Defining sacred bonds:

...ings of the Catholic church in this matter...

...I would take this It is not surprising then to see the details of Bishop Casey's opportunity to challenge the National Conference of Catholic intervention woven into the fiber of the court's final decision...

...through uncharted waters, I consulted theologians like Richard This state of affairs presents a fundamental question: While McCormick, S.J., John Connery, S.J., and John Paris, S.J...

...The present brief acknowledges this year's statement by the AmerARMSTRONG: Today we are able to talk about the constitutional ican Medical Association that under certain circumstances, in rights of privacy because, oddly enough, they found their first cases of terminal illness or permanent coma, there is no disand foremost expression in the abortion decision...

...With- sented in such official documents as the Covenant of Caring...

...comparing the bishops' position in the case of Claire Conroy But the same constitutional principle of privacy seems emi- with what they are now asserting in the Jobes case, I must say nently sound, at least in the main, when it allows individuals to that this latest statement is not my understanding of the fullest make critical decisions about treatment at the end of life, teaching of the Catholic church...

...examination in, a legal trial...

...The however, that along with modern medical science and cumulative effect of court intervention has been to weigh the technology have come complicated ethical dilemmas...

...You may recall the court ruled against a Catholic hospital that threatened to that one of the most central, if not dispositive, witnesses eject a patient in the last stages of amiotrophic lateral sclerosis during the trial was Monsignor Thomas J. Trapasso, the Quin- (ALS) because she refused food and hydration administered by lans' pastor, who advanced the teachings of Pope Pius XII as a naso-gastric tube...

...that they ought not to be so placed, aware probably that courts elsewhere in the world do not play such a central role...

...T.P.H...

...The brief merely asserts that there is a differprivately and according those decisions the highest protection ence, claims that the courts' rulings in the Jobes and Brophy under constitutional law...

...terminal cases to accept, or to continue once begun, artificial We understand the disparity between Catholic teaching on medical measures which provide nutrition and hydration...

...ARMSTRONG: The issues with which we have been dealing will But many of these theologians have subsequently been chas- seem naive when compared with those arising from imminent tised privately, not for the substance of their testimony but for medical-technological developments...

...No less inald Stanton chided the hospital's tendency to find a "pro-life significant was the statement submitted by Bishop Lawrence versus anti-life" issue where none exists...

...Do you detect any parallels between the present apdecisions in each of these cases, physicians, patients, their proach of the bishops and the one adopted at the time of the families, and hospitals are now able to reach sound medical abortion debate...

...of the sacredness of life...

...position and to endorse the moral correctness of the Quinlans' request to take Karen off the cardio-respiratory mechanism...

...As it innovations in medical care, such as artificial respirators or turned out, these concepts constituted the foundation upon which the New Jersey Supreme Court based its ruling in the T. PATRICK HILL...

...a free-lance writer, is director of public information Quinlan case...

...that the rich diversity of the teachings of the church is now manifest in the differing opinions of these same theologians...

...pate that prevailed in 1973 should, as a matter of policy consciously chosen by the bishops, continue to prevail in the ARMSTRONG: Naturally, I laud in principle the decision of the face of today's medical-ethical problems...

...Without that rians who have been able to make their choices in the closest principle, the awful plight of Karen Quinlan, Nancy Jobes, harmony with the teachings of the Presbyterian church, preand countless others would remain legally unresolved...

...But it to seek the legal guardianship of his daughter...

...Of of a calculus of resulting benefits and burdens...

...What is the significance of these cases, in particu- ing that since life is not unlimited, there is an obligation lar, the Quinlan case...

...How significant is B. Casey, Bishop of Paterson (N.J...

...LAW, & MEDICAL POLICY Defining sacred bonds T. PATRICK HILL naso-gastric teeding tubes...

...It is missed opportunity for the Catholic bishops which hard to reconcile the position advanced in the Jobes case with threatens to compound itself if they continue to neglect socie- the long-standing teaching of the church...

...incumbent on each of us to steward his or her own body, especially where medical treatment is concerned...

...These are ings of the Catholic church...

...treat it, and then restore it to proceed naturally to term...

...wrapped in the flag of Catholic orthodoxy...

...From a pastoral or doctrinal position, that is simply not contributed greatly at the time of the 1973 abortion debate...

...Commonweal: 620 HILL: Were there any church leaders who contributed to this and ethical decisions without recourse to the courts...

...In the beginning of life and American law relating to abortion...

...I believe it does and lawyers - in the center of similar cases such as those of an immeasurable disservice to possess possibly the richest Paul Brophy in Massachusetts, Nancy Ellen Jobes and Kath- body of teaching in this area and refuse, of design, to share it leen Farrell in New Jersey...

