The intense battle to prevent Terri Schiavo's husband from removing her feeding tube was horrible enough. To think that some American Catholic universities and their ethics, theology, law, and medical professors bear some responsibility for Schiavo's slow death is almost too much to imagine.
Yet prior to Schiavo's death, professors from top Catholic universities helped convince the courts and the public that removing her feeding tube was acceptable and consistent with Catholic teaching even while the Vatican said it was euthanasia. Several professors sought to publicly undermine Pope John Paul II's clear statements on the moral obligation to feed and hydrate even the most severely injured patients.
It's well-known that the culture of death has made inroads into Catholic higher education in the form of abortion advocacy, but little attention is given to end-of-life issues or so it seemed before the Schiavo debacle. When six Catholic university professors signed an amicus brief in favor of removing Schiavo's feeding tube, the Cardinal Newman Society launched an investigation that revealed the dark side of some Catholic university faculties, which include leading advocates of assisted suicide, vocal dissenters from Vatican teaching on euthanasia, and even top officials of national pro-death advocacy organizations.
The danger is obvious: If the Church is going to face up to a growing movement for euthanasia and assisted suicide in the United States, Catholic universities must help in that important battle. Harboring the enemy and training new spokesmen for the culture of death is not the way to do it.
The brief filed last August by 55 bioethicists urged the Florida Supreme Court to overturn "Terri's Law," the measure passed by the state legislature to empower Gov. Jeb Bush to protect Schiavo's life.
Among the ethicists signing the brief were six Catholic university professors: Charles Baron, professor at Boston College Law School; Carol Bayley, adjunct professor of nursing at the University of San Francisco, Milton Heifetz, adjunct professor at Boston College Law School; Lawrence Nelson, adjunct associate professor of philosophy and of women and gender studies at Santa Clara University; Rev. John Paris, S.J., professor of bioethics in the theology department at Boston College; and James Walter, professor of bioethics and chairman of the Bioethics Institute at Loyola Marymount University.
The ethicists argued that "no legal right is more important in American society than the right of personal autonomy" without explaining exactly how this supercedes the more fundamental right to life. But what was most striking and unusual about the brief was its direct challenge to Pope John Paul II's teaching on the obligatory use of feeding tubes for seriously ill patients in a "persistent vegetative state." During a Vatican-sponsored conference of physicians and ethicists last year, the late Holy Father said that in cases in which a person's ability to function is minimal, but death is not imminent, food and water should be considered "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 . . . 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."
The ethicists argued that "the Pope's speech has not changed anything concerning the centuries-old teachings of the Catholic Church on the care due to patients," which does not require "extraordinary" medical treatment for terminally ill persons. They got that right. What did change, after decades of theological debate about whether a feeding tube could be considered "extraordinary" medical treatment, is that one of the late pope's last contributions to Catholic teaching was to declare that food and water are ordinary care to be provided in almost all circumstances by any suitable means. It is true that even the most ardently pro-life theologians, like Janet Smith of Sacred Heart Major Seminary in Detroit, acknowledge that the question does not appear to be closed at least not without the formality of a papal encyclical but that the Vatican's teaching deserves "great weight" and prayerful reflection.
The following is not what Smith prescribes: arguing with certainty before a court that a woman must die because in direct contradiction to what the pope and Vatican officials have clearly taught Catholic teaching is interpreted to permit starvation and dehydration when a patient's recovery is unlikely. Even in the modern culture of dissent, one might expect more tact especially from Catholic university professors.
The Schiavo brief was just a hint of some of the signers' activities in support of euthanasia and assisted suicide. Charles Baron has intervened in such cases before. He filed a brief for the American Civil Liberties Union (ACLU) in the 1980s with the Massachusetts Supreme Judicial Court in support of removing the feeding tube of Paul Brophy. Like Schiavo, Brophy had suffered brain damage and was diagnosed as living in a "persistent vegetative state" for three years, but he was not terminally ill or facing imminent death. Although Brophy had never expressed his wishes in writing, the court accepted the "substitute judgment" of his wife, and the 48-year-old man was starved to death.
