Amen, Bro.

It's hardly a case of the "elite" slecting who should die; if Terri Schiavo's husband and parents agreed one way or the other or if she had left a living will clearly stating her intentions there would be no news story. The choice, in any event, will remain with either her husband or her parents; the law is not forcing anyone to pull out the feeding tube.

The main reason for the media bias, I believe, is that the people covering it can't imagine that if they were in Terri's position they would want the treatment to continue. This is hardly unreasonable; one doesn't have to embrace the "culture of death" to come to this conclusion. Quoting from Catholic Catechism at http://www.andrewsullivan.com/index.php?dish_inc=archives/2003_10_26_dish_archive.html#106731730741746821 :

"Discontinuing medical procedures that are burdensome, dangerous, extraordinary or disproportionate to the expected outcome can be legitimate; it is the refusal of 'overzealous' treatment. Here one does not will to cause death; one's inability to impede it is merely accepted."

I think a conscientious Catholic might reasonably decide that the treatment here is disproportionate to the expected outcome, though in this case there's enough doubt about Schiavo's wishes that treatment should clearly be continued.

Food is burdensome and disproportionate?

OJ -

Exactly so.

They are killing her *slowly* by removing her feeding tube - and it is just as deliberate as a bullet to the brain. A truly merciful killing would have her die quickly, but would remove the illusion of non-responsibility. Can't have that, right?

Bruce:

Nothing better illustrates the moral tansgression of those who advocate the culture of death than their inability to use traditional terms to speak of what they advocate. We don't kill babies we choose not to carry fetuses to term. We don't kill the disabled, we allow those who are no longer human to die peacefully. Etc.

OJ:

According to the catechism, deciding whether sustanence is disproportionate is with respect to the expected outcome.

In that sense, food is no different than a respirator.

What is the evidence that we can't impede Ms Schiavo's imminent death by merely feeding her?

The doctrine, as I understand it, allows someone who already has numerous severe health problems to decline further medical treatment if the treatment would only give him a few more weeks of life. Such a person could decline dialysis if his kidneys failed, though that would kill himself as surely a bullet to the brain. (And dialysis is less physically intrusive then forcing formula through a tube down someone's throat directly into his stomach.) The basic principle is to sometimes let the body go and let the soul return to God.

The Catechism's wording implies that declining medical treatment is acceptable only when death is imminent and apparently excludes someone in a persistent vegetative state (PVS). But I wonder if the underlying principle applies to PVS when it's believed to be irreversible. (There seems to be some doubt about Terri Schiavo; her parents hope that more aggressive therapy will make her more responsive.) In the hypothetical case above even someone very ill could potentially do more with another few weeks than someone who's permanently vegetative could ever do. If the expected outcome is keeping the rest of the body alive after a lot of the brain tissue has died, then even a feeding tube may be overzealous.

I'm no expert on Catholicism, but the idea that the Church says it's morally permissible to refuse dialysis seems lunatic.

I don't think it'd be permissible to refuse dialysis if your only health problem were with your kidneys. I was imagining a scenario in which you are already critically ill, and then your kidneys fail on top of everything else that's wrong with you.

Peter:

Yes, well, no one is suggesting that government stop people from killing themselves. That's a moral questuion between them and their God. The issue is can you require others to help kill you or make the decision to kill another for them.

OJ:

That's as may be. It seems, though, the words mean that if, as in Terri's case, no amount of medical treatment has any chance of success, then it is morally permissible to end intrusive treatment.

Some may conclude that 13 years is sufficient evidence that no favorable outcome is at all possible.

Jeff:

These are the words cited:

"Discontinuing medical procedures that are burdensome, dangerous, extraordinary or disproportionate to the expected outcome can be legitimate; it is the refusal of 'overzealous' treatment. Here one does not will to cause death; one's inability to impede it is merely accepted."

In order to kill Ms Schiavo it will be necessary to starve her to death. Feeding can not be burdensome or overzealous. Death is not inevitable but will be forced.

Jeff:

Re: your first post.

