New York Times (free registration required) JOHN LELAND
N the parade of faces talking about Terri Schiavo last week, two notable authorities were missing: Aristotle and Descartes. Yet their legacy was there.
Beneath the political maneuvering and legal wrangling, the case re-enacted a clash of ideals that has run through the history of Western thought. And in a way, it’s the essential question that has been asked by philosophers since the dawn of human civilization. Is every human life precious, no matter how disabled? Or do human beings have the right to self-determination and to decide when life has value?
“The clash is about how we understand the human person,” said Samuel Gregg, director of research at the Acton Institute for the Study of Religion and Liberty, a conservative policy group.
Thank you for posting this excellent article, which describes in a very fair and even-handed manner how there are two ways of looking at this issue.
Those who wanted to restore Terri Schiavo’s feeding tubes stated that such actions were neccesary to protect life. But what is life? Is it merely a biolgical existence, or does life, human life at least, require conciousness and sentience? The electro-diagnostic scans of Ms. Schiavo’s brain indicated a total absence of any electrical activity and extreme atrophy of the neural pathways. Accordingly, for those who define human life as requiring conciousness and sentience, Ms. Schiavo died a long time ago.
For those who describe human life as a beating heart, she lived on. And for those who seek a political ammunition with which to wage culture war, that still beating heart became a powerful symbol and source of a new mythology with which to demonize others.
Dean. You are substituting an sociological, rather than biological, definition of death, without being clear about your own presuppositions and values that inform it.
Further, I’m surprised to hear you implicitly approve her starvation. Since you characterize yourself as a liberal who cares about the poor and defenseless, I’d expect you not to abandon the moral foundation that used to inform liberalism. I guess your care stops when the handicapped are sentenced to death.
For an example of clear-headedness from the liberal side, read Nat Henthoff’s piece posted above. Henthoff (like Nader apparently), is a liberal who still holds to traditional liberal values.
While we are at it, let’s clean up one part of your moral and intellectual muddle. You write, “Ms. Schiavo died a long time ago.” No she didn’t. It wouldn’t be necessary to starve and dehydrate her if she were already dead. Don’t redefine death in order to justify a deliberate killing.
One other point. Let’s be clear that your defense of Terri’s starvation runs counter to the moral tradition of Orthodox Christianity. I can’t really see Sts. Basil or Chrysostom concluding that pulling her tubes represents a great leap forward in Christian compassion, can you?
“And for those who seek a political ammunition with which to wage culture war, that still beating heart became a powerful symbol and source of a new mythology with which to demonize others.”
Allow me a little artistic license with this interesting turn of phrase:
“And for those who seek political ammunition with which to marginalize and silence those who respect the Right to Life, the mutterings of Terri Schiavo were valued less than bellowing of a starving cow. Her inability to enjoy television, to watch quality films like Million Dollar Baby, even to speak coherently became a powerful symbol. Terri became a symbol that reinforced their devotion to the culture of death, with which they demonize anyone who refuses to acknowledge that the those who no longer exhibit a sufficiently high level of cognition have a duty to die.”
Father Jacobse and Dan: If there were any hope for recovery, or any sign of minimal consciousness or the potential for minimal consciousness, I would certainly have opposed removing the feeding tube.
However to me it looks like she is already gone, and has been for some time now. She has no brain activity. What would we be keeping alive? The answer, as John Leland suggests, is a purely biological existence.
This isn’t a case of exterminating a damaged human being. This is a case of recognizing the finality of that person’s situation and the futility of further measures.
Clear up your confusion. Study the case. Terri Schiavo was not terminal. This was not an end of life situation. This is the deliberate killing of a brain damaged but otherwise healthy person.
And what gives you the idea she had no minimal consciousness?
Here’s a link with testimony from Terri’s caregivers about her condition (whose affidavits were not considered by the court, btw).
http://www.religionjournal.com/showarticle.asp?id=2124
I’m sorry, Dean, but on this, like so many other issues, we just fundamentally disagree.
I know this isn’t necessarily related to the topic that started this thread (the New York Times article), so my apologies for getting off topic. I very much want to point people to Mark Shea’s weblog. Mr. Shea is a Catholic who is adamantly pro-Life (Odd, isn’t it that simply being a member of the Catholic church, or any Christian church for that matter, no longer means that one is necessarily pro-Life, and that I am adding that description to Mr. Shea?) and adamantly opposed to what is happening to Terri Schiavo.
I especially want to note the following passage, from the link provided above, for anyone, on either side of this situation, who currenlty harbors anger over what is happening to Terri:
“[I]t is a sin to place anger at the core of our being, to relentlessly practice cynicism, to focus ever and always on what is wrong, to overlook what is white in favor of what is gray, and see gray as black as possible. Such adamant insistence on being angry, defeated, bitter, and hopeless when God is telling us, on the Highest Authority, that Joy is the deepest truth, is to allow Hell a completely needless victory.”
Dan – I acknowlege that underneath all the sound and fury lie very important and urgent moral issues. As Leland suggests, once we begin qualifying what is life and what is not life, which types of life are worth protecting and which are not, where does it end? By allowing any euthanasia at all are we opening up a Pandora’s box of greater abuses? When do we stop preserving life with dignity and start practicing eugenics?
