To anyone who follows the inter-and intra-mural battles within and between various religious communities over medical ethics, it comes as absolutely no surprise that there has been a ferocious counteroffensive launched against the Pope's recent powerful statement that it is "morally obligatory" to feed patients diagnosed to be in a "persistent vegetative state."
Since I am conversant with only a small segment of a vast literature, I am trying to be careful not to overgeneralize. But it is fair, I believe, to categorize in the manner that follows at least some of the criticism leveled against Pope John Paul's remarks to the International Congress on "Life-Sustaining Treatments and the Vegetative State: Scientific Advances and Ethical Dilemmas" held in Rome in March.
But in order to critique the critiquers, we need a very quick overview of what the Pope said. Alex Schadenberg of the Euthanasia Prevention Coalition wrote that Pope John Paul established two very important precedents by making this address on March 20.
"First, the pope effectively reinforced the human nature of all persons, no matter their state in life. He especially reinforced the humanity of people in a vegetative state..."
'Second, the pope stated that people in a vegetative state have the right to receive basic health care which includes nutrition and hydration. "
Therefore, Pope John Paul II makes it clear that to withhold or withdraw food and fluids from a person in a vegetative state who is not otherwise dying is euthanasia."
Critics have since stated (or broadly hinted) that the Pope either didn't really understand what he had said, was 'revising' traditional Catholic teaching, didn't appreciate the impact of his words 'in the real world,' or had been misunderstood!
(Before going any further, it's important to appreciate that the Pope was not breaking new ground.
His remarks were wholly consistent with the 1992 U.S. Bishops' Committee for Pro-Life Activities resource paper titled "Nutrition and Hydration: Moral and Pastoral Reflections," which recommended a strong presumption in favor of assisted feeding for patients in a PVS.)
As shown by the subtlety and breadth of Pope John Paul's remarks, intimations that he wasn't up to speed are blatantly false.
The Pope clearly is familiar with the latest science on PVS and with the heartbreak associated when patients lapse into a PVS. When critics offer a laundry list of 'shortcomings' attributed to the Pope (or to those who 'misread' him to be taking a strong pro-feeding stance), it's merely to mask their real objection.
Those who disagree with him are disappointed/angry because he is showing a preferential option to feed the vulnerable, with which some critics completely disagree. Moreover, it is very bad news for those who are adamant that it is acceptable to starve and dehydrate patients with radically diminished cognitive capacities when a man of the Pope's moral stature speaks out so explicitly.
Indeed, they know that one of the reasons they've able to succeed is that, previous to the Pope's address, there had been 'lack of clear and unambiguous guidance at the level of Church teaching,' as we wrote in the April NRL News.
This gap embolden many in Catholic theological circles to follow their own instincts--to counsel withdrawing all protection from PVS patients. Their argument goes something like this.
Patients in a PVS are in a 'terminal' condition, and it requires special justification to intervene to stop the 'natural dying process.' As Richard Doerflinger put it in his story for NRL News, 'By this account, simply sustaining life in a state of unawareness is not beneficial, because it maintains only a 'biological existence' that cannot pursue the higher 'spiritual purposes' to which earthly life is directed. Once a vegetative state is diagnosed as ‘persistent’ and therefore unlikely to change, says this theory, there should be a presumption against assisted feeding. The ensuing death by dehydration is not euthanasia but only a natural death, resulting from the patient's inability to take food normally.”
The Pope took a dramatically different stance towards patients in a PVS. Because they had so much invested in their conclusion that it was morally acceptable to withdraw feeding, it's hardly shocking that there have been many “creative” attempts to get around the Pontiff’s remarks.
In issues of protecting vulnerable life, when what's offered is making an already bad situation worse, typically that next step down the slippery slope is steeped in disguise and deception. That was true with abortion [from "hard cases" to abortion on demand]. And it's equally true with euthanasia.
But sometimes proponents of lethally pushing the envelope are pretty straightforward. Let me explain by first referring back to yesterday's edition.
The major conclusion was a simple one. Angered by the Pope's recent statement that it's "morally obligatory" to feed and hydrate patients in a so-called persistent vegetative state (PVS), critics have used a variety of stratagems to intimate either that he's not up to speed on the issue, is missing the boat entirely, or has been "misread" by those who believe that food and fluids are not "treatment," but examples of minimal care.
But as we have discussed many times, we knew PVS patients would only be the first target. If whether we feed is graded on a curve, and a certain cognitive capacity is required, then potentially millions of Americans would be in harm’s way.
