NOTE:
I wrote this piece several years ago and sent a letter to Pope Benedict XVI concerning the role of secular bioethics in furthering the culture of death and the new theory of "acquired personhood" which has made it much easier to take the lives of human beings who have been deemed non-persons. In that letter I described the corrosive effect that the embracing of Darwinian naturalism and the subject/object dualism of Descartes has had on the depersonalizing of the sick, disabled and dying. I received no reply.
Given the current attempt to pass national health insurance in the United States, this piece is provided in order to focus attention on the need to repudiate the ever growing culture of death which has begun to significantly effect medical care and decision making. The perennial philosophy of St. Thomas Aquinas as always is best suited for that purpose.
--Dr. J. P. Hubert
The Brain is not the Soul:
The Tragic Error of the Terry Schiavo case
John P. Hubert Jr. MD FACS
Biomedical and Health Care Policy Ethicist
As expected, the elite media in the wake of the Terry Schiavo autopsy have suggested that since Terry had “irreversible” brain damage according to the forensic pathologist, it was morally acceptable to kill her.[1] This betrays an alarming misunderstanding of human anthropology which is based in Darwinian naturalism.[2] It also means that the “elites” equate the human brain with the human “mind” and that when the brain is “irreversibly” damaged; the “person” no longer exists since the “mind” no longer functions.[3] This is not a matter of saying that when there is total brain death (total death of the entire brain) the person as an integrated body/soul composite entity has ceased to exist.[4] The assertion being made here is that since Terry Schiavo was judged to be “mindless” due to a profound purportedly irreversible brain injury, she was “non-human.” In other words, she had a “life” (vegetative existence according to culture of death bioethicists) no longer worthy of living.[5] These notions are demonstrably false when subjected to detailed philosophical analysis.[6] In fact, if it were true, it would mean that no one could ever be secure in their status as a human person since at any moment their personhood could be lost. Elite bioethicists or the courts might decide that because of trauma, disease or the effects of aging, a given human being could be subsequently labeled a non-person and thus not deserving of the usual care, compassion and protection of their human rights (the most fundamental of which is the right to existence).[7] Strange as it may seem, this is precisely what is presently transpiring with regard to the prematurely born, the infirm, retarded and other disabled persons in the West, particularly in the Netherlands, Belgium, the U.K. and progressively the United States.
There now exits the widespread assumption that the soul (referred to as “mind” in contemporary parlance an outgrowth of Descartes and Kant) is synonymous with or at least for practical purposes, analogous to the brain. This concept flows from Cartesian false Dualism, the idealism of Emmanuel Kant; (specifically his notion of complete personal autonomy), and radical Darwinism in which it is assumed that reality is completely confined to the material realm that is, there is no immaterial reality.[8] Secular elite bioethicists have utilized these false post-Enlightenment philosophical concepts as a foundation for their bioethic which has now mutated into a "culture of death" characterized by rabid notions of personal autonomy (read unbridled personal selfishness) without regard for and often in direct opposition to the common good. This new ethic is also associated with a virtual complete moral relativism, something Pope Benedict XVI has repeatedly stressed in public commentary.[9] American Catholics continue to be very confused by the constant public promulgation of the "Culture of Death," even by highly visible Catholic politicians and other Catholic public personages particularly in light of the extremely poor level of catechesis which has been ongoing in the West for over 40 years.
These tendencies and developments undergird the secular atheist elite bioethics rubric which has essentially over-taken the dialogue regarding "life issues" particularly in the developed West. It allows the "culture of death" community to discount the lives of all but the most perfect human beings (as secular elite bioethicists define it) among us. This new bioethic embraces the concept of "acquired" personhood in which it is necessary to demonstrate through various abilities and characteristics (most frequently higher cognitive function) that one is not only a human being but a human person as well. It also means that the “elites” artificially separate “human being” from “human personhood” in direct opposition to the substance view of personhood that the Catholic Church has accepted and promulgated through its support of the Aristotelian/Thomistic synthesis.[10] The very notion of acquired personhood is philosophically untenable and is in direct contradiction to Divine Revelation as consistently taught in Sacred Scripture and Sacred Tradition.[11]
It appears that the time has come to approach the great debates in bioethics and the rapidly declining public morality from the perspective of overall worldview analysis in which the diametrically opposite notions of epistemology (theory of truth), metaphysics (theory of reality) and morality (theory of right and wrong) [between the new post-modern atheistic secularism {neo-paganism} The traditional Comprehensive Catholic World View is the only adequate antidote to the increasingly widespread radical secularization which is presently ongoing particularly in the West since it alone possesses the necessary metaphysical resources.
