Wrestling with the final call
When it comes to end-of-life decisions, taking an ethical path isn't always easy
Many religious leaders and theologians, from Pope John Paul II to the Southern Baptist Convention's Richard Land, enjoin the faithful to reflect more on what they stipulate in their medical directives. "The law recognizes the right of a competent patient to direct the withholding or withdrawing of any intervention, including the provision of food," says Focus on the Family's James Dobson. Accepting the legality but questioning the morality of that right, he fears that "people are confused about what is morally appropriate and frightened by the prospect of being disabled."
Although there is a clear diversity of interpretation within faith traditions, the Schiavo case might make it harder for differing views to continue to coexist quite so easily. The Rev. John Paris, S.J., a Roman Catholic priest and professor of bioethics at Boston College, says that the removal of an artificial feeding tube is consistent with 400 years of Catholic teaching on the use of extraordinary means to preserve life. He says that his view is reflected in the practices of American Catholic hospitals. But other Catholics vigorously challenge Paris's claims. John Haas, president of the National Catholic Bioethics Center, points to the March 2004 comments of Pope John Paul II directed specifically at the care of PVS patients. In them, the pope instructed that "the administration of water and food, even when provided by artificial means, always represents a natural means of preserving life, not a medical act." And he elaborated that their suspension can only properly be described as "euthanasia by omission."
As for the Catholic Health Association of the United States, which represents America's 611 Catholic hospitals (more than 10 percent of all U.S. hospitals), its official statement on ethical issues raised by the Schiavo case says that decisions about suspending life-sustaining treatment "are made by assessing the potential burdens of the treatment in proportion to hoped-for benefits relative to the patient's condition and from the patient's perspective." Whether that represents a full or modified embrace of the pope's position, ethicists inside and outside the church disagree. But even someone as sanguine about the current consensus as Caplan worries that the Vatican's recent pronouncement "will put a chill on removal of tubes in Catholic hospitals."
It is not easy to say where most religious Americans stand on the Schiavo case and its ethical implications. But clearly a significant number--particularly evangelical Christians--line up firmly behind the thinking of ethicists like Gilbert Meilaender, a professor of theology at Valparaiso University and a member of the President's Council on Bioethics. "It's not clear that this is a dying patient," he says about Schiavo. "You are not letting her die; you are seeing to it that she does." But beyond the specifics of what he calls a "bad case," Meilaender is hopeful that the controversy will move the nation away from what he views as a "convenient" consensus about the removal of feeding tubes from PVS patients. If the result is an ethical uneasiness, it is preferable, he and many religiously minded ethicists hold, to a dangerous complacency.
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