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by Richard M. Doerflinger
April 9, 2004
Pope John Paul II recently gave a speech on our obligation to care for patients in a "vegetative" state. From some reactions, you would think he had brought back the Spanish Inquisition.
One harsh reaction came from Arthur Caplan, University of Pennsylvania bioethicist. His MSNBC commentary, "Must we all die with a feeding tube?", conjured a "cruel" scenario where patients are "forced to endure medical treatment that they do not want." He says the pope is attacking patient autonomy.
But Caplan is wrong about the problem, and wrong about the Holy Father's speech.
Here's the problem. Twenty years ago, many ethicists started urging broad policies for withdrawal of assisted feeding – not because it is especially ineffective, burdensome, or unwanted by patients, but, as ethicist Daniel Callahan warned, because the ethicists felt that "a denial of nutrition may in the long run become the only effective way to make certain that a large number of biologically tenacious patients actually die." Adding to the problem, health insurance policies now often reward undertreatment, and chronically disabled patients who can survive with basic care are frowned upon once they exceed the average cost allotment for their condition.
Even in the "tube feeding" cases that have divided families and sparked headlines, the patients generally said nothing clear in the matter; some family members want to continue their care while others want to let them die. Some relatives have said the patient is essentially already dead – an "empty shell" with no dignity.
What does this trend have to do with patient autonomy? Not much. If these patients had no human dignity, there would be no reason to respect their autonomy either.
This is the central problem the Holy Father addressed. He insisted that each and every human being has inherent dignity. Even the patient in the so-called "vegetative" state, who cannot visibly respond to us, is no "vegetable" but a human person loved by God; and "the value of a man's life cannot be made subordinate to any judgment of its quality expressed by other men." That patient, and his or her family, deserve the love and support of the entire community so they will not face their burdens alone.
The Holy Father also said that food and water should "in principle" be considered an "ordinary and proportionate" means for sustaining these patients' lives. Such feeding, even if it requires some medical assistance, is "morally obligatory" as long as it serves its proper goals – effectively providing nourishment and alleviating suffering. This was no rigid and mechanical edict, but a recognition that food and water are basic sustenance, without which all of us would die. They should be provided when they serve patients' basic needs, the first of which is life itself.
The Holy Father also cited the latest medical findings about the "vegetative" state, recounted by leading experts at the four-day-long conference preceding his speech. Increasingly, physicians don't know whether they can reliably diagnose such a state, predict its outcome, or estimate how much sensation and consciousness remains in these patients. Science is joining with morality to urge us not to make easy assumptions about these patients – not even, said the Holy Father, the assumption that they cannot feel the suffering of a death by dehydration.
This is no radical change in Church policy. Since 1992, for example, the U.S. bishops' Committee for Pro-Life Activities has urged a strong presumption in favor of assisted feeding for these patients. To be sure, the Pope's statement is especially strong. But he knows that, even as medical science increasingly urges us not to dismiss these helpless patients, medical "ethics" has tragically moved in the opposite direction.
Mr. Doerflinger is Deputy Director of the Secretariat for Pro-Life Activities, U.S. Conference of Catholic Bishops.
NOTE: The Holy Father's speech is available at: www.vatican.va/holy_father/john_paul_ii/speeches/2004/march/documents/hf_jp-ii_spe_20040320_congress-fiamc_en.html
The paper by the U.S. bishops' Committee for Pro-Life Activities is at: www.usccb.org/prolife/issues/euthanas/nutindex.htm
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