This past weekend I flew back into Dulles from Dallas/Fort Worth and made it about 20 minutes down the road to Charlottesville before intense hunger drove me to a Cracker Barrel right before the Route 29 turn-off. Eating alone requires a newspaper, so after being seated at a tiny table wedged between two families (single people always get the crappy tables) I scrounged up four quarters and headed outside to buy a Washington Post. Still 50 cents short of the Sunday price increase, I had to settle for that wonderful combination of a newspaper and People magazine: USA Today.
When my food arrived, I spread out the front page on the two by two foot table and began to read. Glancing at the bottom, I saw a headline that caused me to spit country fried steak, "Pope declares feeding tubes a 'moral obligation.'" After apologizing to the kid sitting next to me for spitting steak and expletive on him, I turned to the article to find out what the Pope had to say.
First, a little background might be helpful. The history of removing care from a patient, specifically respirators and feeding tubes, is a relatively young one. For example, the two commonly discussed legal cases concerning this issue were both argued in the past 30 years, In the Matter of Karen Ann Quinlan and Cruzan v. Missouri (1976 and 1990 respectively.)
Quinlan was argued before the Supreme Court of New Jersey and involved a 22-year-old patient, Karen Quinlan, who suffered a brain injury secondary to oxygen deprivation. She ended up in a state that is commonly referred to as "vegetative," and her breathing was supported by a respirator. Her parents thought this was not a condition that Quinlan would want to remain in, so they asked the physician to turn the ventilator off, but he refused. The eventual ruling of the court went against the doctor by stating that Quinlan had the right to refuse medical treatment, and more importantly, that when she was unable to communicate for herself, her parents were allowed to make that decision for her.
Cruzan is similar to Quinlan in that it also involved a young woman, Nancy Cruzan, who was put into a vegetative state (this time as a result of a car wreck). However, Cruzan is different in that she was not supported by a mechanical ventilator. She was able to breathe on her own, but in order to retrieve nutrition, she had to have a tube placed that allowed food to be put directly into her stomach. It was reported that Cruzan told a friend that she would never want to live in such a state, and as a result, after several years of her showing no improvement Cruzan's parents asked that her feeding tube be removed, so she would be able to die.
The Cruzan case eventually went to the U.S. Supreme Court which generally agreed with the idea that a guardian could request the removal of artificial feeding and hydration but ruled constitutional the Missouri law requiring such wishes to be communicated previously by the patient (the Missouri Supreme Court had ruled that Cruzan's statement to her friend was not enough proof). Within a few weeks of this ruling, the Cruzan family was able to present enough evidence to the Missouri Supreme Court to support their claim that the removal of the feeding tube would be in accord with Cruzan's wishes. The tube was removed, and two weeks later on Dec. 26, 1990, Cruzan died.
Since the Cruzan case, medical staff have largely been working from the conclusions given by the U.S. Supreme Court justices in their majority and dissenting opinions -- essentially, given enough evidence, such as an advance directive for health care, surrogate decision makers (parents, spouses, etc.) are allowed to make the decision to discontinue tube feedings for patients in a "persistent vegetative state" (recognizing the difficulty in making such a diagnosis). And, interestingly enough, I have gathered from talking with other physicians that their experiences with the Catholic Church in this area have largely been supportive (at least lately).
An example is the Florida case of Terri Schiavo, a woman in a condition very similar to Cruzan's (although it is being argued by her parents that she is not vegetative). When her husband, who believed that Terri would not want to live in her current condition, asked a bishop his opinion on the removal of her feeding tube, that bishop did not find the act morally problematic.
The Pope's recent statement, however, begins to shake up the medical community. His claim is that the administration of food and water (even artificially), like the provision of cleanliness and warmth, is a basic and natural means to preserve life and is therefore obligatory. This means that cases such as Cruzan now will be viewed as euthanasia instead of a natural death. This strong statement will spark much debate in the Catholic community, especially since many American Catholics have supported such practices in the past. In the months to come we will see if the statement works its way into the guidelines of Catholic hospitals, thus preventing them from continuing the policies supported by Cruzan.
Patrick Jones is a biweekly columnist. He cn be reached at pjones@cavalierdaily.com.
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