Religious Booknotes:
Cunningham, Lawrence S
RELIGIOUS BOOKNOTES Ecclesiologies in conflict Lawrence S. Cunningham We arc now a generation away from the Second Vati-can Council and my suspicion is that many eyes glaze over at the thought of...
...To the Editors: An appalling number of misperceptions color the debate among Catholics (including theologians and some bishops) about the ethical validity of withholding or withdrawing artificially administered nutrition or hydration from a patient who is terminally ill or comatose...
...tensions which, as Eupenio Corccco points out in a long-detailed essay, spilled over into the new Code of Canon Imw...
...Likewise, a number of the essayists in Alberigo's volume note the somewhat upbeat and optimistic character of the conciliar texts...
...Hentoff provides us with John Cardinal O'Connor...
...19.95...
...The one conclusion that all his contributors share is a conviction that a new generation of commentaries on the council is badly needed to explicate more clearly the tensions in the council...
...essayist) written over the past two years...
...John Cardinal O'Connor, archbishop of New York, is not torn by competing ecclesiologies...
...Like Alberigo and Richard, Orsy thinks we are far from having a full hemeneutical analysis of what the council did and "meant...
...While Richard's volume promises a look to the future, the essays, in fact, concern themselves with a balanced look at the state of certain theological issues today...
...a well written chronicle of O'Connor's rise from the milit;try chaplaincy to the most visible see in the American church...
...Others- most notably Chalcedon and Trent- entered into the life of the church in such a way that their influence must be reckoned with down- to this day...
...As Joseph Komonchak points out in an essay in Alberigo's volume, the local church is the church writ small but it is part of the larger community which makes up the church catholic...
...However, a legitimate concern about the "slippery slope'' should not push the church wittingly or unwittingly into advocating a position which appears to deny patients or their families the right to do "what is morally permissible...
...He proposes a new genre which he calls seminal locutions to describe those insights of the council that point to religious mysteries which arc not fully developed in the documents themselves...
...The New Jersey bishops' brief in the Jobes case cited the identical passage from the NCCB Pro-Life Committee statement about maintaining a "strong presumption in favor" of food and fluids...
...Washington, D.C...
...Awash in the dead sludge of post-conciliar language (the sisters are forever consulting and praying...
...That leads to the ultimate question: Is removal of nutrition or hydration the equivalent, for example, of removal of a respirator...
...In this area, Roman Catholic health-care ethics has shown a sensitivity to people which has been in keeping with the best of Catholic theology...
...172 pages...
...the participation of non-Roman Catholics...
...As the United States bishops...
...So what is Nat Hentoff, a wonderful liberal journalist and self-described member of the Proud and Ancient Order of Stiff-Necked Jewish Atheists, up to in writing a New Yorker profile of the cardinal which is the basis of this book...
...Such an enterprise, of course, does not preclude a look back...
...in time, to second thoughts about its usefulness or the simple acceptance of its reality...
...the near immediate impact of the decrees (e.g...
...RICHARD DOERFLINGER Assistant Director NCCB Committee for Pro-Life Activities Like a lethal injection Los Angeles, Calif...
...John O'Malley, who has written some seminal essays on the historical significance of the council, notes the singularity of Vatican II: the role of the media...
...He notes that some past councils were never' 'received" by the church (e.g., the Council of Florence...
...Nor does the Chicago Archdiocesan Medical-Moral Commission endorse such a broadly permissive position...
...Hentoff, basically, is intrigued by this rigidly orthodox Catholic hierarch who also is passionately pro-labor, against contra funding in Central America, committed to the needs of the poor, and a lifelong servant of the needs of mentally retarded children...
...Finally, I am deeply troubled by the authoritarian style and polemical tone which has characterized their approach to this terribly sensitive issue, an approach unlikely to nurture support among a majority of Catholics or the public...
...they were dead letters soon after their close...
...Obviously these medical and nursing personnel were the people most directly involved in this patient's care...
...Curran argues strenuous-ly that Roman interventions in the area of sexual ethics have had the pur-lous effect of retarding the development of a mature theology of sexualiy in contemporary Catholicism It would be faille to think of the differernces between Father Curran and the Vatican as meraly an argu-ment over the issue of sexual ethics Although that is the neurologic point of their disagreement, it is also clear, as Father Curran notes, that the primary issue is the competition between two quite differient ecclesiologies...