With respect to the growing interest here in Euthanasia and Physician Assisted Suicide (PAS), the author recently participated in the protests against the court ordered death of Terry Schiavo by demonstrating peacefully outside her hospice. This included holding signs, praying, fasting singing hymns and giving several Television interviews in which he attempted to present the Catholic bioethical position against euthanasia to the mass media. None of those interviews made it to air. Any actual explanation of Catholic teaching regarding the prohibition against Euthanasia was simply either marginalized or dismissed as “religious” that is "subjective" and regarded as simply fundamentalist "opinion" (value) rather than philosophically and theologically demonstrable fact.[12]
This “Value/Fact” dichotomy has become a huge problem in the West along with the specious notion of separation of Church and State understood as the disjunction of morality from the civil law, the institutions of government and society at large. Most distressingly, the pro-life demonstrators on behalf of saving Terry had absolutely no help (in our attempt to stop the court ordered killing of Terry Schiavo)[13] from the bishop of St. Petersburg Florida who apparently instructed his priests not to appear at Terry Schiavo's hospice or to speak in public about what was transpiring. Worse yet, in attending mass on several occasions during his stay during Holy Week, not once did the author hear the issue addressed in any homily; something which under the circumstances was obviously missing. This was a disgrace. The protesters were forced to rely on outside help from several Priests (including Fr. Frank Pavone of "Priests for Life") many of whom traveled great distances in order to provide the last rites and the sacrament of Holy Communion to Ms. Schiavo shortly before her death.
It is incumbent upon orthodox Catholics and all people of good will to reject the Cartesian false dualism and metaphysical naturalism of the cultural “elites” including contemporary secular bioethicists in which human personhood is allowed to be “conferred” upon only certain members of the human species by the Gnostics of our time (secular elite bioethicists and the courts). Their empty sophistry must be totally rejected. All human beings are “persons” by definition from the moment of conception until natural death! This must be proclaimed far and wide! It is also something that can be determined by the light of human reason after subjecting the relevant data to meticulous philosophical analysis. It is not necessary to invoke Divine Revelation in the form of Sacred Scripture, Sacred Tradition or constant Magisterial teaching in order to establish the truth of this proposition, although all “3” are perfectly consistent with that conclusion as derived from the study of the philosophy of the human person and the philosophy of nature absent a-priori commitment to a materialistic (metaphysical naturalism) bias. As thoughtful Catholics, we can make the case either philosophically or theologically with equal effectiveness, a fact which demonstrates the need for an aggressively promulgated Comprehensive Catholic World View. We know that secularists are simply wrong when they allege that those who demonstrated on behalf of Terry Schiavo’s right to life were engaging in fundamentalist “opinions” which cannot be established in fact. Our task is to obtain a hearing for the truth while we oppose the lie.
NOTES:
[1] While her brain was significantly atrophied in a generalized way which is consistent with a profound hypoxic encephalopathic injury (due to prolonged lack of oxygen), it is not the case that she was “brain dead and deserving of burial! Her heart and lungs were adequate to sustain her life indefinitely. In fact had she not been dehydrated to death, they might have served in another context as organs for human transplantation, something which was impossible due to the court ordered desiccation dehydration.
[2] Radical Darwinists assert that reality is completely confined to the material realm, that there is no spiritual (immaterial) realm and that human nature is only apparent, not real, that is, constantly changing or “evolving” only giving the appearance of stable “forms.” This means that there is no God by definition and no stable “human nature” according to radical Darwinists.