Last year Baron joined 41 bioethicists who filed an amicus brief with the Ninth Circuit Court of Appeals defending Oregon's Death With Dignity law, which allows physician-assisted suicide. The case, Oregon v. Ashcroft, in which Oregon officials complain that former U.S. Attorney General John Ashcroft improperly banned doctors from using federally controlled drugs to kill their patients, is now before the U.S. Supreme Court.
Well-regarded as an expert on end-of-life issues, Baron has testified before the U.S. House of Representatives and Britain's House of Lords on legalizing physician-assisted suicide. He was the spokesman for a group of academics that published a model state law to legalize physician-assisted suicide in 1996. The model, which has been advocated in Massachusetts since 1997, is posted online among Boston College Law School's faculty papers. Baron now serves on the board of directors of the Death With Dignity National Center, which is the organization most responsible for Oregon's Death With Dignity law and has promoted similar laws in Maine, Hawaii, and Vermont.
How do these activities affect Boston College students? In addition to teaching courses on constitutional law, Baron teaches "Law and Bioethics" including discussion of assisted suicide and "artificial prolongation of human life" and "Health Law and Policy," which includes discussions of "life and death decision-making."
It gets worse. Baron has taught both courses with adjunct law professor Milton Heifetz, also a signatory to the bioethicists' brief supporting Schiavo's death by starvation and co-author of The Right to Die: A Neurosurgeon Speaks of Death With Candor (Putnam, 1975). The book advocates legalizing assisted suicide and even entertains the possibility of euthanasia for severely retarded people and newborns with severe medical problems.
"Is life at birth more significant than at the second, fourth, or sixth month of pregnancy?" Heifetz and co-author Charles Mangel ask. "It is not. True, it is closer to gaining the attributes of man, but, as yet, it has only the potential for those qualities. If this difference is true for the normal newborn, how much less significant is it for the newborn who doesn't even have this potential?"
Bioethics professors Rev. John Paris, S.J., of Boston College and James Walter of Loyola Marymount University were outspoken in the Schiavo case. Catholics ought to be impressed by their credentials: Walter taught at the Catholic University of America, Georgetown University, Loyola University of Chicago, and Marygrove College before chairing the Bioethics Institute at Loyola Marymount. He is also the founding chairman of the International Forum for Catholic Bioethicists. Father Paris has published more than 100 articles on law, medicine, and ethics and has consulted for the President's Commission for the Study of Ethics in Medicine and the U.S. Senate Committee on Aging.
So why the lapse in professionalism when commenting on the Schiavo case? Without having evaluated Schiavo personally, Walter confidently told the National Catholic Reporter last October that "any chance of self-awareness is not going to happen." Walter sought to dispel concerns about Schiavo's suffering when her feeding tube is removed: "All centers of her brain are so severely compromised she can't feel pain or hunger, and if there is any indication of it, she would be sedated during her dying." Walter's confidence gives no hint of the significant disagreements over Schiavo's medical condition and her awareness of pain and her surroundings.
In March, Father Paris admitted that Schiavo "is quite alive," but still "she has no obligation to medical interventions if they prove disproportionately burdensome." Food and water, Father Paris argued, are burdensome interventions. In a Salon.com interview, Father Paris said the Schiavo case was really about "the power of the Christian right. This case has nothing to do with the legal issues involving a feeding tube." He complained: "[T]he family has the radical, antiabortion, right-to-life Christian right, with its apparently unlimited resources and political muscle, behind them." Not exactly the careful analysis one would expect from a respected ethicist.
Credibility is also a problem for Carol Bayley, who teaches nursing at the University of San Francisco but wields greater influence as vice president for ethics and justice education at Catholic Healthcare West, a large hospital system in the western United States. Last April, Bayley represented her employer with a cautious but faithful response to the Vatican teaching on feeding tubes: "We're going to take the Pope's statements very seriously. We're going to look at what effect this could have on our practice." Just three months later, Bayley signed on to the Schiavo brief, pointedly rejecting the pope's teaching with no apparent consequence for her employment.
An Attorney's Legacy
At 82 years old, Florence Wendland cannot forget her six-year battle to prevent her son's death by starvation and dehydration. And she has some idea of what Terri Schiavo's parents have gone through.