...How the local churches, in their bewildering cultural diversity and in their particular needs, simultaneously maintain their sense of self and their sense of being part of the universal church, is a problem, not only of discipline and jurisprudence, but of culture, language, and understanding...
...I became interested in the subject when I helped draft legislative bills in California last year and this year...
...These questions are very much in the air these days but Father Orsy brings to them a cool eye of analvsis and clarification set in the context of a church which both leaches and learns evclesia docens et discern...
...The Reception of Vatican II, edited by Giuseppe Alberigo, et al...
...Father Orsy, for instance, argues that the style of the documents of Vatican II makes them hard to interpret with exactitude...
...Nat Hentoff, Scridner's, $19.95...
...b. the moral obligation to initiate or continue an invasive medical procedure rests upon a judgment which involves weighing the benefits and the burdens...
...Though I agree that there is an ever-present and very real danger that our society might move toward a disregard of the value of human life (indeed, we have done so in many areas already), I am puzzled about the argument that cessation of useless or burdensome treatment will hasten that process...
...The brief, said Archbishop McCarrick,' 'did not address the issue of withdrawing food and water from a terminally ill, dying patient, or an unconscious or dying patient, when the means of providing food and water are dangerous or burdensome to the patient, when continuation is clearly useless in preserving life, or when the actual nutrition and hydration creates new suffering for a dying patient.'' This statement of almost a year ago resolved the apparent conflict between Newark and Chicago...
...In summary: a. providing a patient with artificial hydration and nutrition represents an invasive medical procedure...
...Precisely because we are at some distance from the council, the time has come to look back to fill out a scorecard on its achievements and failures...
...There are three basic issues which focus my differences with the Catholic bishops of New Jersey on this matter...
...In essence, Orsy attempts to answer these linked questions: what is the magisterium of the church"' What assent can it expect...
...Such offices (both elected and appointed) were seen as incompatible with their status as vowed religious...
...Michael Glazier...
...On the contrary, I articulated a moderate-centrist position on this issue...
...The first three deal with his travails with Rome and thus provide an addendum to his published dossier on that unhappy experience...
...If it is, the debate is over...
...for a vernacular liturgy) on the life of ordinary believers, etc...
...if Hentoff is to be believed, does not find it unimaginable that a supremely orthodox, socially liberal, and vigorously mature American could aspire to the chair of Peter...
...Alberigo's volume looks back to the council and forward to the present day in order to assess the reception of the conciliar spirit...
...the notion of the vowed religious life...
...It is consistent with traditional Catholic thinking about the moral obligation to prolong human life...
...The other books in this survey deal with specific issues that illustrate the basic theses of the Alberigo and Richard volumes...
...First, I differ with their contention that providing a patient with artificial hydration and nutrition does not represent an invasive medical treatment, but simply an "ordinary means" of care...
...These decisions should not rest in distant hands whether civil or ecclesiastical...
...Paulist, $12.95...
...However, the patient might live...
...On May 26 Joseph Cardinal Bernadin of Chicago in an address before the University of Chicago Hospital's Center for Clinical Ethics called for a national consensus which would prohibit active euthanasia, but which would allow for withholding or discontinuing artificial hydration and nutrition when these measures are useless or excessively costly or painful...
...Professor Trinkaus correctly points out that the opponents to withholding or discontinuing artificial hydration and nutrition are ill-advised when they claim that artificial hydration and nutrition represent an "ordinary" means of treatment which is normally morally obliged of patients...
...What Hentoff also makes clear is that O'Connor never second guesses a decision or action of the Vatican and, if he ever has doubts about the right-ness of his theological views, he never | articulates them out loud...
...Many of those who believe that the non-use of nutrition and hydration is morally wrong argue that the procedures are not excessively intrusive nor particularly burdensome to the patient, and therefore constitute ordinary means...
...So far, no one has even addressed the basic distinction...
...Secondly, I differ with their contention that withholding or withdrawing artificial hydration and nutrition from a terminally ill or permanently unconscious patient "constitutes a new cause of death- starvation and dehydration...
...The gist of the bills is that nutrition or hydration cannot be withheld or withdrawn if the result will be death from malnutrition or dehydration...