For example, in thinking about abortion, I tried to identify situations that would make those abortions “medically-neccesary”. The most difficult of those situations for me were those in which the parents learn that the fetus will be born with grotesque physical deformities or profound mental impairments. My immediate reaction is that no human being should be sentenced to such an existence and to bring a child into this world with such severe impairments would be cruel and unconscionable. But then, every once in a while, we hear of unbelievably compassionate parents and/or determined children who are coping with these seemingly insurmountable difficulties.
So, I don’t know. These are difficult issues indeed and we do need to have this bioethical debate to sort out our competing priorities and interests.
Dean, as a sometime teacher of the ancient faith, I state categorically that your position on life issues is incompatible with, and indeed destructive to, the Orthodox Christian faith. You have no ground to stand on Scripturally, doctrinally, or morally in implying that God might find it acceptible to destroy a human life on the grounds you name. Your logic is secular, not divine, and your ideas derive directly from Anti-christian figures such as Nietzche, Hitler, Sanger, and Singer. You claim to support the faith, but in fact you agree with and serve the most insidious liars of our time, themselves mere tools of the father of all lies. You would “compassionately” (the worst lie of all) destroy a human life which does not meet your standards for “quality of life?” You simply add to godless mankind’s tally of murdered innocents.
Speaking for myself, I believe that you are a victim of deception, not a conscious perpetrator of malice. But God’s kindness, as St. Paul says, is meant to lead to our repentence. As others too have stated before in debating with you, if you want to be a follower of Christ, you must repent of these death-dealing ideas — these satanic lies — now, not later, and learn the Gospel of life, which you patently do not understand. You do not have to become a Republican or even a conservative to do this. You simply need to pray that your secularism be revealed to you, repent of it, and learn and follow the good news of Christ who conquers death, not accomodates it. God will reveal to you the good things you sincerely ask for.
One more thing. Stop ignoring people who disprove your assertions, and stop thinking that politeness and/or passionate belief justify your holding ideas which are antithetical to the Gospel. You’re not fooling anyone, least of all God. You can’t polish a turd.
Bill – Please go back and read the comments carefully before you go off on me like that again. You bear false witness and slander me unfairly.
You describe me as not having respect for human life. Read Number 4 where I say “If there were any hope for recovery, or any sign of minimal consciousness or the potential for minimal consciousness, I would certainly have opposed removing the feeding tube.”
The pivotal question at the heart of this debate is whether Ms. Schiavo is “alive” in any meaningful sense or not. If she is NOT “alive”, because of a permanent and total loss of brain function then her body should be allowed to expire. If she IS “alive”, with impaired but discernable mental function, her life should be protected. Since the medical doctors, judges and other experts closest to the case have found her brain loss to be total and permanent. That suggested to me that the answer to the pivotal question is that she is not alive in any meaningful way is no.
Philosophers have been arguing the unity or duality of the body and soul since the time of Plato and Aristotle. As Christians we believe that it is the soul that is important. Responding to a question on dietary laws, Christ told His disciples that it’s not what goes into a man that makes him sinful, but what comes out of a man (as expressed by his words and actions). What goes into a body affects the physical, but what comes out of a man reflects the spirit or the soul of that man. If the soul is absent therefore can a person be said to exist at all?
Read post number 8 again where I say “By allowing any euthanasia at all are we opening up a Pandora’s box of greater abuses? When do we stop preserving life with dignity and start practicing eugenics?” How could I be an advocate for a culture of death when I accompany my comments with such careful caveats?
What I was saying, Bill, that the Schiavo case presents us with an extremely complicated issue, and that one’s conclusions depend to a large degree on how one interprets the pivitol question of what constitutes life. A full and complete exploration of the issue requires that we consider all possibilities.
Dean, those are good questions to ponder. To the second one you write, “By allowing any euthanasia at all are we opening up a Pandora’s box of greater abuses?” That Pandora’s Box has been open for some time. As I’ve said elsewhere in this blog, Michael Schiavo had one thing absolutely correct; feeding tubes are removed from people all the time and there’s nary a peep. Most people just do not know the extent to which this is happening (I didn’t give it much thought until I started reading about Terri Schiavo, started investigating her case in light of Wesley J. Smith’s work on this subject).
On your example about abortion: I’m saddened by how you approach this subject. You write, “…no human being should be sentenced to such an existence and to bring a child into this world with such severe impairments…” Again I would refer you to the comments by Mark Shea above, especially this portion “it is a sin … to overlook what is white in favor of what is gray.”
Raising this issue as you do leave me with the impression that there are times when you think you know better than God. Think about it for a moment, just don’t dismiss this as a personal attack, it’s not meant in that manner. Is it all possible that a handicapped child might actually be a blessing from God? Could it be God’s way of telling a mother and father, “I know how strong and capable you two are, so please open your hearts and home to this, the least of my children. Yes, it will be hard. Yes, there may be times when you curse me. Go right ahead, I’m big enough to take it. This child I give to you because I know that you, of all my children, are capable of caring for him.”
Dean, my response to note 8 was indeed heavy-handed and I apologize. But as you look at these questions, I urge you very strongly to consider that for Christians, there is only the Gospel. The scriptural writers were not philosophers, and while Christian thought has benefitted to some extent through its consideration of philosophical categories, it does not depend on them. If we do not understand the difference between God’s revelation and the world’s ideologies, we are vulnerable to deception in the manner I describe.
These issues are simpler than you think.
