HOW BAD IS IT? Interesting article? on the priest shortage in the National Catholic Reporter. The article suggests that the shortage is felt more acutely in the Midwest and South than in other parts of the country, which seems to be my own experience here in Oakland. We have a significant number of foreign born priests, but we also have a significant number of foreign born Catholics in this diocese, as evidenced by the fact that our new Bishop just got back from an intense Spanish immersion course in Mexico.
As he enters his twenty-sixth year as Pope, revered or reviled, there is no mistaking his greatness. For 25 years the Catholic Church has been led by a colossus, whose personal experience encompasses the deepest horrors of the twentieth century, and who has proclaimed the Gospel as he understands it with the authority not only of his ancient office, but of rare intelligence, high courage and uncompromising integrity. No pope for centuries has had so direct – and, in Eastern Europe at any rate, so beneficial – an impact on human destinies, nor set so personal a mark on the Church he serves – and governs.
SCHIAVO: Terri Schiavo’s feeding tube was removed yesterday and she will probably die within a couple of weeks. There is a very intense discussion going on over at Amy’s blog and a number of bloggers have offered to pay the way of Fr. Rob Johansen down to Florida so he can ensure that Terri receives adequate pastoral care in her final days.
I’m feeling a lot more conflicted about this than some others I know. So I’ve decided to get some thoughts down on paper (well, on the screen anyway). This will be a fairly long post, so if you want to bail on it I’ll understand. There are so many issues at stake in this case that it’s hard to untangle them all, and doing so often leads me in different directions. I apologize if the discussion sounds excessively dispassionate and clinical, but that’s how I usually try to think about things.
I believe that individuals have a right to make a decision to forgo medical treatment. No one should be able to force you to receive such treatment against your will. My ethical perspective is that it is morally licit to forgo life-sustaining treatment if the treatment yields no therapeutic benefit to the patient and serves merely to prolong the dying process.
So the first question I wrestle with is whether artificial nutrition and hydration are treatments. Although reasonable people can differ on this, I would generally hold that they are. The human organism is not designed to receive nutrition through a tube, anymore than the human organism ordinarily requires mechanical assistance in breathing.
Now obviously there are times when the use of artificial means of respiration and nutrition/hydration are appropriate to allow the body time to heal itself. In those cases, the intervention obviously yields a therapeutic benefit to the patient and should ordinarily be continued.
Which brings me to the second question I wrestle with. Does providing Terri Schiavo with artificial nutrition and hydration yield a therapeutic benefit to her? Or to put it another way, if we keep this up long enough will she eventually recover the ability to eat, or at least swallow?
I am more than 3,000 miles away from Terri. I am not a neurologist or even a physician. I don’t have access to the imaging studies of her brain, or the results of other medical tests ordered by her physician. I am not competent to diagnose her on the basis of streaming video on the Internet. But given what I do know, I’d be willing to bet that if you picked a random sample of neurologists to examine her, the majority would agree that she is in a “persistent vegetative state” as neurologists generally understand that term.
The problem, though, is that term tells us a lot less than we think it does. It’s called “persistent” because, well, it persists, although it’s not always irreversible. Whether and to what extent a person with PVS can recover depends heavily on the extent of the damage to the brain (click here for a fact sheet) It’s called “vegetative” because the person does not seem to have the ability to interact with their environment. But the truth is that there is still a lot about the brain we don’t know. I am aware, for example, of treatments for stroke patients that involve immobilizing the “good” arm or leg and forcing the person to use their “bad” arm. Over time, it seems that the brain has the ability to partially rewire itself so that the patient can regain greater use of the limb. There have been other recent studies of patients with PVS whose brains—as measured by imaging studies—appear to react to stimuli even if they are unable to give any obvious physical response.
As is often the case, I suspect that medical practice has yet to fully reflect these developments. I wonder whether a diagnosis of PVS sometimes leads too quickly to an assumption of therapeutic futility. I wonder whether aggressive therapy could, in fact, lead to some restoration of function in some circumstances. One would have to admit, though, that even with the best therapy, the likelihood is that the patient would be left with profound mental and physical disabilities.
