic teaching. Their argument calls into question the appropriate use of the time-honored Catholic principle of double effect, which seems applicable in Schiavo's case. This principle applies four criteria to determine whether an act that produces both a good and an evil effect is morally legitimate: (1) the act must be morally good in itself, or at least morally indifferent; (2) the evil effect may not be intended; (3) the evil effect may not be the means to the good effect; and (4) there must be a reasonable proportion between the good and evil that results. In the traditional application of the principle, each criterion must be considered on its own merits and not conflated with the others. Those who argue that withdrawing Schiavo's feeding tube was an act of murder ignore this important feature of the double-effect principle by mistakenly presuming that the act and the intention are inseparably linked. If this claim were valid, then it would seem to follow that any act of removing a life-sustaining treatment would be morally wrong--including the removal of ventilators. It would also seem to extend to cases of direct medical intervention ordinarily covered by the double-effect principle, such as the removal of the cancerous uterus and, necessarily, the unborn fetus, of a pregnant woman.

To argue that a feeding tube is not burdensome, as some did in the Schiavo case, is contrary to another legitimate argument in Catholic teaching for withdrawing treatment: the fact that it is no longer useful to the patient. Surely, given the results of Schiavo's autopsy, it must be evident that the underlying cause of her death was her extreme physically debilitated condition, and that there was nothing to be gained by continuing artificial nutrition except to prolong her life indefinitely. To argue otherwise seems to endorse an idea that the church's moral teaching has traditionally eschewed: vitalism, the preservation of life at any cost regardless of its condition.

GERALD J. WILLIAMS

Denville, N.J.

The writer teaches medical ethics at Kean University.