Knowing when to stop:

...The meeting was convened to discuss some of the ethical issues raised about withholding or terminating the use of artificial hydration and nutrition for patients who are terminally ill or in a persistent vegetative state...

...Amidst the confusion of the miracle of modern medicine and our American impulse to prolong life at any and all costs, Father Joseph brought the wisdom of the African culture to our meeting...

...He and his sisters debated about returning her to the hospital where she could be given water and nutrition artificially...

...And it went on to say: ". . .the conference maintains that nutrition and hydration, which is basic to human life, and as such distinguished from medical treatment, should always be provided to a patient...

...After a few weeks, Father Joseph's mother reached the point where she would no longer eat...

...The video presentation offered a particularly sensitive treatment of the process of deciding when it may be morally appropriate to withhold or terminate the use of artificial hydration and nutrition procedures...

...The conference asked the court to deny Mrs...

...In Catholic teaching, "extraordinary" means have generally been regarded as those which cannot be undertaken without excessive physical, psychological, spiritual, or financial burden, and which, if undertaken, offer no real benefits for the patient...

...Their mother, he said "was already on the journey toward death and to eternal life...

...The statement, basing itself on traditional Catholic medical moral principles, asserted that withholding or discontinuing the use of artificial hydration and nutrition can be morally justified...

...Undoubtedly, Archbishop McCarrick and others who oppose withholding or terminating artificial hydration and nutrition procedures are concerned about the danger of a " slippery slope" leading to the general and widespread acceptance of euthanasia...

...Eight subsequent operations had proven futile in improving her condition...

...For almost seven years she existed in a persistent vegetative state with no hope of recovery...

...She was no longer in need of the food provided by this world...

...Gray's moral right to request discontinuing the artificial hydration and nutrition procedures sustaining his wife...

...Catholics and others who are committed to defending the sacredness of human life must certainly be concerned about such a "slippery slope...

...Apparently Catholics in Chicago believe that medical extremism, even in defense of life, can at times be more a vice than a virtue...

...District Court to force officials at Providence General Hospital to stop feeding his wife...

...The overwhelming reaction of the participants was to applaud the beauty and marvelousness of the Catholic medical moral tradition...

...Father Joseph was present through this time...

...During the discussion Father Joseph's uncle, the patriarch of the family, arrived at the home...

...on the contrary, it should be considered as an acceptance of the human condition, or a wish to avoid the application of a medical procedure disproportionate to the results that can be expected, or a desire not to impose excessive expenses on the family or community.'' At the conclusion of the video the floor was opened for discussion and comment...

...To surrender or compromise the fundamental moral principle of patient self-determination which has long been a cornerstone of Catholic teaching would result in advocating a form of moral elitism which suggests that average people like Nancy Ellen Jobes and Marsha Gray-or their legitimate surrogates-lack the wisdom, the intelligence, or the virtue to make prudent medical moral decisions...

...I recently had the privilege of attending a meeting of people engaged in pastoral care ministry in several Catholic hospitals in the metropolitan New York area...

...I was invited to comment on the substance of the video, and to elicit the reactions of those in attendance...

...Although profoundly loving human life and defending its sacredness, traditional Catholic medical moral thought still manages to reject a moral extremism which asserts that human life must be prolonged even at the cost of imposing unimaginable and futile sufferings on patients and their families...

...Withdrawal of nutrition and hydration introduces a new attack upon human life...

...Catholic teaching has historically made a marvelous contribution to medical ethics through its defense of the right of patients to make those medical decisions appropriate to their conditions...

...I do know, however, that many Catholic health care professionals in New Jersey were not consulted prior to the brief's submission to the state Supreme Court...

...Jobes's unborn child was fatally injured in an automobile accident...

...It even threatens to distort the reasonableness of the Catholic medical moral tradition itself...

...It said:' 'Policies in Catholic health-care institutions in the Archdiocese of Chicago should not prohibit a patient or his/her legitimate surrogate from doing what is morally permissible .'' The Archdiocese of Chicago has come down on the side of the right of the patient to make those decisions which belong first and foremost to the patient...

...Jobes's husband and her mother and father sought legal authorization to discontinue the use of the artificial hydration and nutrition tubes which were sustaining her life...

...Near the end of the meeting, a Father Joseph indicated that sometimes discussions about medical moral issues are more confusing than enlightening...

...At the outset of the meeting the participants viewed a video produced by the Mercy Health Corporation focusing on these issues...

...Christ has risen...

...After experiencing the response of pastoral care professionals to the video, my professional convictions moved to a more profound level...

...JOHN J. MITCHELL, JR., is an associate professor in the religious studies department at Seton Hall University, South Orange, New Jersey...

...They expressed their interest in struggling with this issue in light of the principles of traditional Catholic medical moral theology...

...Then he enlightened everyone with a marvelous tale...

...In January of this year, Bishop Lewis E. Gelineau of Providence, Rhode Island, was confronted with a case similar to that of Nancy Ellen Jobes's...

...Shortly after his return home, the doctors caring for her told him and his sisters that their mother was dying and that there was little they could do for her...

...Many of the episcopal participants are also involved in a public squabble about the appropriateness of some aspects of the recent statement, "The Many Faces of AIDS," issued by the administrative board of the National Conference of Catholic Bishops...

...In its amicus curiae brief, the New Jersey Catholic Conference argued that the discontinuation of Mrs...

...To force her to eat the world's food at this point would only impede her in the journey God had designed for her...

...When people have to confront the profoundly difficult choices about life and death they should be able to look to the church for enlightenment not confusion, moderation not extremism, and caring not condemnation...