Which is, of course, why disability rights activists are so concerned about the Schiavo case and why that concern, in my view, is quite reasonable. What mitigates against aggressive therapy for PVS patients is the idea—not always explicitly stated—that even if we could wean a patient like Schiavo from a feeding tube, her life would still not be “worth living.” The able-bodied commonly make assumptions about the “quality of life” of the disabled that the disabled themselves would challenge.
But given the uncertainties involved, I don’t think a patient diagnosed with PVS has a moral obligation to obtain therapy. Obviously, the patient with PVS is usually unable to make a decision one way or another. But I think it perfectly legitimate for a person to specify their wishes on this score in advance and I think that family members and physicians should honor those wishes.
The problem in the Schiavo case is that we don’t have firsthand knowledge of what Terri would want in this situation. So who gets to make the call? As a general principle, it’s not a bad assumption that a husband would be best placed to know the wishes of his wife. Advocates for Terri have made a number of arguments as to why that’s a bad assumption in this case. They have pointed to a number of actions taken by Michael Schiavo that suggest that he has not acted in Terri’s best interest from the time when she was first diagnosed. Those actions certainly raise concerns for me. But since making Michael look bad is also a critical element of the family’s legal strategy, I have some serious questions about the way in which the evidence has been marshaled against him. I am, for example, particularly suspicious about the timing of the physical abuse allegations and the evidence used to substantiate them.
I wonder whether it would make a difference if Michael had been a saint throughout this entire process, if he was still living alone, if he had initiated more aggressive therapy early on, etc. Would that make a difference? What if he had a signed living will or durable power of attorney from Terri specifying that she would not want treatment under these circumstances? Would that make a difference? Is Michael the issue? Or is it the act in question? Are Terri’s advocates suggesting that it would never be licit to withdraw life-sustaining treatment from a patient in this condition? Or is merely the unique constellation of facts in this case that are leading them to oppose the withdrawal of that treatment?
Although it is a difficult mental exercise, I try to think of what I would do if it were my own wife lying their in the bed. As it happens, my wife has a living will that indicates that she would not want to continue receiving treatment if she were in a situation like Terri’s. And while I think I would be morally obligated to carry out her wishes, I find myself wondering whether I would have the strength to do it, particularly if my wife, like Terri, still had her eyes open. Take a look at the picture in the article cited above and you’ll see what I mean.
So no, I am not certain at all about what the right thing to do is. If Terri would not have consented to Michael’s chosen course of action, then a terrible crime is being committed. But if Terri would not have wanted to continue treatment under these circumstances but had been treated anyway under court order, then something equally terrible, I think, would be happening. This is one of those times when I need to pray for guidance, because I really have come up against the limits of my own understanding.
SCHISM AVOIDED? The Anglican Primates have issued a statement at the close of their meeting. It reaffirms the 1988 Lambeth Conference statements on human sexuality, and rebukes the ECUSA and the Diocese of New Westminster in Canada for their recent actions. While there was no collective decision to expell the ECUSA from the Communion, the statement does not foreclose the possibility of actions by individual provinces if the consecreation of Bishop Robinson procedes:
If his consecration proceeds, we recognise that we have reached a crucial and critical point in the life of the Anglican Communion and we have had to conclude that the future of the Communion itself will be put in jeopardy. In this case, the ministry of this one bishop will not be recognised by most of the Anglican world, and many provinces are likely to consider themselves to be out of Communion with the Episcopal Church (USA). This will tear the fabric of our Communion at its deepest level, and may lead to further division on this and further issues as provinces have to decide in consequence whether they can remain in communion with provinces that choose not to break communion with the Episcopal Church (USA).
It also looks as if the Primates may be willing to consider strengthening the office of the Archbishop of Canterbury by giving him greater authority to take actions aimed at "maintaining communion within and between provinces when grave difficulties arise." No specific steps were taken at the meeting, but a commission was established to explore this issue.