...Thus a great deal turns on whether artificial feeding is generally to be considered extraordinary or disproportionate means...
...A sincere thank you to Commonweal and John Mitchell...
...To that question Alberigo's volume attempts an answer...
...I am confident that my thinking is in accord not only with the thought of some of the most respected Catholic medical ethicists in the United States including Richard McCormick, S.J., John Paris, S.J., and Kevin O'Rourke, O.P., but also with the Advisory Opinion of the Medical Ethics Commission of the Archdiocese of Chicago and the moral stance adopted by Bishop Lewis Gelineau (Providence, R.I...
...c. invasive medical procedures, including artificial hydration and nutrition, are not morally obliged if they are unduly burdensome or if they are useless...
...Occasioned by a famous essay of Karl Rahner (a version of which is in this volume) arguing that Vatican II marked the beginning of a world church and the end of a Eurocentric church, the contributors, all connected to the Weston School of Theology, try to think about the shape of this church of the future...
...Lucien Richard's volume of essays, by contrast, wishes to think beyond the Second Vatican Council...
...Univernty of Notre Dame...
...If this were true, a task force of the New Jersey Catholic Conference, chaired by Bishop James McHugh of Newark, would not still be promoting a draft policy on artificial hydration and nutrition which lacks the moderate reasoning and nonpolemical tone which characterizes the Advisory Opinion of the Archdiocese of Chicago...
...This evolution provides jus-tification for the word "tension" in the title: the tension between past and present Another kind of tension is less healthy...
...As I see it, this distinction is irrelevant to the present controversy...
...The subtitle of Father Orsy's book indicates the topics he takes up: Magisterium-Assent-Dissent-Actulemic Freedom Orsy is a world class canonist and his legal training gives to this volume a crispness and clarity that one finds in the best of legal writing He takes the vexatious issues that often trigger headlines and admirably clarifies what is involved...
...Faithful Dissent (Sheed& Ward, 1986...
...From the content of his letter I presume the latter...
...It is obvious that a ninety-year-old terminal cancer patient need not undergo surgery for a heart condition, which would be ordinary care in most situations, because when we are finished we still have a ninety-year-old terminal cancer patient...
...That brief also went further, seeming to imply in a few passages that such means may never be withdrawn...
...Doerflinger's assertion that Archbishop McCarrick's statement of June 24,1987 "resolved the apparent conflict between Chicago and Newark...
...All Catholics agree (and if you don't agree, forget it) that we should not deliberately kill a dying or comatose patient, whatever the burden...
...d. patients and/or their families are commissioned with the moral responsibility of deciding whether or not invasive medical procedures are obligatory...
...If one were to single out a leitmotif that runs through all of these quite disparate volumes it would be the problem of the relationship of the local church to the Great Church...
...What is confusing about Professor Trinkaus's letter is that he appears to advocate a position regarding the withholding or discontinuing of artificial hydration and nutrition which is even more extreme than those who see it as simply an "ordinary" means of care, suggesting that there is an almost absolute obligation to endure artificial hydration and nutrition except in those cases when death from a terminal illness will occur prior to "starvation...
...dantly clear is that Vatican II was very much a transitional council whose de-liberations, for good historical reasons, cobbled together documents which strained to contain competing theologies that are not always reconcilable...
...There is no need to impose useless or excessively burdensome "treatments" on people...
...While it is understandable that some might interpret the withholding or withdrawal of medical hydration and nutrition as a step toward actions which are indeed immoral, this fear ought not allow us the luxury of mistreatment to the dying and their families...
...an optimism that has drawn criticism from both the right and the left today...
...This is not a valid distinction...
...As to the consultative style of the New Jersey bishops in this matter, I'd be grateful if Mr...
...I will confidently leave to your readers the judgment whether my interpretation misrepresents the substance of these documents...
...In my article I attempted to express these same sentiments...
...edited by Lucien Richard, et al...
...That analysis is most needed precisely because a goodly number of the con-ciliar pronouncements were not written in a technical style and did not...
...1 say "almost" because a volume like this (and Curran's Faithful Dissent) is a case study of the problems raised, at a more theoretical level, by the earlier volumes noted in this review...
...276 pages...
