Catholic Church serves to form our consciences in bioethical matters

BY PETER J. HOWARD, S.T.L.
THE CATHOLIC HERALD
Diocese of Colorado Springs
DECEMBER 3, 2003

SPECIAL TO THE CATHOLIC HERALD

The conscience of America is being put to the test as it confronts the issue of end of life decisions, particularly the administration or removal of assisted nutrition and hydration to those whose lives depend on it.

The drama surrounding the battle for the life of Terri Schiavo has brought this ethical issue to the forefront and has split health care professionals, the legal system, and even many Catholics as to what is morally just in such cases.

We must first look to the official teaching of the Catholic Church, who, guided by the Holy Spirit, is the herald and defender of the Truth in areas of faith and morals. The Magisterium of the Church is entrusted with the essential responsibility of forming our conscience in the truth of Jesus Christ, especially in a society like our own which continues to struggle to prevent the realm of morality from becoming detached from divine and natural law, reducing its precepts to those of a democratic vote.

Pope John Paul II warns us against such a worldly mentality and reaffirms the Church's essential role in forming our conscience according to the truth in his 1993 encyclical Veritatis Splendor ("The Splendor of Truth"). He reminds us that the Church helps our conscience "to avoid being tossed to and fro by every wind of doctrine proposed by human deceit (c£ Eph. 4:14), and helping it not swerve from the truth about the good of man, but rather, especially in more difficult questions, to attain the truth with certainty and to abide in it" (Veritatis Splendor, no. 64).

The underlying issue of assisted nutrition and hydration is whether or not the removal of it from a disabled person constitutes euthanasia, which the Church defines as "an action or an omission which of itself or by intention causes death, in order that all suffering may in this way be eliminated" (cf. Declaration on Euthanasia, Congregation for the Doctrine of the Faith, 1980).

When confronting end-of-life decisions, an error due to a malformed conscience bears the risk of costing a precious human life. This is precisely why the Church must continue to speak out in these critical issues to health care professionals who are responsible for executing just and ethical health care to all patients without any discrimination.

The United States Conference of Catholic Bishops [USCCB] has specifically addressed the issue of assisted nutrition and hydration in two key documents. The first, entitled Nutrition and Hydration: Moral and Pastoral Reflections [NHMPR], was published in 1992 and directly referenced by Pope John Paul II during his October 2, 1998 Ad Limina Address to the Bishops in California. The second, which summarizes much of what was said in Nutrition and Hydration: Moral and Pastoral Reflections, is the USCCB's Ethical and Religious Directives for Catholic Health Care Services, Fourth Edition [ERD] issued in June, 2001.

Both of these documents highlight the duty everyone has to preserve life and use it for the glory of God. That being said, we will begin with the Church's position: "We reject any omission of nutrition intended to cause a patient's death. We hold for a presumption in favor of providing medically assisted nutrition and hydration to patients who need it, which presumption would yield in cases where such procedures have no medically reasonable hope of sustaining life or pose excessive risks or burdens. . .In rejecting broadly permissive policies on withdrawal of nutrition and hydration from vulnerable patients, we must also help ensure that the burdens of caring for the helpless are more equitably shared throughout our society" (NHMPR).

The last part of that statement is a strong admonition for those who, in the name of social justice, advocate removal of nutrition and hydration from those who they deem lack a quality of life worth preserving. This line of thinking was condemned by the U.S. bishops who continue to assert:

"Decisions regarding human life must respect the demands of justice, viewing each human being as our neighbor and avoiding all discrimination based on age or dependency. A human being has 'a unique dignity and an independent value, from the moment of conception and in every stage of development, whatever his or her physical condition. In particular, 'the disabled person (whether the disability be the result of a congenital handicap, chronic illness or accident, or from mental or physical deficiency, and whatever the severity of the disability) is a fully human subject, with the corresponding innate, sacred and inviolable rights.' First among these is 'the fundamental and inalienable right to life"' (NHMPR).

