Medically Assisted Nutrition and Hydration: A Contribution to the Dialogue

Abstract

The Address to Participants the International Congress on Life-Sustaining Treatments and the Vegetative State: Scientific Advances and Ethical Dilemmas, promulgated March of this year by Pope John Paul II, has become a source of considerable controversy, partly due to the theological and clinical complexity of this issue, and partly because of how has been portrayed the popular media. (1) In light of this controversy, many Catholics, as well as Catholic health systems, are re-examining the half-millennium-old tradition of Catholic moral teaching regarding the obligation to use particular means of sustaining human life. (2) In this essay, we seek to foster that effort. In light of that tradition, and particularly the discussion of the principles of proportionate and disproportionate means, we will propose a way of interpreting the recent papal address that has not received significant attention. The Duty to Sustain Life Perhaps the most fundamental tenet of the Roman Catholic moral tradition is that life is a precious gift from God. (3) This conviction is the basis for a duty to protect and preserve our lives, but that duty does not imply an obligation to use every and all means available to sustain our lives at all costs. (4) Catholic moral teaching holds that the ultimate end of human life lies with God and that life on earth is itself only a penultimate good. As Pope Pius XII notes, Life, health, all temporal activities are fact subordinated to spiritual ends. (5) Reaffirming this insight, Pope John Paul II wrote Evangelium Vitae that it is precisely [our] supernatural calling which highlights the relative character of each individual's earthly life. After all, life on earth is not an 'ultimate' but a 'penultimate' reality. (6) Thomas Shannon and James Waiters have recently pointed out that the resulting duty to sustain life has traditionally been understood the Roman Catholic moral tradition as teleological. (7) In the context of the Catholic moral tradition, is not synonymous with consequentialist. Rather, as we understand it, the teleological framework found within the Catholic tradition recognizes the moral relevance both of rules of right conduct and of consequences. (8) In other words, the Catholic moral tradition has always recognized some negative obligations of a fundamentally deontological nature, including of course the obligation never to directly intend the destruction of innocent human life. It is our view, however, that these deontological obligations do not preclude the use of the principles of proportionate and disproportionate means as teleological guides for discerning whether discontinuing a particular life-sustaining treatment would constitute the directly intended destruction of innocent human life. As defined by the Ethical and Religious Directives for Catholic Health Care Services (ERDs), a proportionate means is one that individuals are obligated to use to preserve life insofar as, the judgment of the patient, the means question offer a reasonable hope of benefit and do not entail excessive burdens. (9) One is not obligated to use any means of sustaining life that, one's own judgment, either do not offer a reasonable hope of benefit or entail excessive--that is, disproportionate--burdens. The Catechism of the Catholic Church affirms this when says, Discontinuing medical procedures that are burdensome, dangerous, extraordinary, or disproportionate to the expected outcome can be legitimate; is the refusal of 'over-zealous' treatment. Here one does not will to cause death; one's inability to impede is merely accepted. (10) It is important to note here that neither the ERDs nor the Catechism specify which procedures, diagnostics, or therapies constitute proportionate or disproportionate means. In fact, the ERDs explicitly emphasize that those determinations are to be made in the judgment of the patient. …