ON LISTENING: Tom Friedman has a good column up about the need for the Bush Administration to really listen to some of its critics (at least the more constructive ones). What struck me, though, was this paragraph, taken from a speech given by Richard Brodhead, the dean of Yale College, to the school's incoming freshmen:
"Above all," Dean Brodhead told the students, "don't limit your associations to people who agree with you. . . . I read that American political parties are concluding that the old electoral strategy of first playing to the core adherents and true believers, then reaching out to the independent or unpersuaded, might now be passé, and that parties will succeed best by continuing to appeal to the party base. This may be good politics, but I doubt it's good for the quality of thought that will result from politics. Who do we suppose will be able to deal more constructively with the challenges of our time: people who have only ever experienced preaching to the converted, or people who tested their understanding against the countervailing understandings of others?"
IF HE LIVED IN COLUMBIA HE'D BE DEAD ALREADY: AP reports that the Cubs fan whose deflection of a foul ball may have cost the Cubs game 6 of the NLCS is reportedly "brokenhearted." Security guards have been posted outside his home and Florida Governor Jeb Bush is offering him asylum.
Well, it's all up to the Red Sox now. I can't imagine a less interesting World Series than Marlins versus Yankees...
It is easy for you and me to say, "Of course I love my neighbor as myself," and then turn around and treat myself far better than I treat the family next door or the pitiful slum dwellers in Haiti or Calcutta.
Consider fiery John the Baptist preparing the way for the Lord and making plain the facts of sincere repentance: "Brood of vipers ... the ax is laid to the root of the trees ... and thrown into the fire."
Understandably, the people are shaken up and ask what they should do to show conversion. His answer is plain: "If anyone has two tunics, he must share with the man who has none, and the one with something to eat must do the same." That is real love and sound logic, and any honest person should be able to see it. To live it requires radical conversion.
A lot of the commentary about the ECUSA decision to allow the blessing of same-sex unions as a local option used the "West versus the Rest" as their basic storyline, i.e. contrasting liberal attitudes in the industrialized West with more conservative views in the Third World. While I think that is generally true, I suspect the reality is somewhat more complicated. Even within the Anglican communion in Africa, there seem to be differences, for example, between the Nigerians and the South Africans. Economic globalization and urbanization certainly play a role in all this, and it is hard to see those trends being reversed. Food for thought.
JUST THE FACTS, MA'AM: There's an interesting discussion going on over at Amy Welborn's blog about Cardinal Trujillo's statement about the effectiveness of condoms in preventing the transmission of HIV. I've weighed in a couple of times because the statement made me quite angry. I get really bugged when people exaggerate or distort medical evidence for political purposes, particularly when lives are at stake It's certainly not unique to the Church or to advocates on the right side of the political spectrum. I get equally concerned when the breast cancer lobby plays fast and loose with breast cancer risk statistics to gin up more money for research. As a Christian, I feel I need to have a baseline commitment to the truth, even in cases where the facts may be ideologically or theologically inconvenient.
Okay, rant over. We now return you to your regularly scheduled blog...
At this time, some Catholics may feel politically homeless, sensing that no political party and too few candidates share a consistent concern for human life and dignity. However, this is not a time for retreat or discouragement. We need more, not less engagement in political life. We urge Catholics to become more involved?by running for office; by working within political parties; by contributing money or time to campaigns; and by joining diocesan legislative networks, community organizations, and other efforts to apply Catholic principles in the public square.
The Catholic community is a diverse community of faith, not an interest group. Our Church does not offer contributions or endorsements. Instead, we raise a series of questions, seeking to help lift up the moral and human dimensions of the choices facing voters and candidates:
After September 11, how can we build not only a safer world, but a better world, more just, more secure, more peaceful, more respectful of human life and dignity?
