The Schiavo Case - An Update

Wednesday March 30, 2005

News of the death of Terri Schiavo came to my attention this morning (Thursday, March 31, 2005) at approximately 9:57 AM on my car radio as I drove to St Joseph Church for a funeral. My immediate reaction was a sense of relief. I know that she was in God’s hands prior to her ‘formal’ death and we must now assume that she is now in God’s heart for all eternity.

It remains true that to comment on her case from the sidelines without access to the complete database—medical, legal and moral—is foolhardy if not impossible. Moreover, in as much as access to the complete database is near impossible, nonstop commentaries coupled with polls and instant re-plays in the media, continue to increase the risk of ambiguity and the obfuscation of reality and therefore of the truth. Add to this the political camouflage that has invaded the debate, it defies any absolute to say nothing of an intelligent response. This is no less true this evening than it was last evening or last week or last month.

That stated, it is my intent to approach this dilemma as a pastor in a parallel situation without media hype or global attention, “Been there done that” on several occasions, but, quite frankly, once is too often!

Let me begin at the conclusion. Notwithstanding his legal right as guardian, my sympathy extends to Terri’s biological family but in the light of information that has been forthcoming over the last few days, I am just a bit more sympathetic toward Michael’s position and what he truly believed to be her intention about the prolongation of life in a vegetative state. Based on what has come to light within the last few days, I believe the he has been represented unfairly to the extent that he has been misrepresented.

I believe we are dealing with the conflict between moral fundamentalism and a more holistic view of life and end of life issues.

Ordinarily in such critical situations when injury to the brain renders an individual ‘brain-dead,’ a family will have consulted with doctors and come to some firm conclusions about medical indicators and moral-medical recourse. ‘Brain-dead’ is a category which leaves little doubt that the patient has ceased to function at any human or even animal level even with artificial assistance though the blood will circulate as long as the heart pumps giving the impression that the individual is only sleeping or in a deep coma.

However, never does the individual cease to be a human being.

“A vegetative state” on the other hand is described as a level of functioning that is less than human but still alive and auto-reacting to some stimulation which though seemingly human is considered by the majority of human behaviorists not related to human emotions or pure human instinct. Though the individual remains ‘human’ he/she does not have the capacity to think or to experience human emotions. I suppose the very term ‘vegetative’ would suggest that the level of functioning is no higher than that of a vegetable.

In as much as the chance for even partial restoration of the brain is minimal, the person is assumed to be ‘terminal’ even if not proximately so. Although there have been exceptional cases – most rare – in which a person ‘considered’ to be in a vegetative state, resumed some minimal level of human functioning, it is more likely that the person was not in a true vegetative state to begin with but in a coma.

How does one come to the conclusion that an individual is indeed in a vegetative state except through the diagnosis of a physician? Prior to any discussion of medical recourse and family options, the physician will recommend a second and perhaps a third opinion. Most physicians are conservative and cautious about recommending the termination of life support if for no other reason than fear of litigation. However, I have yet to meet a physician whose concern was not for the wellbeing of the patient who was not at the same more than conscientious about the ethical and moral concerns of the family. I am in awe at the depth of their concern to preserve life until there is absolutely no hope for cure.

It would not be the normal practice to engage a team of ten doctors to confirm the diagnosis if two or three come to the same conclusion about the condition of the patient.

A physician—parishioner and friend—made this comment to me recently after reading this commentary. I think it will be helpful to include her comment:

“What makes the decision more straight-forward for physicians in this case is that there is science behind the decision. Studies that were done on these patients in the ‘60s showed that once the brain-death criteria are met, 100% of the time the body will die soon after without the brain to guide it. We know that absolutely, 100%of the time, there is no chance that the patient will recover, ever. It is very black and white. The Schiavo case is all shades of gray.” Indeed, it remained so to the very end.

What recourse does the immediate family have in such a situation?

