Life and death situations are always delicate matters. They involve not only patients, but also families, friends and in a less personal way, society itself.

These situations involve institutions e.g. hospitals that follow ethical policies that are not always the same as those followed in other hospitals. In my pastoral experience, which includes service on an ethics committee for a large hospital, decisions about life and death can be highly emotional.

Family members are saddened and drained by the natural resistance to let go of those whom they love. Even professional caregivers, medical and pastoral, can be under stress.

Life and death situations require interdisciplinary responses from people who should be in dialogue: family, medical experts, those in pastoral care and legal experts.

Although life and death situations are difficult, they are also teachable moments. They are teachable moments from the viewpoint of the elements of the interdisciplinary conversation on how to respond to both the patient and the total situation.

This week, I want to use my column to reflect on some points of catechesis that address the context of and some individual issues in the now internationally famous case of Terri Schiavo.

The right to life

Most people, including some Catholics, understand “The Right to Life” or “The Gospel of Life” in a very restricted way. They tend to think of life issues exclusively in terms of abortion. The Terri Schiavo case will change that restricted understanding forever.

The Right to Life is about the value and inviolability of human life from its beginning to its natural end. In his Encyclical Letter, “The Gospel of Life”, Pope John Paul II states, “Every person sincerely open to truth and goodness can, by the light of reason and the hidden action of grace, come to recognise in the natural law written in the heart (Romans 2: 14-15) the sacred value of human life from its very beginning until its end and can affirm the right of every human being to have this primary good (life) respected to the highest degree.”

As we pursue right to life issues, it is important that we pay attention to the full right to life agenda and not be selective. People are frequently surprised at the number of issues that the Church includes in the moral theology under the right to life. A review of the Catechism of the Catholic Church and the Compendium of the Social Doctrine of the Church on this matter can be very enlightening.

A consistent ethic of life

The right to life agenda is considered under the fifth commandment – You shall not kill. It forbids murder, which is the direct and intentional killing of another, but allows for legitimate self-defense through proportionate means.

The contemporary teaching of the Church excludes capital punishment as a means of legitimate self- defense for the State since the State has other means for effectively protecting society from further harm. Only when the State has no other means to defend society is capital punishment justified. The Holy Father states, “Today, however, such cases are very rare, if not practically non-existent.”

The fifth commandment also forbids abortion, direct euthanasia, suicide, disrespect for the dignity of persons, of their bodily integrity e.g. kidnapping and it requires everyone to work together to avoid war. It requires people to care for their health and to work for justice in all its forms.

Inconsistency in a life ethic is common e.g. people who are against abortion have no difficulty with the arms race and the under-funding of social budgets. A consistent life ethic provides linkages among the many life issues.

Allowing to die

Long before the Terri Schiavo case, the Catholic Church had an extensive body of precise teaching on medical ethics. I use the word “precise” deliberately because distinctions are necessary to address, in an ethical manner, problems that are caused in part by positive developments in contemporary medical science.

There is a general principle in Catholic medical ethics that no person is obliged to use extraordinary means to sustain life. There is also a distinction in medical ethics between medical treatment that is understood as the medical interventions no matter how complex which are available and appropriate and medical care (sometimes called “comfort care”) that refers to the ordinary help due to sick people.

The discussion among moral theologians centers on the question of whether medically assisted nutrition and hydration is considered treatment or care. More specifically the question is whether the provision of food and water is achieved normally by mouth and can be assimilated into the person's body or is provided artificially and, if artificially provided, whether it is the sole means of keeping the person alive.

Most theologians support the view that since nutrition and hydration are necessities of life for all human beings, there is a strong presumption for their use. The omission of food and water directly intended to cause a person's death is to be rejected. The judgment can change when there is no longer any reasonable hope of sustaining life through artificially assisted nutrition and hydration or providing it poses an excessive risk or burden to the patient.

Vatican intervention

The intervention of the Vatican in this case, specifically the President of the Pontifical Council for Justice and Peace, was based on the common opinion of theologians that nutrition and hydration are required in cases when the patient is not on life support systems and is not dying. The reports in Zenit News Service on the intervention of Cardinal Martino noted that the Cardinal thought removing the feeding tube would open the door to many other decisions about ending life that would be based on purely subjective quality of life criteria.

Persistent vegetative state

The application of the norms already mentioned to people who are in a “ Persistent Vegetative State ” (PVS) is difficult not only emotionally but in principle. People in this condition are not being kept alive through life support systems nor are they dying. Therefore, they have a right to nutrition and hydration. It is clear that the interdisciplinary conversation about this issue will continue well into the future.

Conclusion

Most people do not want to talk about death especially when they are young. The option of living wills can settle some aspects of this medical/ethical challenge. However, living wills themselves must be faithful to the principles of moral theology.

For example, they may not include instructions for “mercy killing” or exclude ordinary medical care. In truth, living wills can test our theology of life.