Tuesday, March 22, 2005

Discontinuing Medical Procedures

In the highly emotional enviroment today surrounding the decisions by the
Florida courts and the Federal court to allow Floridian Terri Schiavo to
pass away naturally without extraordinary methods to keep her alive, we felt
a need to look at what the Catholic Church has to say about euthanasia, or
the putting an end to the lives of handicapped, sick or dying persons. Many
news commentators, the President, and others have promoted a philosophy of
"error on the side of life." Some news reports allege the Catholic Church is
in favor of prolonging the life of Schiavo further.

From the official teachings of the Church, the "Catechism of the Catholic
Church," religious scholars and others have looked at various issues of life
and death and written their conclusions accordingly for guidance, and as the
authoritative doctrine of the Church in ordinary and extraordinary matters
of life.

According to the Catechism, it is "morally unacceptable" to end a life by
"direct euthenasia." (2277) However, the very next paragraph, number 2278
says "Discontinuing medical procedures that are burdensome, dangerous,
extraordinary, or disproportionate to the expected outcome can be
legitimate; it is the refusal of "over-zealous" treatment.
Here one does not will to cause death; one's inability to impede it is
merely accepted.
The decisions should be made by the patient if he is competent and able or,
if not, by those legally entitled to act for the patient, whose reasonable
will and legitimate interests must always be respected."

And in the following paragraph explains: "Even if death is thought imminent,
the ordinary care owed to a sick person cannot be legitimately interrupted.
The use of painkillers to alleviate the sufferings of the dying, even at the
risk of shortening their days, can be morally in conformity with human
dignity if death is not willed as either an end or a means, but only
foreseen and tolerated as inevitable
Palliative care is a special form of disinterested charity.
As such it should be encouraged."

The World Health Organisation defines palliative care as "the active total
care of patients whose disease is not responsive to curative treatment".
This definition stresses the terminal nature of the disease.

Thus, it would seem that the courts so far have decided correctly in light
of the documentation in the current case, and the decisions made by her
legal representative, her husband. Your views are welcome and replies are
encouraged on this subject. Click on the link below to comment.


  1. For reference to the text from the Catechism of the Catholic Church go to this link:

    The text is this section pertains to commentary on the Commandment "Thou Shall Not Kill"

  2. In opposition to the Catechism's discussion of allowance of discontinuation of medical procedures is this:

    In a document from the United States Conference of Catholic Bishops, the 1992 "Resource Paper" we find the following question and response:

    6. Do persistently unconscious patients represent a special case?

    Even Catholics who accept the same basic moral principles may strongly disagree on how to apply them to patients who appear to be persistently unconscious -- that is, those who are in a permanent coma or a "persistent vegetative state" (PVS). ... Some moral questions in this area have not been explicitly resolved by the Church's teaching authority. ("Nutrition and Hydration: Moral and Pastoral Reflections," hereafter N&H)

    There is disagreement in some quarters concerning the proper moral response to persons who are "persistently unconscious." We have already registered our opinion that the mere existence of such disagreement does not by itself preclude there being a moral response dictated by the teachings of the Church. We do not quarrel with the further observation by the committee members that "Some moral questions in this area have not been explicitly resolved by the Church's teaching authority." The very wording chosen "not ... explicitly resolved" is an acknowledgment that the questions may be already implicitly answered by the authority of the Church. The absence of an explicit resolution is entirely consistent with the existence of an implicit resolution dictated by the "Church's teaching authority," much as theorems are dictated by the axioms of a formal theory.

    The committee members claim "wide agreement among Catholic theologians" for two additional points concerning patients in a state of chronic unconsciousness. The first of these reads as follows:

    1. An unconscious patient must be treated as a living human person with inherent dignity and value. Direct killing of such a patient is as morally reprehensible as the direct killing of anyone else. Even the medical terminology used to describe these patients as "vegetative" unfortunately tends to obscure this vitally important point, inviting speculation that a patient in this state is a "vegetable" or a subhuman animal. (N&H)
    There is undoubtedly widespread agreement among Catholic theologians and moral philosophers on this point (including the valuable observation about the term ‘vegetative"). But, reasonable doubts can be recorded concerning the second point for which the committee members claim widespread agreement:

    2. The area of legitimate controversy does not concern patients with conditions like mental retardation, senility, dementia or even temporary unconsciousness. Where serious disagreement begins is with the patient who has been diagnosed as completely and permanently unconscious after careful testing over a period of weeks or months. (N&H)
    Characterizing the debate over permanently unconscious" patients as an "area of legitimate controversy" reveals the committee's impression that the teaching authority of the Church leaves open the question whether or not it is permissible to cut off the food and water of a person judged permanently unconscious. They proceed to quote a rather astonishing argument in favor of withholding care from the unconscious:

    Some moral theologians argue that a particular form of care or treatment is morally obligatory only when its benefits outweigh its burdens to a patient or the care providers. In weighing burdens, they say, the total burden of a procedure and the consequent requirements of care must be taken into account. If no benefit can be demonstrated, the procedure, whatever its burdens, cannot be obligatory. These moralists also hold that the chief criterion to determine the benefit of a procedure cannot be merely that it prolongs physical life, since physical life is not an absolute good but is relative to the spiritual good of the person. They assert that the spiritual good of the person is union with God, which can be advanced only by human acts, i.e., conscious, free acts. Since the best current medical opinion holds that persons in the persistent vegetative state (PVS) are incapable now or in the future of conscious, free human acts, these moralists conclude that, when careful diagnosis verifies this condition, it is not obligatory to prolong life by such interventions as a respirator, antibiotics, or medically assisted hydration and nutrition. To decide to omit non-obligatory care, therefore, is not to intend the patient's death, but only to avoid the burden of the procedure. Hence, though foreseen, the patient's death is to be attributed to the patient's pathological condition and not to the omission of care. Therefore, these theologians conclude, while it is always wrong directly to intend or cause the death of such patients, the natural dying process which would have occurred without these interventions may be permitted to proceed. (N&H)

    A complete discussion can be found at: http://www.catholicculture.org/docs/doc_view.cfm?recnum=5222