CATHOLIC BIOETHICS AND THE CASE OF TERRI SCHIAVO
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File: 03.Nelson Article Created on: 6/28/2005 10:13 PM Last Printed: 10/2/2005 5:08 PM
CATHOLIC BIOETHICS AND THE CASE OF TERRI
SCHIAVO
LEONARD J. NELSON, III∗
Catholic bioethics is pre-modern: it is based on scripture and
the natural law as revealed in the work of moral theologians and
1
the teachings of the magisterium, including papal encyclicals. It
may be contrasted with a modernist, secular bioethics that finds its
origins in the Enlightenment, rejects religion and metaphysics, and
focuses primarily on autonomous human reason.2 It can also be
distinguished from a post-modernist approach that rejects modern-
ist rationalism and any attempts at constructing a coherent, over-
arching moral philosophy.3 And while secular bioethics is con-
cerned more with procedural issues,4 Catholic bioethics is con-
cerned with the principles of good moral decisionmaking rather
than with the identity of who makes the decision.5 A 1991 state-
ment by the Catholic Bishops of Pennsylvania asserts that relig-
iously grounded bioethics provides unique insights on issues that
secular bioethics cannot offer:
Bioethics based on philosophy and legal principles provides
some guidance through the maze of problems in health care.
Yet it is also clear that philosophy and law alone do not ade-
quately address all of the real concerns and pertinent issues.
Religious bioethics makes an invaluable contribution to con-
temporary moral debates by offering insights into human na-
ture, the purpose of life, the meaning of suffering and educa-
tion to true virtue. These considerations assist doctors and pa-
tients alike to make wise choices both in everyday practice and
in the most difficult cases. Religiously grounded bioethics leads
people to place their attention on the right thing to do and
frees the autonomy of choice from a vision which can easily be-
come narrow and even dreadfully wrong. We can humanize the
face of technology by giving it a moral evaluation in reference
∗
Professor of Law, Cumberland School of Law, Samford University.
1
Edmund D. Pellegrino, Secular Bioethics and Catholic Medical Ethics: Moral Philoso-
phy at the “Margins,” in THE BISHOP AND THE FUTURE OF CATHOLIC HEALTH CARE 30
(1997).
2
Id. at 31.
3
Id.
4
Id. at 34.
5
Committee for Pro-Life Activities, Nutrition and Hydration: Moral and Pastoral
Reflections, National Conference of Catholic Bishops 7 (1992) [hereinafter 1992
NCCB Statement].File: 03.Nelson Article Created on: 6/28/2005 10:13 PM Last Printed: 10/2/2005 5:08 PM
544 CUMBERLAND LAW REVIEW [Vol. 35:3
to the dignity of the human person, who is called to realize the
6
God-given vocation to life and love. [footnotes omitted]
Unlike secular bioethics, individual autonomy is not the ulti-
mate value in Catholic bioethics.7 Indeed, the Catholic natural law
tradition has long condemned suicide and voluntary euthanasia.8 It
has also recognized, however, that while patients are morally obli-
gated to accept “ordinary” medical treatment, treatment that is
considered “extraordinary” may be refused even if the result of
non-treatment may be to hasten death.9 Certainly, with competent
patients, the patient is the “primary decisionmaker,” but the patient
is “bound by norms that prohibit the directly intended causing of
death through action or omission and by the distinction between
ordinary and extraordinary means.”10 In the case of incompetent
patients, it is appropriate that family members or a guardian who
share “the patient’s moral convictions” act as surrogate decision-
makers, but these surrogate decisionmakers are morally obligated
to make decisions in accordance with these same ethical norms
even if they believe that the patient would have decided otherwise.11
And a health care provider, while ordinarily required to accede to
the wishes of the patient or the appropriate surrogate decision-
maker, is morally obligated to refuse to participate in a course of
treatment “which he or she views as clearly immoral.”12
When the availability of more advanced forms of medically as-
sisted hydration and nutrition (“MAHN”) made it possible to sus-
tain the life of unconscious patients for several years, the question
arose among ethicists working in the Catholic tradition as to
whether it was morally permissible to withdraw MAHN from a pa-
tient in a persistent vegetative state (“PVS”).13 Catholic bioethicists
have debated this issue over the past three decades with some argu-
ing that continuing to provide MAHN and nutrition for PVS pa-
tients is not morally obligatory and with others arguing that it is in
most cases.14 For Catholics loyal to the magisterium, this issue may
have been settled by a recent statement by Pope John Paul II an-
6
A Statement of the Catholic Bishops of Pennsylvania, Nutrition and Hydration:
Moral Considerations (rev. ed. 1999) (first issued Dec. 12, 1991), available at
http://www.pacatholic.org (footnotes omitted).
7
Id.
8
1992 NCCB Statement, supra note 5, at 1.
9
Id. at 2.
10
Id. at 7.
11
Id.
12
Id.
13
Id. at 3.
14
Id. at 6.File: 03.Nelson Article Created on: 6/28/2005 10:13 PM Last Printed: 10/2/2005 5:08 PM
2005] CATHOLIC BIOETHICS AND THE SCHIAVO CASE 545
nouncing that the continued administration of MAHN and nutri-
tion for PVS patients is morally obligatory in most cases.15
These ethical concerns have been brought to the forefront by
the case of Terri Schiavo, a young woman who was diagnosed by
some physicians as being in a persistent vegetative state.16 The
Schiavo case involved a dispute between the parents of Terri
Schiavo, devout Catholics who wished to continue to provide their
daughter with MAHN in accordance with Catholic teaching, and
her non-Catholic husband who wished to withdraw it. It apparently
was agreed that with the continued provision of MAHN, Terri
Schiavo could have continued to live for many years, and if it were
withdrawn, she would die from starvation in a few days.17 The Flor-
ida Courts, based on some rather scant evidence, applied a substi-
tuted judgment standard and authorized the withdrawal of MAHN
from Terri based on the assumption that Terri Schiavo, if compe-
tent to make the decision, would have wanted it withdrawn.18 In
the original proceedings before the trial court, a priest testified
about Catholic teaching on the withdrawal of MAHN from PVS
patients, opining that the withdrawal would be consistent with
Catholic teaching.19 The parents also attempted to convince the
trial court that Terri was a practicing Catholic who was serious
about her faith, but her husband testified that Terri was a lapsed
Catholic. The appellate court, in a rather off-handed manner,
sided with the husband on the question of Teresa’s religiosity and
affirmed the trial court order permitting the husband to order the
withdrawal of treatment.20 Subsequent to the original proceedings,
a Papal Statement was issued holding that continuation of such
treatment is morally obligatory.21 The parents tried without success
to reopen the case, arguing that under the substituted judgment
standard, the court should assume that Terri, as a faithful Catholic,
15
Pope John Paul II, Address to the Participants in the International Congress on
“Life-Sustaining Treatments and Vegetative State: Scientific Advances and Ethical
Dilemmas” (Mar. 20, 2004) available at http://www.vatican.va/holy_father/
john_paul_ii/speeches/2004/march/documents/hf_jp-ii.