[3] Classically, in the philosophical sense, the mind was called “soul” referring to a spiritual or immaterial reality which utilized the brain as an instrument but was not synonymous with it. See: William A. Wallace, The Modeling of Nature: Philosophy of Science and Philosophy of Nature in Synthesis. Washington D.C.: Catholic University of America Press, 1996. Descartes changed everything with his Cogito-ergo-sum (I think therefore I am). He placed thinking before being rather than the classical notion, “being comes before thinking.”
[4] A separate assertion which can be philosophically debated in a separate context. Terry Schiavo did not have “brain death” she had a severe brain injury of uncertain etiology (explanation) a situation which still exists despite the performing of an autopsy. For an interesting discussion regarding the issue of “Brain Death” and its use as a criterion for death of the person see: William E. May, Catholic Bioethics and the Gift of Human Life. Huntington Indiana: Our Sunday Visitor Publishing Division Our Sunday Visitor, Inc., 2000, chapter 8, particularly pp. 291-310.
[5] Judge Greer found on the basis of highly questionable testimony at the trial court level that Terry would not have wanted to remain alive under those circumstances. Thus the entire issue of killing her became a matter of supposedly “honoring her wishes” an example of Kantian autonomy “run amuck” where individual preference or desire is seen as being more important than the “common good.” See Wesley J. Smith. Forced Exit: The Slippery Slope from Assisted Suicide to Legalized Murder. Dallas: Spence Publishing Co. 2003 for a discussion of elite secular Bioethicists’ notion of life unworthy of being lived.
[6] See my article: “Justice and Freedom for the Human Embryo in light of The Philosophy of the Human Person, the Body/Soul Issue and Ethics”, Social Justice Review, 95: November-December, 2004. See also my essay: “The Moral Status of the Human Embryo ‘Intermediate’ or ‘Special Status’ for the human embryo is invalid”, available upon request.
[7] How many “non-person human beings” can conceivably be defined under this rubric is open to serious question and is constantly being re-defined by secular elite “culture of death” bioethicists, the U.S. judiciary and foreign courts.
[8] Understand that what is at stake here is a debate about the very nature of reality.
[9] e.g. his homily at the start of the recent conclave and in a prior speech at the meeting of the Congregation for the Doctrine of the Faith with the presidents of the Doctrinal Commissions of the Bishops' Conferences of Latin America, held in Guadalajara, Mexico, in May 1996.
[10] In which human beings during life are complex composite matter/form or body/soul entities where the soul is immaterial and serves as the principle of substantial unity. As a spiritual entity the soul thus considered is indivisible and not confined to any physical location in the body including the brain.
[11] See my article: “Justice and Freedom for the Human Embryo in light of The Philosophy of the Human Person, the Body/Soul Issue and Ethics”, Social Justice Review, 95: November-December, 2004. See also my essay: “The Moral Status of the Human Embryo ‘Intermediate’ or ‘Special Status’ for the human embryo is invalid” available upon request.
[12] Based as it is on a correct understanding of human anthropology including the substance view of personhood which the Church has taught for centuries based on the Aristotelian/Thomistic synthesis.
[13] Note that Judge Greer was not satisfied with simply removing Terry’s feeding tube. It was necessary that she be starved and dehydrated to death by ordering that no one was allowed to attempt feeding her by mouth. He had police guards stationed about her room to insure that not one drop of water was administered. The autopsy as expected, documented that she was dehydrated to death.
Showing posts with label Physician Assisted Suicide. Show all posts
Showing posts with label Physician Assisted Suicide. Show all posts
Saturday, August 8, 2009
Saturday, September 15, 2007
Vatican Commentary on Artificial Hydration and Nutrition
The Vatican has once again clarified that nutrition and hydration is obigatory for patients who are medically stable and in whom a diagnosis of "persistent vegetative state" has been made. The following material from Zenit contains a very useful review of the major statements which the Holy See has made on this vital topic beginning in 1957 and extending up to the present. These pronouncements are completely compatible with the Aristotelian/Thomistic view of the human person which from a metaphysical perspective is the composite unity of matter and form i.e. body and soul...
