In many respects, when St. John Paul II wrote Evangelium Vitae it helped the pro-life movement move forward on matters of public policy. It has served as a guide on many incremental approaches dealing with the subject of abortion. However, what does it have to say on matters of public policy that deal with end-of-life issues? Again, this ground-breaking document has laid a path for the pro-life movement.
Yet, what if the movement is divided on the issue of what qualifies as morally obligatory care? What if one element of the movement holds fast to the ideology that all care that is wanted by the patient is morally obligatory? For the last 7 years this fight has played out rather in Texas as National Right to Life, its state affiliate, and prominent pro-life activist Wesley J. Smith have squared off against the Texas Catholic Conference and other pro-life leaders dealing with legislation that pertains to this very issue (which will be covered in Part 2 of this article).
The current law that is being amended is Texas’ infamous Advanced Directives Act that currently allows a patient who wants to continue receiving life sustaining treatment that the doctor and hospital have deemed medically futile to transfer to another hospital within a 10 day period. If a transfer cannot be found within that time the hospital then may discontinue treatment. All factions of the pro-life movement agree that this law is woefully inadequate and needs to be changed in order to better reflect dignity for the terminally ill person. In 2013, the Texas Bishops and their allies supported SB 303 that would have taken the Catholic approach to end-of-life care. However, a faction of the pro-life movement, led by the aforementioned groups, opposed this bill and have taken what is called a “vitalist” position.
Before the intricacies of SB 303 are discussed in Part 2 of this series there needs to be some clarification on what is meant by this term “vitalism”. Eastern Orthodox scholar Fr. John Breck best defines it as a belief “which holds that biological life should be sustained at all costs and by any means available” (The Sacred Gift of Life: Orthodox Christianity and Bioethics, pg. 204). He goes on to state, “While this sounds like a noble defense of the “sanctity of life” principle, it is in fact a form of biological idolatry, which places the abstract value of sustained physical existence ahead of the personal needs and ultimate destiny of the patient” (ibid). As a result, the vitalist fails to make necessary moral distinctions between ordinary and extraordinary care when it comes to the subject of death. All care is deemed morally obligatory if it is requested.
The Church does not hold that all care is morally obligatory, rather, medical care can fall into one of two categories: ordinary or extraordinary care. Ordinary care are those medical means which tend to be routine, reasonably available, and typically successful. So taking antibiotics while one has the flu would be considered ordinary. Archbishop Jose H. Gomez outlines extraordinary care in his A Will to Live: Clear Answers on End of Life Issues as, “The ethically extraordinary nature of any given method is determined by various criteria: the type of means, the degree of risk, the difficulty of access for those who may request it, its high cost, the increase of suffering it may cause the patient, and a comparison of these factors relative to the expected outcome for a particular patient. If after making this comparison, the various factors considered are disproportionate to the foreseen results, then the method can be morally optional, i.e. not morally obligatory”(no. 14). St. John Paul II echoes this belief when he declares, “To forego extraordinary or disproportionate means is not the equivalent of suicide or euthanasia; it rather expresses acceptance of the human condition in the face of death” (EV, no. 65). Simply, if a treatment is considered extraordinary and the patient does not want treatment to continue then the patient is not doing anything morally objectionable.
But what about cases in which a doctor determines that a patient is truly on death’s doorstep and the patient is asking for treatment that will have no physiological benefit? St. Pope John Paul II answers this question by stating, “To refuse to take part in committing an injustice is not only a moral duty; it is also a basic human right. Were this not so, the human person would be forced to perform an action intrinsically incompatible with human dignity, and in this way human freedom itself, the authentic meaning and purpose of which are found in its orientation to the true and the good, would be radically compromised…Those who have recourse to conscientious objection must be protected not only from legal penalties but also from any negative effects on the legal, disciplinary, financial and professional plane” (EV no. 74).
Basically, it is being asserted that a doctor can conscientiously refuse extraordinary care if he believes it will not be of any physiological benefit to the life of the patient. If the patient’s death will continue to be imminent, the doctor has no moral obligation to provide treatment even if the patient requests it. This is the “biological idolatry” on the behalf of the patient that Fr. Breck was speaking of. The vitalist vehemently disagrees with this point since all treatment at the request of the patient is seen as obligatory and life is to be sustained at all costs, even if it is at the cost of the doctor’s authentic conscientious objection.
Note, St. John Paul II is not speaking of a “quality of life” ethic here. In fact, he is explicit in what it is and its condemnation, “I confirm that euthanasia is a grave violation of the law of God, since it is the deliberate and morally unacceptable killing of a human person” (EV, no. 65). Euthanasia actively and deliberately seeks the death of the patient precisely because it is deemed burdensome on others for various “quality of life reasons” such as age or disability. Recognizing that one is truly physiologically dying and responding appropriately, even if this means the denial of care because it will no longer prove to be of any benefit to the patient or may even prove to be harmful, is not euthanasia, but rather an acceptance that God is calling this person home.
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