Truncating Catholic Tradition: Florida Bishops Avoid Full Consideration of Ethical Issues in Schiavo Case

Article excerpt

For most of Christian history, Roman Catholics wrote the book on medical ethics. As David Kelly explains in Contemporary Catholic Health Care Ethics, the best discussions and writings on moral issues in medicine took place in the church from the 12th century until about 1970, when the secular discussion of bioethics began to develop rapidly. The reasons were simple: pastoral concern for the physical and not just the spiritual health of those under clerical care, well-developed medical and moral traditions from ancient Greece and Rome that were preserved and expanded by clerics and laity in the church, and awareness that matters of health and life involved moral issues of great importance. So it is not surprising that church leaders were active in the controversial discussions about the case of Terri Schiavo, who died March 31.

The Catholic bishops in Florida have taken the lead in this discussion, and rightfully so. Terri Schiavo was Catholic and a Florida resident, as are her parents, Bob and Mary Schindler. At the practical level, her situation is of acute interest because many people find themselves faced with similar issues. At the theoretical level, the questions raised are important for how they relate to traditional Catholic teachings. The bishops' teachings have been sometimes less than helpful, however, because they have not represented adequately their own medical ethical traditions. By selecting and using limited aspects of the received tradition, the bishops have avoided full consideration of the issues.

Pope John Paul II's 1980 "Declaration on Euthanasia" is the standard Catholic reference on end-of-life issues. In section IV, it presents this set of principles: 1) It is for the consciences of sick persons or those qualified to speak in their name to make these decisions. 2) There is a duty to care for one's own health or to seek care from others. 3) Those who care for the sick should use remedies that seem necessary or useful. 4) The principle that one is never obliged to use "extraordinary" or "disproportionate" means to preserve life still holds good. 5) "In any case, it will be possible to make a correct judgment as to the means by studying the type of treatment to be used, its degree of complexity or risk, its cost and the possibilities of using it, and comparing these elements with the result that can be expected, taking into account the state of the sick person and his or her physical and moral resources." 6) It is wrong to "impose on anyone the obligation to have recourse to a technique which is already in use but which carries a risk or is burdensome."

Clarification is necessary here to avoid needless confusion. First of all, to say that it is for the conscience of sick persons (or their proxies) to decide means that conscience is the ultimate subjective norm of morality in those particular cases. That is standard Catholic moral teaching. When the bishops and the pope teach, however, they discuss objective norms of morality that apply in general. They do not (indeed, cannot) tell people how to act in conscience because conscience is the domain of the person before God. Second, the distinction between "extraordinary" and "ordinary" means is a moral, not a medical, distinction. This means that ill persons, not doctors, determine what constitutes "extraordinary" and "ordinary" means, and that they do this according to an assessment of the burdens and benefits involved, not in line with the criteria of normal medical practice. It is here that differences in moral judgment often arise.

In a March 2004 address on "Life-Sustaining Treatments and Vegetative State," Pope John Paul II said, "The administration of water and food, even when provided by artificial means ... should be considered, in principle, ordinary and proportionate, and as such 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 [sic] suffering. …