A century ago Terri Schiavo would have died almost instantly from her original brain collapse, prompted by chronic bulimia. In a bizarre irony she would have died because she refused to administer sufficient nutrition for her body. Last week she died because others were forced to assume the same responsibility with which she had once struggled.
But the question remains: was Schiavo killed or allowed to die? It seems to me that the absolutists in both camps miss something important. Those who argue that she was in effect already dead miss what is best described as the dignity of the human person — even when incapacitated. What makes someone human is not the extent of their capacities but their humanness itself. While a human being breathes on her own and her bodily functions remain largely intact despite massive degeneration in the brain, she is still a human being. Moral sense tells us so.
But our moral sense also tells us that when a person’s condition is such that she cannot in effect feel, think, eat or drink on her own and her survival depends on a sophisticated method of medical nutrition and pharmaceutical support, it is clear that she is not alive as even the tiniest foetus is alive.
When she has been in a vegetative state for a decade and a half, when there is not the faintest hope for her recovery, her life is in effect over, even as she lives. A foetus has a future as a full human being; Schiavo didn’t for years. She could never be what she once was.
Is there therefore a middle way, a means to negotiate these issues that technology now forces us to confront, a way to balance both these truths about a dying person and treat her with dignity and respect? There is. Catholic theology until recently had a 400-year-old unbroken and pragmatically subtle approach to these matters. It argued that there was a distinction between “ordinary” and “extraordinary” means for prolonging life; and that there comes a point at which it is morally permissible to refuse extraordinary methods.
Let me quote from the most recent Vatican document on the question, which remains authoritative. The 1980 teaching affirms that there can come a time at which advanced medical techniques can be legitimately spurned: “One cannot impose on anyone the obligation to have recourse to a technique which is already in use but which carries a risk or is burdensome. Such a refusal is not the equivalent of suicide; on the contrary it should be considered as an acceptance of the human condition, or a wish to avoid the application of a medical procedure disproportionate to the results that can be expected, or a desire not to impose excessive expense on the family or the community.”
For Christians, life is not an absolute good and death is not an absolute evil. It is strange to see those who believe in a glorious afterlife clinging so emphatically to earthly life in any form. There comes a point at which respect for life can become a form of denial of the human condition rather than its acceptance. Is a sophisticated “feeding tube” a “burdensome” or risky method? That is a difficult question.
Last year the Pope insisted that such technology was the moral equivalent of feeding a sick person: “The administration of water and food, even when provided by artificial means, always represents a natural means of preserving life, not a medical act. Its use, furthermore, should be considered, in principle, ordinary and proportionate, and as such morally obligatory.” So the feeding tube — with its mixture of nutrients, hydration and medicine — is “not a medical act”.
This seems to miss the difference between a person able to eat, swallow and drink on her own and someone who is incapacitated. It conflates the sophisticated material in the tube with simple food and water. Does keeping someone on such a tube for more than a decade with no hope for recovery alleviate a person’s suffering or prolong it? Or can suffering also mean having one’s dignity stripped away? Does the pace of medical progress affect this? What may seem incurable today may in another decade or so become treatable. Do we keep people half-alive indefinitely in the hope of such a possibility? Each case is different. A person who has just become vegetative and has yet to pursue all possible therapies to recover some kind of consciousness should be artificially fed. But a relatively hopeless case after 15 years? We have to make a prudential judgment: one that takes into account the wishes of the patient (if stated), her family, medical science, the specific nature of her malady and the prospects for recovery.
In a case like Schiavo’s we are distant from the particulars. Those particulars are disputed and fully knowable only in the consciences of people involved. As far as I can know the decision to remove the feeding tube after 15 years is as compatible with Catholic teaching as maintaining it. The morality of such a decision is applicable solely to the person who makes that decision, in this case, the legal guardian, her husband.
I have used the Catholic arguments because this case involved a Catholic, but they apply more generally. What we have lost today is the prudence and moderation of old moral teaching. Thomas Aquinas, the father of Catholic natural law theology, argued that a human being did not exist as such immediately after conception. He believed that the soul entered at about the time of “quickening” — roughly the first trimester.
Even today we accept that a fertile procreating woman spontaneously aborts countless fertilised eggs after conception. That does not make her guilty of involuntary manslaughter on a massive scale. So the abortion of a foetus the morning after conception is intuitively different from an abortion in the third trimester. But that insight was dropped by the church in its fierce opposition to every aspect of modernity in the last part of the 19th century.
Relative judgments get turned into absolute ones when religion feels threatened by new technology or new ways of life. We live in an era of two great trends. One is the miracle of modern science and its awesome capacity to prolong and better life. The other is the rise of religious fundamentalism in which bewilderment at technology, global change and cultural and moral diversity understandably leads some to cling to the most absolute of moral claims.
The two trends may intensify in a tightening spiral. At some point the spiral will uncoil. We will reach a moral balance the way they did centuries ago. But not yet. Not before countless other lives and deaths are resolved by gruelling bouts of moral and political conflict.