How will we protect the weakest in our midst--innocent unborn children? How will our nation resist what Pope John Paul II calls a "culture of death"? How can we keep our nation from turning to violence to solve some of its most difficult problems--abortion to deal with difficult pregnancies; the death penalty to combat crime; euthanasia and assisted suicide to deal with the burdens of age, illness, and disability; and war to address international disputes?
How will we address the tragic fact that more than 30,000 children die every day as a result of hunger, international debt, and lack of development around the world, as well as the fact that the younger you are, the more likely you are to be poor here in the richest nation on Earth?
How can our nation help parents raise their children with respect for life, sound moral values, a sense of hope, and an ethic of stewardship and responsibility? How can our society defend the central institution of marriage and better support families in their moral roles and responsibilities, offering them real choices and financial resources to obtain quality education and decent housing?
How will we address the growing number of families and individuals without affordable and accessible health care? How can health care better protect human life and respect human dignity?
How will our society combat continuing prejudice, overcome hostility toward immigrants and refugees, and heal the wounds of racism, religious bigotry, and other forms of discrimination?
How will our nation pursue the values of justice and peace in a world where injustice is common, desperate poverty widespread, and peace is too often overwhelmed by violence?
What are the responsibilities and limitations of families, community organizations, markets, and government? How can these elements of society work together to overcome poverty, pursue the common good, care for creation, and overcome injustice?
When should our nation use, or avoid the use of, military force--for what purpose, under what authority, and at what human cost?
How can we join with other nations to lead the world to greater respect for human life and dignity, religious freedom and democracy, economic justice, and care for God's creation?
DO WE HAVE TO CHOOSE? Kilian McDonnell OSB offers some reflective commentary in The Tablet on John Paul II's encyclical on the Eucharist, Ecclesia de Eucharistia. He notes that many liturgists and theologians had some difficulty with the document, particularly the emphasis on Eucharistic Adoration. But McDonnell wonders whether we really have to make a choice between contemporary liturgical theology and devotional Catholicism. While one can argue that certain medieval practices did, in fact, detract from active participation by the faithful in the Eucharistic celebration, that does not seem to be the case today. McDonnell writes:
Undoubtedly during the Middle Ages eucharistic adoration did supplant active liturgical participation, but after decades of the modern liturgical renewal it is unhistorical to judge present practice by the medieval situation or by pre-Vatican II Catholic life. Though there have been a considerable number of attempts by a variety of people to return Catholic life to its pre-Vatican II pattern, present-day eucharistic adoration is not necessarily “restorationism”. For one thing, the norms given above indicate that post-Vatican II devotional life is in a new theological situation made possible by the biblical, patristic, and liturgical movements. Eucharistic adoration needs to be judged in this new context. But it should lead back to eucharistic celebration. Liturgy and devotions, as the Congregation for the Sacraments and Divine Worship reminded us in the 2001 Directory on Popular Piety and Liturgy, are mutually supportive.
The late Godfrey Diekmann OSB and Michael Marx OSB, both of whom were liturgists and editors of the liturgical magazine Worship, were open, progressive theologians, and neither was a promoter of eucharistic adoration outside the Mass. In spite of this, both used to say that such eucharistic adoration is a devotional extension of the liturgical celebration of the community and is authentic as long as the devotional practice does not usurp primacy. If there is a hierarchy of values with regard to the place of devotional practices in the life of the Church, mentioned above, there is a further hierarchy of values within the eucharistic life itself. What is primary is the communal sharing (koinonia) in celebration of the sacrificial meal by the people gathered together in the Holy Spirit; in the Eucharist as food to be eaten; in the hearing of the proclaimed Word; and thereafter in extension of food and Gospel to the poor. Eucharistic adoration outside the Mass, a devotional prolongation of the eucharistic celebration, is, in this formulation, in fifth place, but it belongs on the scale.
FADING? Frank Bruni writes in the NYT about the decline of Christianity in Europe. There are some hopeful countertrends, such as the religious commitment of many immigrant communities, and a modest return to religious practice by those under the age of 30. All in all, though, it's not a very encouraging picture.