...This is no time for what John Milton, as long ago as 1644, called "cloisHILL: You criticize the bishops for what you describe as a lack tered virtue...

...outcome...

...The courts themselves acknowledge the arena of public policy...

...no slight matter that the secular resolution of Quinlan's di- By the way, while these voices may have been united then, lemma, in which he played such a key role, was rooted in the further cases have posed additional questions to the court so teachings of the Catholic church...

...Unfortunately, the nature of the abortion decision has, since In its present form, the bishops' participation can lead to 1973, clouded the issue of appropriate medical treatment or mischief...

...It is important to note that the right cases have gone too far, and fails to acknowledge the previous, of privacy is not unlimited and that a vigorous argument for the differing positions advanced in the cases of Quinlan and Conmoral limitation of the exercise of that right would have roy...

...clearly be crucial in establishing the ethical tone of our You may recall that a Catholic theologian, John Paris, S.J., pluralistic society...

...You must remember that in America, unlike stance, similar in scope to their peace pastoral, on medical elsewhere in the civilized world, health care decisions are ethics...

...Namely, the distinction lowed the so-called "pro-life" movement - including those in law and practice between the "non-obligation to use ex- who regard artificially provided nutrition and hydration as traordinary means of treatment in cases that are determined by ordinary means, required and not optional - to present itself competent medical authority to be hopeless, and euthanasia...

...A third is the ARMSTRONG: Historically, Quinlan was the first case to pre- distinction between ordinary and extraordinary means of med= sent to an American court issues concerning the use or non-use ical care, the use or pon-use of which can be justified by means of certain forms of medical treatment at the end of life...

...the circumstances that necessitate bringing cases like Quinlan, Brophy, and Jobes to court...

...ARMSTRONG: It should be of particular significance to the The statement served also to clarify what the bishop saw as the leadership of the Catholic church in America, which has aloverriding issue in the Quinlan case...

...Where does this participation leave your criticommunity in America is whether the decision not to partici- cism...

...The question is, do you sacrifice a constitutional brief is not promising for the development of an ecumenical principle at any cost...

...However, recently the New Jersey tion - i.e., testimony, evidence, as amicus curiae - in the Conference of Catholic Bishops did submit an annicus curiae American courts...

...What the Quinlan case made clear, however, is sense that they were participating in something much larger that the law does recognize the right of each of us to make than themselves...

...pointed out the critical need to close that gap...

...New Jersey bishops to take an active part in the Supreme Court's deliberations in this particular case...

...The plight of Karen Ann Quinlan presented for examination the rights and obligations of patient, FROM the moment in 1975 when Joseph Quinlan walked family, and care-giver in this critical area...

...As a legal precedent, the Quinlan decision legal landmark of both national and international signifi- parsed out - delineated the subjects, the verbs, the modifiers cance...

...Since then you have eventual decision of the court...

...The first is the sacredness of been involved in similar cases, most recently that of Nancy each human life...

...These competing positions and establish procedures which will insu- dilemmas are now before the American public...

...But it HILL: How do you explain the bishops' approach in this reseems to be peculiar to America that the things Americans hold gard...

...good enough...

...out this right of privacy, citizens, who so preferred, might not The seeming discrepancy between Catholic and Presbyterian be able to decline abortion were it ever proposed as a social teaching now reflected in the New Jersey Catholic bishops' necessity...

...testified in the Quinlan case...

...From this came course, physicians had been making decisions of this kind as a the working principle that one is not morally obliged to use a matter of course long before Quinlan...

...We are on the threshold advancing it publicly...

...in the cases of Karen Ann Quinlan and Claire Conroy...

...and at the end of life, sustains almost indefinitely those who are in the ARMSTRONG: In order to prepare for what was a voyage final stages of terminal illness...

...It is also hard to ty's present debate over the so-called right-to-die issue...

...It cannot be forgotten, make these difficult and fundamentally private decisions...

...What role, if any, before us in almost geometric proportions as health care, at the did Catholic ethical teaching play throughout your handling of start of life, reaches into a mother's uterus to withdraw a fetus, the case...

...But there is a less parochial without interference from medical care-givers who feel that a consideration...

...As Armstrong expresses it, "We came to fundamental decisions for ourselves about medical treatment know that a higher hand was directing the affairs of what later while we are dying, and, if we are unable, allows those closest came to be known as In the Matter of Karen Ann Quinlan, a to us to do so...

...But as a result of the court HILL...

...Issues like busing, segregation, and abortion ARMSTRONG: It appears to originate in the understanding that, are good examples of the judicial procedure, a uniquely Amer- in a pluralistic society, when questions about the beginning ican way of resolving some of society's most complicated and the end of life are posed before an American court, it is social policies...