--Dr. J. P. Hubert
The Sick "Have the Right to Basic Health Care"
VATICAN CITY, SEPT. 14, 2007 (Zenit.org).- Here is a commentary issued today by the Congregation for the Doctrine of the Faith on "Responses to Certain Questions of the United States Conference of Catholic Bishops Concerning Artificial Nutrition and Hydration."
* * *
The Congregation for the Doctrine of the Faith has formulated responses to questions presented by His Excellency the Most Reverend William S. Skylstad, president of the United States Conference of Catholic Bishops, in a letter of July 11, 2005, regarding the nutrition and hydration of patients in the condition commonly called a "vegetative state."
The object of the questions was whether the nutrition and hydration of such patients, especially if provided by artificial means, would constitute an excessively heavy burden for the patients, for their relatives, or for the health care system, to the point where it could be considered, also in the light of the moral teaching of the Church, a means that is extraordinary or disproportionate and therefore not morally obligatory.
The address of Pope Pius XII to a congress on anesthesiology, given on Nov. 24, 1957, is often invoked in favor of the possibility of abandoning the nutrition and hydration of such patients. In this address, the Pope restated two general ethical principles. On the one hand, natural reason and Christian morality teach that, in the case of a grave illness, the patient and those caring for him or her have the right and the duty to provide the care necessary to preserve health and life.
On the other hand, this duty in general includes only the use of those means which, considering all the circumstances, are ordinary, that is to say, which do not impose an extraordinary burden on the patient or on others. A more severe obligation would be too burdensome for the majority of persons and would make it too difficult to attain more important goods. Life, health and all temporal activities are subordinate to spiritual ends. Naturally, one is not forbidden to do more than is strictly obligatory to preserve life and health, on condition that one does not neglect more important duties.
One should note, first of all, that the answers given by Pius XII referred to the use and interruption of techniques of resuscitation. However, the case in question has nothing to do with such techniques. Patients in a "vegetative state" breathe spontaneously, digest food naturally, carry on other metabolic functions, and are in a stable situation. But they are not able to feed themselves. If they are not provided artificially with food and liquids, they will die, and the cause of their death will be neither an illness nor the "vegetative state" itself, but solely starvation and dehydration.
At the same time, the artificial administration of water and food generally does not impose a heavy burden either on the patient or on his or her relatives. It does not involve excessive expense; it is within the capacity of an average health care system, does not of itself require hospitalization, and is proportionate to accomplishing its purpose, which is to keep the patient from dying of starvation and dehydration. It is not, nor is it meant to be, a treatment that cures the patient, but is rather ordinary care aimed at the preservation of life.
What may become a notable burden is when the "vegetative state" of a family member is prolonged over time. It is a burden like that of caring for a quadriplegic, someone with serious mental illness, with advanced Alzheimer's disease, and so on. Such persons need continuous assistance for months or even for years. But the principle formulated by Pius XII cannot, for obvious reasons, be interpreted as meaning that in such cases those patients, whose ordinary care imposes a real burden on their families, may licitly be left to take care of themselves and thus abandoned to die. This is not the sense in which Pius XII spoke of extraordinary means.
Everything leads to the conclusion that the first part of the principle enunciated by Pius XII should be applied to patients in a "vegetative state": in the case of a serious illness, there is the right and the duty to provide the care necessary for preserving health and life. The development of the teaching of the Church's magisterium, which has closely followed the progress of medicine and the questions which this has raised, fully confirms this conclusion.
The Declaration on Euthanasia, published by the Congregation for the Doctrine of the Faith on May 5, 1980, explained the distinction between proportionate and disproportionate means, and between therapeutic treatments and the normal care due to the sick person: "When inevitable death is imminent in spite of the means used, it is permitted in conscience to take the decision to refuse forms of treatment that would only secure a precarious and burdensome prolongation of life, so long as the normal care due to the sick person in similar cases is not interrupted" (Part IV).