Not only are you weak on the moral clarity of the Gospel Dean, you also are confused on Orthodox teaching about soul and body. There is no duality between soul and body in the Christian moral tradition. Both make the person. That is the significance of the bodily resurrection of Christ, and the promise of a new body at the general resurrection that Paul speaks of in 1 Corinthians 15.
For a discussion of this in philosophical terms, especially the idea prevalent among secularists that the body is extrinsic to being — an idea you seem to have unwittingly absorbed, read the first chapter of Robert P. George “A Clash of Orthodoxies.”
Finally, you again assert a point I challenged earlier: “The pivotal question at the heart of this debate is whether Ms. Schiavo is ‘alive’ in any meaningful sense or not.”
No. The pivotal question is whether or not we should kill Terri Schiavo.
Don’t obsfucate language. Terri Schiavo is alive, for the time being anyway. At this point her internal organs have dried out and are beginning to crack. What you are really asserting, albeit in a whisper, is that she does not have a life worth living. Your euphemistic reconstruction of the pivotal question would not be necessary otherwise.
Again, if she were dead, it would not be necessary to starve and dehydrate her in order to kill her.
Whether your confusion is deliberate or unwitting, I don’t know. But confused thinking is dangerous because it obscures the moral clarity necessary to recognize evil.
Fr. Hans writes: “This is the deliberate killing of a brain damaged but otherwise healthy person.”
One is reminded here of the dark joke “Aside from that Mrs. Lincoln, how did you enjoy the play.”
Yes, Terri Schiavo is otherwise healthy. Aside from that fact that she has no cerebral cortex, no thoughts, no emotions, no consciousness, no perceptions. Aside from the fact that she has no hope of recovery or improvement. Aside from the fact that she has only reflexes and autonomic brain stem activity. Yes, other than that she’s in fine condition.
Question: if it makes sense to maintain PVS patients in a perpetual state of unconsciousness, and if “there is no duality between soul and body in the Christian moral tradition” then why don’t we keep brain-dead people indefinetly on life support?
I’m serious. What is the difference? Why is permanent lack of consciousness in a brain dead patient, with no hope of recovery, a blank check to pull the plug, but permanent lack of consciousness in a PVS patient, with no hope of recovery, is taken almost as a trivial condition. Yeah, other than that she’s in fine condition!
If you say that it’s Ok to pull the plug on a brain dead patient, with no consciousness and no hope of recovery, even if the rest of the body is in a superb condition, then you might be one of the saints. If you say that it’s Ok to pull the plug on a PVS patient, with no consciousness and no hope of recovery, then you’re the spawn of Satan, and agent of the culture of death, second cousin to Hitler, herding people into Auschwitz, a liberal who is eventually going to strangle disabled people in their beds.
I don’t get it.
Jim, again you retreat into technicalities. Terri Schiavo is not the symbol for all difficult cases. Don’t treat her as an abstraction. This is a living human being that is being starved to death.
I notice the only time your thinking closes in on anything that resembles a moral judgment is when you are talking about classes of people, never individuals.
Brain dead people need respirators. You should know that. There is no moral obligation to keep people on respirators, although with the cold heartedness of the euthanasia crowd on display this week, I’m not sure I want them around people suffering from this terrible malady either.
As for PVS patients, much more care and deliberation than was shown to Terri Schiavo. Missourian is better qualified to answer this than I am. Always, always, err on the side of life.
BTW, how do you think the legal team will celebrate their victory? A steak dinner perhaps?
Fr. Hans writes: “Jim, again you retreat into technicalities. Terri Schiavo is not the symbol for all difficult cases. Don’t treat her as an abstraction. This is a living human being that is being starved to death.”
It’s not a technicality. Look, it’s not enough to have strong emotions about a single case. You have to develop a consistent philosophical approach that can be applied across all cases.
My point is this: once you assume that “there is no duality between soul and body in the Christian moral tradition” then why is it that we can disconnect life support from a brain dead person but not someone in a PVS? (By the way, by “brain dead” what me mean is absence of electrical activity in the brain.)
The distinction is this: whole brain death (“brain dead”) vs. cortical death (“PVS”). Both states involve permanent unconsciousness. The only significant difference (from my non-physician perspective) is that brain death entails no electrical activity in the brain whereas PVS involves reduced and abnormal activity reflective of brain stem activity. And in PVS a patient will exhibit various movements, vocalizations, and expressions that reflect autonomic or reflexive brain stem activity.
Again I have to ask: why is it that one can advocate “pulling the plug” on brain dead patients and still be considered a moral person, in good standing in the church — whereas advocating “pulling the plug” on PVS patients puts you in the class of Hitler and Dr. Kevorkian? If there is “no duality between soul and body in the Christian moral tradition” how is this distinction significant? Why is it that you don’t insist on keeping brain dead people alive? Given “no duality between body and soul”, what is the moral difference between whole brain death and cortical death?
With all due respect, I’m the guy accused of being a culture of death advocate, so I think I deserve an answer.
Jim, the consistent philosophical approach has to be moral, not technical. A technical approach is what allows you to justify starvation in the end.
Brain dead people live through artificial means (not including food and water in this defintion) such as respirators primarilly. Stopping the respirator is not immoral because they are in the state of imminent death.
PVS states, where no respirator is needed, do not call for death.
Does this impose a burden on society? Yes.
Hitler killed paralytics, the elderly, the deformed, all people very much alive but disabled in some way. Kervorkian ended up killing people who were not even terminal in some cases (autopsies were performed). Greer ordered a person needing only a feeding tube to live even when the parents offered to take care of her. This is culture of death stuff.