16
While others have disputed the accuracy of the diagnosis, I will not attempt to
resolve this controversy.
17
Terri Schiavo’s feeding tube was removed on March 18, 2005, and she died on
March 31, 2005.
18
Guardianship of Schiavo, 792 So. 2d 551 (Fla. Dist. Ct. App. 2001).
19
Excerpt of Trial Testimony of Father Murphy, Jan. 24, 2000, Before Judge W.
Greer, Case No. 90-2908-GD3 I, available at http://www.miami.edu/eth-
ics2/schiavo/timeline.htm.
20
Guardianship of Schiavo, 789 So. 2d 176, 180 (Fla. Dist. Ct. App. 2001).
21
Pope John Paul II, supra note 15.File: 03.Nelson Article Created on: 6/28/2005 10:13 PM Last Printed: 10/2/2005 5:08 PM
546 CUMBERLAND LAW REVIEW [Vol. 35:3
would want her treatment continued in accordance with the Papal
22
statement.
The labeling of patients as vegetative is controversial with
some, including John Paul II, who has characterized the term
“vegetative” as an adjective that deprives the patient of human dig-
nity.23 He has also questioned whether “persistent vegetative state”
is a helpful diagnostic category, noting that for patients with this
diagnosis, “there are well-documented cases of at least partial re-
covery even after many years.”24 But I will not attempt to resolve
these issues. Nor will I attempt to resolve questions as to whether
the Catholic position on such issues should be enacted into law
even though, as John Paul II observed in Evangelium Vitae, I recog-
nize that the Gospel of Life is for believers and non-believers alike.25
Instead, I will provide a primer on Catholic teaching on end-of-life
care with a focus on the withdrawal of MAHN. In this regard, I will
begin with a discussion of the controversy between those Catholic
bioethicists who have been labeled as proportionalists and others
working in the Catholic natural law tradition whom I will refer to as
traditionalists. Then, I will describe the methodologies used by
these competing schools. I also will discuss the traditional distinc-
tion between ordinary and extraordinary treatment. Finally, I will
focus on the particular controversy among Catholic ethicists over
the withdrawal of MAHN and the recent Papal Statement.
I. THE CONTROVERSY BETWEEN TRADITIONALISTS AND
PROPORTIONALISTS26
The approach taken by Catholic moral theologians through
the middle of the twentieth century was typified by “an exposition
of fundamental moral principles derived from natural law and di-
vine revelations, followed by a casuistic analysis of specific top-
22
Steven Haidar & Kathy Cerminara, Key Events in the Case of Theresa Marie Schiavo,
available at http://www.miami.edu/ethics/schiavo/timeline.htm. The District
Court of Appeals subsequently denied an application for writ of certiorari to re-
view the Circuit’s order. Schindler v. Schiavo, No. 2D04-3451, 2004 WL 2726107
(Fla. Dist. Ct. App. Nov. 24, 2004).
23
Pope John Paul II, Address, supra note 15, ¶ 3.
24
Id. ¶ 2.
25
POPE JOHN PAUL II, THE GOSPEL OF LIFE [EVANGELIUM VITAE] ¶ 101 (1995), avail-
able at http://www.vatican.va/holy_father/john_paul_ii/encyclicals/documents
/hf_jp-ii_enc_25031995_evangelium-vitae_en.html.
26
The discussion in this section is adapted from discussion in my previous article
on Catholic hospitals. See Leonard J. Nelson, III, God and Woman in the Catholic
Hospital, 31 J. LEGIS. 69, 102-15 (2004).File: 03.Nelson Article Created on: 6/28/2005 10:13 PM Last Printed: 10/2/2005 5:08 PM
2005] CATHOLIC BIOETHICS AND THE SCHIAVO CASE 547
ics[.]”27 It was also characterized by deference to the magisterium.28
In the Catholic natural law tradition, certain specific moral norms
are “absolute and exceptionless” while others, although true, are
not absolute.29 An example of the former is the prohibition on the
intentional taking of innocent human life.30 Accordingly, the pro-
hibitions on euthanasia and suicide are also considered absolute
norms.31
Moreover, traditional Catholic moral theologians argue that
the magisterium of the Church has infallibly taught certain core
moral precepts such as those summarized in the Decalogue, pre-
cisely “as these [precepts] have been traditionally understood within the
Church[.]”32 This would include the traditional proscription against
the taking of innocent human life and more specifically against
euthanasia and suicide.33 Traditionalists argue that as to these spe-
cific norms dissent among Catholic theologians is not permissible.34
The principle of double effect also plays a significant role in the
traditional Catholic natural law approach. For example, the prin-
ciple of double effect treats as morally licit the use of painkillers
such as morphine for terminally ill persons even if the effect of
such pain killers may be to hasten death as long as the intent is to
relieve suffering rather than to cause death.35
27
ALBERT R. JONSEN, THE BIRTH OF BIOETHICS 36 (1998).
28
Id. at 36-37.
29
WILLIAM E. MAY, AN INTRODUCTION TO MORAL THEOLOGY 106 (2d ed. 2003).
30
Id.
31
Id. at 252.
32
Id. at 253.
33
Id. at 252.
34
Id. at 255-57.
35
Gerald Kelly notes that under the principle of double effect, an action is
deemed morally licit if the following requirements are met:
1) The action, considered by itself and independently of its effects, must not be
morally evil. . . . 2) The evil effect must not be the means of producing the good ef-
fect. The principle underlying this condition is that a good end cannot
justify the use of an evil means. . . . 3) The evil effect is sincerely not intended,
but merely tolerated. . . . In the cases we are considering, therefore, neither
the patient nor the physician may intend the loss of fetal life or the ster-
ilization. The attitude toward these effects must be one of mere toler-
ance. 4) There must be a proportionate reason for performing the action, in spite
of its evil consequences. In practice, this means that there must be a sort of
balance between the total good and the total evil produced by an action.
Or, to put it another way, it means that, according to a sound prudential
estimate, the good to be obtained is of sufficient value to compensate for
the evil that must be tolerated.