Still less can one interrupt the ordinary means of care for patients who are not facing an imminent death, as is generally the case of those in a "vegetative state"; for these people, it would be precisely the interruption of the ordinary means of care which would be the cause of their death.
On June 27, 1981, the Pontifical Council Cor Unum published a document entitled "Some Ethical Questions Relating to the Gravely Ill and the Dying," in which, among other things, it is stated, "There remains the strict obligation to administer at all costs those means which are called 'minimal': that is, those that normally and in usual conditions are aimed at maintaining life (nourishment, blood transfusions, injections, etc.). The discontinuation of these minimal measures would mean in effect willing the end of the patient's life" (No. 2.4.4.).
In an address to participants in an international course on forms of human preleukemia on Nov. 15, 1985, Pope John Paul II, recalling the Declaration on Euthanasia, stated clearly that, in virtue of the principle of proportionate care, one may not relinquish "the commitment to valid treatment for sustaining life nor assistance with the normal means of preserving life," which certainly includes the administration of food and liquids. The Pope also noted that those omissions are not licit which are aimed "at shortening life in order to spare the patient or his family from suffering."
In 1995 the Pontifical Council for Pastoral Assistance to Health Care Workers published the Charter for Health Care Workers, paragraph 120 of which explicitly affirms: "The administration of food and liquids, even artificially, is part of the normal treatment always due to the patient when this is not burdensome for him or her; their undue interruption can have the meaning of real and true euthanasia."
The Address of John Paul II to a group of bishops from the United States of America on a visit "ad limina," on Oct. 2, 1998, is quite explicit: Nutrition and hydration are to be considered as normal care and ordinary means for the preservation of life. It is not acceptable to interrupt them or to withhold them, if from that decision the death of the patient will follow. This would be euthanasia by omission (cf. No. 4).
In his address of March 20, 2004, to the participants of an international congress on "Life-sustaining Treatments and the Vegetative State: Scientific Progress and Ethical Dilemmas," John Paul II confirmed in very clear terms what had been said in the documents cited above, clarifying also their correct interpretation. The Pope stressed the following points:
1) "The term permanent vegetative state has been coined to indicate the condition of those patients whose 'vegetative state' continues for over a year. Actually, there is no different diagnosis that corresponds to such a definition, but only a conventional prognostic judgment, relative to the fact that the recovery of patients, statistically speaking, is ever more difficult as the condition of vegetative state is prolonged in time" (No. 2).[1]
2) In response to those who doubt the "human quality" of patients in a "permanent vegetative state," it is necessary to reaffirm that "the intrinsic value and personal dignity of every human being do not change, no matter what the concrete circumstances of his or her life. A man, even if seriously ill or disabled in the exercise of his highest functions, is and always will be a man, and he will never become a 'vegetable' or an 'animal'" (No. 3).
3) "The sick person in a vegetative state, awaiting recovery or a natural end, still has the right to basic health care (nutrition, hydration, cleanliness, warmth, etc.), and to the prevention of complications related to his confinement to bed. He also has the right to appropriate rehabilitative care and to be monitored for clinical signs of possible recovery. I should like particularly to underline how 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, to the extent to which, and for as long as, it is shown to accomplish its proper finality, which in the present case consists in providing nourishment to the patient and alleviation of his suffering" (No. 4).
4) The preceding documents were taken up and interpreted in this way: "The obligation to provide the 'normal care due to the sick in such cases' (Congregation for the Doctrine of the Faith, Declaration on Euthanasia, p. IV) includes, in fact, the use of nutrition and hydration (cf. Pontifical Council Cor Unum, "Some Ethical Questions Relating to the Gravely Ill and the Dying," No. 2, 4, 4; Pontifical Council for Pastoral Assistance to Health Care Workers, Charter for Health Care Workers, No. 120).
