Excellent Article on "Care" vs Heroic Measures

The lessons of Terri Schiavo

The difference between taking care and heroic measures

Father Raymond J. de Souza

National Post (Canada)

April 1, 2005

Theresa Marie Schiavo has died. Despite her suffering, the human response is sadness at the loss of life because life is always, in even a weak or disabled state, a great good. We pray now that she might enjoy eternal life in the company of the saints in heaven, which is an even greater good.

And therein lies the delicate balance for the Christian believer, as Mrs. Schiavo was. For life is always good -- it is never "unworthy of life"; a human being never becomes a vegetable; life is never without inherent dignity. It is always wrong to destroy innocent human life, even -- or especially – life that is weak.

At the same time, life in this world is not the ultimate good. There are many goods greater even than earthly life -- the truth, faith, honour, loyalty, love. That's why a father does not hesitate in risking his life to protect his family; it is why the church honours the witness of the martyrs. Life in this world -- even for those with longevity -- is only a short prelude to eternity. That's why eternal life is the greater good.

So it is not necessary to prolong life in this world in the face of imminent death, or ravaging disease, or the demands that one's faith be betrayed.

But one cannot deliberately act to directly kill innocent life, whether one's own or another's.

The Schiavo case has given rise to much confusion. The fact that Pope John Paul II had a nasal feeding tube inserted on the day she died caused greater confusion still.

Classic moral thinking about such matters insists that, while there is an obligation to take care of one's own life and health, there is no need to undergo treatment that is disproportionate to the foreseen benefits. That's why many elderly people refuse the radiation or chemotherapy younger people would routinely take.

The key question relates to what constitutes medical treatment and what is just ordinary care. It is generally considered that ordinary care -- which does not constitute treatment -- includes warmth, hygiene, nutrition, hydration and pain control. Ordinary care is not "life support"; it is possible to die from infected bedsores, but preventing bedsores in a comatose patient is not "life support."

In case of imminent death, even ordinary care can be forgone. There is no need to use an IV for fluids if the patient will die tomorrow. But it would be wrong to withhold or refuse ordinary care, especially if it was intended to hasten death.

A good rule of thumb is to ask: What will cause the patient's death?

If it will be dehydration or starvation, then ordinary care, including food and water, should be provided. Otherwise, death is not the result of disease or trauma, but from lack of ordinary care. That's the moral difference between allowing someone to die, and actively causing death. Mrs. Schiavo was not dying; her death was the result of her food supply being cut off.

There are thousands of cases every day in which further medical treatment is refused on the grounds that it would be too burdensome. There are many cases in which even ordinary care is withdrawn because death is imminent, a matter of hours or a few days. No one need die hooked up to a vast array of machines. But it is a different matter to die for lack of food and water.

Yesterday's news also indicated that Pope John Paul II was not getting enough food after his tracheotomy, and so he has had a nasal feeding tube inserted to enhance his nutrition. He is obviously not on "life support" -- the feeding tube is the provision of ordinary care.

Some commentators speculated that the news was evidence that, if it came to that, John Paul would want to be on "life support" as long as possible. There is no evidence for that. The acceptance of ordinary care -- tube feeding -- does not imply anything about other treatment. Given his age and deteriorating medical condition, it would be perfectly understandable -- and morally permissible -- if John Paul indicated that he wished no more aggressive medical treatments.

About five years ago, John Paul himself wrote: "Despite the limitations brought on by age, I continue to enjoy life. At the same time, I find great peace in thinking of the time when the Lord will call me: from life to life!"

That is the balance -- to treasure life in this world and to look forward to life in the next. Death is part of life, killing is not. The lines can become blurred and the situations complex, but the principle remains: Life is always good, but not the greatest good.

© National Post 2005