Via RNS

In a recent column (originally published on Religion News Service), Charles C Camosy, in writing about new research about people who are in a "persistent vegetative state", cited Dr Joseph Fins’ studies of what Fins calls "deep brain stimulation". Fins reports that his research reveals that many patients diagnosed as in a persistent vegetative state in fact have some level of consciousness.

That leads Fins, and with him Camosy, to favour "a new civil rights" movement to be sure all brain-injured patients get “up-to-date” diagnoses, good pain management and the latest therapies to help them improve. That aspirational goal sounds as if it ought to be readily adopted.

Patient care

Photo courtesy of Pixabay/Creative Commons

 

"Camosy’s view that medically assisted feeding and hydration are “ordinary” treatments means they would be morally required. But traditionally, a medical treatment is considered “ordinary” only if it offers hope of improved health. If there is no hope of improvement, there is no moral reason to pursue the treatment."

But Camosy goes further by invoking the case of Terri Schiavo, the Florida woman in a persistent vegetative state whose case drew international attention in the mid-2000s when her husband moved to end her life support. "We were there for Terri Schiavo and her family,” Camosy notes, before saying, “There are new and influential allies to be had in the fight to protect people who have serious brain injuries.” He concludes, “The time to move is now.”

It is important not to confuse Schiavo's case with the patients with whom Fins is concerned. In his autopsy report, Florida’s Pinellas County chief medical examiner, Jon R Thogmartin, confirmed that her condition was consistent with that of someone in a persistent vegetative state, that her brain had "atrophied" to about half that of normal, that she was blind and that no treatment could have remotely improved her condition.

Throughout his piece, Camosy’s analysis, unlike Fins', does not differentiate among the categories of those who suffer serious brain injuries: “brain death,” “persistent vegetative state,” “locked in syndrome,” a “minimally conscious state” and “coma.” For Camosy, all of these are lumped into “persistent vegetative states” and classified as “vegetables.”

In this Camosy is not unique. John Paul II in a 2004 address to the Pontifical Academy for Life argued that patients in a persistent vegetative state are not vegetables, but human beings with all of the dignity of others created as humans. In the same address John Paul maintained that "artificial" nutrition and fluids are "natural" means, not medical treatments. As such they are "ordinary care" that must be provided to every unconscious patient.

Every medical association that has addressed the issue and every court of final jurisdiction that has ruled on it, including the US Supreme Court, has rejected that analysis. Each declared that artificial nutrition and fluids, unlike food and water, are medical treatments to be assessed as any other medical intervention, ie, on the subjective assessment of the patient (or proxy), as to the proportionate benefit and burden of the intervention.

Here the medical societies and the various appellate courts follow the consistent analysis of Catholic moral theology from Pope Basil the Great in the 4th century through the Vatican’s 1980 Declaration on Euthanasia and John Paul II’s 1995 encyclical Evangelium Vitae, all of which hold that medical interventions have limited efficacy. They are to be utilised on the basis of the patient’s (or proxy’s) judgment on the benefit and burden that accrue to the patient from their use. 

Camosy’s view that medically assisted feeding and hydration are “ordinary” treatments means they would be morally required. But traditionally, a medical treatment is considered “ordinary” only if it offers hope of improved health. If there is no hope of improvement, there is no moral reason to pursue the treatment.

Even if there is a hope of benefit, the benefit alone does not always make a treatment morally obligatory. If a treatment is either physically or morally burdensome for the patient or others, then one can morally withhold or withdraw the treatment. The assessment of the burdensomeness of a treatment is a quality-of-life judgment, made by the patient or her surrogates, relative to the patient’s perception of his or her own life.

In his 1957 address to physicians, Pope Pius XII made what is considered a classic statement on medical care and reminds us that a Christian’s life is not just about being alive. Rather, all of our activities are subordinated to our spiritual ends. We are more than biological life and called to higher spiritual goals.

In addition to ignoring the traditional Catholic teaching on the due use of medical remedies, Camosy omits any mention of the landmark 1974 essay entitled "To Save or Let Die? The Dilemma of Modern Medicine" by Rev Richard McCormick, widely considered the most distinguished Catholic moral theologian of the late 20th century. In his essay, published in The Journal of the American Medical Association, McCormick set out a standard on which to make that assessment. “Granted that by using modern medical technology the life can be saved," he asked, "but what kind of a life are we saving?”

In a profoundly theological analysis, McCormick notes that life was created by God, not as an end in itself, but after this mortal coil is completed for "eternal dwelling" with God.

Thus for McCormick, as it was for Basil the Great, Thomas Aquinas in the 13th century and the outstanding Dominican moral theologians of the 16th century, there was no moral duty to employ technological means to extend the life of a patient who would have to "endure the unendurable" to attain a prolonged and perilous existence. In his Long Rules, Basil condemned “whatever requires an undue amount of thought or trouble or involves a large expenditure of effort and causes our whole life to revolve, as it were, around solicitude for the flesh.”

McCormick put it more succinctly when he wrote of the 1974 opinion by Maine Superior Court Judge David Roberts in Houle v Maine Medical Center that if there is a medical need and there is a feasible medical intervention, that intervention must be utilized to preserve the patient’s life. In McCormick’s words, “Such a standard is nothing short of "idolatry.”

Human life, he asserts, is a gift from God given for limited purposes. Its raison d’etre is both earthly and eternal life.

"A failure to appreciate the historical context of the ‘sanctity of life’ has led some to distort its meaning. In doing so, they attempt to impose the duty to extend every life regardless of medicine’s capacity to do so or the patient’s desire for an extended dying process. Therein lies the danger of over-reading Fins’ research."

In support of his opinion, McCormick cited Pope Pius XII’s 1957 statement to the International Congress of Anesthesiologists entitled “Prolonging Life.” Pius maintained that we are morally obliged to use only "ordinary means" to preserve life. In the extensive history of Catholic moral analysis, the terms "ordinary" and "extraordinary" refers not to hardware or technique but to moral obligation. A failure to observe that obligation would be seriously sinful. The Vatican's Declaration on Euthanasia, aware that "ordinary" and "extraordinary" are frequently confused, misused and abused, proposed substituting "proportionate" and "disproportionate" benefit and burden to the patient.

A failure to appreciate the historical context of the ‘sanctity of life’ has led some to distort its meaning. In doing so, they attempt to impose the duty to extend every life regardless of medicine’s capacity to do so or the patient’s desire for an extended dying process. Therein lies the danger of over-reading Fins’ research.

In his book Rights Come to Mind, Fins himself observes, “The Schiavo case was a source of a great deal of misinformation with politicians and others deliberately misusing medical terms for ideological purposes.” He warns, “In this early stage of their development, neuroimaging methods do more to deepen the mysteries of the mind than resolve them.”

Such restraint is a call for further study, not a clarion call for action. As Justice Louis Brandeis cautioned in Olmstead v US, “The greatest dangers to liberty lurk in insidious encroachment by men of zeal, well meaning but without understanding.”

Rev John J Paris is a professor emeritus and research professor at Boston College. Rev Kevin Wildes is university professor at St Joseph’s University. Both are Jesuit priests.