The moral logic defending Hitlerian, Kervorkian, Greer, ideals is simple. It’s utilitarianism. Human value is determined stricly by an economic calculus. BTW, euthanasia is outlawed in Germany (wonder why?) and they seem to be managing quite well without it.
No duality between soul and body refers to Dean’s misunderstanding of Christian anthropology. Secularists see the body as extrinsic to the person — a machine for pleasure to put it crudely. Dean is confused about whether Terri Schiavo has a life worth living because she is not sensate to the same measure he is. As a result, he thinks we can discard her body with little or no moral repercussion. This idea is brought into euthanasia thinking as well. Read Robert P. George (Singer’s counterpart at Princeton).
Fr. Hans writes: “Brain dead people live through artificial means (not including food and water in this defintion) such as respirators primarilly. Stopping the respirator is not immoral because they are in the state of imminent death. PVS states, where no respirator is needed, do not call for death.”
Let me push on you a some more here, because I think the distinctions between brain death and PVS are not as clear-cut as you would like them. In other words, the same problems and considerations that arise in PVS are the very same considerations that arise in brain death — a fact conveniently ignored throughout this discussion.
Brain dead people are not in a state of imminent death. Well, sure, if you turn off the respirator. But there are lots of conscious people who can live for years on a respirator and we don’t say that they are in a state of imminent death even though they’d die just as fast with the respirator turned off. Sometimes people can live for a very long time on respirators. There have been cases of pregnant, brain dead women who are kept alive long enough to allow the fetuses to develp and be born. Then the respirator is turned off. How’s that for utilitarianism?
Speaking of utilitarian, if you think my approach to PVS is utilitarian, then brain death is utilitarian on steriods. Why is that? Because of . . . drum roll please . . . organ harvesting! Yes, now your hospital too can be an organ transplantation center. You too can be a member of UNOS – the United Network for Organ Sharing, whose members last year performed 27,025 transplants using organs taken from 14,138 donors. Not all of these transplants will be from brain dead donors, but many will be. In fact, where I work, the ER staff call motorcycles “donorcycles” because of all the organ donations that their brain-dead riders generate.
Now organ transplantation is big business, and it comes with decent reimbursement from Medicare and most insurers. A transplant program will give your hospital more prestige. It will attract famous surgeons and cardiologists to your facility. Since most of the expense of transplants is related to post-transplant care, transplant patients are a continual source of revenue even after the transplant. So think of it — your ancillary departments — your cardiac cath lab — your pharmacy — all are important revenue centers with transplant patients. So stock up on all those expensive anti-rejection drugs, because that stuff will be going out the door like a sale at Walmart.
Utilitarian? Utilitarian? You ain’t seen utilitarian until you’ve seen brain death.
But of course brain death really is death? Isn’t it? I mean, there’s no question about that, right? Well, not always. Take Japan, for example, that bastion of animism, unholy Samurai traditions, and pagan worship. After the first heart transplant in Japan from a brain dead donor in 1968 the primary physician was accused of murder and unethical experimentation on a human, though he was not prosecuted. Subsequent to that there were debates in Japan over whether brain death was actually death.
In Japan this debate was also reflected in a number of books, some of which were bestsellers:
“Two well-known journalists, Michi Nakajima and Takashi Tachibana, immediately published popular books that criticized the concept of brain death. Nakajima insisted in her book, Invisible Death, that ordinary people at the bedside of a family member could not accept brain death because the brain dead patient’s body was still warm and moist. She concluded that brain death is an ‘invisible death’ that conflicts with everyday intuition. In Brain Death, Tachibana analyzed the medical aspects of the concept of ‘whole brain death’ and concluded that the Japanese criteria for brain death could test only the cessation of the brain’s observable functions, not the actual death of all brain cells. He insisted that if some brain cells remained alive after the determination of brain death (which is unknown, since an electroencephalogram cannot detect the activities of cells deep inside the brain), some inner consciousness might exist inside the patient’s brain, just as in cases of ‘locked-in syndrome.’ Their books became bestsellers. Tachibana’s book sold more than 100,000 copies, and more than one hundred other books concerning brain death and transplantation were published from 1985 to the early 1990s.”
http://www.lifestudies.org/reconsidering.html
So there’s not universal agreement that brain death is in fact death. But unlike an uncertain diagnosis such as PVS, at least we KNOW when someone’s brain dead . . . don’t we? Well, not necessarily. You can find lists of the various criteria for brain death on the web. It is a medical finding about which is it possible to make a mistake, just like any other finding. Now the reason why physicians started talking about brain death in the first place was because the absence of natural respiration and circulation no longer denoted clinical death. So they had to figure something else out:
“As technological complexity and advancements in critical care continued to explode during the past several decades, the concept of death as defined by neurological criteria, that is, ‘brain death,’ emerged and evolved as a necessary measure for determining death. Before the development of these neurological criteria, death was classically described as the cessation of circulation and respiration. However, the advent of mechanical ventilation and of methods for cardiovascular support presented new challenges for determining the end of life for patients with catastrophic cerebral injuries whose lives could be preserved by using these complex technological devices.”
http://www.aacn.org/aacn/jrnlccn.nsf/0/5ebf8de743ead0fa8825674e005a8950?OpenDocument
Note the phrase “whose lives could be preserved . . .” In other words, we could keep these people alive, but we choose not to. We turn off the machines and kill them.