GERALD KELLY, MEDICO-MORAL PROBLEMS 13-14 (1958). See also CHARLES J.
MCFADDEN, MEDICAL ETHICS 33 (3d ed. 1955).File: 03.Nelson Article Created on: 6/28/2005 10:13 PM Last Printed: 10/2/2005 5:08 PM
548 CUMBERLAND LAW REVIEW [Vol. 35:3
Dissenting Catholic theologians (sometimes referred to as
proportionalists) generally reject the notion that the violation of
specific norms may be considered intrinsically immoral acts not-
withstanding their consequences and context.36 The approach
taken by traditionalists may be characterized as deontological while
the approach taken by the proportionalists may be characterized as
teleological. In appraising the morality of particular acts, deon-
tologists focus on pre-existing transcendent norms, thereby accept-
ing that certain acts are intrinsically evil notwithstanding their
seemingly beneficial consequences. Teleologists, on the other
hand, focus on whether a proportionate good is brought about by
the act in question.37 The traditional Catholic natural law method-
ology is typically characterized as deontological.38 The proportion-
alists have generally rejected the deontological approach taken by
the traditionalists insofar as it proposes specific absolute moral
norms.39
The proportionalists also generally contend that it is permissi-
ble for Catholic theologians to dissent publicly from non-infallible
teachings proposing specific moral norms.40 Professor May traces
the “roots of the rejection of moral absolutes” by the proportional-
ists to the controversy over contraception.41 Ultimately, the propor-
tionalists rejected the traditional natural law approach and devel-
oped an alternative methodology.42 Building on the principle of
double effect, they developed a method for approaching medical
ethical issues that rejected the application of pre-existing specific
absolute moral norms.43 Professor May summarizes the major prin-
ciples undergirding the assault of the proportionalists on specific
absolute norms as proportionality, totality, and historicity.44 Pro-
36
See e.g., CHARLES E. CURRAN, MEDICINE AND MORALS 29 (Corpus Books 1970)
stating:
And generally speaking, in other complicated areas of human life, the
theologian cannot say that this or that action must always be performed.
In many matters of medicine the ethician can merely tell the doctor to
exercise his own prudent moral judgment.
Id.
37
CHRISTOPHER KACZOR, PROPORTIONALISM AND THE NATURAL LAW TRADITION 10-11
(Catholic University of America Press 2002).
38
Id. at 13-14.
39
Id. at 12.
40
MAY, MORAL THEOLOGY, supra note 29, at 255.
41
Id. at 142-145.
42
CURRAN, supra note 36, at 29.
43
JONSEN, supra note 27, at 54 (discussing the work of Richard McCormick).
44
MAY, MORAL THEOLOGY, supra note 29, at 147.File: 03.Nelson Article Created on: 6/28/2005 10:13 PM Last Printed: 10/2/2005 5:08 PM
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portionality proposes that acts are considered moral where they are
“done for the sake of a proportionally greater good.”45 Totality
proposes that the morality of an act can be appraised only by taking
account of the totality of its effect and the intention of the actor.46
And historicity proposes that specific moral norms develop in par-
ticular historical contexts and thus are subject to revision based on
changing circumstances.47
Charles Curran, a well known dissenting proportionalist theo-
logian, has criticized traditional Catholic medical moral theorists’
reliance on pre-existing, absolute, specific moral norms.48 Curran
argues that the traditionalists’ approach is based on an archaic
“classicist worldview” that focuses on unchangeable principles in-
stead of a more enlightened “historical worldview” that focuses on
change and evolution.49 These two worldviews in turn create two
different methodologies—while the classicist focuses on preexisting
abstract principles, the historicist focuses on the context of the
act.50 Curran also criticizes the traditionalists’ “fundamentalist”
acceptance of the authority of the magisterium on medical moral
51
issues. Instead, he suggests that statements of the magisterium
should be viewed “in the light of the historical, cultural, and scien-
tific circumstances of the time in which they were composed.”52
Notwithstanding the importance of the work of the propor-
53
tionalists, the Catechism of the Catholic Church and two papal encyc-
licals issued in the 1990s reaffirm the significance of specific abso-
lute norms and the Catholic natural law tradition. The Catechism
states: “There are concrete acts that it is always wrong to choose,
because their choice entails a disorder of the will, i.e., a moral evil.
One may not do evil so that good may result from it.”54 And simi-
55 56
larly in Veritatis Splendor (1993) and Evangelium Vitae (1995), Pope
John Paul II rejected the approach taken by proportionalist theo-
45
Id.
46
Id. at 148-49.
47
Id. at 150-51.
48
CURRAN, supra note 35, at 43.
49
Id. at 19-20.
50
Id. at 20-21.
51
Id. at 31.
52
Id. at 31-32.
53
CATECHISM OF THE CATHOLIC CHURCH (1994) (English translation).
54
Id. ¶ 1761, at 487.
55
POPE JOHN PAUL II, VERITATIS SPLENDOR (1993), available at http://www.vati-
can.va/holy_father/john_paul_ii/encyclicals/documents/hf_jp-ii_enc_06081993_
veritatis-splendor_en.html.
56
POPE JOHN PAUL II, EVANGELIUM VITAE, supra note 25.File: 03.Nelson Article Created on: 6/28/2005 10:13 PM Last Printed: 10/2/2005 5:08 PM
550 CUMBERLAND LAW REVIEW [Vol. 35:3
logians and decried the existence of widespread attacks on the
sanctity of life.
Veritatis Splendor was issued in response to the crisis in moral
theology precipitated by dissenting theologians.57 The restatement
of the basic truths of moral theology is seen as a necessary response
to the widespread public dissent from traditional teachings and the
rejection of the authority of the Magisterium.58 Veritatis Splendor
clearly affirms the authority of the Magisterium to establish specific,
absolute norms governing moral conduct.59 The encyclical rejects
the emphasis on individual autonomy in contemporary moral dis-
course and condemns the work of moral theologians who subvert
absolute moral norms.60 Veritatis Splendor reaffirms the existence of
specific, moral absolutes governing human conduct that are valid
always and everywhere.61 It rejects arguments that moral norms
must be viewed as the product of particular cultural contexts and
that consequently, moral norms are changeable rather than immu-
table.62 It also criticizes the use of “pastoral solutions” to under-
mine absolute norms.63 And rejecting the emphasis of some moral
theologians on the primacy of the individual conscience in making
moral decisions, it instead emphasizes the preeminent role of the
teachings of the Church in forming the consciences of Christians.64
Veritatis Splendor also rejects arguments by proportionalists that
the morality of acts must be evaluated “on the basis of a technical
calculation between the ‘premoral’ or ‘physical’ goods and evils
which actually result from the action.”65 And it rejects their empha-
sis on the maximization of goods and the minimization of evils.66 It
notes that while the foreseeable consequences of an act may miti-
gate its gravity, the consequences can never “alter its moral spe-
57
POPE JOHN PAUL II, VERITATIS SPLENDOR ¶ 86 (1993) (emphasis in original).