The evaluation of probabilities, founded on waning hopes for recovery when the vegetative state is prolonged beyond a year, cannot ethically justify the cessation or interruption of minimal care for the patient, including nutrition and hydration. Death by starvation or dehydration is, in fact, the only possible outcome as a result of their withdrawal. In this sense it ends up becoming, if done knowingly and willingly, true and proper euthanasia by omission" (No. 4).
Therefore, the responses now given by the Congregation for the Doctrine of the Faith continue the direction of the documents of the Holy See cited above, and in particular the Address of John Paul II of March 20, 2004. The basic points are two.
It is stated, first of all, that the provision of water and food, even by artificial means, is in principle an ordinary and proportionate means of preserving life for patients in a "vegetative state": "It is therefore obligatory, to the extent to which, and for as long as, it is shown to accomplish its proper finality, which is the hydration and nourishment of the patient."
It is made clear, secondly, that this ordinary means of sustaining life is to be provided also to those in a "permanent vegetative state," since these are persons with their fundamental human dignity.
When stating that the administration of food and water is morally obligatory in principle, the Congregation for the Doctrine of the Faith does not exclude the possibility that, in very remote places or in situations of extreme poverty, the artificial provision of food and water may be physically impossible, and then "ad impossibilia nemo tenetur."
However, the obligation to offer the minimal treatments that are available remains in place, as well as that of obtaining, if possible, the means necessary for an adequate support of life. Nor is the possibility excluded that, due to emerging complications, a patient may be unable to assimilate food and liquids, so that their provision becomes altogether useless. Finally, the possibility is not absolutely excluded that, in some rare cases, artificial nourishment and hydration may be excessively burdensome for the patient or may cause significant physical discomfort, for example resulting from complications in the use of the means employed.
These exceptional cases, however, take nothing away from the general ethical criterion, according to which the provision of water and food, even by artificial means, always represents a natural means for preserving life, and is not a therapeutic treatment. Its use should therefore be considered ordinary and proportionate, even when the "vegetative state" is prolonged.
[1] Terminology concerning the different phases and forms of the "vegetative state" continues to be discussed, but this is not important for the moral judgment involved. [Original text: English]
--Dr. J. P. Hubert
The Sick "Have the Right to Basic Health Care"
VATICAN CITY, SEPT. 14, 2007 (Zenit.org).- Here is a commentary issued today by the Congregation for the Doctrine of the Faith on "Responses to Certain Questions of the United States Conference of Catholic Bishops Concerning Artificial Nutrition and Hydration."
* * *
The Congregation for the Doctrine of the Faith has formulated responses to questions presented by His Excellency the Most Reverend William S. Skylstad, president of the United States Conference of Catholic Bishops, in a letter of July 11, 2005, regarding the nutrition and hydration of patients in the condition commonly called a "vegetative state."
The object of the questions was whether the nutrition and hydration of such patients, especially if provided by artificial means, would constitute an excessively heavy burden for the patients, for their relatives, or for the health care system, to the point where it could be considered, also in the light of the moral teaching of the Church, a means that is extraordinary or disproportionate and therefore not morally obligatory.
The address of Pope Pius XII to a congress on anesthesiology, given on Nov. 24, 1957, is often invoked in favor of the possibility of abandoning the nutrition and hydration of such patients. In this address, the Pope restated two general ethical principles. On the one hand, natural reason and Christian morality teach that, in the case of a grave illness, the patient and those caring for him or her have the right and the duty to provide the care necessary to preserve health and life.
On the other hand, this duty in general includes only the use of those means which, considering all the circumstances, are ordinary, that is to say, which do not impose an extraordinary burden on the patient or on others. A more severe obligation would be too burdensome for the majority of persons and would make it too difficult to attain more important goods. Life, health and all temporal activities are subordinate to spiritual ends. Naturally, one is not forbidden to do more than is strictly obligatory to preserve life and health, on condition that one does not neglect more important duties.
