Schiavo Case Highlights Divisions in Catholic Views on Treatment

Article excerpt

Catholic teaching and secular medical ethicists agree that those charged with deciding the fate of deeply debilitated family members should ultimately weigh two factors. First, the medical situation--what precisely is the person suffering from and what are the benefits and burdens that would likely flow from a particular course of action? Next, the patient's wishes: What would the family member want?

It's a thoughtful two-tiered analysis that, in the extraordinarily tangled case of 41-year-old Terri Schiavo, provides precious little guidance.

Medically, Florida courts have accepted the determination that Schiavo is in a "persistent vegetative state"--unaware of the world, unable to interact with those around her, and unlikely to improve. Others, including Schiavo's parents, contend that she may be in a "minimally conscious state"--aware to some degree of her environment, capable of limited interaction, and a candidate for therapeutic treatment that could yield tangible benefits.

"You've got competent medical experts lined up on both sides," said Dr. John Kilner, president of The Center for Bioethics and Human Dignity, Bannockburn, Ill.

And Schiavo's wishes? Florida courts have sided with Schiavo's husband, Michael, who says that prior to Terri's February 1990 incapacitation, she told him that she would not wish to continue to live if she found herself in such circumstances. But Michael Schiavo, say others, is hopelessly compromised--with both financial conflicts (he benefited from a malpractice award related to Terri's care) and personal interests (he is involved in a relationship with another woman who is the mother of his two children).

"You can't help but wonder about his motives," said Russell B. Connors, assistant professor of theology at Minnesota's College of St. Catherine.

"In the absence of an advance directive, there's commonly an ordering of who is in the best position to act in [the patient's] best interests and it's normal and natural that the spouse would be at the top of the list because the spouse has a unique relational commitment to that person," said Kilner. But in the Schiavo case, "virtually anyone would be in a better position [to carry out that role] than her husband."

Despite disputes over the nature of Terri Schiavo's condition and her intentions, the law has spoken and the gastric tube that provided her nourishment has been removed.

Does Catholic teaching allow for such a course of action? It depends, once again, on both the individual circumstances and the individual answering the question.

Though the terms are often misunderstood, traditional Catholic teaching distinguishes between "extraordinary" and "ordinary" means of medical treatment. "Extraordinary" doesn't necessarily mean cutting edge. Instead it relates to the burdens (physical, financial, familial) and benefits (such as extended life) that a particular treatment or procedure might entail. Depending on the circumstances, treatment with an antibiotic could be considered "extraordinary," while use of a Ventilator to allow breathing may be "ordinary." Generally speaking, Catholics are free to forgo "extraordinary" treatment and obligated to accept "ordinary" treatment.

As the U.S. bishops said in June 2001, "A person may forgo extraordinary or disproportionate means of preserving life. Disproportionate means are those that in the patient's judgment do not offer a reasonable hope of benefit or entail an excessive burden, or impose excessive expense on the family or the community." The bishops' "Ethical and Religious Directives for Catholic Health Care Services" also say, "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."

Such nuances--"sufficient benefit to outweigh the burdens involved"--were largely cast aside a year ago by Pope John Paul II when he declared that nutrition and hydration is not treatment, but instead a routine form of care that should be available to everyone, including those in a persistent vegetative state. …