One must, therefore, never forget the individual justice due the patient, especially one who is incompetent, when considering the fate of others in the name of social justice.

One may then ask, "Can nutrition and hydration ever be withdrawn?" The Church recognizes that there is always a subjective element in weighing the extent of the burdens imposed upon the disabled person whose life is sustained via assisted nutrition and hydration. However, there are only a very limited number of situations that allow one to stop these provisions.

The Church teaches us that "nutrition and hydration are not morally obligatory either when they bring no comfort to a person who is imminently dying or when they cannot be assimilated by a person's body" (ERD). The USCCB continues: "A person may (halt those provisions) for extraordinary or disproportionate means of preserving life. Disproportionate means are those that in the patient's judgment do not offer a reasonable hope of benefit or entail an excessive burden, or impose on the family or the community" (ERD).

This is not meant to mean simply any burden. Obviously, anyone whose condition warrants assisted nutrition and hydration is burdensome. The Church, rather, is referring to treatments which are excessively burdensome that the patient may undergo. It is also worth noting that the context in which the Church presents her teaching on assisted nutrition and hydration is one where a patient's death is "imminent." Imminent death does not refer to a ' diagnosis of cancer where one is informed that he or she may have only months to live. It does not even refer to weeks. Imminent death is literally the last day or hours of a person's life. Nutrition and hydration has never been considered by the Church, and a even society, a "medical treatment" - and certainly is never considered "excessive". Food and water constitute the most basic care for all persons. When we examine Terri Schiavo and her family fight for her right to live -- in light of what the Catholic Church has consistently set forth in its teachings regarding assisted nutrition and hydration -- we can come to no other conclusion that the removal of food and water from her clearly constitutes an act of euthanasia.

There are some who argue that the reinsertion of Terri's feeding tube is a barbaric and inhumane act because it interrupts her death process. The underlying motive for their efforts to cause Terri's death is because they do not believe Terri's "quality of life" is worthy of existence.

As Father Frank Pavone, national director for Priests for Life, commented on this issue: "Terri Schindler-Schiavo is not a dying patient. She simply doesn't function at the same level as the rest of us. There was no 'death process' underway until her food and water were taken away. That's what is inhumane and barbaric. And this is the test for all of us, to see if we remember the difference."

Father Tad Pacholczyk is a respected bioethicist from Falls River, Mass., who, by age 38, has earned a doctorate in neuroscience from Yale University, four undergraduate degrees (in molecular and cellular biology, chemistry, biochemistry and philosophy) and two degrees in advanced theology from the Pontifical Gregorian University in Rome. In a recent interview with Texas Catholic, the Dallas diocesan newspaper, he accurately summarized the Terri Schiavo case:

"The real moral question in Terri's case is very distinct from the case of a person who is terminally ill and is actively in the dying process. Such individuals can refuse disproportionate or extraordinary means of support that would only serve to extend their imminent dying process. This has been the teaching of the Church in this area. Terri's case, however, clearly does not come under this heading. What is being debated here is a question of active euthanasia under the guise of the intentional decision to withhold food and liquids."

Catholic health care professionals have a critical responsibility to ensure that hospital policies concerning end-of-life decisions accurately reflect Catholic Church moral teaching. Reminding health care professionals of their essential duty to justly and compassionately serve the sick and dying, the Congregation for the Doctrine of the Faith reiterates today:

"As for those who work in the medical profession, they ought to neglect no means of making all their skill available to the sick and the dying; but they should also remember how much more necessary it is to provide them with the comfort of boundless kindness and heartfelt charity. Such service is also service to Christ the Lord, who said: "As you did it to one of the least of these my brethren, you did it to me [Mt. 25:40]" (Declaration on Euthanasia, CDF, 1980).

Editor's note: Peter Howard holds a licentiate in Sacred Theology from the Angelicum in Rome