While hard cases donít make good law, Terri Schiavoís
circumstance crystallizes all the major issues surrounding care
for the terminally ill, and provides an opportunity to preach
and educate our people about human rights, the inherent dignity
of all human life, and the limits of medical treatment.
In the American west in April 1879, a superior court rejected,
thankfully, a District Attorneyís claim that a local Indian leader was
not a person "within the meaning of the law." A month later Standing
Bearís brother, Big Snake, tried to leave the reservation. The Army
General in command explained to Big Snake that the court decision
granting his brother personhood applied only to Standing Bear, not to
him. Big Snake didnít understand, and was shot to death while resisting
Exactly what human qualities constitute personhood have been debated for
centuries, perhaps beginning in earnest in the sixteenth century with
the discovery of Africa and South America by Portuguese and Spanish
explorers. Their subsequent enslavement of portions of the native
population led to intense philosophical debate within the Church. One
side argued that the nativesí primitive culture and habits testified to
their subhuman nature, justifying their enslavement by the more
culturally advanced Europeans. The other side, the winning side in the
end, stressed that primitive habits and lack of education were not
sufficiently egregious shortcomings to disqualify the natives from the
human rights due all men made in Godís image and likeness.
This debate was the match that lit a slow fuse of thought that burned
its way through the centuries. The explosion it eventually ignited blew
slavery to bits, gave women the right to vote, and humanized
factory-working conditions, among many other accomplishments. Its
supreme achievement resulted in the universal recognition of inalienable
human rights in the Christian countries of the West, rights guaranteed
Unfortunately, these rights, thought to be "self evident" and
"inalienable" by the writers of the Declaration of Independence, are
proving more difficult to define and defend only slightly more than two
centuries after their manifest nature was so famously proclaimed. The
massive legal seawall protecting human rights is eroding at its base.
This debate was the match that lit a slow
fuse of thought that burned its way through the centuries. The
explosion it eventually ignited blew slavery to bits, gave women
the right to vote, and humanized factory-working conditions,
among many other accomplishments.
The sixteenth-century debate over personhood and human dignity discussed
whether incest, lack of a written language, nakedness, human sacrifice,
child abandonment, and other primitive habits disqualified a tribe from
the human community and its corresponding legal protections. The current
debate over personhood concerns no such matters of behavior or custom.
Todayís debate over dignity concerns matters of dependency.
There is a growing tendency to justify an attack on any life that exists
in a condition of radical dependency. Pro-abortionists, for example, no
longer quibble over whether preborn life is human life or not, since
sophisticated imaging technology has removed that weapon from their
arsenal. Yet they can argue that the childís state of complete
dependence on its mother excludes it from the circle of legal protection
afforded autonomous persons.
The real and theoretical achievements of the sixteenth-century debate
are thus being slowly unraveled. The bonds tying personhood to human
life are being snipped cord by cord. So while a pro-abortionist will
acknowledge that the baby in the womb is a human life, that
acknowledgement itself is insufficient to guarantee that same baby the
right to life. In other words, just because someone is alive does not
therefore mean that he is a person. Only autonomous human life thus
rises to the level of personhood and its legal protections. Dependent
human life, however, because of its need for outside aids to maintain
itself, does not qualify for personhood. We are thus left with a new
category of individual: the human non-person.2 That this
sounds ridiculous does not preclude people from believing it. Just ask
Big Snake of the Poncas.
Terri Schiavoís situation
Moving on from the abortion debate, the argument that human non persons
have no rights is now being applied to those on the other end of lifeís
spectrum, to the elderly and terminally ill. The withdrawal of
artificially delivered nutrition and hydration from the terminally ill
is the next battleground in the struggle to defend the dignity of
marginalized human life. The circumstances of Floridian Terri Schiavo
highlight the difficulty of discerning whether certain medical
procedures violate or promote human dignity. While hard cases donít make
good law, Schiavoís circumstance crystallizes all the major issues
surrounding care for the terminally ill, and provides an opportunity for
priests to preach and educate our people about human rights, the
inherent dignity of all human life, and the limits of medical treatment.
