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Artificial Nutrition and Hydration and the Permanently Unconscious Patient: The Catholic Debate.

ARTIFICIAL NUTRITION AND HYDRATION AND THE PERMANENTLY UNCONSCIOUS PATIENT: THE CATHOLIC DEBATE. Edited by Ronald P. Hamel and James J. Walters. Washington: Georgetown University, 2007. Pp. ix + 294. $29.95.

The positioning of "The Catholic Debate" in the subtitle of this volume is apt. With rare exception no one outside the Catholic community has entered the debate occasioned by the August 1, 2007, response of the Congregation for the Doctrine of Faith (CDF) to a query from the American Catholic bishops. The bishops sought guidance during the Terri Schiavo controversy on whether or not the provision of artificial nutrition and hydration (ANH) is morally obligatory for a patient in a permanent vegetative state (PVS).

Despite the political fiasco surrounding the Schiavo case, the medical and legal issues concerning the provision of ANH have been settled in this country since the 1990 ruling by the Supreme Court in Cruzan. There the court ruled that ANH is a medical treatment to be evaluated as any other medical intervention on the basis of the proportionate benefit and burden to the patient. That perspective coincided with the centuries-old teaching in Catholic moral theology that no one was obliged to undergo "extraordinary" or "disproportionately burdensome" medical interventions.

A 2004 allocution of Pope John Paul II on "Care for Patients in a Permanent Vegetative State" and the subsequent response and commentary by the CDF seem to present a different perspective. In John Paul II's words: "The administration of water and food, even when provided by artificial means, always represents a natural means of preserving life, not a medical act. Its use, furthermore, should be considered in principle ordinary and proportionate and, as such, morally obligatory" (205).

The 21 essays in Hamel and Walters's anthology provide the background and wide range of theological perspectives needed to assess this seemingly 180-degree turn from 500 years of consistent Catholic moral analysis on care of the sick patient.

The first paper is an informative essay by the American Academy of Neurology (AAN) on "Certain Aspects of the Care and Management of the Persistent Vegetative State Patients." As in ethics, good public policy necessarily begins with good facts. The AAN published this paper in Neurology in 1989 to inform courts and the lay community on the medical aspects of the then little understood diagnosis of PVS. Such patients, the Academy notes, have no capacity to feel, experience joy or pain, or have any conscious activity.

Essays by Myles Sheehan, S.J., professor of medicine at Stritch School of Medicine, and Daniel Sulmasy, O.F.M., a professor of medicine and ethics at New York's St. Vincent Hospital, explore the implications of that medical reality and of the papal position on the use of feeding tubes for patients in PVS. As Sheehan puts it, "Both the decision to use a feeding tube and the care of a patient with such a feeding tube requires sophisticated medical knowledge, clinical skill, and ongoing medical attention" (16). Sheehan concludes his medical description on the use of feeding tubes with the forceful observation that "neither the bishops nor the Holy Father have the competence to make medical decisions" (22). Sulmasy reinforces that criticism when he writes, "The way that claims about the financial costs of treatments have been bandied about in recent discussions appears to draw upon an insufficient understanding of the actual clinical and economic reality" (191). In his estimation the cost of nursing home care for a patient would exceed $868,000 per year, a reality that is not acknowledged in the CDF's commentary that the care of such patients "does not involve excessive expense."

The historical roots of Catholic tradition on the duty owed to the sick person--dating from the 16th-century writings of Francisco de Vitoria and Dominic Soto, O.P.--are examined in great detail in three essays. The development of that tradition in the 20th century is seen in statements such as Pope Pius XII's allocution on "The Prolonging of Life," the 1980 "Vatican Declaration on Euthanasia," and the U.S. Conference of Catholic Bishops' 2007 "Ethical and Religious Directives" for Catholic hospitals.

The anthology provides a broad spectrum of theological interpretations on ANH that range from Germain Grisez's insistence that "in our affluent society and others like it, food ordinarily should be provided even for comatose persons" (175) to Kevin O'Rourke's conclusion that "at best [many of the] statements [in John Paul II's allocution] seem out of touch with reality" (246). H. and W. have done a significant service by providing the reader with the medical, legal, theological, and magisterial materials necessary to formulate a position on the significance of the prudential teaching offered in John Paul II's 2004 allocution and the CDF response to the American bishops on the obligation to use artificial nutrition and hydration to prolong life.


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Author:Paris, John
Publication:Theological Studies
Article Type:Book review
Date:Dec 1, 2008
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