1.Advanced Directives. When an individual has explicitly stated in a signed affidavit authorizing the withdrawal of extraordinary or artificial measures should he/she be diagnosed as ‘vegetative,’ such measures may be withdraw morally or not even morally applied.

2.Power of Attorney. In such cases in which an individual has designated another person of whatever relationship as having power of attorney in such a situation in which he/she is no longer capable or competent to render a moral judgment about his/her condition, that person holding power of attorney would be expected to abide by the same moral judgment that binds the individual who is no longer competent. However, in such a case, the limits or the unrestricted nature of that power should be explicit in the granting of the power of attorney,

3.The expressed ‘desire’ or ‘wish’ of the individual. This is obviously the most difficult because there is no ‘proof’ other than an assumption that this is the recourse that the individual would want in such a situation. However, ordinary people often make statements such as, “I don’t want to be kept alive if I am just a vegetable” and other similar statements. Most of us are not familiar enough with medical indicators to know what constitutes a life-threatening or terminal condition. What one person assumes is a vegetative state another may assume is a coma or a state that renders the person immobilized but not vegetative. As a result, ambiguity arises as to the exact nature of the condition and the intention of the patient.

My experience with the medical profession has convinced me that only when all else has failed will a physician with great reluctance recommend the removal of life support. In fact, recommendation is too strong a term. They will simply state the alternatives with possible outcomes leaving the ultimate decision to family.

The problem with the Schiavo case is obviously the ten-year conflict between Terri’s parents and her husband Michael.

I would be more persuaded that it was Terri’s wish that her life not be prolonged through assisted feeding, which is technically speaking extraordinary and artificial if the entire family agreed even if with some reservation that this was her desire. Despite Michael’s legal right to speak for Terri, I believe that Terri’s parents also had the right to intervene, making known their opinion not so much about her medical condition as to her intention or desire. The absence of documentation has contributed not to the ambiguity in the legal arena but in the moral as well. Terri had a moral right to decide whether or not she would want her life prolonged under such circumstances. If Michael’s representation of her intention was/is correct, then the courts were right to protect that right, notwithstanding the position of Jesse Jackson, Father Pavone and Father Neuhaus the last two of whom do not speak for the Church. Quite frankly, I found Father Paris’s opinion expressed so eloquently on PBS radio last week and on CNN this evening much more compelling than the opinion of both Pavone and Neuhaus. I would have found Father Neuhaus’ position much more compelling had he taken a similar position regarding the Iraq war, which has cost the loves of many innocent men, women and especially children. Ironically, his dissent from the Holy Father’s position in this regard is remarkable. As I mentioned above, the mix of morality and authority is often ambiguous indeed.

Moreover, I was disappointed in the commentary of our own Bishop Serratelli in this week’s edition of our diocesan paper, The BEACON, which I believe simplistic and quite frankly inconsistent with the statement on euthanasia of the American Bishops several years go. While condemning the outright intention to take life away from the dying, it clearly defended the right of a Catholic, indeed, any human being, to refuse extraordinary and artificial means to prolong life when all hope for a complete recovery is gone.

Faith does not demand the abandonment of human intelligence in order to allow Church authorities to think and decide for us. It does require that we take seriously the moral teachings of our Church in the course of our discernment about moral choices but in the end, our conscience must be our guide.

The preponderance of medical testimony, as close to unanimous as it can get, seems to confirm the fact that she has been and remains in a vegetative state, i.e., no brain activity other than reflex movements. Nevertheless, given the absence of specific legal directives by Terri, I believe the presumption is in favor of life no matter how minimal the quality, assuming of course that she is not experiencing pain or intense stress.

In other circumstances as stated above, next of kin could have concluded years ago with moral justification that it would be Terri’s desire to remove life support and it would have been a private matter. The tube would have been removed with little or no notice. It happens every day across the country and across the world.

But what is morally permissible is not necessarily morally warranted.