But read on, it gets better:
“The concept of brain death continues to be a topic of international debate among medical clinicians, anthropologists, philosophers, and ethicists. Much of this discussion is the result of the awareness of continuing technological advances, neurodiagnostic developments, and clinical insight. Thus, this ongoing dialogue can be viewed as a dynamically developing process of achieving a multidisciplinary consensus that is responsive to a continually changing technological environment.”
The upshot of all that verbiage is that we may be declaring people brain dead who actually are not, and as technology gets better we’ll do a better job of diagnosing brain death.
The article continues, but I’ll quote only the first part of the next sentence: “Although the concept of death determination continues to evolve . . . ” So forget about absolute certainty in anything, even death determination.
So here’s the point of all this. The Schindler side of the discussion likes to throw around all the hyperbolic phrases such as “murder,” “Hitler,” and my favorite, “culture of death.” They are in continual outrage over the Schiavo case, and they see evil and injustice in everything related to this case. They launch ad hominem attacks at those on the other side of the issue, as if ad hominem were simply a standard discussion technique.
Meanwhile, when it comes to turning off machines on brain dead people they couldn’t care less. Not a single worry. “Well, the guy’s dead, unplug him” is as deep as the analysis goes.
So let me chew on you a little more and give you a critique of your position on brain death, using the language that you use to critique my position on PVS:
“You, Father Hans, say that brain dead patients are in a state of imminent death. But we know clinically that this is not true. We know that many can be kept alive indefinetly through the application of standard technology. You yourself admit that they are alive: “Brain dead people live through artificial means . . . .” Yes, they do LIVE through artificial means, but not after you decide to KILL them through suffocation. Why the rush to disconnect life support? You don’t even care whether ther person is actually brain dead. You attribute god-like powers to physicians to determine brain death, even when physicians themselves don’t know with precision when or if it occurs. You assume that the life of the brain dead person has no value, even though pagans in other countries value it. Of course, the brain dead person has value as a dispenser of organs, thus supporting a multi-billion dollar a year industry. So other people get organs, hospitals get revenue, and the brain dead person gets to die of suffocation. But you raise not a word against this barbaric practice. Hitler killed paralytics, the elderly, the deformed, all people very much alive but disabled in some way, in just the same way that you would execute the brain dead, but perhaps with even less concern. Your moral logic defending Hitlerian, Kervorkian, Greer, ideals is simple. It’s utilitarianism. Human value is determined stricly by an economic calculus. And brain dead people are definetly an economic commodity. Thus, your thinking has been completely polluted by the culture of death. You see living “brain dead” people as things that can be suffocated on the word of a physician. You are a part of the culture of death, and one if it’s advocates.”
So, Father, welcome to the culture of death. We’re glad to have you aboard.
Let’s not lose sight of the goal here: the removal of Terri’s feeding tubes as an immoral act. The distinction between minimal conciousness or PVS and brain death is that with brain death, life continues through a respirator, thus pulling the plug would not constitute an immoral taking of life.
You can argue that brain death is not always certain death, and you would be right, and as you indicate sometimes people are kept on respirators until some organs can be harvested. Yet, they remain in a state of imminent death because if the respirator is discontinued, they would die. The organ farms, etc. is a different but just as serious ethical problem.
Again, staying focused, Terri was not on a respirator, just feeding tubes. You argue of course that feeding tubes are not different than a respirator. I argue that food and water are basic nourishment and denying it is morally wrong.
If, by some chance, Jessie Jackson succeeds and the Florida legislature were to overturn Judge Greer’s ruling, would you see this as a moral good?
There are so many ideas presented above that I don’t know who mentioned the ancient philosophical and later catholic religious outlook concerning union of soul and body. The viewpoint is that personality rests also on the potency within the human person. As long as this power is present with its ability to become actualized the human being is a person. The statement that Terri Schiavo can longer become actively conscious (if indeed she is not already actively conscious to some degreee)is made only on a small number of medical diagnoses and subsequent probabilities, not certainty. Even these diagnoses could be objectively flawed.
In reference to the faith of christian believers, are the souls of the departed persons or not?
Fr. Hans writes: “Yet, they remain in a state of imminent death because if the respirator is discontinued, they would die.”
How does that differ from any other patient who is ventilator dependent? For example, someone with one of the muscular dystrophies? From a moral point of view, if we’re going to keep someone with Duchenne muscular dystrophy alive for ten years on a ventilator, how does that differ from keeping a brain dead person alive for ten years on a ventilator? If we’re going to do one, why not the other? Both are in a state of “imminent death,” as you define it, since both will die within minutes if the ventilator is withdrawn. In the one case the patient cannot breathe on his own because the part of the brain that controls breathing is not active. In the other case the patient cannot breathe because the diaphragm becomes too weak to support breathing. Both require ventilation to sustain continued existence.
My answer would be that the key difference is one patient is permanently unconscious and the other is not. And I’m willing to say, with the vast majority of medical providers, that permanent unconsciousness is tantamount to death. You don’t want to make that move, because to do so points out the similarity of PVS patients to brain dead patients. The only difference between PVS and brain dead patients is that a different part of the brain has died. Both are not conscious nor ever will be, and if having at least the possibility of consciousness is a criterion for continued, long-term medical intervention, then that undermines much of the argument for Terri Schiavo. And as I pointed out, the same diagnostic uncertainties and potential moral difficuilties exist for both brain dead and PVS patients.