"I just pray to the Lord to help them," she told the Mercury News.
Wendland also knows something about the problem of euthanasia activists teaching at Catholic universities. Lawrence Nelson, the attorney who urged the California Supreme Court to sanction the removal of her son's feeding tube, is a medical and legal ethics professor at the Jesuits' Santa Clara University.
Robert Wendland was in a car accident in 1993 and was severely disabled unable to speak or walk on his own, but occasionally able to make limited movements like writing the letter "R." Unlike Schiavo, it was apparent that Robert was not in a persistent vegetative state. His wife, Rose, nevertheless sought to remove his feeding tube, and Robert's mother Florence and sister Rebekah sued to prevent it. Nelson testified at the trial level in support of starving Robert, then later took over the case as the attorney for Robert's wife.
Despite losing to Robert's family at the California Supreme Court which ruled that a feeding tube could be removed only in instances of a coma or imminent death, or with the patient's explicit instructions in writing Nelson has continued to plead his case to the public under the auspices of Santa Clara University. Nelson has admitted that Rose Wendland knew her husband was alive but believed "that this was no life for Robert, no life he would ever want. The only experiences he seemed to have were negative. She thought it was wrong and even cruel in a way." It was a textbook case of "mercy killing."
Despite his views supporting such an atrocity, Nelson has been designated a scholar at Santa Clara University's Markkula Center for Applied Ethics and is identified on the university's Web site as a media source on "death and dying." Through the Markkula Center, Nelson has written and made presentations on assisted suicide and the Wendland case. Nelson argues that even in circumstances where a patient's wishes are not known for certain, "close family members should presumptively be the ones who decide when it is right to forgo treatment of their incompetent relative," including removal of a feeding tube.
Also published by the Markkula Center is "A Brief Case for the Moral Permissibility of Stem Cell Research," in which Nelson argues that "scientists must destroy embryos in order to obtain primordial stem cells. This destruction is ethically defensible because embryos have only a modest moral status and can be destroyed for substantial reasons."
Florence Wendland's attorney, Janie Hickok Siess, says that one of the most disturbing things about Nelson is his collaboration with Ronald Cranford, a faculty member at the University of Minnesota's Center for Bioethics. Cranford has a history of court testimony in support of euthanasia. He was the expert witness who declared Schiavo to be in a persistent vegetative state despite the lack of certain medical tests that some doctors said might have revealed significant brain activity. Cranford testified that Robert Wendland's movements which included operating a motorized wheelchair and using a television remote control were comparable to those of a trained animal.
In 1999, Nelson and Cranford published their arguments for removing Wendland's feeding tube in the Journal of Contemporary Health Law and Policy, which is sponsored by the Catholic University of America law school. They describe Wendland as "minimally conscious" since they could not reasonably label him vegetative and argue that for such individuals who cannot communicate, "Their biographical and personal life is over."
Siess, who is a Lutheran, wonders why Nelson is teaching ethics at a Catholic university: "I don't believe that his views, as I understand them, are consistent with the Gospels and the teaching of Jesus." One of her children attends a Christian college, and she expects something different from a faith-based education: "If you're sending your kid to a church-affiliated school, you would want the school to be consistent with the teaching of that church."
Santa Clara University officials see it differently. In 2003, the Markkula Center awarded Nelson a grant to develop "a theory of constitutional personhood," considering the moral status of human embryos outside the womb, "moral respect for the disabled," and "forgoing treatment of conscious, independent persons." The same year, Santa Clara's Bannan Center for Jesuit Education gave Nelson a grant "to explore the place of philosophical ethics in Jesuit higher education and mission."
Nelson and the other five Catholic university professors who signed the Schiavo brief are not the only employees of Catholic universities who have contributed recently to a culture of death:
Tom Beauchamp, philosophy professor at Georgetown University and a senior research scholar at the university's Kennedy Institute of Ethics, has served on the board of directors of the Compassion in Dying Federation since 1999. This national organization advocated Oregon's assisted dying law and challenged laws prohibiting assisted suicide in Washington and New York, taking its fight to the U.S. Supreme Court. Beauchamp organized the amicus brief signed by Baron, Beauchamp, and 40 other bioethicists in Oregon v. Ashcroft, arguing for Oregon's Death With Dignity law. Beauchamp co-authored Principles of Biomedical Ethics (Oxford, 1979), which is often cited in arguments for euthanasia and assisted suicide.