...A H ILL: As an attorney, you were identified closely with the number of concepts proved critical, particularly in light of the Karen Ann Quinlan case of 1976...

...to clarify the church's this observation...

...Bishops to make plain, not only to Catholics but also to the American public, what are the medical options for treatment HILL: One of the outcomes of the Quinlan case has been to and non-treatment at the end of life which are morally availplace the entire American legal apparatus - courts, judges, able according to the teachings of the church...

...Their statement implies that Catholics - patients non-treatment at the end of life for those who are , or choose to and their families, as well as care-givers - are now obliged in be, less discerning about the clear difference between the two...

...most sacred eventually, for good or ill, find themselves under court scrutiny...

...What is tinction between nutrition and hydration and, for example, sacred to American society is the concept of making decisions chemotherapy...

...of participating deliberately in our own evolution...

...If you do, the consequences may be theology in issues like these, the resolution of which will worse than anything for which you made that sacrifice...

...The significant point here is that every secular body that made always with the possibility of liability...

...As a result, has wrestled with these problems, sooner or later looks to the decisions are frequently made to diminish the threat of liability Quinlan decision which in essence was shaped by the teachrather than to serve the best interests of the patient...

...HILL: In a recent case - In the Matter of Beverly Requena - ARMSTRONG: Two come to mind immediately...

...Nancy Ellen Jobes and her family are Presbytepatient is dishonoring some moral prescription...

...A second is stewardship and the understandEllen Jobes...

...Commonweal: 622...

...21 November 1986: 621 ARMSTRONG: The prevailing view of the legal experts advising of forthrightness in their participation in the public debate on the bishops during the abortion debate was to avoid participa- medical-ethical issues...

...Karen, all should be remembered that American law does not recognize those involved, including attorney Paul W. Armstrong, had a any such right...

...That ruling clearly underscores the degree to for the Citizens' Committee on Biomedical Ethics, Inc., in Summit, which a secular, pluralistic society now leans upon the teachNew Jersey...

...for society as a whole what had hitherto been decisions The plight of Karen Ann Quinlan dramatized how far medi- confined to the privacy of a physician's relationship with cal technology had outstripped the law and social policy, and patients, their families, and hospitals...

...forthrightly with a society sorely in need of authoritative guidance, directly in the medical-ethical arena, indirectly in ARMSTRONG: I think not...

...Can reconcile this brief with those submitted by the bishops earlier you elaborate...

...to we can do all of this, ought we to do it...

...For Paul Armstrong it is gain a more technical understanding of the church's teachings...

...We have had a late the traditional physician-patient relationship so that deci- President's Commission Report on these same dilemmas...

...He is one of several courageous theologians willing to enunciate the teachings of the Catholic HILL: What immediate challenges - legal, ethical, and medichurch in the press and pull of, and under direct and cross cal - do you see facing the Catholic community in America...

...But as is often the way, medically appropriate form of treatment if that treatment offers the law had taken time to catch up with certain technical no hope of cure but merely prolongs the process of dying...

...In all the cases with which I am familiar, the court has adopted the testimony of theologians...

...The most obvious was the United Nancy Ellen Jobes, opposing the request of the Jobes family to States Supreme Court decision in 1973 adopting the abortion withdraw nutrition and hydration from their permanently comdecision...

...The implications of the use or non-use of medical technology continue to unfold HILL: Like the Quinlans, you are a Catholic...

...New Jersey Superior Court Justice Regthey related to medical treatment at the end of life...

...Newspaper headinto the Morris County Legal Aid Office (New Jersey) lines tended to portray her case in terms of a right-to-die...

...However, I am at H 1LL:You seem to suggest that the abortion debate was a a loss to know what to make of the actual brief submitted...

...I see sions can be made without the danger of criminal or civil nothing but good coming from a bishops' pastoral, for inliability...

...better not to participate - not to forthrightly spell out the range of moral options available to Catholic families - for H ILL: In specific terms, what have the courts accomplished fear of contributing to the diminution, in the secular view, in these so-called right-to-die cases...

...Is this a good development...

...The question that must be posed by the Catholic atose daughter...

...But nothing could be more shortsighted than to withhold from one of the chief institutions, ARMSTRONG: Without exception, the courts have been the first namely the courts, entrusted by society with the responsibility to recognize that the sacred bond between physician, patient, of advancing the sacred autonomy of human life, a significant family, and hospital is the most suitable means by which to means to fulfill that responsibility...

...For following that advice, the bishops have brief before the New Jersey Supreme Court in the case of . paid a price in many ways...