58
Id. ¶ 85.
59
Id. ¶ 25. “The moral prescriptions which God imparted in the Old Covenant,
and which attained their perfection in the New and Eternal Covenant in the very
person of the Son of God made man, must be faithfully kept and continually put into
practice in the various different cultures throughout the course of history. The task
of interpreting these prescriptions was entrusted by Jesus to the Apostles and their
successors, with the special assistance of the Spirit of truth.” Id. ¶ 26 (emphasis in
original). “In the moral catechesis of the Apostles, besides exhortations and direc-
tions connected to specific historical and cultural situations, we find an ethical
teaching with precise rules of behaviour.” Id.
60
Id. ¶ 35-37.
61
Id. ¶ 52.
62
Id. ¶ 53.
63
Id. ¶ 56.
64
Id. ¶ 64.
65
Id. ¶ 65.
66
Id. ¶ 74-75.File: 03.Nelson Article Created on: 6/28/2005 10:13 PM Last Printed: 10/2/2005 5:08 PM
2005] CATHOLIC BIOETHICS AND THE SCHIAVO CASE 551
cies.”67 It rejects the proportionalist argument that the evaluation
of the morality of an act must take into account of the “totality of the
68
foreseeable consequences of that act for all persons concerned.” Instead,
Veritatis Splendor reemphasizes the continuing validity of the tradi-
tional teaching that “[t]he morality of the human act depends primarily
and fundamentally on the ‘object’ rationally chosen by the deliberate will.”69
In 1995, Pope John Paul II issued The Gospel of Life [Evangelium
Vitae], 70 an encyclical letter dealing with abortion, euthanasia, and
the death penalty. Evangelium Vitae was written to combat the preva-
lence of a “culture of death” that is “excessively concerned with
efficiency” and accordingly devalues the lives of those who impose
burdens on others.71 The encyclical refers to a “culture of death”
that had emerged in the Western developed nations that is “in a
certain sense . . . a war of the powerful against the weak.”72 In these
circumstances, “[a] person who, because of illness, handicap or,
more simply, just by existing, compromises the well-being or life-
style of those who are more favoured tends to be looked upon as an
enemy to be resisted or eliminated.”73
The encyclical refers to the unleashing of a “conspiracy against
74
life” and notes that attacks on life enjoy widespread support from
members of the health care professions.75 Evangelium Vitae traces
the current attacks on human life to an excessive emphasis on indi-
vidual autonomy and the rejection of traditional authority.76 It re-
fers to an ongoing struggle between a “culture of life” and a “cul-
ture of death.”77 As to dissenting theologians, the encyclical enjoins
them to “never be so grievously irresponsible as to betray the truth
and their own mission by proposing personal ideas contrary to the
Gospel of life as faithfully presented and interpreted by the Magiste-
rium.”78
67
Id. ¶ 77.
68
Id. ¶ 79 (emphasis in original).
69
Id. ¶ 78 (emphasis in original).
70
POPE JOHN PAUL II, EVANGELIUM VITAE, supra note 25.
71
Id. ¶ 12.
72
Id. (emphasis in original).
73
Id.
74
Id. (emphasis in original).
75
Id. ¶ 17.
76
Id. ¶ 19-20.
77
Id. ¶ 21.
78
Id. ¶ 82 (emphasis in original).File: 03.Nelson Article Created on: 6/28/2005 10:13 PM Last Printed: 10/2/2005 5:08 PM
552 CUMBERLAND LAW REVIEW [Vol. 35:3
II. THE DISTINCTION BETWEEN ORDINARY AND EXTRAORDINARY
TREATMENT
The Catholic natural law tradition distinguishing between or-
dinary and extraordinary treatment dates back to the sixteenth cen-
tury.79 In recent years, it has become more common to replace the
terms “ordinary” and “extraordinary” with the terms “proportion-
ate” and “disproportionate” care.80 The focus on proportionality
seems to embrace the approach taken by proportionalist theologi-
ans, who place less emphasis on specific, absolute norms concern-
ing the means of treatment and greater emphasis on the context
and ends of treatment.81 And certainly the methodology employed
by traditionalists in this area focuses on the relative benefits and
burdens of treatments in determining whether a particular medical
treatment is extraordinary and thus may be withdrawn or refused.
But there may still be a distinction between the approach taken by
proportionalists and traditionalists. While traditionalists focus
more on the benefits and burdens of the particular treatment, pro-
portionalists focus more on quality of life concerns.
In 1957, Pope Pius XII, in his address to a group of anesthesi-
ologists, explicitly drew the distinction between ordinary and ex-
traordinary treatment in response to a specific question: “Does the
anesthesiologist have the right, or is he bound, in all cases of deep
unconsciousness, even in those that are considered to be com-
pletely hopeless in the opinion of the competent doctor, to use
modern artificial respiration apparatus, even against the will of the
family?”82 In answering the question, Pius XII opined that one is
required to accept only “ordinary” treatments to preserve life, i.e.,
“means that do not involve a grave burden for oneself or an-
other.”83
In 1980, the Sacred Congregation for the Doctrine of the
Faith, with the approval of Pope John Paul II, issued a Declaration on
Euthanasia84 that retains the message of the 1957 Address but ex-
pands on it and other Papal statements in light of “new aspects of
79
Ronald Hamel & Michael Panicola, Must We Preserve Life?, AMERICA Apr. 19-26,
2004, at 6-7.
80
Id. at 7.
81
Id.
82
Pope Pius XII, Address to an International Congress of Anesthesiologists (Feb.
24, 1957), at http://www.lifeissues.net/writers/doc/doc_31resuscitation.html. See
also Matter of Quinlan, 355 A.2d 647, 658 (N.J. 1976).
83
Pope Pius XII, Address, supra note 82.
