Euthanasia and Extraordinary Care (Part 1)

The case of Hugh Finn and the withdrawal of his feeding tube has been given much publicity. Would you please give a fuller explanation of what the Church says about all forms of ordinary and extraordinary care which are required to be given in the case of patients in persistent vegetative states. Also, how the circumstances of the family come into play, that is financial resources, medical, age etc. -- A reader in Falls Church Since the mid-20th century, the Catholic Church has strived to give the clearest guidance possible regarding the usage of life-support systems. Much of the teaching has been delivered in the context of the teaching on the immorality of euthanasia. Pope Pius XII, who witnessed and condemned the eugenics and euthanasia programs of the Nazis, was the first to explicate clearly this moral area and provide guidance. In 1980, the Sacred Congregation for the Doctrine of the Faith released its Declaration on Euthanasia which further clarified this guidance, especially in light of the increasing complexity of life-support systems and the promotion of euthanasia as a valid means of ending life. More recently, Pope John Paul II in his encyclical Evangelium Vitae (#64) affirmed these teachings and warned against the "alarming symptoms of the 'culture of death'... which sees the growing number of elderly and disabled people as intolerable and too burdensome." The Catechism (#2276-2279) also provides a succinct explanation of our Catholic teaching on this subject. Further guidance concerning the feeding and hydration of individuals particularly those in comas or persistent vegetative states has been addressed by the Pennsylvania Catholic Bishops (Nutrition and Hydration: Moral Considerations (1991)), the National Conference of Catholic Bishops (Ethical and Religious Directives for Catholic Health Care Services (1994)), and the United States Bishops Prolife Committee (Nutrition and Hydration: Moral and Pastoral Reflections (1993)). Many solid, Catholic moral theologians, including Dr. William May, Msgr. William Smith, Dr. Germain Grisez, and Bishop James McHugh, have also offered guidance on this issue in concert with the Magisterium. Before addressing the intricacies of the feeding and hydration of individuals, particularly those in comas or persistent vegetative states (PVS), we must first remember some basic Catholic moral principles: First, the Catholic Church holds as sacred both the dignity of each individual person and the gift of life. We respect the sacredness of the continuum of life from conception until death. We must also have a respect and a vision not only for life here and now on this planet and in this time frame, but also for eternal life, hopefully with Almighty God in Heaven. Therefore, each person is bound to lead his life in accord with God's plan and with openness to His will, looking to life's fulfillment in Heaven. Second, the care for our lives is not a matter of mere "physicalism" where we focus so much on the body and the physical life that we lose sight of the soul and the spiritual life of the individual. Consequently, we must weigh whether a treatment is simply keeping a body functioning and postponing death versus assisting in the strengthening of life and restoring health. We must recognize that the time comes for us to depart from this life and return to our Lord in a new life. Third, we believe that each person is bound to use ordinary means of caring for personal health. Here one would think of basic care, which obviously includes proper nourishment and hydration — food and water — and ordinary medial care — common medical treatments. Ordinary means would be those which offer reasonable hope of benefit and are not unduly burdensome to either the patient or the family. A person may, but is not bound to, use extraordinary means — those means which primarily are not considered ordinary care or common medical treatments. These means do not offer reasonable hope of benefit and may be excessively burdensome to either the patient or the family. Factors to consider in determining whether a treatment is extraordinary include the type of treatment, the degree of complexity, the amount of risk involved, its cost and accessibility, and the state of the sick person and his resources. One would weigh the proportion of pain and suffering against the amount of good to be done. Granted, in our world today, exactly what constitutes extraordinary medical care becomes harder and harder to define. For instance, accepting an artificial heart is clearly experimental and would be extraordinary, whereas the usage of a respirator or ventilator is oftentimes a standard procedure to aid the patient's recovery. Fourth, the purposeful taking of the life of an innocent person is a grave, mortal sin. Vatican Council II condemned "all offenses against life itself, such as murder, genocide, abortion, euthanasia, and willful suicide..." Gaudium et Spes, #27). Euthanasia, literally translated as "good death" or "easy death," is "an action or omission which of itself or by intention causes death, in order that all suffering may in this way be eliminated" (Declaration on Euthanasia). In other words, euthanasia involves the purposeful termination of life by a direct action, such as lethal injection, or by an omission, such as starvation or dehydration. Note that euthanasia is commonly known as "mercy killing": this term is most appropriate because the act involves an intentional killing, no matter how good the intention may be to alleviate suffering. Pope John Paul II also asserted that euthanasia involves a false mercy, a perversion of mercy: "true compassion leads to sharing another's pain; it does not kill the person whose suffering we cannot bear" (Evangelium Vitae, #66). Therefore, the Holy Father confirmed, "Taking into account these distinctions, in harmony with the Magisterium of my Predecessors and in communion with the bishops of the Catholic Church, I confirm that euthanasia is a grave violation of the law of God, since it is the deliberate and morally unacceptable killing of a human person" (#65). However, euthanasia must be distinguished from the stopping of extraordinary means of health care or other aggressive medical treatment. The patient — or guardian in the case of an unconscious patient — has the right to reject outright or to discontinue those procedures which are extraordinary, no longer correspond to the real situation of the patient, do not offer a proportionate good, do not offer reasonable hope of benefit, impose excessive burdens on the patient and his family, or are simply "heroic." Such a decision is most appropriate when death is clearly imminent and inevitable. Here a person may refuse forms of treatment which at best provide a precarious and burdensome prolonging of life. In these cases, the person would place himself in God's hands and prepare to leave this life, while maintaining ordinary means of health care. Given this foundation, we will continue next week, turning specifically to the usage of nutrition and hydration, persistent vegetative states, and suffering. Fr. Saunders is pastor of Queen of Apostles Parish in Alexandria. Copyright ?1998 Arlington Catholic Herald, Inc. 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