The general principles of Catholic Health Care and their practical
applications are explained in the Ethical and Religious Directives for
Catholic Health Care Services (the ERDís.) Written by the Committee on
Doctrine of the USCCB and approved by the Vatican, these Directives are
normative for Catholic Health Care in the U.S. They do not attempt the
impossible by trying to solve every conceivable health care dilemma.
They do, though, provide enough authoritative guidance to help untangle
the twisted knot of concerns which difficult end of life situations
In general, the Churchís position on artificial nutrition and hydration
(AN/H) is summed up in Directive # 58: "There should be a presumption in
favor of providing nutrition and hydration to all patients, including
patients who require medically assisted nutrition and hydration, as long
as this is of sufficient benefit to outweigh the burdens involved to the
patient." Leaving aside the question of benefits and burdens for the
moment, the Churchís position basically means that when a patient can no
longer swallow food and water, it is presumed that nutrition and
hydration will be delivered to that patient artificially.
There are two important exceptions to this general position, summarized
in the Introduction to Part Five of the Directives: "Öhydration and
nutrition are not morally obligatory when they bring no comfort to a
person who is imminently dying or when they cannot be assimilated by a
Artificial nutrition and hydration should not be categorized as
medical treatment. Itís medical care, not medical treatment. It
is on a par with the clean sheets, warm room, and bed care given
even the most terminal patients.
According to the first exception, when death is imminent AN/H can be
withdrawn, provided it is giving no comfort to the patient. In such
circumstances the lack of nutrition and hydration does not cause death.
The disease process runs its course before the lack of nutrition and
hydration has the chance to adversely affect the body. The only
difficulty with this exception is that doctorsí skills at predicting
death are overrated. Nonetheless, to the extent that an imminent death
is foreseeable, AN/H need not be continued if it gives the patient no
The other main exception to the presumption of providing AN/H
concerns those patients suffering from stomach cancer, liver or kidney
problems, and other pathologies in the abdominal cavity. As their
diseases progress it becomes impossible for them to assimilate any
nutrition or hydration whatsoever, even if artificially delivered. In
such cases nutrition and hydration is considered futile care since it
provides no nourishment. Because it goes undigested, it can also hasten
the patientís death by causing bloating and other complications.
Terri Schiavo suffered severe brain damage after cardiac arrest deprived
her brain of oxygen for ten minutes in 1990. Since that time she has
never been on a ventilator, yet she is unable to swallow food and water
naturally. Applying the principles and exceptions stated in the ERDís
allows us to come to some conclusions about her situation.
Terri Schiavoís death is not imminent. She is not on a ventilator,
dialysis, or other life sustaining equipment. She is not awaiting a
transplant or other major surgery. She is not in pain. She has two
parents and siblings who love and care for her. She has access to good
health care. If given basic care and food and water her life will
continue in more or less its present state. The very fact that her
present state is pretty miserable is precisely why some think she should
The Church does not advocate the use of life sustaining technology at
all costs, but is against the withdrawal of technology for the express
purpose of causing death (ERDís, Intro. Part V.) Those advocating Terri
Schiavoís death, including her husband, are not making their case on
medical grounds, but on Terriís radical condition of dependency and low
quality of life.