One should note, first of all, that the answers given by Pius XII referred to the use and interruption of techniques of resuscitation. However, the case in question has nothing to do with such techniques. Patients in a "vegetative state" breathe spontaneously, digest food naturally, carry on other metabolic functions, and are in a stable situation. But they are not able to feed themselves. If they are not provided artificially with food and liquids, they will die, and the cause of their death will be neither an illness nor the "vegetative state" itself, but solely starvation and dehydration.
At the same time, the artificial administration of water and food generally does not impose a heavy burden either on the patient or on his or her relatives. It does not involve excessive expense; it is within the capacity of an average health care system, does not of itself require hospitalization, and is proportionate to accomplishing its purpose, which is to keep the patient from dying of starvation and dehydration. It is not, nor is it meant to be, a treatment that cures the patient, but is rather ordinary care aimed at the preservation of life.
What may become a notable burden is when the "vegetative state" of a family member is prolonged over time. It is a burden like that of caring for a quadriplegic, someone with serious mental illness, with advanced Alzheimer's disease, and so on. Such persons need continuous assistance for months or even for years. But the principle formulated by Pius XII cannot, for obvious reasons, be interpreted as meaning that in such cases those patients, whose ordinary care imposes a real burden on their families, may licitly be left to take care of themselves and thus abandoned to die. This is not the sense in which Pius XII spoke of extraordinary means.
Everything leads to the conclusion that the first part of the principle enunciated by Pius XII should be applied to patients in a "vegetative state": in the case of a serious illness, there is the right and the duty to provide the care necessary for preserving health and life. The development of the teaching of the Church's magisterium, which has closely followed the progress of medicine and the questions which this has raised, fully confirms this conclusion.
The Declaration on Euthanasia, published by the Congregation for the Doctrine of the Faith on May 5, 1980, explained the distinction between proportionate and disproportionate means, and between therapeutic treatments and the normal care due to the sick person: "When inevitable death is imminent in spite of the means used, it is permitted in conscience to take the decision to refuse forms of treatment that would only secure a precarious and burdensome prolongation of life, so long as the normal care due to the sick person in similar cases is not interrupted" (Part IV).
Still less can one interrupt the ordinary means of care for patients who are not facing an imminent death, as is generally the case of those in a "vegetative state"; for these people, it would be precisely the interruption of the ordinary means of care which would be the cause of their death.
On June 27, 1981, the Pontifical Council Cor Unum published a document entitled "Some Ethical Questions Relating to the Gravely Ill and the Dying," in which, among other things, it is stated, "There remains the strict obligation to administer at all costs those means which are called 'minimal': that is, those that normally and in usual conditions are aimed at maintaining life (nourishment, blood transfusions, injections, etc.). The discontinuation of these minimal measures would mean in effect willing the end of the patient's life" (No. 2.4.4.).
In an address to participants in an international course on forms of human preleukemia on Nov. 15, 1985, Pope John Paul II, recalling the Declaration on Euthanasia, stated clearly that, in virtue of the principle of proportionate care, one may not relinquish "the commitment to valid treatment for sustaining life nor assistance with the normal means of preserving life," which certainly includes the administration of food and liquids. The Pope also noted that those omissions are not licit which are aimed "at shortening life in order to spare the patient or his family from suffering."
In 1995 the Pontifical Council for Pastoral Assistance to Health Care Workers published the Charter for Health Care Workers, paragraph 120 of which explicitly affirms: "The administration of food and liquids, even artificially, is part of the normal treatment always due to the patient when this is not burdensome for him or her; their undue interruption can have the meaning of real and true euthanasia."
The Address of John Paul II to a group of bishops from the United States of America on a visit "ad limina," on Oct. 2, 1998, is quite explicit: Nutrition and hydration are to be considered as normal care and ordinary means for the preservation of life. It is not acceptable to interrupt them or to withhold them, if from that decision the death of the patient will follow. This would be euthanasia by omission (cf. No. 4).
