Posted on 03/24/2005 12:04:38 PM PST by kingattax
John J. Paris, S.J., is professor of bioethics at Boston College, in Massachusetts.
ONCE AGAIN A "RIGHT TO DIE" case has captured national attention. What brought the issue to the fore this time were actions by some members of the family of Hugh Finn and by Governor James S. Gilmore 3rd of Virginia, who sought to block the removal of a feeding tube from Mr. Finn, who was being cared for in a nursing home in Virginia.
The facts in the case are relatively straightforward. Hugh Finn, a popular, 44-year-old news anchorperson in Louisville, Ky., ruptured his aorta in 1995 in a traffic accident. The resulting anoxic damage to his brain left him, like Karen Ann Quinlan and Nancy Cruzan, irreversibly comatose. Though he was incapable of any conscious activity, a feeding tube inserted through his abdomen supplied the nutrition and fluids necessary to sustain life.
Mr. Finn, a Catholic who had reported on the earlier cases, had drafted a written statement opposing such life-prolonging measures for himself, but at the time of his accident he had not yet signed it. His wife, with the support of her husband's sister, but over the objections of her husband's parents and his six brothers, requested that the physician remove the feeding tube and allow her husband to die. The relatives opposing that decision brought suit to block the removal of the feeding tube.
Once again issues raised in the landmark Paul Brophy and Nancy Cruzan cases were argued: that removal of life-sustaining medical technology is not allowing to die, it is killing; that the action itself, not the patient's condition, would cause the death; that food and water are not medical treatments, they are basic care; that if treated the patient could survive another 30 years; that failure to provide that care is murder.
Those arguments had been heard and rejected by every court of final jurisdiction that has reviewed "right to die" cases since Quinlan in 1976 and Brophy in 1983 first occasioned consideration of these questions. They took on renewed strength, however, when presented at a televised news conference by a state governor claiming he had a duty to intervene to protect the interests of the most vulnerable of the state's citizens.
A Prince William Circuit Court judge and subsequently the Virginia Supreme Court rejected the Governor's argument that removing the feeding tube that had sustained the severely brain damaged Hugh Finn for three and a half years would constitute euthanasia. In an emergency ruling, the Virginia Supreme Court upheld the trial court's finding that the withdrawal of nutrition and fluids from a patient in Hugh Finn's condition merely permitted the natural process of dying; it was not an illegal "mercy killing."
The politicization of the case was compounded when a local state representative, Delegate Robert B. Marshall, claimed that disconnecting the feeding tube would not only be illegal, "it would be against the teachings of the Catholic faith." "To me, the law doesn't allow it," he said. "He's not on life-support. He's not on a respirator. He's not brain dead. To me it is active euthanasia." That view was supported by the Rev. Paul de Laudurantaye, the secretary of education for the Diocese of Arlington, Va., who observed, "Mr. Finn has not yet reached the point where death is imminent. To withdraw [food and water] now would be homicide, for it is the adoption, by choice, of a proposal to kill him by starvation and dehydration. Such killing can never be morally right and ought never be permitted." On the other hand, the archbishop of Mrs. Finn's diocese, Thomas C. Kelly, O.P., of Louisville, wrote her a letter of support, assuring her that her decision fell within the framework of Catholic moral teaching.
The Catholic tradition on the use of medical interventions to sustain life was the subject of an essay Richard McCormick, S.J., and I wrote for this journal some years ago (5/2/87). There we reviewed the 400-year-old Catholic teaching that no one need undergo interventions that are disproportionately burdensome or offer no realistic expectation of restoration to a functioning cognitive existence. The church's teaching on that topic, from its earliest formulation, applied specifically to the issue raised in the Finn case: the withholding or withdrawal of nutrition and fluids.
The clearest statement of that position is found in the Relationes Theologicae by the 16th-century Dominican moralist Francisco de Vitoria. In that commentary de Vitoria provides an everyday example of the type of "delicate treatment" that would be beyond what one is obliged to employ to preserve life: "Chickens and partridges, even if ordered by the doctor, need not be chosen over eggs and other common items, even if the individual knew for certain that he could live another 20 years by eating such special foods." If not even a special diet was morally obligatory in de Vitoria's time, how much the less obligatory are total parenteral nutrition, feeding gastrostomies, nasogastric tubes and other artificial means of providing alimentation?
