Schiavo redux.

Your editorial "Extraordinary Means" (April 8) captures the careful nuances of Catholic moral reflection on end-of-life care. It is unfortunate that this nuance has not been present in the general discussion of the tragic case of Terri Schiavo. As your editorial notes, many people have incorrectly cited Pope John Paul II's March 2004 statement at a conference in Rome as the last word on this issue. In that statement the pope said that providing artificial nutrition and hydration for PVS patients "in principle" is to be considered morally obligatory. A better translation of the Latin phrase might be "as a general rule." However translated, it is clear that the papal statement does not eliminate the need for ethical reflection and discernment on the specifics of each case. Such discernment could well conclude that, in a particular instance, artificial nutrition and hydration is not obligatory.

Similarly, as the editorial notes, papal statements must be studied for their authority in the context of previous and subsequent papal statements. On November 12, 2004, the Holy Father, addressing a Vatican conference on palliative care, reaffirmed that a "decision not to start or halt treatment will be deemed ethically correct if the treatment is ineffective or obviously disproportionate to the aims of sustaining life or recovering health." While the focus of this address was not the same as the March statement, it does present the larger ethical context within which the earlier address is to be studied.

(REV.) MICHAEL D. PLACE

Chicago, Ill.

The writer is former president of the Catholic Health Association.