In his address of March 20, 2004, to the participants of an international congress on "Life-sustaining Treatments and the Vegetative State: Scientific Progress and Ethical Dilemmas," John Paul II confirmed in very clear terms what had been said in the documents cited above, clarifying also their correct interpretation. The Pope stressed the following points:
1) "The term permanent vegetative state has been coined to indicate the condition of those patients whose 'vegetative state' continues for over a year. Actually, there is no different diagnosis that corresponds to such a definition, but only a conventional prognostic judgment, relative to the fact that the recovery of patients, statistically speaking, is ever more difficult as the condition of vegetative state is prolonged in time" (No. 2).[1]
2) In response to those who doubt the "human quality" of patients in a "permanent vegetative state," it is necessary to reaffirm that "the intrinsic value and personal dignity of every human being do not change, no matter what the concrete circumstances of his or her life. A man, even if seriously ill or disabled in the exercise of his highest functions, is and always will be a man, and he will never become a 'vegetable' or an 'animal'" (No. 3).
3) "The sick person in a vegetative state, awaiting recovery or a natural end, still has the right to basic health care (nutrition, hydration, cleanliness, warmth, etc.), and to the prevention of complications related to his confinement to bed. He also has the right to appropriate rehabilitative care and to be monitored for clinical signs of possible recovery. I should like particularly to underline how 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, to the extent to which, and for as long as, it is shown to accomplish its proper finality, which in the present case consists in providing nourishment to the patient and alleviation of his suffering" (No. 4).
4) The preceding documents were taken up and interpreted in this way: "The obligation to provide the 'normal care due to the sick in such cases' (Congregation for the Doctrine of the Faith, Declaration on Euthanasia, p. IV) includes, in fact, the use of nutrition and hydration (cf. Pontifical Council Cor Unum, "Some Ethical Questions Relating to the Gravely Ill and the Dying," No. 2, 4, 4; Pontifical Council for Pastoral Assistance to Health Care Workers, Charter for Health Care Workers, No. 120).
The evaluation of probabilities, founded on waning hopes for recovery when the vegetative state is prolonged beyond a year, cannot ethically justify the cessation or interruption of minimal care for the patient, including nutrition and hydration. Death by starvation or dehydration is, in fact, the only possible outcome as a result of their withdrawal. In this sense it ends up becoming, if done knowingly and willingly, true and proper euthanasia by omission" (No. 4).
Therefore, the responses now given by the Congregation for the Doctrine of the Faith continue the direction of the documents of the Holy See cited above, and in particular the Address of John Paul II of March 20, 2004. The basic points are two.
It is stated, first of all, that the provision of water and food, even by artificial means, is in principle an ordinary and proportionate means of preserving life for patients in a "vegetative state": "It is therefore obligatory, to the extent to which, and for as long as, it is shown to accomplish its proper finality, which is the hydration and nourishment of the patient."
It is made clear, secondly, that this ordinary means of sustaining life is to be provided also to those in a "permanent vegetative state," since these are persons with their fundamental human dignity.
When stating that the administration of food and water is morally obligatory in principle, the Congregation for the Doctrine of the Faith does not exclude the possibility that, in very remote places or in situations of extreme poverty, the artificial provision of food and water may be physically impossible, and then "ad impossibilia nemo tenetur."
However, the obligation to offer the minimal treatments that are available remains in place, as well as that of obtaining, if possible, the means necessary for an adequate support of life. Nor is the possibility excluded that, due to emerging complications, a patient may be unable to assimilate food and liquids, so that their provision becomes altogether useless. Finally, the possibility is not absolutely excluded that, in some rare cases, artificial nourishment and hydration may be excessively burdensome for the patient or may cause significant physical discomfort, for example resulting from complications in the use of the means employed.
These exceptional cases, however, take nothing away from the general ethical criterion, according to which the provision of water and food, even by artificial means, always represents a natural means for preserving life, and is not a therapeutic treatment. Its use should therefore be considered ordinary and proportionate, even when the "vegetative state" is prolonged.
[1] Terminology concerning the different phases and forms of the "vegetative state" continues to be discussed, but this is not important for the moral judgment involved. [Original text: English]
Subscribe to:
Posts (Atom)