That de Vitoria's views were neither unique nor subsequently abandoned is best seen in an essay published in Theological Studies in 1950 on "The Duty of Using Artificial Means of Preserving Life," by the widely respected Jesuit moralist Gerald Kelly. Father Kelly was concerned with the same question confronted by the courts in the Hugh Finn case: Is there a moral obligation to continue intravenous feeding of an irreversibly comatose patient? After a thorough survey of the prior teachings on the subject, Father Kelly found that the authors hold that "no remedy is obligatory unless it offers a reasonable hope of checking or curing a disease (nemo ad inutile tenetur)." From this Father Kelly concluded that no one is obliged to use any means--whether natural or artificial--if it does not offer a reasonable hope of success in remedying that person's condition.
When asked if oxygen and intravenous feeding must be used to extend the life of an irreversibly comatose patient, Father Kelly replied: "I see no reason why even the most delicate professional standard should call for their use. In fact, it seems to me that, apart from very special circumstances, the artificial means not only need not but should not be used, once the coma is reasonably diagnosed as terminal. Their use creates expense and nervous strain without conferring any real benefit."
The application of that teaching to patients in what is now labeled a "persistent vegetative state" (P.V.S.) was provided by the Roman Catholic bishops of Texas in a 1990 statement, in which they noted that their analysis of such patients differs substantially from those who would describe such patients as "unconscious but non-dying." The Texas bishops describe P.V.S. patients as "human beings" who "are stricken with a lethal pathology which, without artificial nutrition and hydration, will lead to death." If there is evidence the now irreversibly comatose patient would not want to be maintained by artificial nutrition and fluids, these may be foregone or withdrawn. Such an action, in the bishops' understanding, "is not abandoning the person. Rather, it is accepting the fact that the person has come to the end of his or her pilgrimage and should not be impeded from taking the final step."
This subordination of physiological concerns to the patient's spiritual needs and obligations is a hallmark of authentic Catholic thinking. It is based on a clear and careful reiteration of the ethical assumptions upon which medicine and the efforts to treat people have been based--"to prolong living in order to pursue the purpose of life." The burden a person would experience in striving to attain the purpose of life--not the burden associated with the means to prolong it--is and traditionally has been the focus of Catholic moral concern.
That view is updated and applied to non-competent patients in an insightful essay on "quality of life" by Kevin Wildes, S.J., in a recent issue of Theological Studies (September 1998). There Father Wildes observes: "In order for a treatment to be morally obligatory, it must be useful for both medical and personal goals. The mere fact that a treatment is useful, however, does not suffice to make that treatment obligatory." Father Wildes's insistence on the need to place medical interventions in the context of the individual's total situation reflects Pius XII's position that "Life, health, all temporal activities are in fact subordinated to spiritual ends."
Reflecting on that papal statement, Kevin O'Rourke, O.P., notes, "When the potential for spiritual function is no longer present, then it seems that all treatment or care efforts which sustain physiological function are ineffective." Applying that position to patients in a persistent vegetative condition, he concludes, "If the cognitive affective potential is nonexistent, the person is still a human being, but a human being toward whom we do not have an ethical obligation to prolong life."
If there is no benefit--physical or spiritual--to be gained from delaying death, traditional Catholic moral theology on the use of artificial means to prolong life would support the Virginia Supreme Court's ruling in the Finn case: Remove the medically supplied measures to sustain bodily existence, and allow the lethal pathology incurred in the tragic automobile accident to progress to its natural end.
Hugh Finn died at a nursing home on Oct. 9, 1998, eight days after his wife had his feeding tube removed. But that was not the end of the story. The local coroner then had the body taken to a funeral home so he could perform an autopsy. Since there was no question concerning the cause of death, the circuit court ordered the body returned to the family. That ruling finally allowed the family to lay Hugh Finn's body to rest in peace
So this person wanted to die, and again was blocked in the attempt by obssessed people.
there is no corroborated proof that "again" terri wanted to die. only hearsay, which apparently is good enough for some people.
I would take her husbands word over someone who doesnt know her in a heartbeat.
And I would take her parents, sister, and brothers word over his.
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