...The heady enthusiasm of the conciliar period gave way...
...Vatican II: The Unfinished Agenda...
...For while Mitchell implies that life-sustaining means are devoid of benefit whenever they cannot restore the patient to cognitive functioning, the Chicago commission classifies such means as beneficial so long as they offer "any reasonable hope of success of prolonging life.'' This commission recommended to hospital personnel a statement by the NCCB Committee for Pro-life Activities to the effect that "since food and water are necessities of life for all human beings, and can generally be provided without the risks and burdens of more aggressive means for sustaining life, there should be a strong presumption in favor of their use...
...Similarly, the essays on ecclesiology, the centrality of preaching, and the shifting notions of sacramentality point to the future only in the sense that they set out the problems with which the church will have to deal in the future...
...Vatican II obviously belongs to that latter category...
...MELANIE MATHEWS Excessive treatment...
...We abhor suicide and active euthanasia, for reasons that are not the subject of this letter...
...To the Editors: John Mitchell, Jr., is quite correct in his interpretation of the Catholic tradition ["Knowing When to Stop," May 6...
...This overlooks the fact, as pointed out in Professor Mitchell's article, that in determining what is ordinary or extraordinary, we are not confined to considering the burden of the treatment itself, but might consider also whether the medical procedure is disproportionate to the result...
...In some not insignificant sense, Vatican II was very much a sixties event...
...We also agree that some procedures, such as a ventilator (respirator), can be removed if the treatment is extraordinary under the traditional distinction...
...Kolbenschlag's anthology chronicles the cases of Agnes Mary Mansour (head of Michigan's Department of Authority, Community, and Conflict, edited fry Madonna Kolbenschlag, Sheed A Ward, $17.95...
...225 pages...
...It is only recently that we have paid a goodly amount of attention to the local church and, with that attention, problems inevitably arose which, as of this date, have not found fully satisfactory solutions...
...In fact the Declaration says this only of a treatment ' 'which carries a risk or is burdensome.'' In other words, this applies only to extraordinary or "disproportionate" means...
...One State Senator on the Judiciary Committee tried to brush it aside as being simply a matter of "statistics...
...My position on the ethics of withholding, limiting, or discontinuing artificial hydration and nutrition is simple, straightforward, and, I believe, consistent with the Catholic medical-moral tradition...
...How docs dissent relate to the magisterium...
...These two volumes, taken together, offer abundant proof that we The Church: Learning and Dissent, Ladislas Orsy...
...The commission also opposed omitting such means "with the intention of shortening the life of the patient or bringing on death," and urged particular care in protecting "those who are seriously ill or permanently impaired in one way or another" because of society's "profound disregard" for the dignity of their lives...
...Knowing When to Stop" has placed this issue in perspective for me and given me a sense of peace that my beliefs are founded in my church's moral tradition...
...Mitchell begins by misquoting the Vatican's Declaration on Euthanasia as saying "withdrawing treatment is not equivalent to suicide...
...If one reads Vatican II in a certain fashion, that is a great consolation: if one reads it in a different manner, however, it is reason to be suspicious of a man who...
...To the Editors: John J. Mitchell's use of the Vatican and the Chicago Archdiocese to criticize the New Jersey bishops on the subject of tube feeding ["Knowing When to Stop," May 6] rests on misrepresentations of all three sources...
...202 pages...
...I am puzzled by Mr...
...other essays deal with questions of sexual and social ethics...
...His books include The Catholic Experience and The Catholic Faith: An Introduction...
...I suggest, however, that it is actually the equivalent of administering a lethal injection...
...If a respirator is removed, the patient will probably die from lack of oxygen brought on by the underlying injury or disease...
...The Alberigo volume is the fuller and more technical of the two but when both are read in tandem one can only conclude that the theological task is enormous, both in the need to understand what has happened to us in the last generation (the task of retrieval ) and him one goes about constructing a theology (theologies...
...The middle section of the book offers some theological essays on the situation but the most valuable part of the book is the last section which reprints the entire correspondence between the Sisters of Mercy and the Roman authorities...
...I made no attempt in my article to break new ground in Catholic medical ethics with regard to the morality of withholding, limiting, or discontinuing the use of artificial hydration and/or nutrition for the terminally ill or irreversible comatose patient...
