Should we use every means medically possible to keep an ill person alive?

Question: Should we use every means medically possible to keep an ill person alive? What is the Catholic teaching on this question?

I reviewed some of the general principles that Catholics apply to the question of using medical technology to sustain or prolong a person’s life. Such questions are in the realm of the discipline of bioethics, which explores the ethical questions that arise in the presence of such dramatic advances in medical technology as we have seen in recent years. Bioethics is a relatively recent field, mostly developed since the 1960s, and represents the best attempts of ethicists to respond to rapidly changing situations in the light of the fundamental values of life, freedom, and human dignity.

I also explored more particularly the situation of a person who, as in the recent widely publicized case of Terri Schiavo, is diagnosed as being in “a persistent vegetative state.” A person in this condition is not able to swallow or take nourishment on his or her own, but not in immanent danger of death, so long as he or she is hydrated artificially. What are the moral implications of disconnecting this person’s feeding tube, which will result in his or her eventual death from lack of water and nourishment?

In the past, Church teaching has approached such questions by employing a distinction between “ordinary” and “extraordinary” means. Any means is considered ordinary when the benefit to me is greater than, or at least equal to, the burden. “Extraordinary means” involves burdens greater than the benefits to me, such as negative side effects and the impact upon my total state of health. The definition of what is ordinary and what extraordinary is reserved to the individual. What may be a benefit or a burden for one person may not be viewed that way by another. Thus, I have the fundamental responsibility to make this decision with regard to my own life, although it’s wise to consult with doctors, family and trusted advisors.

But what if the ill person is no longer conscious or competent to assume that responsibility? The most common view has been that the right to make health care decisions for myself can be maintained in the form of a proxy who can exercise the right to decide for me. In that case it’s very important to leave instructions regarding my own wishes, which the proxy is morally bound to follow. If I have left no instructions, then the proxy can make the decision, in the presumption that he or she knew me well enough to decide what is in my best interest and what my wishes would have been in such a circumstance.

The standard Catholic teaching since the new medical technologies have been developing is that when one is near death or terminally ill, one need not start or continue procedures that merely prolong dying. The same moral consensus held about persons who were so brain damaged that they were in what was judged by the doctors to be a permanent coma, incapable of revival. In this case, treatments such as a ventilator or an artificial feeding and hydration tube would be considered “extraordinary.” A persistent vegetative state is considered exactly like being in a coma in terms of the person’s experience and consciousness, except for the fact that his or her eyes are open, whereas in a coma they remain closed. If a persistent vegetative state is diagnosed accurately and allowed to continue long enough to ensure that there is no medical potential for reversal, Catholic teaching allows a proxy to judge the use of artificially administered food and water to be extraordinary for this person and to discontinue their use.

For the Catholic, another factor entering into the making of such a decision is belief in the resurrection and eternal life. As R.M. Friday notes in the New Catholic Encyclopedia, this belief “frees the believer and his or her family and care-givers to allow ‘letting go’ of this gift of biological life entrusted to the person by the Creator in order to attain the greater gift of eternal life with God.” (NCE, 2nd edition, p. 459). David Brooks noted in an op-ed column in The New York Times, “most of us believe in transcendence, in a life beyond this one. Therefore why is it so necessary to cling ferociously to this life? Why not allow the soul to ascend to whatever is in store for it?” (NYTimes, March 26, 2005).

There seems to be developing among some Catholics a point of view which challenges this recent tradition of the Church and holds that artificially admionistered fluid and nutrition is absolutely ordinary in all cases, including those of persons in a coma or persistent vegetative state. Some argue that maintaining biological life, even without consciousness, is of sufficient benefit to the patient. Others recognize that the individual patient may not receive benefit but that continuing to maintain his or her life is symbolic of respect for life in general, and especially for that of the weakest of the living. This certainly remains at present a minority point of view which, if it were to gather a future consensus, would mark a shift away from what has long been regarded as the mainstream Catholic position.

The case of Terri Schiavo has made evident the anguish involved in such decisions and the need to approach what are often complex and ambiguous situations with prayer, thoughtful respect, and humility.