Sursum Corda
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Topical musings from a Catholic perspective

Friday, October 24, 2003
LESS THAN PERFECT: The other day I posted links to two comments on Terri Schiavo, one by Amy Welborn and the other by David Morrison. Taken together, they express some of the contradictory feelings I have about the case and about the broader issues it raises. I wanted to close the week with some final reflections.

David expresses my basic position on the general ethical issues raised by the Schiavo case. I believe that artificial nutrition and hydration are forms of medical treatment, not comfort care. I believe that a patient has the right to forgo such treatment when the burdens of that treatment exceed its benefits. In cases where the patient’s wishes have not been specified in advance, I believe it is reasonable for a surrogate to make that decision on behalf of the patient. I believe the courts should take care to ensure that the surrogate is truly acting in the patient’s best interest and that there should be a presumption in favor of continuing nutrition and hydration until evidence of the patient’s wishes can be presented. I believe that all these positions are in accord with Catholic teaching on this subject as I understand it.

But while I’m intellectually comfortable with that position, I’m not entirely emotionally comfortable with it. Because the Schiavo case isn’t occurring in a vacuum. It’s happening in the midst of a culture where human life is increasingly viewed in utilitarian terms. As Wesley Smith argued the other day in NRO, “many believe that becoming disabled is the worst thing that can happen in life,” a view that heavily influences views on everything from abortion to care for the dying. When a person is unable—as Terri Schiavo is now—to communicate their own wishes about treatment, it is all too easy to assume that no “rational” person would want to live like that.

There are a lot of people who think that Michael Schiavo never had any intention of providing care for Terri. I’m not sure I believe that. I think I agree with Lynn that it is more likely that he pursued what avenues of treatment he thought were available, and then gave up. I suspect he received advice from more than one physician who shook his head sagely and said “there’s really nothing that can be done.”

Did he give up too soon? I don’t know. But I think it’s true that we, as a society, often encourage people to give up. I think that it’s also true that those decisions don’t just affect ourselves; they affect others as well. If my wife and I decide to have an abortion because we can’t imagine raising a child with a genetic disease, we make it just a little bit harder for someone else to imagine that they could do so. If I put an DNR on my mother with Alzheimer’s, I make just a little bit harder for that caregiver who is struggling to keep going.

So while I don’t see any workable legal alternative to letting individuals make most of these decisions, I think one of the roles of the Church is to walk with the people who have to make them and broaden their sense of what’s possible. We need to let them know that God is with them, and we need to give flesh that belief with concrete acts of solidarity. We need to be a community of “less than perfect” people who show how “less than perfect” lives can be sacramental.

posted by Peter Nixon 2:27 PM
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THE CREED: Nice triptych in Christianity Today of a review of Luke Timothy Johnson's The Creed, an interview with Johnson, and an excerpt from the book, which reads in part:

Every Sunday millions of Christians recite the creed. Some sleepwalk through it thinking of other things, some puzzle over the strange language, some find offense in what it seems to say. Perhaps few of them fully appreciate what a remarkable thing they are doing. Would they keep on doing it if they grasped how different it made them in today's world? Would they keep on saying these words if they really knew what they implied?

In a world that celebrates individuality, they are actually doing something together. In an age that avoids commitment, they pledge themselves to a set of convictions and thereby to each other. In a culture that rewards novelty and creativity, they use words written by others long ago. In a society where accepted wisdom changes by the minute, they claim that some truths are so critical that they must be repeated over and over again. In a throwaway, consumerist world, they accept, preserve, and continue tradition. Reciting the creed at worship is thus a countercultural act.

posted by Peter Nixon 12:51 PM
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I'M SUCH A SAP: Any other men out there who break down in tears while reading the last chapter of Charlotte's Web to your children?

posted by Peter Nixon 10:41 AM
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BEST PART ABOUT HAVING YOUR CHILDREN IN CATHOLIC SCHOOL: Usually we do one Our Father and one Hail Mary with the kids before bed (they are five and three), since that is about as long as they can sit still. The other night my son says that he wants to do ten Hail Marys. "Ten," I say. "Wow, that's a lot." "It's just a decade of the rosary," he replies....

posted by Peter Nixon 10:40 AM
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WORST PART ABOUT HAVING YOUR CHILDREN IN CATHOLIC SCHOOL: Fundraising, fundraising, fundraising...

posted by Peter Nixon 10:37 AM
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TILL DEATH DO US PART: Slate's legal correspondent Dahlia Lithwick weighs in on Terri Schiavo. She notes that a series of legal decisions have created fairly clear rules about who gets to make decisions about care in cases where a patient is unable to communicate their own preferences:

The law has spoken on this issue as well. And in general, the spouse is granted preference over family members. Why? For the same reason most states give spouses the decision over how to dispose of the body of the deceased, and for the same reason states allow spouses to inherit first. Because the difference between your parents and your spouse is that you chose the latter to care for you and to care for in return. As a consequence of that choice the law assumes that your spouse knows you intimately and shares with you a sphere of legal privacy into which even your parents and siblings may not intrude. Do some of us choose badly? Certainly. But is it still a generally sound legal presumption that your mate knows you best? Yes.