No offence, good buddy, but you have just given a terrific example of why an exclusive reliance on scientific rationalism can be so dangerous. By methodically applying its principles with rigour and logic, you have argued yourself into the position where you can't tell the difference between failure to recusitate someone and denying them food. Imagine what such confusion could do in the hands of an enthusiastic bureaucrat.

A simple, uneducated woman is supposed to have said to Darwin in answer to his agnostic musings: "Mr. Darwin, I know sugar is sweet in my mouth and I know my redeemer liveth." Jeff, put your test tubes and calculators away. We know what is killing and what is ceasing to use artifical means to extend life fruitlessly.

But you are using artificial means to keep people in vegetative states alive (unless you consider feeding tubes to be "natural"). People in PVS also require a certain level of medical care to prevent infections from developing. Death from starvation is not a whole lot more gruesome than death from suffocation (if someone who had stopped breathing were not respirated), heart failure, renal failure, or any other common exit.

Regarding PVS, we can identify three issues:

(1) If you have no real idea of what the person would have wanted, what should the default position of the law be? I'd say keep the tube in, regardless of what a spouse says.

(2) Should the law allow "living wills" to cover PVS? I'd say yes.

(3) Is it moral for someone to make a living will requesting that the tube be removed if he's diagnosed as being permanently vegetative? I'd say yes. The Catholic Church, hardly a contributor to the "culture of death", allows people with terminal diseases to refuse aggressive treatment and check into a hospice instead of a hospital. Yet If I were permanently vegetative, then my brain tissue would already be as thoroughly destroyed as it might eventually be by brain cancer.

The best argument against is that it's tough to make a proper prognosis on whether someone is permanently vegetative, so people like Terri's creepy husband might jump the gun. But if an accurate prognosis can be made, then allowing someone to write a living will specifying that the tube be withdrawn and all other treatment halted (except treatment for pain) seems more consistent with the principle behind the Catholic doctrine than keeping the body alive after the mind is long gone. This would prevent us from callously bumping people off when their lives become too inconvenient for the rest of us, while allowing someone to reject what strikes me as overzealous treatment disproportionate to the expected outcome.

Peter:

Anytime you allow me to bind you to an action that you may consider immoral you've stumbled into a ground where it's futile to speak of morality any longer. Let those who can kill themselves, but don't let them or those who can't kill themselves make others do the killing. In particular, don't allow them to make doctors (whose primary concern should be life)kill people and don't hand the decision to those who have a vested interest in death (heirs, insurance companies, hospitals). Want to kill people? Have judicial panels decide to kill them, have their estates revert to charity, and have designated executioners do the killing.

It's hard to see how you can have any system of government without binding people to actions they consider immoral. Some consider the war in Iraq to be utterly immoral, yet we are all obliged to pay taxes to support it. Some consider it immoral to stop treating a brain dead patient under any circumstances; others consider it immoral to continue treatment if the brain dead person had left clear instructions to the contrary in a living will.

I certainly agree with you that the decision should not be left to doctors or people who might have a conflict of interest, so any "do not resuscitate" order or order to remove the feeding tube should only come from a probate judge authorized to do so by a living will.

Peter:

We don't make people kill people in war if they have moral objections.

Peter B:

Peter Caress makes my point better than I did. But, despite not being Catholic, I can read and understand English.

The operative term is "overzealous," which is related to the expected outcome. If there is no expectation that Terri condition will ever change, then forced feeding is the only thing separating her from an eventual death, and fulfills the same function as a respirator--unless you can somehow morally separate forced breathing from forced feeding.

The text cited provides guidance on what constitutes an morally acceptable decision. Absent the money angle, I would be willing to bet plenty of Catholics would fall out on both sides of this one.

Jeff:

we've provided each other food in times of need for millions of years. Seldom with breath.

Jeff:

"Forced feeding"? Do you consider CPR to be "forced breathing" and therefore morally dicey absent clear consent.

I have no problem with the living will for seniors or childless adults, but unless the law demands the same kind of rigourous formality and proof of an absence of duress and conflicts of interest that it used to demand for ordinary wills, you are going to have a lot of gray areas and a lot of pressure to kill within them.

That's as may be. All I'm doing is trying to parse what the Catholic guidance means.

Jeff:

Why? You aren't Catholic. Go with Darwin--kill the weak.