84
Declaration on Euthanasia, Sacred Congregation for the Doctrine of Faith (May
5, 1980) at http://www.vatican.va/roman_curia/congregations/cfaith/documents
/rc_con_cfaith_doc_19800505_euthanasia_en.html.File: 03.Nelson Article Created on: 6/28/2005 10:13 PM Last Printed: 10/2/2005 5:08 PM
2005] CATHOLIC BIOETHICS AND THE SCHIAVO CASE 553
the question of euthanasia” that have been brought about by “the
progress of medical science.”85 The Declaration rejects both sui-
cide86 and euthanasia, understood here as intentionally causing
another’s death in order to eliminate suffering.87 In discussing the
“Value of Human Life,” the Declaration notes that “[e]veryone has
the duty to lead his or her life in accordance with God’s plan.”88
Accordingly, because our lives are “entrusted” to us by God, suicide
is equated with murder and is “considered as a rejection of God’s
sovereignty and loving plan.”89 Similarly, with respect to euthana-
sia, “the killing of an innocent human being,” including those “suf-
fering from an incurable disease, or a person who is dying[,]” is
impermissible.90 It is morally impermissible for a person to ask to
be killed, to request it for others, or to “consent to it, either explic-
itly or implicitly.”91
In the section titled “Due Proportion In the Use of Remedies,”
the declaration focuses on the moral obligations of the sick person
or those charged with that person’s care, whether family members
or health care providers, to accept or to provide various modes of
treatment. It acknowledges the potential complexity of these deci-
sions and the difficulty of applying ethical principles in a given
case.92 While reiterating the traditional principle that no one is
obligated to use “‘extraordinary’ means,” the declaration acknowl-
edges that the obligation “is perhaps less clear today, by reason of
the imprecision of the term and the rapid progress made in the
treatment of sickness.”93 It further acknowledges that “some people
prefer to speak of ‘proportionate’ and ‘disproportionate’ means”
rather than “ordinary” and “extraordinary.”94 The Declaration con-
tinues:
In any case, it will be possible to make a correct judgment as to
the means by studying the type of treatment to be used, its de-
gree of complexity or risk, its cost and the possibilities of using
it, and comparing these elements with the result that can be ex-
85
Id.
86
Id.
87
Id.
88
Id.
89
Id.
90
Id.
91
Id.
92
Id.
93
Id.
94
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554 CUMBERLAND LAW REVIEW [Vol. 35:3
pected, taking into account the state of the sick person and his
95
or her physical and moral resources.
In applying this approach, the Declaration notes that it is mor-
ally permissible to refuse to accept even readily available, estab-
lished modes of treatment that are risky or burdensome and that
such refusal should not be equated with suicide where the refusal is
motivated by desire to avoid burdens of the treatment that are
“disproportionate to the results to be expected” or where the
treatment is excessively expensive to “the family or the commu-
nity.” 96
The Catechism of the Catholic Church discusses end-of-life issues
within its discourse on the Fifth Commandment.97 The Catechism
states: “Those whose lives are diminished or weakened deserve spe-
cial respect. Sick or handicapped persons should be helped to lead
lives as normal as possible.”98 In addition, “direct Euthanasia,” de-
fined as “an act or omission which, of itself or by intention, causes
death in order to eliminate suffering,” is deemed morally unac-
ceptable.99 It recognizes, however, that the withdrawal of “medical
procedures that are burdensome, dangerous, extraordinary, or dis-
proportionate to the expected outcome can be legitimate.”100 This
approval of withdrawal of treatment is premised on the notion that
in these circumstances the intent is not to cause death but merely
to accept the inability to impede it.101 Either the patient or those
authorized by law to speak for the patient may make this decision
as long as the patient’s “reasonable will” and “legitimate interests”
are respected.102
In Evangelium Vitae, John Paul II explicitly condemns euthana-
103
sia as “a grave violation of the law of God.” This condemnation “is
based upon the natural law and the written word of God” as taught
104
by the Magisterium. The encyclical notes that the situation of
those who are “incurably ill” or “dying” is exacerbated “by a cultural
climate which fails to perceive any meaning or value in suffering,
but rather considers suffering the epitome of evil, to be eliminated
95
Id.
96
Id.
97
CATECHISM OF THE CATHOLIC CHURCH ¶¶ 2276-2279.
98
Id.
99
Id.
100
Id.
101
Id.
102
CATECHISM OF THE CATHOLIC CHURCH ¶¶ 2276-2279.
103
POPE JOHN PAUL II, EVANGELIUM VITAE, supra note 25, ¶ 65 (emphasis in origi-
nal).
104
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at all costs.”105 It observes that euthanasia if frequently justified by a
“utilitarian motive of avoiding costs which bring no return and
which weigh heavily on society.”106
Although Evangelium Vitae condemns euthanasia, i.e., “[an act]
or omission which of itself and by intention causes death, with the
purpose of eliminating all suffering,”107 it further distinguishes
euthanasia from the refusal of “aggressive medical treatment”
where the burdens imposed by treatment are disproportionate to
the expected benefits or “impose an excessive burden on the pa-
tient and his family.”108 In such cases, where death is “imminent
and inevitable,” it is permissible to refuse excessively burdensome
treatment so long as normal care is continued.109 At this point, the
encyclical suggests that it may be appropriate to take into account
quality of life concerns: “Certainly there is a moral obligation to
care for oneself and to allow oneself to be cared for, but this duty
must take account of concrete circumstances. It needs to be de-
termined whether the means of treatment available are objectively
proportionate to the prospects for improvement.”110 But this com-
ment appears in the context of a discussion of cases where death is
imminent and inevitable, and it is not clear that this approach
would apply in the case of PVS patients.
In 1994, the Pontifical Council for Pastoral Assistance issued a
Charter for Health Care Workers.111 The Preface refers to the document
as a “deontological code for those engaged in health care.”112 The
Charter admonishes health care workers to provide patients with all
“‘proportionate’ remedies,” but further states “there is no obliga-
tion to apply ‘disproportionate’ ones.”113 It further refers to the
distinction between ordinary and extraordinary remedies, ordinary
methods being those “where there is due proportion between the
means used and the end intended.”114 The document also specifi-
cally addresses the withholding of MAHN from a patient whose
105
Id. ¶ 15.
106
Id.
107
Id. ¶ 65.
108
Id.
109
Id.
110
Id. See also Ronal Hamel & Michael Panicola, Must We Preserve Life?, AMERICA,
Apr. 19-26, 2004, at 7 (discussing this passage and arguing that even for traditional
moralists the benefits and burdens of treatment must be assessed “relative to the
person’s overall situation”).
111
PONTIFICAL COUNCIL FOR PASTORAL ASSISTANCE, CHARTER FOR HEALTH CARE
WORKERS: TO HEALTH CARE WORKERS (1994).
