Bioethics in Faith and Practice, Volume 2, Number 1

Bioethics in Faith and Practice ⦁ 2016 ⦁ Volume 2 ⦁ Number 1 11 the question may be best framed something like this: “If God is calling you home, how much do you argue?” To move from a theological perspective to a practical one, it should be considered, consistent with Directives 56 and 57, how much can, should or must be done and at what cost in terms of financial and other personal and community resources, discomfort and distress for the family and patient? The question may be stated simply as done by Kelly, but it defies an easy answer, contributing to the “centuries of wrestling with these concerns. ” 65 Francisco de Vitoria attempted to outline how far our duty extends, limiting it (in terms of nourishment) to “common and regular foods” and without imposing a duty to travel to a more healthful climate or location, particularly when “depression of the spirit is…low,” the effort great so as to be akin to “a certain impossibility. ” 66 In such instances one may be excused from making the effort to sustain one’s life “especially where there is little hope of life, or none at all. ” 67 Pope Pius XII’s pronouncements in 1957 on the requirement to “use ordinary means,” 68 which were confirmed by Cardinal Juan de Lug o 69 and Kell y 70 are again found in Directives 56 and 57 which apply what might be thought of as a ‘rule of reason’ when balancing benefits and burdens for a particular patient with her unique circumstances, disease state or injury, etc. More than twenty years after Pope Pius XII’s ‘ordinary means’ statement, perhaps reflecting rapid advances in medicine generally and medical technology in particular, the Sacred Congregation for the Doctrine of the Faith, in its Declaration on Euthanasia (1980), refers more to appropriate or proportionate means being obligatory rather than the classic ordinary test. Inappropriate or disproportionate (extraordinary) means are not obligatory, but are permitted, since the duty is limited “to make do with the normal means medicine has to offer. ” 71 Without situating Directive 58 in the context of the individual patient, JPII’s view on ANH in PVS (as now reflected in ERD5) seems to Peter Clar k 72 to be taking the Church in a different direction from the traditional analysis, which applied previously for both patients at the end of life and in PVS. Whether the obligation to provide ANH under all circumstances should be an unqualified rule appears to be debatable, despite Directive 58. Clark and others are inclined to limit the use of these statements to counter the undesirable effects of our Western culture of death , but perhaps these statements may undermine the battle with that culture by diminishing the value that the Church’s traditional approach has had. The traditional benefits- burdens method found in CST and CMT may seem a bit vague or even clumsy and imprecise, but perhaps that situation is unavoidable, due to the uniqueness of each life and each person’s life experience that should be considered where PVS is involved. Such a process of consideration is made all the more difficult for PVS patients, since they can no longer communicate their wishes and the health care team must rely on instructions from agents for these patients. JP II’s allocution upon which Directive 58 is based also has some other problems to which Harvey alerts us. By limiting the effect of the allocution (and Directive 58’s mandate) to the first class of PVS patients described by Harvey, that would dramatically reduce the number of patients kept on life support indefinitely. As Harvey says: The Holy Father spoke at length about…’reawakening centers’…It is clear from his words that he was speaking only about those individuals who were in PVS as a result of head trauma or poisoning by drugs or alcohol. It is this group of patients who do not necessarily have a fatal pathology and may recover consciousness months or even years after the traumatic insult. 73 In addition to the above problems that Harvey describes with JPII’s allocution, Clark observes that “’it seems logically inconsistent to classify nutrition and hydration as basic care that is always obligatory, even