Mirror of Justice

There is an excellent article in the Jan. 21-28 issue of America.  The title:  Church Teaching and My Father's Choice.  The author:  John J. Hardt, who is an assistant professor of bioethics at the Neiswanger Institute for Bioethics and Health Policy at Loyola University Chicago's Stritch School of Medicine.  Alas, the article is available only for subscribers.  But here are some passages that may encourage you to track down the whole piece:

'IF I'M EVER IN A SITUATION where I'm permanently unconscious and unable to eat," says my father, "I'm begging you: Let me go. I don't want to be kept alive by a feeding tube." We are sitting at my parents' table on a pleasant Sunday morning, with advance health care directives sharing space with coffee cups and the newspaper.

I probe my father's reasoning about such an important decision: "What if I think you're able to recognize us, but you are unable to speak, communicate or engage us? What about end-stage Alzheimer's or Parkinson's, where you might stop eating on your own? You both know that doctors are rather certain that patients in a persistent vegetative state don't experience pain or discomfort, right?"

No response.

"What if I want to keep you alive in that condition?" I ask with a smile.

My father responds with a chuckle. "If there were a decent chance that I'd get better and everything else is working well, then I'd trust your judgment," he tells me. "Otherwise, the answer is no. Let me go!"

"But why," I ask, "if you're unaware of your own condition?"

"Because I know nam that I don't want to continue like that. What am I continuing for? With whom could I communicate? Whom could I love? Would I not have somewhere better to be, anyway?" My father's quip reflects our shared faith in Christ's salvific death and resurrection. "Let me go."

Real people bear both the grace and the burden of thinking as the church does about the meaning of living and dying. So it is with my still-living father's words in mind that I think about a recent statement of the Congregation for the Doctrine of the Faith concerning the morality of removing artificial nutrition and hydration from a patient who lives in a persistent vegetative state. I have my parents' power of attorney for health care, a decision they made prompted by the publicity surrounding the Terri Schiavo case. I now have a more personal stake in a discussion that had already engaged me professionally, as a Catholic bioethicist teaching in a Catholic medical school. It is now my responsibility as a son who cherishes his parents to help ensure that the manner of their dying as Catholics will be consistent with the way they lived as Catholics.....                

My father, in our conversation at the kitchen table, for example, did not suggest any inclination to end his life prematurely. He does not seek a false sense of control over his dying that betrays the truth of our Christian narrative, namely, that suffering is constitutive of who we are as brothers and sisters of Christ and that the experience of dying, while possibly frightening and lonely, is ultimately identified with Christ's dying and redeemed in Christ's rising. But his judgment, informed by his faith, is that a massive neurological injury that leaves him permanently unconscious, unable to purposefully eat or swallow, would constitute in itself a fatal pathology, one that carries no obligation to persist any longer in that state.

When I consider my father's questions-"What am I persisting for? With whom could I communicate? Who could I love? Don't I have a better place to be?"-I hear faithful echoes of our Catholic tradition. That tradition consistently affirms that while biological life is an important value, it is not an absolute good. How should my father judge a future burden that is not his now and, were it ever to become his burden, he would not be able to judge?

Perhaps it is in the fourth exception noted by the C.D.F. that my father's thinking finds its voice. While the other three exceptions offered by the congregation focus on objective circumstances, this final exception simply notes those "rare cases" where artificial nutrition and hydration "may be excessively burdensome." This exception stands out because it comes with no modification. It simply holds open a possibility. While the C.D.F. does not offer any examples, it sounds to me like the condition my father described over our kitchen table.

My father's words tell me that he judged the maintenance of his baseline biological existence as a P.V.S. patient to be an excessive burden. It is a burden to him to know now that we, his family, would care for him in this condition for a prolonged period of time. It is a burden to him to know that he would be unable to engage in meaningful human activity. And, finally, it is a burden to him to think that his death from a devastating neurological injury was being held at bay by the insertion of an unwanted and, in his judgment, invasive feeding tube. My father believes that such a procedure would pose an unwanted and unnecessary obstacle to his next life in heaven, the end of a journey he began at birth, the fulfillment of a promise sealed in his baptism.

In other words, my father has judged that the burden of persisting in a vegetative state far outweighs the benefit of being sustained that way. This is, in my view, a very Catholic way of thinking, shared by other faithful Catholics, and consistent with Catholic tradition.