112
Id. at 11.
113
Id. at 65.
114
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556 CUMBERLAND LAW REVIEW [Vol. 35:3
death is imminent. In a section titled “Death With Dignity,” it
states: “The administration of food and liquids, even artificially, is
part of the normal treatment always due to the patient when this is
not burdensome for him: their undue suspension could be real
and properly so-called euthanasia.”115
End-of-life care is also addressed in the Ethical and Religious Di-
rectives for Catholic Hospitals (“ERD”), a set of norms adopted by the
National Conference of Catholic Bishops and updated in 2001.116
“The directives describe procedures that are judged morally wrong
by the National Conference of Catholic Bishops and the United
States Catholic Conference.”117 Catholic hospitals are required to
follow the ERD when their local bishop adopts these directives.
The ERD restate traditional Catholic teaching on the distinction
between ordinary and extraordinary care. Thus persons are mor-
ally obligated “to use ordinary or proportionate means in preserv-
ing life”118 but “may forego extraordinary or disproportionate
means.”119 The burdens imposed on the patient by the treatment
and its expense for the patient’s family and community are bal-
anced against the expected benefits of the treatment for the pa-
tient to determine the proportionality of treatment.120
The ERD approved by the Bishops in 1994 addressed for the
first time “the moral issues concerning medically assisted hydration
and nutrition.”121 While noting that that the Church’s teaching
prohibits euthanasia, the 1994 ERD observes “that hydration and
nutrition are not morally obligatory either when they bring no
comfort to a person who is imminently dying or when they cannot
be assimilated by a person’s body.”122 Directive 58 of the 1994 ERD
further states that “[t]here should be a presumption in favor of
115
Id. at 105.
116
UNITED STATES CONFERENCE OF CATHOLIC BISHOPS, ETHICAL AND RELIGIOUS
DIRECTIVES FOR CATHOLIC HEALTH CARE SERVICES (4th ed. 2001) (hereinafter “2001
ERD”). See also Kenneth R. White, Hospitals Sponsored by the Roman Catholic Church:
Separate, Equal and Distinct, 78 MILBANK Q. 213, 216 (2000) (“The moral responsi-
bility of Catholic health care is outlined in the Ethical and Religious Directives for
Catholic Health Care Services.” ).
117
White, supra note 116, at 216. In 2002, the National Conference of Catholic
Bishops and the United States Catholic Conference merged to become the United
States Conference of Catholic Bishops.
118
2001 ERD, supra note 116, Directive 56, at 31.
119
Id.
120
Id. Directives 56, 57, at 31.
121
United States Conference of Catholic Bishops, ETHICAL AND RELIGIOUS
DIRECTIVES FOR CATHOLIC HEALTH CARE SERVICES (1994), available at http://www.
usccb.org/bishops/directives.htm (hereinafter “1994 ERD”).
122
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providing nutrition and hydration to all patients, including patients
who require medically assisted nutrition and hydration, as long as
this is of sufficient benefit to outweigh the burdens involved to the
patient.”123 Identical language is used in the 2001 ERD.124 Both the
1994 and 2001 editions of the ERD also specifically address the
withdrawal of medically assisted hydration and nutrition from PVS
patients by referring to a report of the NCCB Committee on Pro-
life Activities that “points out the necessary distinctions between
questions already resolved by the magisterium and those requiring
further reflection.”125 Thus, the 2001 ERD do not take a definitive
position on the withdrawal of MAHN from PVS patients.
III. THE DEBATE OVER THE WITHDRAWAL OF MAHN FROM PVS
PATIENTS
The morality of withdrawing MAHN from PVS patients has
been debated among Catholic moral theologians since the 1980s.
On this issue, some argue that an approach which would allow the
withdrawal of MAHN from PVS patients is more compatible with
Catholic tradition. Indeed, the distinction between extraordinary
(disproportionate) and ordinary (proportionate) treatments seems
to incorporate the approach of the proportionalists and on this
basis some argue that on end-of-life issues, the Catholic ethical tra-
dition is essentially teleological rather than deontological.126
Ronald Hamel and Michael Panicola argue that it is the traditional-
ist moral theologians who are the revisionists on this issue because
their argument that MAHN must always be provided regardless of
the patient’s overall situation focuses only on physical life, and this
focus is inconsistent with the Catholic ethical tradition.127 Hamel
and Panicola state:
In essence, two standards for making decisions about nutrition
and hydration have emerged and now exist side by side. One is
a more holistic standard based on the traditional teaching, in
which benefits and burdens are understood broadly relative to
the person, and any means of preserving life is subject to a
benefit-burden analysis. The other is a more restrictive stan-
123
Id.
124
2001 ERD, supra note 116, at 30-31.
125
Id. at 30. See also 1994 ERD, supra note 121, at n.39 (citing Committee for Pro-
Life Activities, National Conference of Catholic Bishops, Nutrition and Hydration:
Moral and Pastoral Reflections (Washington, D.C.: United States Catholic Confer-
ence, 1992)).
126
CHRISTOPHER KACZOR, PROPORTIONALISM AND THE NATURAL LAW TRADITION 14-15
(2002) (describing the proportionalist position).
127
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558 CUMBERLAND LAW REVIEW [Vol. 35:3
dard based on recent revisions of the traditional teaching, in
which benefits and burdens are understood narrowly, apart
from relative factors, and nutrition and hydration are given a
128
special moral classification.
Notwithstanding the attempts of Hamel and Panicola to re-
frame the debate, for purposes of my analysis of the controversy
over the withdrawal of MAHN, I will continue to distinguish be-
tween traditionalists, defined as those who focus on the sanctity of
life and take a deontological approach, and those who focus on
quality of life concerns and take a more teleological approach. On
this issue, the traditionalists tend to emphasize the burdens and
benefits of MAHN itself rather than the quality of life concerns of
the PVS patient. Accordingly, they argue that in most cases con-
tinuation of MAHN is morally obligatory. On the other hand, oth-
ers tend to largely ignore the burdens and benefits of MAHN and
focus instead on the quality of life of PVS patients and the costs,
both emotional and financial, of keeping them alive. Accordingly,
they conclude that in PVS cases continuation is not morally obliga-
tory.