This isn't to say that spouses may execute their partners at will. Or that one's spouse is one's property, any more than one's child is one's property. But in death, as in life, the courts must ultimately grant some decision-making powers to someone. It is a mistake to view these end-of-life cases as analogous to death penalty cases. The only issue on the table is who best knows what you'd have wanted for yourself. The courts must conduct a thorough inquiry to that end—is this guardian fit? Is he in fact expressing the patient's wishes for herself? Is her medical condition indeed irreversible? In this case, the courts have done all this. Medical experts have spoken. Michael Schiavo was not given this decision cavalierly. It was given him as his wife's partner and caretaker, someone she took until death do us part.

posted by Peter Nixon 10:04 AM
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THE WORD FROM ROME: Rome was overflowing with cardinals and bishops last week because of the beatification of Mother Teresa and the October 21st consistory, which gave John Allen a lot of people to talk to. Worth reading.

posted by Peter Nixon 9:52 AM
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STILL MORE READING: A poster over at Amy’s blog who goes by the name of alkali recently posted links to four Florida Appeals Court decisions dealing with the Schiavo case. Included are decisions issued January 24, 2001; July 11, 2001; October 17, 2001; and June 6, 2003.

I thought I would post these here for those who didn't take the time to read through the hundreds of comments over at Amy' blog, although I think you might want to consider doing so. If you only have time for a few, this particular thread is well worth the effort.

posted by Peter Nixon 9:37 AM
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MAY GOD BLESS AND KEEP TERRI SCHIAVO: New statement from the Florida Catholic Bishops (thanks to Amy Welborn for the link). The statement reads, in part:

In their statements concerning Terri Schiavo, the Florida Bishops and Bishop Robert N. Lynch of the Diocese of St. Petersburg, have clarified the Church’s teaching about when it is permissible to withhold or withdraw nutrition and hydration. They have made clear that there should be a presumption in favor of providing medically assisted nutrition and hydration as long as it is of sufficient benefit to outweigh the burdens involved to the patient. They clarified also that there are times when one may refuse treatment, if it would result in a burdensome prolongation of life and that this may be properly seen as an expression of our hope in the life to come.

The Legislature will undoubtedly consider Florida’s Life-Prolonging Procedure Act during the 2004 session. The statutory definition of Persistent Vegetative State (PVS) does not square with clinical diagnoses of this condition. Clarity is needed here, but regardless of how this case is resolved, it must never be assumed that a PVS patient should automatically have nutrition and hydration removed. This should never be done without clearly knowing the patient’s wishes.

posted by Peter Nixon 9:18 AM
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Thursday, October 23, 2003
WHITE MEN? ECUSA Bishop-elect Gene Robinson, when asked why the opposition to his consecration was so strong, responded that his election posed a "threat to the way things have been done, when white men have pretty much been in charge of everything."

I found this to be an odd comment. First of all, it seems that support for Robinson is strongest in the provinces of the Anglican Communion that are dominated, well, by "white men" (i.e., England and North America), while opposition is strongest in places like Africa. If it wasn't for "white men," the recent meeting of the Anglican primates would probably have expelled the ECUSA from the Anglican Communion.

More troubling is what appears to be a casual use of PC rhetoric to avoid confronting the very serious theological issues that Robinson's election raises. If Robinson is going to be a bishop, he owes his own denomination-- and Christians generally--better than this.

While we're on the subject, Christianity Today has a more in-depth analysis of the Anglican Primates' statement which is unclear on what, exactly, will happen if--as everyone expects--Robinson is actually consecrated.

posted by Peter Nixon 12:35 PM
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A STORY: When I was visiting my parents over the weekend, we got to talking about a friend of theirs who had Parkinson’s disease. He was a career military officer who had retired at the rank of Colonel. I think they raised three kids, one of whom was a doctor and another a lawyer. They were a loving family who believed in giving back to their community and their country.

The official medical line about Parkinson’s is that it doesn’t shorten your life, i.e. it’s not the disease itself that kills you. What tends to happen is that Parkinson’s weakens the body and leaves it vulnerable. A large number of Parkinson’s patients end up dying of pneumonia. They gradually lose the ability to swallow and aspirate food into the lungs, which triggers the pneumonia. Physicians of a certain generation sometimes refer to pneumonia as the “old man’s friend,” since it’s a fairly easy way to go (compared to some alternatives), particularly now that we are able to use medication to ameliorate respiratory distress.

When my parents’ friend entered end-stage Parkinson’s and began to lose the ability to swallow, the family had to decide whether or not to go with a feeding tube. They decided against it. They continued to feed him orally. Eventually, he developed pneumonia and died.

The family weren’t fools. They knew the risk of continuing to feed him orally, a risk that at some point probably rose to a certainty. But they also believed that resorting to artificial nutrition and hydration would unnaturally prolong a life that was coming to its close.

Did they make the right call? Was this “letting die” or “killing?” I happen to think it was the former. But it’s a close call. The man wasn’t “terminally ill” as many discussants here and elsewhere would like to define the term. With a feeding tube, the man might have lived for many more months or even years. On the other hand, the family did not withdraw all efforts at sustenance. They weighed the risks and benefits of the means of providing sustenance and made an informed choice to go with a means that was less intrusive, but carried a higher risk of death.