...After all, most young people have no memory of any other kind of church...
...If nutrition or hydration is discontinued, the patient will die from starvation or dehydration very shortly...
...223 pages...
...What are the limits of the assent...
...Food and water are no more basic than oxygen...
...Ethical and Religious Directives for Catholic Health Facilities points out, the denial of these normal or "ordinary" means is "equivalent to euthanasia...
...His logic obliges a form of medical vitalism which has no defense within the Catholic tradition...
...His own opening essay is worth the price of the book...
...I share the archbishop's concern in this regard...
...pro-vide succinct canons summing up their authoritative teaching...
...He incarnates the old dictum Roma locuta, causa finita...
...It is true that this issue raises some questions which are not easily resolved...
...JOHN J. MITCHELL, JR...
...I think those who require such treatment in all cases are untrue to the tradition that some of them claim to uphold...
...To strike a healthy balance may be one of the premier tasks of the church as it moves towards the new millennium, CORRESPONDENCE (Continued from page 418) cial feeding or hydration they have an obligation to receive it, even if it must be forced upon them...
...Some of these misperceptions were assembled and approved by John G. Mitchell, Jr., in his Commonweal article...
...I would suggest that the existence of these useless and burdensome treatments makes it easier, not harder, for those who support active euthanasia to bring about legislative changes in our society...
...14.95...
...in the Marsha Gray case...
...According to Professor Trinkaus's reasoning, artificial hydration and nutrition may never be withdrawn from a patient in a persistent vegetative state...
...the Fifth Lateran Council...
...The procedure is terminated, and the result is in the hands of God...
...the Vatican is forever requesting clarifications and citing canon law), these letters almost manage to hide the fundamental character of the issues at stake: the nature of the church...
...One of his primary themes in these essays is to chronicle, by careful reading, how ethical positions have changed and become more nuanced over the years The social teachings from Leo XIII down to the present pontiff do not form a seamless whole hut a process of refinement and evolution as the Thomistic basis for social teaching(s) gave way to other insights form other sources...
...Social Services), Elizabeth Morancy (Mate legislator in Rhode Island), and Arlene Violet (the same state's attorney general) who all, in the end, lost their appeals to Rome...
...Doerflinger would forward to me a list of the Catholic health-care professionals in New Jersey who were consulted by the bishops prior to the filing of the brief with the New Jersey Supreme Court in the Nancy Ellen Jobes case...
...Good journalist that he is...
...Death is as inevitable and as certain as though a lethal injection were given...
...are indeed between two theological worlds and the lineaments of what our future theology will look like are still not clear...
...If not, I must assume that the denial of nutrition or hydration is euthanasia or suicide...
...What is the relationship between magisterium and the university...
...Unfortunately, Mr...
...I have heard the argument that the distinction between nutrition/hydration and a respirator is that food and water are basic...
...the fundamental mission of the church...
...Doerflinger's assertion that I have misrepresented the Vatican's Declaration on Euthanasia, the Advisory Opinion of the Archdiocese of Chicago, and the position of the Catholic bishops of New Jersey in the Nancy Ellen Jobes case is both self-serving and inaccurate...
...Richard Doerflinger and Professor Trinkaus...
...indeed, proper understanding of theology and of the basic message of Jesus forbids it...
...the lack of canons;-the verbosity and lack of technical character in the documents...
...363 pages...
...Catholic University, $39.95, $19.95 paper...
...Richard's two essays point out the issues inherent in the shift from a preoccupation with missions (as in: foreign missions) to the more fundamental notion of the church in mission...
...This idea has some family resemblance to Newman's theory of doctrinal development...
...This essay provides a nice complement to the work of Alberigo's volume...
...One of the major reasons why people want such legislative changes is that they fear a long illness where healthcare professionals treat uselessly...
...On the other hand, those, like Professor Mitchell, who advocate withholding/ removal of nutrition/hydration under the ordinary/extraordinary dichotomy, run into another problem, and one that I think is insurmountable...
...The same paragraph of the Declaration notes that in such cases one may "make do with the normal means that medicine can offer...
...What Alberigo and his fellow contributors (mainly European, North American, and Latin American professional theologians) make abunLAWRENCE S. CUNNINGHAM will be teaching theology at the University of Notre Dame next fall...