The approach taken by the traditionalists is set out by William
May and others in a 1987 article.129 They begin by setting out some
basic presuppositions and principles, including the statements that
“the omission of nutrition and hydration is an act of killing by
omission”130 and that “remaining alive is never rightly regarded as a
burden, and deliberately killing innocent human life is never
rightly regarded as rendering a benefit.”131 They regard deliber-
ately withholding medically assisted MAHN from PVS patients for
the purpose of causing death as homicide,132 and they characterize
the withholding of it from disabled persons as “status based dis-
crimination” when done because of quality of life concerns.133 They
also make a slippery slope argument that the withholding of
MAHN from PVS patients could easily be extended to other dis-
abled persons whose quality of life is deemed inadequate, and,
since death by starvation is painful and slow, to the acceptance of
128
Id. at 10.
129
William E. May et al., Feeding and Hydrating the Permanently Unconscious and Other
Vulnerable Persons, 3 ISSUES IN LAW & MED. 203 (1987), reprinted in QUALITY OF LIFE:
THE NEW MEDICAL DILEMMA 195 (James J. Walter & Thomas A. Shannon eds.,
1990).
130
May, Feeding & Hydrating, in QUALITY OF LIFE, supra note 129, at 196.
131
Id. at 197.
132
Id. at 199.
133
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lethal injection as the preferred means of causing death.134 In ef-
fect, they characterize MAHN as ordinary treatment that should be
provided to PVS patients.135
Nonetheless, May and his co-authors concede that there may
be exceptional circumstances in individual cases where continued
feeding is considered “useless or excessively burdensome” because
of complications from the feeding itself rather than because of
quality of life concerns.136 But they reject arguments that continued
feeding of PVS patients could “ordinarily impose excessive burdens
by reason of pain or damage to bodily self[,] . . . . [p]sychological
repugnance, restrictions on physical liberty and preferred activities,
or harm to the person’s mental life[.]”137 Likewise, they reject ar-
guments that such care could be considered excessively costly, not-
ing that the cost of the treatment itself is not expensive, and they
further argue that the cost of continuing the lives of disabled per-
sons should be borne by society without respect to quality of life
concerns.138 Thus they conclude that “in the ordinary circum-
stances of life in our society today, it is not morally right, nor ought
it to be legally permissible, to withhold or withdraw nutrition and
hydration provided by artificial means to the permanently uncon-
scious[.]”139
Among Catholic moral theologians, one of the leading advo-
cates for the morality of withdrawing MAHN from PVS patients is
Kevin O’Rourke. In a 1986 article, O’Rourke concludes that it is
appropriate to withhold tube feeding from persons in an irreversi-
ble coma in order to allow a fatal pathology to take its course.140 In
support of this conclusion, he argues that there is no obligation to
preserve life in one who no longer has the cognitive-affective ability
to pursue the purpose of life.141 O’Rourke does not deem the abil-
ity to preserve physiological function sufficient to justify continued
feeding.142 In this article, however, O’Rourke does not attempt to
characterize the treatment as extraordinary based on a balancing of
the burdens of the treatment against the benefits.143 Instead, he
134
Id.
135
Id. at 199.
136
Id.
137
Id. at 200.
138
Id.
139
Id. at 201.
140
Kevin O’Rourke, The A.M.A. Statement on Tube Feeding: An Ethical Analysis,
AMERICA, Nov. 22, 1986, at 321 (cited in WILLIAM E. MAY, CATHOLIC BIOETHICS AND
THE GIFT OF HUMAN LIFE (2000)).
141
Id. at 322.
142
Id.
143
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560 CUMBERLAND LAW REVIEW [Vol. 35:3
argues that the sole criterion in determining the morality of with-
drawing MAHN from an irreversible comatose patient is whether
144
the treatment could be useful in restoring cognitive function.
In a 1988 article that was republished in book form by the
Catholic Health Association (“CHA”), O’Rourke refined his argu-
ments in favor of the morality of withdrawing MAHN from PVS
patients.145 In this article, O’Rourke bases his arguments on the
traditional distinction between ordinary and extraordinary treat-
ment. But he reinvents those categories by focusing on spiritual
goals as well as physical goals. He argues that modern technology
has created a situation where a patient may be kept alive, but un-
able to participate in spiritual activity.146 He further argues that
“any medical therapy that would make the attainment of the spiri-
tual goal of life less secure or seriously difficult could be judged a
grave burden and could be considered an optional or extraordi-
nary means to prolong life.”147 Noting that only physiological func-
tion can be sustained in a PVS patient, he concludes that there is
no moral obligation to preserve life where there is no cognitive
function to support spiritual activity.148 O’Rourke bases his argu-
ment on a statement by Pope Pius XII, who, in discussing the mo-
rality of refusing extraordinary treatment, opined that “[l]ife,
health, [and] all temporal activities are in fact subordinated to
spiritual ends.”149 O’Rourke thus reformulates the distinction be-
tween ordinary and extraordinary treatment as follows:
Emphasizing the spiritual goal of human life specifies more
clearly the terms “ordinary” and “extraordinary,” a specification
that was not required when life support systems were not as ad-
vanced as they are today. Contemporary life support systems
may prolong a state of existence which not only involves grave
burdens for the patient, but also preclude spiritual activity on
the part of the patient. Thus a more adequate and contempo-
rary explanation of “ordinary” means to prolong life would be:
those means which are obligatory because they enable a person
to strive for the spiritual purpose of life without grave burden.
“Extraordinary” means would seem to be: those means which
are optional because they are ineffective or a grave burden in
helping a person strive for the spiritual purpose of life. One
144
Id.
145
KEVIN O’ROURKE, DEVELOPMENT OF CHURCH TEACHING ON PROLONGING LIFE 12-
14 (CHA 1988), originally published in HEALTH PROGRESS, (Jan.-Feb. 1988) (cited in
MAY, CATHOLIC BIOETHICS, supra note 140).
146
Id. at 13.
147
Id. at 12.
148
Id. at 14.
149
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cannot judge what is effective or a grave burden without con-
sidering the physiological condition, as well as the social and
150
spiritual circumstances of the patient.