This assault is not new. The offensive against people with, say, Alzheimer's has been gathering steam for years. It is now reaching the popular press more often, as a recent letter to the editor to America magazine and an article in the New York Times illustrate.
The magazine had run one of the more sophisticated attacks on Pope John Paul's message in its April 19 edition titled, "Must We Preserve Life?” The letter did the authors' argument one better (actually, one worse).
The letter writer was upset, not by the article's insistence that it's morally licit to withhold food and fluids. She was angered by a quote from the New Jersey Catholic Conference, included in the article. The conference wrote in 1987, "Today food and nutrition is withdrawn from someone in a persistent comatose state: tomorrow such care is withdrawn from someone suffering from Alzheimer's disease."
We learn that she is the executive director of a facility that "cares only for people with Alzheimer's disease and other dementing [!] illnesses." (Interesting choice of language, isn't it?)
Now nobody would disagree that end-stage Alzheimer's is devastating and very difficult on the family. What's scary in her letter is how effortlessly she segues from PVS to Alzheimer's (and, one might speculate, other "dementing illnesses"). By the time she finishes her letter, there is no essential difference between the two.
The condition of Alzheimer patients as they worsen mimics, in her view, the "normal dying process." Alluding to the Pope's remarks, she angrily writes, "Now we are being told that allowing these persons to progress to a dignified death must be stopped and we must insert tubes to keep them alive?"
Let me make a few comments. First, the economic costs of inserting a feeding tube are minimal. Those who do not want the patient fed this way complain about the ensuing costs: the patient must be cared for because she remains alive!
Second, when the quality-of-life arguments first began in earnest, the wedge used was how wrong it'd be to employ "high tech" care. Feeding someone by tube is about as "low tech" as it gets.
Third, many patients are already "terminally sedated." As a critic of this practice, Barbara A. Olevitch, Ph.D., explains, patients who are terminally sedated have "their mouths moistened" or are "given small amounts of liquid, dosed exactly to alleviate symptoms of thirst without meeting requirements for continued survival." They are also sedated..
Fourth, fortunately, there still is resistance to accepting that it's okay to starve a helpless woman or man to death. "There are people in my field who have legitimate concerns that we might be too eager to pull the plug," Dr. Christine Cassel, an expert in geriatrics, ethics, and end-of-life care and president and chief executive of the American Board of Internal Medicine, recently told the New York Times. "Just because someone has Alzheimer's disease doesn't mean their life has no value."
Fifth, and finally, the range of patients "eligible" to be starved and dehydrated to death has very broad parameters. It is by no means confined to the hardest of the hard cases--PVS patients and end-stage Alzheimer's patients.
Swept up are the "pleasantly senile," those with mental retardation, and those who are mentally ill. In fact there are moves afoot to deny treatment and to starve ANY patient whose judgment and ability to communicate are judged sufficiently impaired that she cannot competently speak for herself.
It is no accident that such thinking is first cousin to the mentality that undergirds assisted suicide. Let me conclude with this from a review of Wesley Smith's book "Forced Exit," which appeared in the magazine "First Things":
"Assisted suicide, Smith says, is only the opening wedge of an argument that will inexorably lead to involuntary euthanasia. Once it becomes licit for doctors to end their patients' lives for compassionate reasons in the case of terminal illness, what will stop that same compassion from administering death to those who, although not terminally ill, are suffering from intractable pain?
If there is in fact a constitutional right to die, how can it be denied to those who are comatose? And if deliverance by death is thought to be an appropriate beneficence for the senile elderly, why is it not equally appropriate for medically compromised children who face a lifetime of pain and debilitation? Indeed, why must one be a 'patient' at all? Why shouldn't all the arguments apply with equal force to those who are not ill, but have nevertheless been reduced by the vicissitudes of life to the point where they simply no longer wish to live?"
Assisted sucicide is OK only, but always, if it is entirely voluntary. The legal debate over the Schiavo case is whether or not he husband knows what her wishes are.
I'm not Catholic, so I don't follow the Pope anyway, but I am wondering why witholding food from a comatose patient counts as murder but witholding it from a starving African child does not.
To anyone who follows the inter-and intra-mural battles within and between various religious communities over medical ethics, it comes as absolutely no surprise that there has been a ferocious counteroffensive launched against the Pope's recent powerful statement that it is "morally obligatory" to feed patients diagnosed to be in a "persistent vegetative state."