I’m not trying to draw an explicit link between this situation and the Schiavo situation. Clearly, they are different in many ways. But I think it’s helpful to look at where we come down in different cases to see if the underlying moral principles that drive our decisions end up being reasonably consistent. I’d be interested to see if people react differently to the case I’ve described above than they do the Schiavo case and, if so, why.

posted by Peter Nixon 12:08 PM
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Wednesday, October 22, 2003
MORE READING: Excellent post by Amy Welborn today on building a culture of life, followed by a number of great comments, including one by David Morrison that he also posted on his blog. I wish I could link to some of the other comments directly, but I don't seem to be able to do that. Click over and check them out.

posted by Peter Nixon 4:26 PM
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DEBATING THE PLEDGE: Jeff Rosen and Roger Severino debate the Pledge of Allegiance case in TNR.

posted by Peter Nixon 3:08 PM
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READING: I thought I might post links to some documents that have been helpful to me in evaluating the ethical issues at stake in the Schiavo case from a Catholic perspective. The first is the 1980 Declaration on Euthanasia from the Congregation for the Doctrine of the Faith (section 4 is particularly relevant). The second is the Fourth Edition of Ethical and Religious Directives for Catholic Health Care Services, published in 2001. Part 3 (The Professional-Patient Relationship) and Part 5 (Issues in Care for the Dying) seem particularly relevant to the Schiavo case. Also see Nutrition and Hydration: Moral and Pastoral Reflections, a 1992 Resource Paper published by the USCCB Committee for Pro-Life Activites, particularly the "Questions" section. The paper contains a helpful appendix on the technical aspects of medically-assisted nutrition and hydration. The Assisted Suicide/Euthanasia page of the Committee also has a number of helpful links. A number of commenters have also referenced an article, "Care of PVS Patients: Catholic Opinion in the United States," written in 2001 by two Dominican theologians that tries to summarize the state of theological debate on this question.

Comments on any or all of these articles are, of course, welcome. Folks can also feel free to continue the thread on the post I put up last week.

posted by Peter Nixon 11:25 AM
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PHONE CALL FROM THE GOVERNOR Gov. Jeb Bush on Tuesday, acting under powers given him by a bill passed earlier in the day by the state legislature, ordered a feeding tube reinserted into Terri Schiavo, who had been disconnected from such a tube last week.

Here are the critical provisions of the law:

Section 1. (1) The Governor shall have the authority to
17 issue a one-time stay to prevent the withholding of nutrition
18 and hydration from a patient if, as of October 15, 2003:
19 (a) That patient has no written advance directive;
20 (b) The court has found that patient to be in a persistent
21 vegetative state;
22 (c) That patient has had nutrition and hydration withheld;
23 and
24 (d) A member of that patient’s family has challenged the
25 withholding of nutrition and hydration.
26 (2) The Governor’s authority to issue the stay expires 15
27 days after the effective date of this act, and the expiration of
28 that authority does not impact the validity or the effect of any
29 stay issued pursuant to this act. The Governor may lift the stay
30 authorized under this act at any time. A person may not be held
31 civilly liable and is not subject to regulatory or disciplinary
32 sanctions for taking any action to comply with a stay issued by
33 the Governor pursuant to this act.
34 (3) Upon the issuance of a stay, the chief judge of the
35 circuit court shall appoint a guardian ad litem for the patient
36 to make recommendations to the Governor and the court.
37 Section 2. This act shall take effect upon becoming a law.

I'll try to post some thoughts on the new law later.

posted by Peter Nixon 10:01 AM
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JUST GOT BACK from a short trip to the Southwest to celebrate my father's 74th birthday. Thanks to all who have kept various discussion threads going. More blogging soon.

posted by Peter Nixon 9:23 AM
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THE SHRINKING MIDDLE? Henry Brinton, the pastor of Fairfax Presbyterian Church, writes about how his congregation has changed over the last 50 years:

Once it was a booming, traditional, middle-of-the-road church that served as a meeting ground for a large, diverse community of believers who may not have agreed on politics or shared the same cultural outlook, but who identified themselves with a particular religious tradition and proudly wore the label "Presbyterian," with all that it implied. But over the years it has lost members left and right to more specialized, politically focused churches and communities.

In this regard, the story of Fairfax Presbyterian echoes a broader, troubling change in denominations across the nation. It is a change that could lead to the disappearance of churches that strive for balance in religious practice and belief, that seek moderation and a way to combine respect for tradition with an understanding of the need for innovation. This shrinkage of the moderate religious middle reflects the polarization of contemporary politics, where the most powerful voices now speak from the far right and left. It seems to me that what we've lost in the process is our belief in the importance of meeting grounds -- communities where people of diverse opinions and perspectives may gather, talk, debate and argue. To me as a churchman, given that we live in a world being so profoundly affected by religious extremists of all faiths, this is a loss we cannot afford.

posted by Peter Nixon 9:13 AM
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