Fr. Hans: “Let’s not lose sight of the goal here: the removal of Terri’s feeding tubes as an immoral act.”
That’s the issue at hand. Let’s not beg the question.
Fr. Hans: “I argue that food and water are basic nourishment and denying it is morally wrong.”
The issue is not the substance but the manner of delivery. Let me give you a silly but informative example: Having a heart is basic. Having a heart transplant is a medical procedure.
There are many examples of how elements basic to life can be administered through medical procedures. For example, being in a reasonably warm room is basic to life. Administering inhalation warming or extracorporeal blood warming are medical procedures. You focus on the substance, the nutrition and water. With all due respect, you need to look at the *administration* thereof. Is there any doubt that a surgically-implanted feeding tube is a medical intervention? If it’s not a medical procedure, what it is? Would you let your accountant give you one?
Fr. Hans: “If, by some chance, Jessie Jackson succeeds and the Florida legislature were to overturn Judge Greer’s ruling, would you see this as a moral good?”
I would see it as a tremendous moral good if I sincerely believed that Terri Schiavo’s wishes were to be maintained in her current condition. For me the touchstone of the entire case is the determination of her wishes. (By the way, the parents disagree with this. They said that they would continue to maintain her in a PVS state even if she didn’t want to be. That’s in the trial court record.) But I simply don’t believe the she would have wanted to be maintained in her current condition. Period. Do I know this with certainty? No. Am I reasonably certain? Yes. Am I certain to the point that I would risk my own money on it? Yes.
“There is only the Gospel”…Bill, are you perhaps an Evangelical convert, because as a life-long Orthodox Christian, I can safely say that I have never heard any of my priests say that!
Also, thank you Jim for calling it a ventilator. It’s a machine that does the mechanical act of ventilation…respiration is a physiological act that your lungs do with oxygen. No machine does that.
I think I stated this elsewhere, but I’ll state it again…a feeding tube, like a ventilator, can have many uses. In this particular case, it’s use is to prolong the life of Terri Schiavo. Without it, she is unable to feed herself, and without it, others are unable to feed her (she would just aspirate the food). As a health care worker, I do not see the distinction between a ventilator and a feeding tube in this particular case, aside from the removal of one would cause death in hours, the other in days. One we are comfortable with, the other not so much…why is that? Do people have a right to food, but not to oxygen??
I looked at those videos on the “support Terri” websites, and as somebody who sees a LOT of neurological exams, I could go on and on about how misleading those videos can be. Two key points are that we have no idea what is happening outside the camera range and also that in order to be valid, any response she gives must be reproducible…something those videos don’t demonstrate. From what I have seen and read, I still believe that she is in a PVS.
So finally Jacobse…how can Terry acheive theosis in her current state? Assuming she in in PVS, what spiritual growth can occur if her cortex is gone and there is no thought, feeling, emotion or consciousness? Are we not guilty of “playing God” by artificially prolonging her life when theosis is no longer possible? Is theosis not the “point” of it all?
Still struggling…
For the time being, forget about how a person can “achieve theosis” (an unfortunate term) if they are unconcious. What is bearing on you and me in life and death issues is the commandment of the Gospel: Love God and neighbor.
Definitions of what makes a person, and thus what value we give to human life, rely on more factors than whether the person is conscious or not. If conciousness is the only criteria, then removing the feeding tube (or lethal injection down the road) of any person in an unconcious state, who we think might never recover, or we think has been in a coma a few weeks too long, whatever, can be killed.
Further, if conciousness is the only criteria, then we can justify organ farms, or growing clones from embryo’s by keeping them in a brain unconcious state, whatever. Sounds a bit wacky but thats where the logic leads, and where economic demand can lead us, short of a working moral compass.
If I read you correctly, you seem to be arguing that it is proper to remove the feeding tubes of Terri Schiavo because she is PVS, correct?
Keep in mind that the difficult medical cases about death and dying, cases like Terri Schiavo, ought not to become the sole moral and legal ground by which we define the value of a person. Conciousness is indeed an important criteris by which end of life decisions are made, but it is not the sole criteria.
Note 18. Jim good questions that need answers but more than I can answer today. I would take issue however, with the implicit assumption that the value of a human being rests solely in a determination of its conciousness state, which seems to be the moral criteria on which you think society should establish its legal standards about life and death.
I’m surprised too that you haven’t moderated your acceptance of the Schiavo decision given the doubt that surrounds the case.
Note 22: Tania, thanks for requesting the clarification. Since you ask, I am not an Evangelical, but Orthodox. I graduated St. Vladimir’s Seminary in 1991, with highest honors. I am not saying that the tradition of the Church must be thrown out, as perhaps certain (although not all) Evangelicals might. Within the context of the Church’s “body of teaching,” the Gospel (that is to say, the prophetic and apostolic preaching of the good news of Christ as it is written in the Bible) is the primary source of the Church’s tradition and thus conditions and qualifies what the Church can say. An indicator of this is that we call the Bible the “Word of God” (Christ incarnate in language) and “God’s revelation”, but we never say this about the tradition. If the tradition derives from and is faithful to the Gospel, it is worth keeping, but not vice-versa. I am of course aware that many Orthodox and Catholics see it differently, but I do not think their position makes sense much beyond an institutional attempt to tame the undermining effect of the Gospel on institutional thinking, which exists even within the Church on earth. (If anyone has a thoughtful [not reactionary] difference with on this matter, I’d be very interested to hear it.) In turn, of course, I am not trying to be a reductionist. I do not question the Church’s nature as the Body of Christ… as defined primarily by Scripture. Another way of putting it is that the Church is subject to Scripture, but not the other way around.
