Euthanasia and Extraordinary Care (Part 2)
Last week, we began our review of Catholic teaching on the sanctity of human life, the necessity of using ordinary means of health care, and the immorality of euthanasia, either through commission or omission.
At this point, we can specifically address the issue of nutrition and hydration. Never forget that basic, ordinary care for one's health entails food and water. The Ethical and Religious Directives for Catholic Health Care Services asserts, "There should be a presumption in favor of providing nutrition and hydration to all patients, including patients who require medically assisted nutrition and hydration, as long as this is of sufficient benefit to outweigh the burdens involved to the patient" (#58). The U.S. Bishops' Pro-Life Committee echoed this point, and added, "Such measure must not be withdrawn in order to cause death, but they may be withdrawn if they offer no reasonable hope of sustaining life or pose excessive risks and burdens" (#6).
Interestingly, the Holy Father, at a meeting with a group of U.S. Catholic Bishops from California, Nevada, and Hawaii in Rome on October 2, 1998 affirmed this statement of the Pro-Life Committee. He said that the statement "rightly emphasizes that the omission of nutrition and hydration intended to cause a patient's death must be rejected and that, while giving careful consideration to all the factors involved, the presumption should be in favor of providing medically assisted nutrition and hydration to all patients who need them. To blur this distinction is to introduce a source of countless injustices and much additional anguish, affecting both those already suffering from ill health or the deterioration which comes with age, and their loved ones" (Catholic News Service, Oct. 5, 1998). Interestingly, the Oct. 2 meeting was the same day the tubes providing food and water for Hugh Finn were removed.
Therefore, nutrition and hydration (food and water) are considered normal, basic, ordinary care. Moreover, nutrition and hydration provided through IVs or gastric tubes do not generally cause grave discomfort; serious, lasting side effects; or costly financial burdens. (Please note that if a serious medical condition did arise from the means of providing nutrition and hydration, the proportion of benefit would have to be considered against the burden.) Generally, providing a patient with nutrition and hydration may cease only when a person is imminently dying and such care is really useless, or when the person can no longer assimilate the nutrition and hydration. (Confer William May, et. al., Feeding and Hydrating the Permanently Unconscious and Other Vulnerable Persons, 1987).
A truly vulnerable person in this matter is the one in a persistent vegetative state (PVS). Note that we must be careful not to confuse PVS with brain death. PVS is deeper than a coma; it is a form of deep unconsciousness. Here the cerebrum is impaired and therefore many of the regular activities of a person cease. However, the brain stem is still functioning, and this portion of the brain controls involuntary functions such as breathing, blinking, involuntary contractions, and cycles of waking and sleep. A PVS patient may also have a near-normal EEG. Keep in mind that the diagnosis of "brain death" is based on the "total and irreversible cessation of all brain function, including the brain stem" (cited in the Cruzon case). A PVS patient is therefore alive. Granted, the likelihood of his recovery is slim. Nevertheless, to remove nutrition and hydration must not be with the intention to kill the patient. (Confer Pennsylvania Catholic Bishops, Nutrition and Hydration: Moral Considerations, pp. 7-8.)
Finally, the last moral point to remember is our Christian perspective of suffering. No one enjoys suffering. However, we must remember that each of us was baptized into Christ's passion, death, and resurrection. We all share in our Lord's cross, and that at times may be very painful. This suffering, however, especially at the last moments of one's life, must be seen as a sharing in our Lord's sufferings. By uniting our suffering with our Lord's, we expiate the hurt caused by our own sins and help to expiate the sins of others, just as some of the early martyrs did who offered their sufferings for sinners. Sometimes, such suffering finally heals the wounds that have divided families. In all, we must look to Christ to aid us in our suffering and guide us from this life to Himself.
In all of these principles, the Church strives to uphold the sanctity of human life as well as provide clear moral guidance in an age where medical technology-- for all of its goodness-- has complicated dying. We must never forget that there is a great difference between purposely killing someone and allowing a dying person to die peacefully with dignity. We must remember that "what a sick person needs, besides medical care, is love, the human and supernatural warmth with which the sick person can and ought to be surrounded by all those close to him or her, parents and children, doctors and nurses" (Declaration on Euthanasia). Sharing in the sufferings of our loved ones and helping them to prepare to return to our Lord is indeed a great act of love.
Fr. Saunders is pastor of Queen of Apostles Parish in Alexandria. © Arlington Catholic Herald, 200 N. Glebe Rd., Suite 607, Arlington, VA 22203-3797, (703) 841-2565, www.catholicherald.com.
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