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In this nation, many families face end-of-life
issues each day involving loved ones and family members. Most of
these decisions are made quietly with the assistance not only of
medical doctors and health care professionals but often with the
advice of members of the clergy and counselors. Few decisions
reach the level of public notice as the case involving Terri
Schiavo. Despite the prayers of many, myself included, her
family has not been able to come together to make a single,
unified, mutually agreed upon decision concerning Terri’s
situation. Now the matter is approaching a legal climax with
judges making decisions properly reserved for families. How sad.
Some in Terri’s family believe that her condition calls for the
removal of her feeding tube and others do not. Even physicians,
who have evaluated Terri’s condition, with varying degrees of
access for clinical analysis, disagree on her condition. In
Florida, when families cannot agree, trial judges are permitted
to act as proxies and make decisions about life-prolonging
procedures. In so doing, we ask our judges to make decisions
that they might not make for themselves or their loved ones, but
ones that clear and convincing evidence shows the individual
would make for herself or himself.
Proper care of our lives requires that we seek necessary medical
care from others but we are not required to use every possible
remedy in every circumstance. We are obliged to preserve our own
lives, and help others preserve theirs, by use of means that
have a reasonable hope of sustaining life without imposing
unreasonable burdens on those we seek to help, that is, on the
patient and his or her family and community. In general, we are
only required to use ordinary means that do not involve an
excessive burden, for others or for our ourselves. What may be
too difficult for some may not be for others.
Our Catholic Church has traditionally viewed medical treatment
as excessively burdensome if it is “too painful, too damaging to
the patient’s bodily self and functioning, too psychologically
repugnant to the patient, too suppressive of the patient’s
mental life, or too expensive.” [cf. “Life, Death and Treatment
of Dying Patients: Pastoral Statement of the Catholic Bishops of
Florida, 1989]
Our Catholic teaching is also clear that “nourishment or
hydration may be withheld or withdrawn where that treatment
itself is causing harm to the patient or is useless because the
patient’s death is imminent, as long as the patient is made
comfortable. In general, the terms ‘death is imminent’ and
‘terminally ill’ imply that a physician can predict that the
patient will die of the fatal pathology within a few days or
weeks, regardless of what life prolonging methods are utilized.”
[Statement of Florida bishops cited above]
Terri Schiavo’s case is especially difficult because her actual
medical situation is in dispute. The court has determined based
on the medical evidence which was presented to it that she is in
a “persistent or permanent vegetative state,” commonly referred
to as PVS. Her husband agrees with this. Her parents and other
family members do not. Physicians who have examined her also
have opposing opinions. It is currently assumed that Terri
cannot swallow food naturally. All agree, however, that there is
extensive and permanent damage to her brain but it is not clear
whether the medically assisted nutrition and hydration is
delaying her dying process to no avail, is unreasonably
burdensome for her, and contrary to what she would wish if she
could tell us.
In these most difficult cases, our Church teaching is that there
should be a presumption in favor of providing medically assisted
nutrition and hydration to all patients as long as it is of
sufficient benefit to outweigh the burdens involved to the
patient.
If Terri’s feeding tube is removed, it will undoubtedly be
followed by her death. If it were to be removed because the
nutrition which she receives from it is of no use to her, or
because it is unreasonably burdensome for her and her family or
her caregivers, it could be seen as permissible. But if it were
to be removed simply because she is not dying quickly enough and
some believe she would be better off because of her low quality
of life, this would be wrong.
This situation is tragic. I strongly recommend that
1. in the presence of so
much uncertainty and dispute about her actual physical state,
all parties pursue a clearer understanding of her actual
physical condition;
2. Terri’s family be allowed to attempt a medical protocol which
they feel would improve her condition;
3. Excessive rhetoric like the use of “murder” or the
designation of the trial judge or appellate judges as
“murderers” not be used by anyone from our Judeo-Christian
tradition. This is a much harder case than those who use facile
language might know.
Please join me in praying for a peaceful, moral, legal and just
resolution of this case.
At some point in time, we will all face “end of life.” Each
person has an uncertain future and we live in a world of
constant technological changes and developments. When a person
is not competent to make his or her own decisions, it is very
appropriate for a family member or guardian to be designated as
a proxy to represent the patient’s interests and interpret his
or her wishes. Decisions made by those legally entitled to act
for the patient must always be respected. For this reason, I
wish to use this moment to remind all our Catholic people that
it is extremely important for all to have designated a medical
proxy to someone who is trusted and to leave a “living will” in
which you indicate your wishes. It is also important to note
that such proxies and medical directions can never “trump” or
override appropriate moral considerations. In this regard,
Catholic teaching notes that the proxy may not deliberately
cause a patient’s death or refuse ordinary and normal treatment,
even if he or she believes a patient would have made such a
decision. I encourage everyone to
1. Become informed about the
complexities surrounding end of life issues, discuss them with
your families and doctors, and formulate your own wishes that
could direct treatment;
2. Designate a medical surrogate to act on your behalf in the
eventuality that your own competence is impeded at some time in
the future.
3. Have in place and on file, with your family, medical
surrogate, attorney, or perhaps even your pastor, a “living
will.”
My prayer is that these words will help others in the future
avoid the situation that surrounds the case of Terri Schiavo.
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