[Question:]{.underline} Some people maintain that the withdrawal of hydration and nutrition from Terri Schiavo (+March 30, 2005) was not immoral. Do they have any solid reason for affirming this?
[Answer:]{.underline} Those who dare deny the necessity of hydration and nutrition in those persons considered to be in a vegetative condition have done so on the basis of one of two reasons. The first excuse is the subjective one of “quality of life”, which is all important for the humanist way of thinking. A person’s life is to be considered as lacking in quality, unproductive, and not worth living because of brain damage or mental retardation. It is no secret to anyone that such a materialistic, pragmatic conception is directly opposed to the sovereign right that God alone has over life and death, and consequently to the fifth commandment.
The second reason that is given is that artificial nutrition and hydration can be considered in certain circumstances (e.g. incurable vegetative state) as extraordinary means, on account of the cost and effort required, and consequently disproportionate to the benefit that can reasonably be expected — the prolongation of life — and that consequently they would not be obligatory in conscience.
The resolution of this question depends upon the clear distinction between ordinary and extraordinary means. It was treated very thoroughly by Father Iscara in the July 1997 issue of the Angelus, in which he established that feeding and hydration are always ordinary means and consequently obligatory in conscience, regardless of the condition of the person. He there describes the liberal evolution of these concepts over the past half century.
It is certainly true that if all admit the distinction between ordinary and extraordinary means, nevertheless the judgment of which are extraordinary and which are ordinary means has not in general been defined by the Church. Moreover, this distinction is not absolute, nor identical in every case, for a means might be ordinary for some people but extraordinary for others, due to variable considerations such as excessive cost, pain and discomfort, location and difficulty in using the means, danger of complications and high chance of failure. However, traditionally, and rightly so, the essential consideration is an objective one. An ordinary means is one that can be procured by ordinary effort and diligence, whereas an extraordinary means requires that effort which is out of the common order of things. A person who does not follow the quality of life theory could consequently only allege that hydration and nutrition were not obligatory by establishing that they are extraordinary means on account of the great cost, effort and/or suffering involved. This could certainly be said for the case of intravenous feeding, but not for intragastric feeding, which is simple, uncomplicated and relatively inexpensive. The withdrawal of such nutrition and hydration can consequently not be considered as anything other than indirect euthanasia, a grave sin against the fifth commandment.
Moreover, this whole question was resolved authoritatively by Pope John Paul II in a discourse that he gave to the participants in the International Congress on “Life-Sustaining Treatments and Vegetative State: Scientific Advances and Ethical Dilemmas” on March 20, 2004. He there teaches that the quality of life is irrelevant (§3). He states that is irrelevant to human dignity, which is true, but we would have preferred that he had pointed out that it is irrelevant to the practice of charity and the observance of the law of God.
However, his clearest statement concerns the use of the term “ordinary means” with respect to nutrition and hydration. He states that, unlike other medical treatments, nutrition and hydration are like nursing care: they are always and necessarily an ordinary means, and they cannot be considered to be an extraordinary means, no matter what they cost. Here is the text:
“The sick person in a vegetative state, awaiting recovery or a natural end, still has the right to basic health care (nutrition, hydration, cleanliness, warmth, etc.) and to the prevention of complications related to his confinement to bed…I should like particularly to underline how the administration of water and food, even when provided by artificial means, always represents a natural means of preserving life, not a medical act. Its use, furthermore, should be considered, in principle, ordinary and proportionate, and as such morally obligatory, insofar as and until it is seen to have attained its proper finality, which in the present case consists in providing nourishment to the patient and alleviation of his suffering…The evaluation of probabilities, founded on waning hopes for recovery when the vegetative state is prolonged beyond a year, cannot ethically justify the cessation or interruption of minimal care for the patient, including nutrition and hydration. Death by starvation or dehydration is, in fact, the only possible outcome as a result of their withdrawal. In this sense it ends up becoming, if done knowingly and willingly, true and proper euthanasia by omission.” (§4).
Although not a formal definition, this is a statement of the Church’s highest authority, clarifying a question of morals. It must be accepted, given that it is in line with Catholic Tradition. Consequently, there can no longer be any doubt as to whether or not hydration and nutrition constitute ordinary means. They are always ordinary, and they are always obligatory in just the same way as nursing care is obligatory, regardless of how much it might cost to hire nursing staff. The outrage that Catholics in the U.S. have felt and expressed concerning the apparent inability of the executive and judicial powers to stop this tragic euthanasia is perfectly justified, and any person who does not feel this way needs to return to the Gospel of St. Matthew and ask for charity: “For I was hungry and you gave me not to eat: I was thirsty, and you gave me not to drink…Amen I say to you, as long as you did it not to one of these least, neither did you do it to me.” (25:42 & 45).
Answered by Father Peter Scott, SSPX.