"True compassion leads to sharing
anotherís pain; it does not kill the person whose suffering we
As John Paul II points out in Evangelium Vitae, the meaning of
death is closely tied to the meaning of life. If a culture erodes the
meaning of life itís no wonder that changes in the meaning of death
follow close behind. "When the prevailing tendency is to value life only
to the extent that it brings pleasure and well being, suffering seems
like an unbearable setback, something from which one must be freed at
all costs. Death is considered senseless if it suddenly interrupts a
life still open to a future of new and interesting experiences. But it
becomes a "rightful liberation" once life is held to be no longer
meaningful because it is filled with pain and inexorably doomed to even
greater suffering." (#64)
Because Terri Schiavo cannot speak, express much emotion, enjoy what
life has to offer, or have a life "still open to a future of new and
interesting experiences" some consider her life expendable. Terri has
never said "Put me out of my misery." It is more likely that her
continued survival bothers the consciences of those who find the
emotional and practical demands of caring for her too much. She has
become a drain on their quality of life. They, in a sense, want to put
her out of their misery. This is a far cry from the ideals of
Evangelium Vitae: "True compassion leads to sharing anotherís pain;
it does not kill the person whose suffering we cannot bear." (#66)
The Terri Schiavo case presents a teaching moment for the Church, which
translates into a learning moment for our parishioners. In sum: we
defend human life in all its forms, regardless of its condition of
dependency; medical technology is to be used to sustain life unless that
technologyís burdens outweigh its benefits; no one is obligated to use
extraordinarily expensive, painful, ineffective, and risky technologies
to sustain life; and AN/H is generally not considered extraordinary
A summary and talking points
Food and water is not medicine. When weíre hungry we donít say "Iím
starving, letís go to McDonalds and pick up some medicine."
Artificial nutrition and hydration should not be categorized as
medical treatment. Itís medical care, not medical treatment. It is
on a par with the clean sheets, warm room, and bed care given even
the most terminal patients.
Artificial nutrition and hydration is not extraordinary care. At
times, though, it can be futile care.
There is a huge difference between keeping a patient on a ventilator
and artificially delivering food and water. A ventilator is
expensive, requires medical supervision, leads to infection, cannot
be used for more than a few weeks, is extremely uncomfortable, and
replaces a major body function ó breathing. It is clearly
extraordinary care, unlike artificial nutrition and hydration.
technology used to deliver artificial food and hydration is not
excessively burdensome. It is not very expensive, painful, rare,
difficult to use, or compromising of human dignity.
being able to swallow is not a fatal pathology.
What is the familyís intention when removing food and water? Is the
intention to cause death?
"What is grandma dying of? Is she dying of her disease process? Or
is she dying of a lack of food and water?"
Does human dignity decline along with the ability to enjoy life?
Doesnít imperfect human life show in a more tangible and powerful
way our truly dependent nature before God?
Food serves the same purpose in a terminally ill person as it does
in a healthy person. It keeps him alive. If a healthy person is
denied food and water, heíll die. If a sick person is denied food
and water, heíll die.
Church focuses more on the inherent value of life than on the
relative quality of life. Human life is not merely an instrumental
good, but an inherent good. It is a good of the person, not just for
Raymond Dennehy, Anti-Abortionist at Large, (Trafford
Publishing, Victoria BC, 2002) Pg. 146. Dennehy is quoting from an
essay by Germain Grisez entitled "When Do People Begin."
For a summary of the philosophical roots of the "human non
person," see Torchia, Joseph, Postmodernism and the Persistent
Vegetative State, The National Catholic Bioethics Quarterly,
summer 2002. Pg. 263.
Reverend Michael Black. "The Case of Terri Schiavo: When Does Dignity
End?" The Homiletic & Pastoral Review (November 2004).
This article is reprinted with permission from The Homiletic &
Pastoral Review. All rights reserved. To subscribe phone: (800)
651-1531 or write: Homiletic & Pastoral Review PO Box 591120 San
Francisco, CA 94159-1120
Reverend Michael Black is a priest of the Diocese of Rockford, IL. He
was ordained in 2000 from Mt. St. Mary's Seminary in Emmitsburg,
Maryland, with an M.A. in moral theology. He is associate pastor at the
Newman Catholic Student Center
at Northern Illinois University and teaches Health Care Ethics at St.
Anthony College of Nursing in Rockford.