In the context of my messages to Dean (which are by extension addressed to anyone who holds ideas that are directly contrary to and destructive of the good news), I repeat merely what the Scripture AND the tradition state: One cannot serve two masters, but must love one and despise the other. Either one clings to the Good News or falls away from it into error, which may be subtle or egregious, but is still error, and usually ends up being fatal if one does not repent from it.
Thanks again.
Bill,
What you are saying probably isn’t that controversial, but can easily be taken the wrong way. It appears that you might be setting up the Bible as an independent source of authority separate from and outside of the Church. It is possible for the Church to stray from the Apostolic faith as contained in the Bible. After all, during the Iconoclastic period almost every important Bishopric in the East was held by a heretic. Thankfully, the popes of this period held on to the faith once delivered, and all was put right in the end.
In any case, I wanted to post this view of Kallistos Ware that is in the Orthodox study Bible, and addresses the role of the Bible within holy Tradition. Is this view, as expressed by Bishop Kallistos, essentially the same as the one you hold?
“Note that the Bible forms a part of Tradition. Sometimes Tradition is defined as the oral teaching of Christ, not recorded in writing by his immediate disciples(Oxford Dictionary). Not only non-Orthodox but many Orthodox writers have adopted this way of speaking, treating Scripture and Tradition as two different things, two distinct sources of the Christian faith. But in reality there is only one source, since Scripture exists within Tradition. To separate and contrast the two is to impoverish the idea of both alike.
Orthodox, while reverencing this inheritance from the past, are also well aware that not everything received from the past is of equal value. Among the various elements of Tradition, a unique pre-eminence belongs to the Bible, to the Creed, to the doctrinal definitions of the Ecumenical Councils: these things the Orthodox accept as something absolute and unchanging, something which cannot be cancelled or revised. The other parts of Tradition do not have quite the same authority. The decrees of Jassy or Jerusalem do not stand on the same level as the Nicene Creed, nor do the writings of an Athanasius, or a Symeon the New Theologian, occupy the same position as the Gospel of Saint John.
Not everything received from the past is of equal value, nor is everything received from the past necessarily true. As one of the bishops remarked at the Council of Carthage in 257: “The Lord said, “I am truth.” He did not say, I am custom (The Opinions of the Bishops On the Baptizing of Heretics, 30). There is a difference between Tradition and traditions: many traditions which the past has handed down are human and accidental pious opinions (or worse), but not a true part of the one Tradition, the essential Christian message.
It is necessary to question the past. In Byzantine and post-Byzantine times, Orthodox have not always been sufficiently critical in their attitude to the past, and the result has frequently been stagnation. Today this uncritical attitude can no longer be maintained. Higher standards, of scholarship, increasing contacts with western Christians, the inroads of secularism and atheism, have forced Orthodox in this present century to look more closely at their inheritance and to distinguish more carefully between Tradition and traditions. The task of discrimination is not always easy. It is necessary to avoid alike the error of the Old Believers and the error of the Living Church: the one party fell into an extreme conservatism which suffered no change whatever in traditions, the other into a Modernism or theological liberalism which undermined Tradition. Yet despite certain manifest handicaps, the Orthodox of today are perhaps in a better position to discriminate aright than their predecessors have been for many centuries; and often it is precisely their contact with the west which is helping them to see more and more clearly what is essential in their own inheritance.”
Thank you Bill for your clarification. I have pondered over the view that Bishop Kallistos puts forward in the OSB many times and have been pleased to see a distinction being made between Tradition and tradition, and also to see that Scripture in considered part of Tradition and not the “only the literal Bible” approach other Christians seem to endorse.
To Fr. Hans, I would never advocate that consciousness is the sole determinant of defining life. “What defines life” is at the centre of many of these moral quandries. Take birth control. Oral contraception can work by preventing a fertilized egg from implanting. If you believe that life begins when the egg is fertilized, taking oral contraception could be interpreted as a form of abortion. However, when you consider that we now understand that many fertilized eggs never implant, or are “shed” shortly after implantation (without contraceptive methods), it seems that many “lives” are lost without our knowledge anyway. God’s mystery perhaps – did each of those non-implanted zygote have a soul? I would never presume to know, but you can see how suddenly the debate becomes very complicated.
I guess I’m approaching this from the “other” end, and reacting against what I see as right-wing fanaticism (not you in particular, just the whole media frenzy) to push a political agenda at the expense of a woman who is ill. I see patients and families alike suffer every day with issues like this. “When should we give up hope?” “Will she ever recover?” “Can’t anything else be done?”. The early Church Fathers could never have predicted the dilemnas we face in medicine today. Should not the whole of Tradition (and Scripture)be taken into account with a healthy dose of Christ’s compassion to deal with each case on an individual basis? Is there no love in allowing a person to die of natural causes? Do we deny the existence of death so much that we must avoid it at all costs?