Maxwell Gregg Bloche, professor at the Georgetown University Law Center and co-director of the joint program in law and public health with Johns Hopkins University, also signed an amicus brief in Oregon v. Ashcroft arguing that doctors' actions protected by the Oregon assisted-suicide law constitute "sound and ethical medical practices."
As touted on Seattle University's Web site, adjunct law professor Robert Free has served as an advisory board member for Compassion in Dying of Washington, which advocates assisted suicide. Free helped the organization prepare amicus briefs challenging the Washington state law criminalizing physician-assisted suicide and defending Oregon's Death With Dignity law.
Howard Freed, clinical associate professor of emergency medicine at the Georgetown University School of Medicine, signed an amicus brief in Oregon v. Ashcroft complaining that the former attorney general interfered with "physicians' ability to care for terminally ill patients nationwide" and warning that "many health professionals will retreat from their obligations to their terminally ill patients."
The Georgetown University Law Center's Web site describes Lawrence Gostin as an expert on constitutional law, health law, and bioethics, but it neglects to mention that Gostin has twice joined amicus briefs in Oregon v. Ashcroft defending Oregon's assisted-suicide law. Gostin holds several positions at Georgetown including law professor, faculty affiliate of the Kennedy Institute of Ethics, and director of the Center for Law and the Public's Health (a joint program with Johns Hopkins University). Gostin is the health law and ethics editor of the influential Journal of the American Medical Association and serves on the editorial board of the International Journal of Bioethics and the executive committee of the ACLU board of directors.
Former Jesuit priest Daniel Maguire, theology professor at Marquette University, not only supported removal of Terri Schiavo's feeding tube, but he told FOX News that "this woman should have been allowed to complete her dying 15 years ago when they realized that she had terrible damage to her brain and was no longer capable of personal consciousness." Maguire accused Pope John Paul II and Vatican officials of a "fetishism of life signs," using any sign of life as a justification for delaying death.
Rev. Richard McBrien, theology professor at the University of Notre Dame, argued in support of removing Terri Schiavo's feeding tube. "This is not a question of euthanasia," he told Bill O'Reilly on FOX News, directly contradicting the Vatican. "[T]his is the removal of an extraordinary means of sustaining life, which is an indirect killing because eventually she will die, but it is not with the intention of killing her, of bringing about her death."
Fairfield University identifies associate philosophy professor Curtis Naser as an expert in biomedical ethics and "end of life decisions." Naser joined Beauchamp, Nelson, and 39 other bioethicists in an amicus brief filed in the 1997 U.S. Supreme Court cases Vacco v. Quill and State of Washington v. Glucksberg, arguing against New York and Washington state bans on physician-assisted suicide. They argued that "medical ethics and trust in physicians are better served by physician-assisted suicide where the patient can have the care, comfort and treatment of his or her doctor at the time the patient acts to hasten death."
Rev. Kevin O'Rourke, O.P., ethics professor at the Loyola University of Chicago Medical School, told the Miami Herald that preserving Schiavo's life was "blasphemy": "I can attest from a theological point of view that what the [Florida] governor and others are doing to Terri is not doing any good for her . . . For Christians, it is a blasphemy to keep people alive as if you were doing them a favor."
Ignoring the Pope
O'Rourke drafted a statement that was circulated at a meeting of Catholic Health Association ethicists in March. The statement scolds Bishop Elio Sgreccia, president of the Pontifical Academy for Life, for arguing that withholding nutrition and hydration is euthanasia the same argument made by Pope John Paul II. O'Rourke complains that the Vatican position is "irresponsible" and "simply an insult," because it contradicts prior statements by theologians and bishops and infers that they support euthanasia.
There is no question that by declaring the provision of food and water through an artificial feeding tube to be normal care, Pope John Paul II embarrassed many American theologians and bishops who for decades had been advising families differently. Some grumbling about the Vatican's position was expected, but the opposition has become disrespectful and rebellious. By their quick and total dismissal of Vatican teaching and their aggressive advocacy of what the Vatican calls euthanasia, critics like O'Rourke have resorted to public dissent.