There have been several responses to Father O’Rourke’s ar-
guments. William May argues that “O’Rourke errs seriously when
he claims that a means is ‘ordinary’ only if it enables a person to
pursue . . . [a spiritual] goal and that it is ‘extraordinary’ and hence
not obligatory if it is ineffective in helping a person strive for the
spiritual goal of life.”151 May argues that persons who are incapable
of spiritual activity because they are cognitively impaired are still to
be regarded as “persons” and are thereby entitled to medical
treatments even if those treatments would not allow them to pursue
spiritual goals.152 He gives the example of a mentally incompetent
elderly person’s cutting an artery and argues that such a person
would be entitled to treatment to stop the bleeding even though
that treatment would not enable the person to pursue spiritual
goals.153 He further argues that a proper understanding of the
Pope’s statement is that treatments having the potential side effect
of impairing cognitive function so as to preclude the pursuit of
spiritual goals could properly be refused as extraordinary treat-
ments.154
A 1989 paper issued by Bishop James McHugh of Camden,
New Jersey, also attempts to refute O’Rourke’s arguments by focus-
ing on the question of whether MAHN could ever be considered
extraordinary medical treatment.155 He is primarily concerned with
the situation of PVS patients who could live for many years if pro-
vided with MAHN.156 Referring to O’Rourke’s argument that there
is no obligation to continue feeding PVS patients because of their
inability to pursue spiritual goals, Bishop McHugh argues that such
patients could continue to pursue a spiritual purpose, i.e., union
with God, “if that person has intended that all of his or her suffer-
ing or debilitation be offered to God in union with the suffering of
150
Id. at 12-13.
151
WILLIAM E. MAY, CATHOLIC BIOETHICS AND THE GIFT OF HUMAN LIFE 255-56
(2000) (emphasis in original).
152
Id. at 256.
153
Id.
154
Id.
155
The Most Reverend James McHugh, Bishop of Camden, N.J., Artificially Assisted
Nutrition and Hydration 19 ORIGINS: NC NEWS SERVICES, Sept. 21, 1989, at 314-16
(cited in MAY, CATHOLIC BIOETHICS, supra note 151, at 267, 281).
156
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562 CUMBERLAND LAW REVIEW [Vol. 35:3
157
Christ.” He also characterized MAHN as “basic means of sustain-
ing life” rather than as “forms of therapeutic medical treatment.”158
Bishop McHugh further observes that continuing MAHN is
“not customarily burdensome because they are commonplace
medical technologies, not overly expensive . . . [and] do not usually
increase the suffering of the patient.”159 He mentions that there
have been cases where PVS patients have regained consciousness.160
He argues that if those withdrawing feeding intend that the PVS
patient die, then their action amounts to euthanasia.161 Finally, he
concludes that “[a]bsent any other indication of a definite burden
for the patient, withdrawal of nutrition/hydration is not morally
justifiable.”162
In an open letter responding to Bishop McHugh’s paper,
Kevin O’Rourke reiterates his arguments that the use of MAHN in
PVS patients is “an ineffective means of care or therapy.”163 He ar-
gues that persons who are PVS are not capable of performing “hu-
man acts,” and thus a previous intention, for example, to offer up
one’s suffering to God, would not be spiritually efficacious.164 He
notes that McHugh and others would recognize that MAHN need
not be continued in persons whose death is imminent and argues
that this implicitly recognizes that the medical treatment is subject
to ethical evaluation.165 Accordingly, he specifies the true basis for
disagreement with McHugh as revolving around the question of
whether the health care is ineffective.166 In terms of balancing the
burdens and benefits of continued feeding in PVS patients, he
takes issue with Bishop McHugh’s statement that such treatment is
“not overly expensive” noting that the relevant cost is the cost per
day of continuing care in a hospital or long-term care facility rather
the cost of the feeding.167 He also counts as costs the psychological
and social stresses on the family.168 O’Rourke analogizes the re-
moval of MAHN from PVS patients to the removal of a ventilator,
and notes that the latter action has been recognized as morally
157
Id.
158
Id.
159
Id.
160
Id.
161
Id. at 316.
162
Id.
163
Kevin O’Rourke, Open Letter to Bishop McHugh: Father Kevin O’Rourke on Hydra-
tion and Nutrition, 19 ORIGINS: NC NEWS SERVICE, Oct. 26, 1989, at 351-52.
164
Id. at 352.
165
Id.
166
Id.
167
Id.
168
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permissible.169 Finally, he argues that the PVS patient has a fatal
pathology, i.e., the inability to swallow, and thus should be treated
as a dying patient.170
In a 1988 article, Thomas A. Shannon and James J. Walter also
argue in favor of the morality of withdrawing MAHN from PVS pa-
tients.171 They explicitly endorse the use of quality of life considera-
tions in arguing that the withdrawal of MAHN is consistent with the
Catholic ethical tradition.172 They caution against treating the con-
tinuation of physical life as an absolute value and contend that
“quality of life judgments properly supplement and enhance the
Christian emphasis on the sanctity of life.”173 With reference to the
traditional distinction between ordinary and extraordinary treat-
ment, Shannon and Walter argue that “the concepts of burden and
quality of life should be linked.”174 On this basis, they conclude that
continuing MAHN in PVS patients may be considered extraordi-
nary treatment precisely because of quality of life considerations,
i.e., the burden of continuing the patient’s life for the patient’s
family and the professionals who care for the patient.175
There has also been disagreement among bishops on this is-
sue. In 1988, Bishop Louis Gelineau, Bishop of Providence, Rhode
Island, issued a statement endorsing the removal of MAHN from a
PVS patient.176 In 1990, the Texas Conference of Catholic Bishops
issued a statement opining that in some cases it is morally permissi-
ble for the family of PVS patients to discontinue MAHN.177 On the
other hand, in 1991, the Catholic Bishops of Pennsylvania issued a
statement concluding that “in almost every instance there is an ob-
ligation to continue supplying nutrition and hydration to the un-
169
Id.
170
Id.
171
Thomas A. Shannon & James J. Walter, The PVS Patient and the Forgo-
ing/Withdrawing of Medical Nutrition and Hydration, 49 THEOLOGICAL STUDIES 623
(1998), reprinted in QUALITY OF LIFE, supra note 129, at 203-23.
172
Shannon & Walter, The PVS Patient, in QUALITY OF LIFE, supra note 129, at 211-
12.
173
Id. at 213.
174
Id. at 214.
175
Id.
176
Bishop Gelineau’s Statement on Removing Nutrition and Hydration from Comatose
Woman, 17 ORIGINS, Jan. 21, 1988, at 546.
177
Texas Conference of Catholic Bishops, On the Care of Vegetative Patients, 20
ORIGINS: NC NEWS SERVICE, May 7, 1990, at 53. Two Texas Bishops dissented from
the statement. Id. at 53. See also Bishop Rene H. Gracida, A Dissent from the “Interim
Pastoral Statement on Artificial Nutrition and Hydration” Issued by the Texas Conference of
Catholic Health Facilities and Some of the Bishops of Texas, available at http://
www.catholicculture.org/docs/doc_view.cfm?recnum=5266.You can also read
