Charles Rice | Wednesday, September 22, 2004
Your family can expect to face this problem sooner or later: Grandma is in the hospital, incurably ill. She is comatose or in a persistent vegetative state (PVS). She receives nutrition and hydration through a tube. She is not dying and not in pain. If food and water are continued, she will live for years. Can you turn off that tube and let Grandma go “home” in peace? Tough question. Fortunately, in his address last March on the care of PVS patients, Pope John Paul II gave a clear answer.
First, the basic principles: “[T]he direct and voluntary killing of an innocent human being is always gravely immoral” (Evangelium Vitae). This includes euthanasia, which is an act, or omission, which of itself and by intention causes death to eliminate suffering. We also have a positive, but not absolute, duty to use all ordinary and proportionate means to preserve our own lives and the lives of those in our care.
The civil law permits, but does not require, some acts or omissions forbidden by the moral law. If a patient is competent he can legally refuse all treatment, including food and water. The law permits withholding of treatment or food and water from an incompetent patient based on the patient’s previously expressed intent, or on the decision of his health care agent that the patient would have wanted such withdrawal or that it would be in his best interest. In moral terms that can be euthanasia.
An advance directive, which the patient had executed when he was competent, can specify the care to be given to him, and it can designate a person to make treatment decisions for him. The basic advance directives are the living will and the power of attorney. A living will is a statement of your intention as to the care you will receive if you become incompetent. It must be interpreted and implemented by the physician and your family. A power of attorney is preferable. It appoints a person you trust to make health care decisions for you if you become incompetent. In moral terms, as the U.S. Bishops put it, that decision-maker “may not deliberately cause a patient’s death or refuse … ordinary means, even if he or she believes the patient would have made such a decision.”
In his March 2004, address, the Pope said “the administration of water and food, even … by artificial means, always represents a natural means of preserving life, not a medical act. Its use [is] ordinary and proportionate, and … morally obligatory, insofar as and until it is seen to have attained its proper finality, which … consists in providing nourishment to the patient and alleviation of his suffering … [W]aning hopes for recovery cannot ethically justify the … interruption of minimal care … including nutrition and hydration. Death … is … the only possible outcome as a result of their withdrawal … [I]t ends up becoming, if done knowingly and willingly, true and proper euthanasia by omission.”
As Monsignor Kevin McMahon, of St. Charles Borromeo Seminary, described it, this papal teaching is an “authoritative interpretation” forbidding Catholic facilities to withhold or withdraw nutrition and hydration from PVS patients as long as it preserves life or alleviates suffering. The law allows religious hospitals to decline to follow instructions in advance directives that conflict with their stated policies.
Grandma’s feeding tube is not supposed to cure her illness but only to sustain her biological life. The fact that it prolongs what some might regard as a pointless existence does not justify its removal. Morally, Grandma’s feeding tube may be withheld or withdrawn only in three general situations: 1. If it is useless in sustaining bodily life because her body is unable to absorb the nutrients; 2. In the final dying process when inevitable death is imminent despite the provision of feeding and medical treatments and the removal of the tube would therefore not be a cause of her death; or 3. If the administration of the nutrition and hydration itself causes unreasonably burdensome pain and suffering to the patient. If the tube were excessively painful, which it rarely is, you could remove it if your intent were to relieve the pain and to replace it if and when it could be done without such pain. If your intent in removing it were to cause Grandma’s death for her own good, that removal would be euthanasia, a form of murder.
So Grandma’s quality of life may not be so good. But, as John Paul said, the value of her life “cannot be made subordinate to any judgment of its quality expressed by other men.” Nobody has a right intentionally to starve and dehydrate her to death. The bottom line? Feed the hungry. Give drink to the thirsty.
Prof. Emeritus Rice is on the Law School faculty. His article appears every other Thursday. He can be contacted at Plawecki.firstname.lastname@example.org.
The views expressed in this column are those of the author and not necessarily those of The Observer.