By Patricia Pitkus Bainbridge
Director, Respect Life Office
The circumstances surrounding Terri Schlinder Schiavo have raised many questions about end of life decisions. While some of these decisions may be fraught with complexities—making decisions difficult—the decision in Terri’s case should not be complex, The teachings of the Church provide the principles for moral decision making.
As many questions and comments have been directed to the Respect Life Office about Terri and her plight, I thought it might be helpful to share some of these questions and comments as well as the answers/responses.
Comment: “We don’t have enough information to offer an opinion on what should happen to Terri.”
Response: Saying we do not have enough information to opine about Terri Schiavo’s plight is like saying we don’t know enough about what happened in Auschwitz or Dachau to comment on those crimes against humanity.
While the secular media cannot be trusted always to report the truth, by selecting trusted sources of information, we know all we need to know to apply Church teaching to Terrri’s situation.
Question: “Well, what do we know about Terri?”
Answer: We know that she is 41 years old, that she is severely brain damaged, and that she is unable to speak or feed herself. As a result, she receives nutrition and hydration via a feeding tube. We know that she is not “hooked up” to life support and she is not receiving extraordinary medical treatment.
We cannot be certain about speculative reports concerning the circumstances surrounding Terri’s condition (what she can and cannot do), her estranged husband, and her prior wishes regarding being fed via a feeding tube.
Question: What exactly is a feeding tube?
Answer: “Feeding tube” is the common term used
to refer to methods of artificial nutrition and hydration (ANH). When a person is unable to eat or drink independently or has difficulty swallowing, nutrition and hydration may be provided by one of several means. Short-term ANH may be provided intravenously (IV) or by a nasogastic (NG) tube through the nose to the stomach.
For long-term ANH, a tube may be inserted into the stomach (percutaneous endoscopic gastrostomy— PEG). This is accomplished by a simple surgical procedure that may be done under local anesthetic in the patient’s room.
It is important to recognize that there are individuals who have feeding tubes and live otherwise normal lives. You might pass by someone carrying groceries for her family when she herself has a PEG tube.
Comment: Feeding tubes seem so unnatural.
Response: In the April 1995 edition of First Things, Nancy Harvey addresses this when she writes:
The extreme, high-tech procedures imagined by ordinary people are rarely the subject of debate; it is simple feeding tubes and common antibiotics that are labeled “unnatural” by “ethicists”—in the thought that the life which they sustain is also unnatural and should not be continued. Feeding tubes are artificial and unnatural, of course, although they are low-tech and simple to use. . . But the nature of man is to live in an unnatural environment. There are many people in our society who are kept alive by unnatural technology. There are many people with mild chronic diseases or physical handicaps who are not robust enough to live without electricity, running water, air-conditioning, cars, microwaves, and telephones.Nancy Harvey knows of what she writes—she receives nutrition and hydration via a feeding tube.
Perhaps we should ask a different question. Perhaps we should ask, “Is it natural or unnatural for man to use technology to increase his physical comfort?” Having spent a fair amount of time dehydrated and malnourished, I can confidently say that hydration is far more pleasant than the opposite. Anyone who doubts this can forgo fluids for a few days or nourishment for a few weeks and experience the reality. . . There may be times when a cancerous mass or fluid retention causes tube feeding to be painful. And there comes a time when the gut and kidneys shut down. The body cannot use food and water after that point, and death is very close. But I cannot understand taking away food and fluid before the body itself decides to quit.
Question: “Why don’t they just let Terri die? Why don’t they just let her go?”
Answer: Terri is not dying, While she is brain damaged, she is not in the process of dying. If, however, her feeding tube is removed, she will die a painful death due to dehydration and starvation. This will not be letting her die, this will be causing her death.
Question: What is the teaching of the Church regarding artificial nutrition and hydration?
Answer: The United States Conference of Catholic Bishops (USCCB) in its Ethical and Religious Directives for Catholic Health Care Services states, “There should be a presumption in favor of providing nutrition and hydration to all patients, including patients who require medically assisted nutrition, as long as this is of sufficient benefit to outweigh the burdens involved to the patient.”
ANH may become burdensome to the patient when he or she is truly in the process of dying from disease. When death is expected within a few hours or a few days, it may be morally acceptable to cease ANH as long as comfort care (including keeping the mouth, nose, and eyes moist) is provided. However, the USCCB Office of Pro-Life Activities paper, “Questions About Medically Assisted Nutrition and Hydration” states, “Even in the case of the imminently dying patient, of course, any action or omission that of itself or by intention causes death is to be absolutely rejected.”
On October 2, 1998 Pope John Paul II commented, “. . . a great teaching effort is needed to clarify the substantive moral difference between discontinuing medical procedures that may be burdensome, dangerous or disproportionate to the expected outcome, and taking away the ordinary means of preserving life such as feeding.”
The Holy Father clarified this difference in March 2004, when he said, “I should like particularly to underline how the administration of water and food, even when provided by artificial means, always represents a natural means of preserving life, not a medical act. Its use, furthermore, 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 suffering.”
Responding on February 28, 2005 to Terri Schiavo’s situation, the Florida Bishops write, “Simply put, we are called to provide basic means of sustenance such as food and water unless they are doing more harm than good to the patient, or are useless because the patient’s death is imminent. As long as they effectively provide nourishment and help provide comfort, we should see them as part of what we owe to all who are helpless and in our care.”
The Vatican recently spoke out against removing Terri’s feeding tube. Bishop Elio Sgreccia, president of the Academy for Life and the Vatican’s lead spokesman on bioethical issues, said, “To prevent someone access to food and water, represents a way of killing that person… we regard as illicit the decision to remove the gastric feeding tube from Mrs. Terri Schiavo…[it would be] a pitiless way to kill.”