...Moreover, if the removal of nutrition or hydration is to be permitted with death the inevitable result, the proponents of euthanasia will argue that it is foolish and inhumane to use this method of causing death, when a lethal injection would be quicker and easier on the patient...
...Archbishop McCarrick of Newark corrected this impression on June 11, 1987, when he publicly explained that the brief was primarily directed against a' 'quality of life" rationale for removing easily provided food and fluids from unconscious but nondying patients in nursing homes...
...In the last stages, when death is imminent, nutrition and hydration can be withdrawn because death will not result from malnutrition or dehydration...
...WALTER R. TRINKHAUS Professor Emeritus Loyola Law School The author replies: I am grateful for the opportunity to respond to Mr...
...Nonetheless, as scholars endlessly note, the council represented a sea change in the history of Catholicism...
...Pittsburgh, Pa...
...This implies that a patient not only has a "right to life" but a "duty to live...
...For example, some philosophers and some theologians argue against the Catholic tradition by insisting that the withholding of medical (artificial) hydration and nutrition is a direct killing, that it is the act of omitting nourishment which kills the patient...
...That competition is perfectly illustrated by Madonna Kolbenschlag's anthology which centers on Rome's insistence that some Sisters of Mercy resign from the public offices they held...
...He accuses me of misrepresentation because my interpretation is at variance with his own...
...RELIGIOUS BOOKNOTES Ecclesiologies in conflict Lawrence S. Cunningham We arc now a generation away from the Second Vati-can Council and my suspicion is that many eyes glaze over at the thought of rehearsing the events of that watershed convocation...
...If we want to resist the "euthanasia movement," we will do it better by supporting humane and morally correct treatment policies than by imposing burdensome measures on the sick...
...Doerflinger failed to indicate whether he was speaking "officially" for the Bishops' Committee for Pro-Life Activities or simply expressing his own opinions on the views I expressed...
...But the Catholic moral tradition, correctly in my judgment, has argued that it is the disease which kills the patient, and that excessively burdensome or humanly useless treatments need not be imposed...
...Mitchell's further claim that the New Jersey bishops failed to seek input from those who directly care for patients is puzzling...
...DAVID F. KELLY Duquesne University Any reasonable hope...
...a competition made all the more difficult because Vatican II did not com-pletely solve the tensions between the notion of the church as a societas per-fecta and the church as the Pilgrim People of God...
...that takes into account the new Catholicism which Karl Rahner saw as coming after Vatican II...
...The biggest trap for the unwary is the familiar distinction between "ordinary" and "extraordinary" means of preserving life (or as some prefer "heroic" versus "non-heroic" or "proportionate" versus''non-proportionate...
...The Jobes family filed suit only because the owners and staff of the nursing home were adamantly opposed in conscience to removing Nancy Jobes's nourishment...
...They do not want this for themselves or for their families...
...Such a tally in theological jargon goes under the name of reception: how did the Catholic world "receive" the teaching(s) of the council...
...Mitchell claims without evidence that it falls into this category whenever a patient is "in a persistent vegetative state with no hope of recovery.'' But the Vatican Declaration nowhere says this, and documents such as the Vatican Statement for the International Year of Disabled Persons declare that the right to have one's life preserved and protected exists regardless of the extent to which a person has lost his or her mental faculties...
...Father Charles Curran has been at the center of a struggle with the Roman authorities over the precise issues discussed by Father Orsy in his book His latest vulume collects essays (Father Curran is primarily an Tendons in Moral Theology Charles Curran...
...a code which, by turns, legislates for a hierarchically organized church and exhorts a pastoral assembly of believers in Jesus Christ...
...This slim volume, a model of good sense and deep learning, brings much light to an area where, alas, we often have a surfeit of heat, It should be required reading for anyone who wishes to enter the ongoing debates about the role of dissent in contemporary Catholicism...
...If anyone has a more substantial response to my argument, I would like to hear it...
...Death is not inevitable, as Karen Quinlan dramatically demonstrated...
...as earlier councils were wont to do...
...In my article I indicated my appreciation for Archbishop McCarrick's concern about the "slippery slope" in matters pertaining to the withholding or terminating of life-prolonging medical treatments...
Vol. 115 • August 1988 • No. 14