Like the Bionic Man…”we have the technology”, so does that mean that we should preserve life no matter what? To take your argument to it’s logical conclusion, why then would you ever disconnect a ventilator? If ALL life is worth preserving, how can you draw a line at a ventilator, but not at a feeding tube? Both can be used to artificially prolong life, or can be used to aid in a person’s recovery. In Terri’s case it is clearly the former…there is no realistic hope of recovery. What “life” are we saving here? A definition based on a beating heart? As I said above, I don’t presume to know how God defines life…all of the complexities of human physiology make that a very tricky question. What I do know is that I have nothing but compassion for this woman. Who among us would trade places with her to promote a “culture of life”?
If Terri were to be granted a miracle of waking up for 15 minutes and TRULY understanding her condition, and that after her 15 minutes she would go back to PVS and could be kept alive indefinitely in that state, would she want to continue? I know that I wouldn’t, and I would pray for God’s mercy to deliver me quickly and painlessly.
Tania, I understand the compexities and I understand that there is ambiguity in some circumstances. I have dealt with it as well.
And yes, decisions on end of life get made everyday, by necessity. Yet, the court ordering the forced starvation of a women crosses a line that should not be crossed. This case is significant in that it killed a woman from whom we have no real evidence that she wanted to die.
I’m glad that you don’t see conciousness as the sole determinant of defining life. Many of the people who want to see Terri Schiavo die believe that it is. That’s why they are eager to see her die.
But killing Terris Schiavo did not have to happen. She had parents who would have taken care of her. We have affidavits from her care-givers that she was responsive and not PVS. We’ve discussed all this already and there is nothing more to be said. Those who have a low regard for human life do not comprehend the killing as the tragedy that it is, and have no awareness of what will be unleashed if they are allowed to prevail. They call evil good, and good evil.
How do I know this? Because they would not even allow anyone to moisten her lips. They forced her mouth to dry out. Her father was prevented from giving even this elementary comfort. You are a nurse. You know what I mean. I am a father. I think that the anguish of Terri’s father much reach to the very core of his soul. I think of his sorrow, forcing to witness the deliberate killing of his own daughter. These are things only barbarians do to their enemies.
The judgments that deny such simple compassion come from a heart of ice and a calculating and determined mind. They wanted her to die.
Fr. Hans…you assume I am a nurse…and I am not. You also seem to assume that Michael Schiavo and his proponents are evil and want her to die – I do not. As none of us are involved in this case, I don’t think it our place to judge those involve based on assumptions made from information that we read in the paper or see on CNN. We can all (myself included) be considered biased in interpreting the evidence presented to us because we will filter it through our own biases and beliefs. And we can all be guilty of making incorrect assumptions.
The ultimate truth of this situation is known, and He will judge. I’ll just keep them all in my prayers because I do have a regard for life, for love, and for compassion.
Tania, yes, I did assume you were a nurse. I apologize for the mistake.
And yes, I do think the killing of Terri Schiavo is evil. For this I do not apologize.
You are certainly correct that all of us file information through our beliefs. The killing (and it is a killing) of Terri Schiavo is moral issue, and morality always draws from the well of belief.
And yes, God will judge. “I was hungry and you gave me no food; I was thirsty and you gave me no water…” (Matthew 25).
Tania, you express an important need for humility in judging the actions of others. But Christ does not tell us to acquiesce to evil; instead, to combat it with the truth. We are indeed called to discern evil from good, and to resist it. Evil is real; it is also by its nature deceptive. This is why people can do evil but believe that they are acting from the best motives. It is certainly correct and safe to say that Michael Schiavo, Greer, Felos, et al acted evilly without pronouncing final judgement on them.
The following was a challenge given out [Ed. note: which has now been slightly modified April 18, 2005] and also included below is a URL for our press release:
From your friendly neighborhood moderator/creator of terrisjustice. See below. We have been challenged and now I must issue my challenge to you.
Those in the pinnacles of authority [Jeb Bush and others] believe that we are going to melt away and give up seeking justice for Terri.
The famous motto of the Zapatistas is one response of ours in this regard: Ya Basta!
We will never surrender! We will never tire!
Challenge to you: go out and inform 10 other people what happened to Terri. Get them signed on terrisjustice. Ask them to do the same.
This is how the grassroots grows and is the only true means of getting a true geometrical progression realized.
If you are not for getting justice for Terri against those with blood on their hands do not join this list. If you are a spy or have mal-intents and you try to join or succeed in joining please leave the list or it may be that one day you will die a horrible death not at our hands but as a result of your disingenuous actions which resulted in karmic repercussions. This is a form of what is called felos-de-se (a senseless or purposeful act of self-murder).
NOTE:
A great deal of lee-way is necessary, given the scope of the work, and I am committed to freedom of expression. HOWEVER, it does sometimes become necessary to remind ourselves of our purpose and the basic rules of etiquette when communicating with others.
Flame wars and attacks on the character of others are not allowed on this list, and other members of the list not involved should not be subjected to emails containing such material – carry them on in private please if you must, or more adult behavior, don’t indulge in them at all.
We will remind once in awhile if things get a little out of hand, and any continued offense will be dealt with by either a moderation of the posts of the offender(s) or, when all else fails, a complete ban on those posts, especially when several complaints have been received from offended list members.
We have never had to take action in some years of doing this, and we hope this will never be necessary. Thank you for your support, and may your experience on this list be as enjoyable as it is informative.
URL for press release [also contained in Yahoo! News]:
http://www.prweb.com/releases/2005/4/prweb229498.php
JS