One well-used strategy is to portray the Vatican teaching as ambiguous or allowing broad discretion for the families of severely injured patients. Pope John Paul II was quite clear that the intentional removal of a feeding tube even from patients in a persistent vegetative state is "true and proper euthanasia by omission." Bishop Sgreccia said regarding Schiavo: "The removal of the gastric feeding tube from this person, in these conditions, may be considered direct euthanasia . . . The gastric feeding tube cannot be regarded as an 'extraordinary' or as a therapeutic 'means.' It is an integral part of the modality in which Schiavo can be fed and hydrated."
Nevertheless, John Collins Harvey, senior research scholar at Georgetown University's Kennedy Institute of Ethics and chairman of the bioethics committee at Georgetown University Hospital, tried to muddy the waters.
"[I]t's important to understand that the words of the Holy Father were interpreted in many different ways, so that it's hard to really come to the conclusion of what exactly he said to everyone," Harvey said on PBS's Religion & Ethics Newsweekly. "He talked very carefully and said 'in principle,' food and water is ordinary treatment. It's not a medical treatment, and therefore it's part of comfort care and must always be used. But 'in principle,' which means there are conditions and times when it can be omitted."
Father McBrien has claimed that the pope did not speak authoritatively on the matter of feeding tubes. In Schiavo's case, "Catholic moral theologians would say this is an exception." Speaking to the Los Angeles Times, he characterized an editorial in L'Osservatore Romano which echoed the Vatican position as "theologically erroneous and irresponsibly so, given the highly public nature of this controversy."
Critics have also complained that the late pope took them by surprise at a 2004 conference in Rome by attempting to impose new moral guidelines at the behest of pro-life activists. But contrary to media reports, Pope John Paul II addressed the topic as early as 1998 in his ad limina address to the bishops from California, Nevada, and Hawaii. He drew a sharp distinction between what the Catechism of the Catholic Church calls "the refusal of 'over-zealous' treatment" and taking away the ordinary means of preserving life, such as feeding, hydration, and normal medical care.
Walter at Loyola Marymount University plays the sympathy card, arguing the Vatican's position "might even drive people toward euthanasia, by making them feel that they have lost a traditional and sympathetic ally in their final journey."
Among the Vatican's critics, Boston College's Father Paris is perhaps the most confrontational. He dismissed the late Holy Father's statements as pandering to "radical right-to-lifers."
"The right-to-life types want to renounce brain death and keep everyone going forever," Father Paris told Newsweek. "It seems that Lenin's mausoleum will be the model for the future. The entire enterprise is mischief-making at the Vatican."
Regarding the pope's 2004 address, Father Paris told the St. Petersburg Times: "I think the best thing to do is ignore it, and it will go away. It's not an authoritative teaching statement . . . The problem here is that non-Catholics think when the Pope says 'Jump,' we all say, 'How high?'
In Honor of Terri
Following a Florida court's ruling in favor of removing Schiavo's feeding tube, Bishop Sgreccia warned: "If such a decision was confirmed and leads to Terri Schiavo's death, it would create a juridical precedent and would present euthanasia in reality as a right before the courts of the United States, with the serious consequences that can be easily imagined for the lives of many other more or less autonomous persons, in this country and elsewhere."
That may well be the road paved by Catholic ethicists who advance the culture of death. These are the consequences of a Church leadership and laity reluctant to hold Catholic universities accountable for scandal understandable because lay-directed universities are autonomous and responsible for their own actions and policies, but negligent because we too often forget that "Catholic identity" is not the universities' to define or distort.
Catholic universities must be committed to the difficult task of rooting out the culture of death from their halls. They also must advance a culture of life, educating their students about the Church's authentic teaching on end-of-life issues as well as college-age concerns about sexuality. Such would be a fitting tribute to Terri Schiavo.
Patrick J. Reilly is president of the Cardinal Newman Society (www.cardinalnewmansociety.org), a national organization that seeks the renewal of Catholic identity at Catholic colleges and universities in the United States.
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