Bioethics in Faith and Practice, Volume 2, Number 1

12 Smith ⦁ ANH and PVS Patients if artificially supplied, while not doing the same for oxygen supplied by mechanical ventilation or other basic elements of care necessary for life.’” 74 Clark finds this inconsistency as to what is to always be regarded as ‘basic care’ to be “not only illogical but…irrational. ” 75 In addition, I concur with Clark that JPII’s classification of the withdrawal of ANH as being the creation of a “second pathology, starvation/dehydration ” 76 and thus such withdrawal constituting the “direct killing of the patient” 77 to be moral error based upon a misunderstanding of the clinical facts. This is so because withdrawing ANH for a PVS patient involves an “intention [which]…is not to end the life of the patient but to forgo a burdensome treatment and allow the patient to die from the original pathology. ” 78 The traditional Catholic view is that life is a good but not the highest good, so there are limits on what must be done to preserve life. Determining what is obligatory and what may be foregone is a difficult task, since a simple assertion that we need not “do everything to maintain life at all costs,” consistent with Pope Pius XII’s guidance, does not provide a clear path for “most medical decisions” which, according to Kevin W. Wildes, “fall somewhere in between” the prohibition against taking innocent life and a do everything approach . 79 Within these boundaries lie the dilemmas, the places where the Catholic tradition sets the guideposts of ordinary and extraordinary means, which have the vice of being vague but the virtue of being flexible enough to adapt to the situation of the individual patient in question . 80 Wildes cites Archbishop Daniel A. Cronin, who emphasized in his 1958 doctoral dissertation that humans have only an imperfect dominion over their own lives, such lives being gifts from God, to be contrasted with the more perfect dominion humans have over animals and things in the physical world. Included within this notion of dominion is the concept of mastery, humans having mastery over certain operations conducted by them, but not mastery over their own lives. 81 In this latter dominion is demonstrated the “considerable, though limited, freedom” given to human beings wherein we are obligated to conserve our lives, but in so doing to balance that obligation against “other obligations and the view that love of God orders all obligations.” 82 The two main roadblocks presented that may prevent the use of a particular life-conserving means include physical and moral impossibility. When looking at potential means as possibilities for action, if neither of these impossibilities is present, then the means may be considered ordinary. Wildes' focus, though, is on the effect of the treatment on the lives of this patient, such patient’s family and the others involved with the patient, rather than on the specific “means of treatment or care” involved . 83 For Wildes, the proper standard is a situated one, without absolutes and where the conscience of the individual, exercising “rational self-interest but according the promptings of the Holy Spirit” will be involved: clearly a patient-centered approach . 84 To be considered extraordinary, a means must be morally impossible, require excessive effort, involve great pain or discomfort, hardship-level expense or be repugnant to the patient. 85 Conclusion: Whether to intervene at the outset with ANH for a PVS patient or to continue ANH once begun after a sufficient period of time has passed for good clinical judgment to be made is something to be decided with and for a particular patient and with due consideration for that patient’s values. If the process remains focused on a particular patient and such patient’s hopes, dreams, desires and goals, we may avoid the concerns over discrimination and eugenics about which JPII has warned us. Unless read more broadly in the context of the CST and the remainder of ERD5 (including Directives 56 and 57), Directive 58 of ERD5 can be considered as having effectively closed the door to considerations appropriate in CST to a balancing of interests in favor of an unqualified obligation to provide ANH in essentially all PVS cases. Rather than