Euthanasia and Extraordinary Care (& the difference between ordinary and extraordinary care-Schiavo)

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.

Definitive teaching of Catholicism, as per the Catechism of the Catholic Church and Pope JPII:

Catechism # 2276 Those whose lives are diminished or weakened deserve special respect. Sick or handicapped persons should be helped to lead lives as normal as possible.

Thus an act or omission which, of itself or by intention, causes death in order to eliminate suffering constitutes a murder gravely contrary to the dignity of the human person and to the respect due to the living God, his Creator. The error of judgment into which one can fall in good faith does not change the nature of this murderous act, which must always be forbidden and excluded.

ADDRESS OF POPE JOHN PAUL II TO THE PARTICIPANTS IN THE INTERNATIONAL CONGRESS ON "LIFE-SUSTAINING TREATMENTS AND VEGETATIVE STATE: SCIENTIFIC ADVANCES AND ETHICAL DILEMMAS"

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 eventual 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, insofar as and until it is seen to have attained its proper finality, which in the present case consists in providing nourishment to the patient and alleviation of his suffering.

The obligation to provide the "normal care due to the sick in such cases" (Congregation for the Doctrine of the Faith, Iura et Bona, p. IV) includes, in fact, the use of nutrition and hydration (cf. Pontifical Council "Cor Unum", Dans le Cadre, 2, 4, 4; Pontifical Council for Pastoral Assistance to Health Care Workers, Charter of Health Care Workers, n. 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.

In this regard, I recall what I wrote in the Encyclical Evangelium Vitae, making it clear that "by euthanasia in the true and proper sense must be understood an action or omission which by its very nature and intention brings about death, with the purpose of eliminating all pain"; such an act is always "a serious violation of the law of God, since it is the deliberate and morally unacceptable killing of a human person" (n. 65).

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