It is hard for me to turn on the TV these days. When I do, it seems like there is nothing but reruns of shows I don’t want to watch again, or news stories about Terri Schiavo.
I have followed this case, and been involved in it, for more than five years now. One of my long-term professional interests in medical ethics has been end-of-life care. It is an area that I have been involved with clinically, written about and lectured on around the world.
So, I get a little irritated when I hear lots of half-truths, or no truths, on shows like Larry King Live. That said, here are some basic parameters that need to be kept in mind:
1. Persistent Vegetative State (PVS): This is Terri’s condition. On any given day in the United States, there are 20,000 patients who are PVS. It is a state from which there is no recovery. When the tissue of the brain is destroyed, it does not regenerate. The American Academy of Neurology has defined PVS as one of permanent unconsciousness with a loss of cerebral cortical functions, which leads to complete unawareness of self or of the environment, though there is the persistence of sleep-wake cycles.
Because of these cycles, the families of patients often think the patient is responsive. The families see what they hope for. For physicians to give an off-the-cuff diagnosis without ever having examined the patient is irresponsible.
2. Coma: People don’t seem to understand that there are different types of comas. Some are medically induced to help healing. This often happens after surgery. Some are prolonged states of unconsciousness from which people can awake. These are stories that make the news. There are some comas, like PVS, from which patients will not recover. Death: Death is part of human life that has been transformed by modern medicine. For most of human history, people simply died. This is how most of us still think of death.
But death has changed. It is estimated that because of our ability to prolong life, 85 percent of people die because someone makes a choice. Either the patient or the patient’s surrogate decides to stop medical interventions, and the patient dies. Death for most Americans involves a choice.
4. The Obligation to Sustain Life: This is a tough one. I can clearly set out my obligation for not taking life. The obligation to sustain life is a positive obligation. How far do I need to go?
Here the Catholic tradition on “ordinary-extraordinary means” is helpful. In this tradition of thought there is no list of medical interventions that must always be used.
Rather, the tradition asks two fundamental questions when a patient’s life is threatened and the patient can do something to prolong life. First, if a medical intervention is proposed, is there a hope it will bring health? If not, then there is no obligation to use it.
Second, if there is a hope of health, the patient needs to weigh the benefits and burdens of the intervention and the impact on his or her life. The notion of burden, traditionally, has covered everything from impact of the intervention on the family, on finances, as well as the psychological or spiritual fear of being kept alive in a particular way.
5. The Government: One question played out in this case is the appropriate role of the government. We normally assume that the government has a role in protecting life. But there has been a consistent body of court rulings and legislation in the past 30 years that have left these decisions to patients and patient surrogates.
We normally assume a patient’s spouse is the best one to make these decisions. In the Schiavo case, which has been reviewed by state and federal courts, no one has ever raised a serious question about Michael Schiavo’s competence to decide for his wife. I fear that the unusual government intervention may fuel those Americans who are sympathetic to physician-assisted suicide who fear their wishes may be ignored when they are too weak to speak for themselves.
6. Life: This case brings us face to face with our mortality and the fragility of human life. It challenges each of us to think about what we think makes for a good life and a good death. How we imagine the end of our life will be tied to how we understand the meaning of our lives.
For Christians, the meaning of life is not an end itself. Such a view would be idolatry and violate the First Commandment. Rather, as Pope Pius XII said, the good of life is subordinate to “higher spiritual ends.” In this season of Easter and the celebration of the Resurrection, that is a wise insight for Christians to remember.
The Rev. Kevin Wildes, S.J., university president, is an accomplished bioethicist and theologist.