While the intervention of the president and congress is unprecedented, many precedents have been broken in recent years. In my opinion, it was neither demanded by moral principle nor necessary on political grounds.

Whether we like it or not, whether we agree or not, the lower courts and the Supreme Court all had spoken. We can and will argue about the moral and legal grounds on which the courts based their judgments but the judgments were made and should stand.

Now, a word about starvation. To compare Terri’s ‘starvation to that of a healthy individual is grossly unfair and quite frankly medically incorrect. Many people who are terminally ill and still conscious have made and continue to make the decision to stop eating, in most cases because they are not hungry! Even the very elderly who remain in reasonably good health often have to force themselves to eat for lack of an appetite.

Nature has a way of taking over and when dehydration sets in, the biological systems begin to break down and the person gradually looses consciousness. In those cases in which there is pain – not from hunger but from the effects of a terminal illness, compassionate palliative care will provide for sedatives and medications that help to dull the pain and discomfort. I have never heard of a case in which pain accompanied the deprivation, self-imposed or otherwise – of food and liquid. In fact, in some cases, the prolongation of liquid intravenously has also prolonged the dying process and even the pain.

When someone whom we have loved dearly in life approaches death, the grieving is incalculable and we will look for any and all signs that they will not die. Three days before my mother passed away, having not eaten in over a week, she asked for eggs and toast. I thought I was hearing things. We knew intellectually that she had less than a week to live and here she was asking for a ‘full’ breakfast. Could she be recovering? My imagination ran wild. My heart too over and I imagined that we may be witnessing a miracle. However, it was not to be. She ate one egg but that was her last nutrition. She lapsed into a coma later that day and died two days later – at peace with all whom she loved and at peace with her God.

The suggestion that Terri would be able to ‘know’ much less to understand what has been happening at her bedside is unlikely. It is inevitable that she will die soon if not by the time of this publication. We Christians believe that she is now in God’s hand and will soon rest in “the bosom of Abraham.”

One last comment. I mentioned above that what is morally permissible is not necessarily morally warranted. Should the decision have been otherwise, i.e., that the tube be replaced, Terri’s life would still have value if for no other reason than it called the attention of a nation and of a world to the importance that most of the population – believers and non believers alike – place on life. Even those who have supported the decision to stop the tubal feeding did so not because they do not respect life but because they believe that she has suffered enough and that she is entitled to a safe passage to the next life.

This is hardly more than an introduction to the issue. Some of both sides of the issue may take issue with what I have written. So be it. I have written as a pastor not as a clinician. I have ministered literally to hundreds of dying patients who had a right to live with dignity but who also had a right to die with dignity. This has been and continues to be the position of our Church.

We believe that when Terri leaves this earth, she will be welcomed home to the God who loved her into being and who will love her into eternity. For us the living there remains only the need to be reconciled to all life issues, not just life in the womb and life at death’s door but life in all in forms and phases in between.

I remain astounded that the children who have died of medical neglect in Iraq before and during the war have as well as the starving throughout the world have not warranted the same world wide attention as Terri Shiavo. This does not denigrate the attention given to her but surely points out the need to broaden our interest in all life issues, which, in the words of Cardinal Joseph Bernardin, is a seamless garment.

Recent Articles

Seventh Sunday of Easter 'B'

Living the Mystery at the town square As I walked recently to the Green in the center of Morristown after my…continue reading...

Sixth Sunday of Easter 'C'

In all things, charity It continues to astound me how the Scriptures come to life over and over again under different…continue reading...

Sixth Sunday of Easter 'C'

In all things, charity It continues to astound me how the Scriptures come to life over and over again under different…continue reading...

Fifth Sunday of Easter 'B'

Let’s stay connected. It’s not unusual to hear family members or close friends at the departure gates of life say to…continue reading...

Fourth Sunday of Easter 'B'

Watch out for the leopards! When my sister and I were kids, my father would whistle for us when it was…continue reading...