Bioethics in Faith and Practice, Volume 2, Number 1

Bioethics in Faith and Practice ⦁ 2016 ⦁ Volume 2 ⦁ Number 1 13 adopting this literalist approach to Directive 58, I submit that the Church and respect for the dignity of the person of the PVS patient involved would be better served by a more inclusive benefits-burdens analysis, to be conducted in accordance with the historic ordinary-extraordinary distinction found in CMT and CST, at least insofar as any case under consideration falls in the second category of cases described by Harvey, if not all PVS cases. Even if the particular patient in question came to be in PVS due to a failed suicide attempt, the clinical reality and corresponding ethical analysis would be the same for that patient as for one who came to be in PVS due to a traumatic event not of the patient’s own making. Regardless of the cause, if the patient falls in Harvey’s second category of cases, providing ANH for such a patient should not be morally obligatory. PVS patients are and remain persons and are thus entitled to the dignity, respect and protection afforded to persons. However, PVS patients are in a “…clinical condition of complete unawareness… ” 86 and such a state of ‘unawareness,’ at least in Harvey’s second category of cases, removes permanently the patient’s ability to be a functioning and interactive member of the human community and to have relationships with others facilitated by perception and communication. To insist on continuing ANH for all PVS patients as Directive 58 can be read to do amounts to requiring futile care at considerable financial and human cost that is essentially 'arguing too much' with God, when He has, in effect, already 'called' this person to come home. As Todd A. Salzman and Michael G. Lawler have counseled with respect to reproductive matters, 87 further dialogue within the Church on ANH and PVS is not only desirable, but also necessary. This is so because providing ANH to PVS patients merely delays death by maintaining biological existence, rather than preserving life. Providing ANH may well be permissible here, but it should not be morally obligatory in all cases. Applying new Directive 58 literally and without a full contextual approach conflates protection of human dignity with preservation of biological existence. It also does not serve the common good or conserve scarce resources as would be consistent with the duty found in CST’s injunction for us to be the good stewards of the ‘goods’ of this world. Finally, Directive 58’s ‘legalistic’ approach does not aid in the needed reform Lysaught calls us to accomplish by making Christian health care ethics less about “isolated, rare, occasional treatment decisions” and more about Christian discipleship and the “shape of the entire Christian life as lived within and around the context of medicine. ” 88 1 Richard McCormick, “ 'Moral Considerations' Ill Considered,” i n America, volume 166, number 9 (March 14, 1992), pp. 210-214 at p. 214. 2 United States Conference of Catholic Bishops, Ethical and Religious Directives for Catholic Health Services, Fourth Edition, Washington, D.C. (2001) [ERD4]; United States Conference of Catholic Bishops, Ethical and Religious Directives for Catholic Health Services, Fifth Edition, Washington, D.C. (2009) [ERD5]. 3 Thomas A. Shannon and James J. Walter, "Assisted Nutrition and Hydration and the Catholic Tradition," in Theological Studies , volume 66, number 3 (September, 2005), pp. 651-662. Shannon and Walter point out "four unacknowledged shifts" in the Catholic tradition, ending with JPII's allocution in 2004, which they describe as "revisionist" and conclude strongly when they say that "...the Catholic tradition on end-of-life issues has never mandated doing useless or inane things to people in the name of morality. We should not start doing this now." Ibid . pp. 653, 662. Treating JPII's views as 'revisionist' has been challenged by, among others, John J. Paris, James S. Keenan and Kenneth R. Himes in "Did John Paul II's Allocution on Life Sustaining Treatments Revise Tradition?" in Theological Studies , volume 67, number 1 (March, 2006), pp. 163-168. 4 See, e.g. , Justin F. Rigali and William E. Lori, "Human Dignity and the End of Life," in America , volume 199 number 3 (August 4, 2008), pp. 13-15, who would concur with the new version of Directive 58, since they argue that "food and water...constitute the 'basic care' that patients should receive." Ibid . p. 15.