For the Vatican, Schiavo’s Case Hits Close to Home
When the Vatican made the unusual move of taking sides in the case of Terri Schiavo, the parallels to the gradual incapacitation of Pope John Paul II were unmistakable.
Senior Vatican officials said the removal of the feeding tube from the severely brain-damaged Florida woman amounted to euthanasia. “It is a ruthless way to kill a person,” Monsignor Elio Sgreccia, the Vatican’s top bioethicist, said this month.
Sgreccia, head of the Pontifical Academy for Life, said the Vatican rarely voiced opinions on specific legal cases but decided that silence this time might be interpreted as approval when a life was at stake.
The Schiavo case and, in a different way, the health of the pope highlight a thorny question: Starkly put, when does the Roman Catholic Church say it is permissible to pull the plug?
Aides to John Paul, who suffers from Parkinson’s disease, insist he is recovering after two recent hospitalizations and an emergency tracheostomy. But with continuing health problems, the pontiff is undeniably on the decline. In a brief videotaped appearance Thursday, he looked gaunt and didn’t speak. The broadcast had to be interrupted three times, apparently because he couldn’t continue.
The Catholic church does not require that extraordinary means be applied to sustain the life of an ill person. It does not support keeping a person alive at all costs. But the boundaries have shifted with advances in modern medicine, and the definition of extraordinary is ever-changing.
“A person is not obliged to use measures that are disproportionate to the advantages that those measures would obtain,” said Cardinal Jorge Arturo Medina Estevez of Chile, former head of the Vatican department that governs worship. “If all the tubes in the world are only going to extend life for two more weeks, it doesn’t make sense.”
Medina Estevez was recently named by the pope to the position of senior deacon, which means, among other things, he would step onto the balcony over St. Peter’s Square to announce the election of a new pope.
“When there is a real hope for recovery, then yes, you can make extraordinary efforts,” he said during an interview in his office here. “But you must consider the proportion. Rather than speak of extraordinary or ordinary measures, it is preferable to speak of means that are proportionate or disproportionate to the results and quality of life.”
Blood transfusions, for example, were once considered extraordinary but no longer are. Less clear cut is the use of artificial respirators and feeding tubes for vegetative patients or those in comas, and the church for years has debated the ethics of such cases.
The matter is especially problematic when, as in the Schiavo case, the patient hasn’t left a living will that says whether he or she wishes to be resuscitated or kept alive with artificial means.
In a major statement aimed at ending the debate, the pope said a year ago that physicians and other caregivers had a moral duty to preserve the lives of patients in a vegetative state.
“Sick people in a vegetative state, waiting to recover or for a natural end, have the right to basic healthcare (nutrition, hydration, hygiene, warmth, etc.),” the pope told an international conference of Catholic medical associations. “The administration of water and food, even when provided by artificial means, always represents a natural means of preserving life, not a medical procedure.
“Therefore, their use must be considered ordinary and proportionate and, as such, morally obligatory.”
When the vegetative state has lasted longer than a year, the pope continued, the unlikelihood of recovery “cannot ethically justify abandoning or interrupting basic care, including food and hydration, of a patient.” The withdrawal of food and water from such patients “is truly euthanasia by omission.”
As far as is publicly known, the pope has not left instructions in case he becomes incapacitated and is no longer able to indicate his wishes. But most experts say his March 2004 statement would apply in such a case.
Some critics and church dissidents contend the Vatican has gone too far in emphasizing physical life over quality of life.
In the Christian tradition, death is not necessarily such a bad thing. It is the entry to the afterlife, to the house of God.
Daniel C. Maguire, an ex-priest and moral theologian who teaches at Marquette University in Milwaukee, criticized Vatican hard-liners for a “fetishism of life signs” whereby any sign of life is used as justification for postponing death.
“They are putting tremendous stress on physical life signs rather than survival of the personality,” he said in an interview. The risk with that policy, taken too far, is that functions such as breathing or a heartbeat are being maintained when the “personal consciousness” is no longer there, he said.
In the end, “you could easily have a totally incompetent pope for an indefinite period,” Maguire said. “It is a very interesting conundrum that they are boxing themselves into.”
Some theologians also argue that the decisions on care must involve whether it causes pain; the costs involved; and whether there is a reasonable chance of recovery, an element that can be subjective.
Paul Keeley, a physician who specializes in palliative care at the Glasgow Royal Infirmary, cautioned that extreme measures could rob a patient of a dignified death.
“The Catholic church today has a difficult job in affirming life and balancing this with the fact that we must all face death,” Keeley wrote in the Tablet, a Catholic weekly from London. “If the pope’s closest advisors in the Vatican can step back and see what is happening, they may have the chance to save Pope John Paul from an ugly, medicalized death.”
The nagging uncertainties over an incapacitated pope, combined with medicine’s ability to keep someone alive for long periods, have led to suggestions that future popes might choose to retire, rather than die in office, or be bound by an age limit, as cardinals and bishops are.
Bishops must submit their resignations at 75, and cardinals are no longer eligible to vote in the selection of a new pope after they turn 80. John Paul will be 85 in two months.