instruere...inlustrare...delectare Disputations

Tuesday, March 30, 2004

An on-going dispute

As might be expected, Fr. Kevin O'Rourke, OP, has something to say in response to statements made at the recent Life-Sustaining Treatments and the Vegetative State congress in Rome to the effect that artificial hydration and nutrition [AHN] for permanent vegetative state [PVS] patients is "simply care," and therefore cannot be discontinued. Fr. O'Rourke considers AHN to be unduly burdensome medical treatment offering no therapeutic hope to PVS patients, and therefore discontinuable.

A statement Fr. O'Rourke is circulating among U.S. Catholic healthcare ethicists asserts, "The tradition of Catholic theologians in regard to removing life support has been confirmed by Pope Pius XII (1957), the Congregation for Doctrine of the Faith (1980) and Pope John Paul II (1995)," assuring "us that life support may be withdrawn if it does not offer hope of benefit or imposes an excessive burden. The decision concerning hope of benefit is to be made by the patient or the patient's proxy. A representative of the church may offer guidance, but should not preempt the right of patient or proxy."

This is not a simple ethical problem -- witness the need for a congress to discuss it -- and, to my mind, even figuring out how to solve it is not straightforward. Who gets to decide these things? "Hope of benefit" is a medical judgment, except for the part that's a moral judgment. "Undue burden" is a personal judgment, made in this case on behalf of a person who isn't giving his own current judgment, except for the part that's a moral imperative. Things change, and what was extraordinary yesterday is ordinary today; what is a medical treatment today might be considered basic care tomorrow. Medical ethicists see themselves as in the right spot for setting down principles, knowledgeable about both medicine and morality, but to what extent is hospital experience a help in judgment, and how much is it a hindrance? (Do medical ethicists even recognize the risks of familiarity to judgment? Do the rest of us even recognize the possibility of benefit from familiarity?)

(I also wonder about how much weight should be given to the fact that Fr. O'Rourke's position is one "that would be accepted by a significant majority of U.S. Catholic ethicists," or even by statements by American bishops, since I suspect that a significant majority of U.S. Catholic ethicists, and th bishops who rely upon them, have been trained, directly or indirectly, by Fr. O'Rourke.)

I haven't read enough about the recent congress or the American response to change my previous opinion that Fr. O'Rourke's position begs some essential questions, starting with, "Is a patient diagnosed as being in a permanent vegetative state actually in a vegetative state permanently?" But I do think he is right to take issue with mischaracterizations of his position as entailing that a PVS patient "ceases to be a person." If the matter really is as clear as some at the congress seem to have said it is, it should be explicable without invoking straw-man counterarguments or demeaning those not yet convinced.