...In advancing this position, the Chicago statement went one step further...

...There is little reason to believe that this public debate among members of the Catholic hierarchy in the United States will be resolved in the near future...

...The discussants in the video included physicians, patients, nurses, family members, pastoral care professionals, and medical ethicists who are frequently involved in these difficult choices...

...Long before the meeting began I had publicly indicated my support for the right of Catholic patients, or their families, when appropriate, to request the withholding or termination of artificial hydration and nutrition procedures...

...Such an action, the bishop asserted, would not violate traditional Catholic medical moral principles...

...Catholics who are aware of the Chicago statement (which presumably was issued with the knowledge of Cardinal Joseph Bernadin, Archbishop of Chicago, and chair of the Committee on Pro-Life Activities of the National Conference of Catholic Bishops), of Bishop Gelineau's support of the Gray family in Providence, and of the action taken in the Archdiocese of Newark by Archbishop McCarrick can rightfully wonder aloud how an action which is defended in one Catholic jurisdiction as a right under the rubric of traditional Catholic medical moral thought can be prohibited under the same rubric in another...

...Today, a public debate about the ethics of withholding or terminating artificial hydration and nutrition is under way among members of the Catholic hierarchy in the United States...

...Catholics who are engaged in the public debate about the ethics of withholding or terminating the use of artificial hydration and nutrition procedures need to learn the simple, yet profound truth that Father Joseph's story teaches us all...

...The participants shared stories of their agonizing yet deeply enriching experiences with patients and their families when the sacred moment arrived to confront the difficult choices about life and death, hope and fear, communion and the reality of human mortality...

...God was already sustaining her in her journey to eternity with an immortal food...

...Such a decision could be morally appropriate for a patient in a persistent vegetative state with no hope of recovery, as well as a patient who is in a terminal condition...

...Gray's husband, H. Glenn Gray, filed suit in U.S...

...A cynical observer might suggest that these current debates are less about substantive issues than about ideological posturing...

...The uncle finished his lesson with these words:' 'When God calls those we love we must let them go to him...

...In recent years the Vatican Congregation for the Doctrine of the Faith has utilized a distinction between "proportionate and disproportionate means" when discussing the moral significance of the church's traditional teaching in this matter...

...We need not fear death anymore.We need not fear death anymore...

...Eight years ago, Mrs...

...Bishop Gelineau publicly supported Mr...

...I do not know if all the Catholic bishops in New Jersey actually supported Archbishop McCarrick in the position argued in the brief...

...Christ has died...

...From my vantage point I am afraid that this debate may create more confusion than enlightenment...

...A few years ago Father Joseph's mother took seriously ill and he returned to his native Africa to be with her...

...Since January 1986, Marsha Gray lay in a persistent vegetative state after suffering a cerebral hemorrhage...

...Jobes had indicated that she would not want her life sustained artificially if there were no hope for her recovery...

...The statement applied this judgment to terminally-ill patients, as well as to patients who are in persistent vegetative states...

...I came away from the meeting with a renewed sense of the importance of pastoral care professionals in Catholic health care ministry, and with a deep conviction that those who are anxious for moral guidance about these troubling issues should turn to those who are on the front line in caring for the sick and the dying...

...More than a year ago the New Jersey Catholic Conference, (Continued on page 277) (Continued from page 272) under the leadership of Archbishop Theodore McCarrick of Newark, filed a friend of the court brief with the New Jersey Supreme Court in the case of Nancy Ellen Jobes...

...It is direct...

...His sisters took their mother home and cared for her as she grew progressively weaker...

...We should not force them to eat so they will stay with us beyond their time...

...The brief read: "The denial of food and fluids, of hydration and nutrition, ultimately results in starvation, dehydration, and death...

...I had come into the company of a group of people who knew far more than I about the logic, reasonableness, and beauty of the Catholic medical moral tradition, a tradition which resists moral extremism...

...Jobes's family the legal right to discontinue the treatment, and argued that such an action would violate the basic tenets of Catholic medical moral thought...

...In June of 1987 the Medical Ethics Commission of the Archdiocese of Chicago issued a statement on the ethics of withholding or terminating the use of artificial hydration and nutrition procedures...

...In the fall of 1987, Archbishop McCarrick sent a letter to the Catholic hospitals in the Archdiocese of Newark asking that the patient admission consent form at each hospital be amended effectively to prohibit the right of a patient, or a patient's family, to request or insist on the withholding or the termination of artificial hydration and nutrition procedures...

...In light of this traditional distinction, a number of Catholic moralists have concluded that there may be situations when a decision to withhold or withdraw artificial hydration and nutrition procedures can be morally appropriate within the framework of traditional Catholic medical moral thought...

...They asserted that in conversations prior to this tragedy Mrs...

...The following excerpt from the Vatican's "Declaration on Euthanasia" (1980) supports this position: "Withdrawing treatment is not equivalent to suicide...

...However, a legitimate concern about the potential danger of the "slippery slope" should not push members of the Catholic hierarchy or others into a kind of moral extremism which rejects the reasonableness of the Catholic medical moral tradition in issues pertaining to the moral obligation to prolong human life...

...It is unnatural, as unnatural as denying one the air needed to breathe, or murder by asphyxiation...

...The video noted that Catholic medical moral thought- utilizing a traditional distinction between "ordinary and extraordinary means"-has long taught that a patient normally has a moral obligation to accept "ordinary" means of treatment, but that a patient does not have a moral obligation to endure "extraordinary" means of treatment...

...During the course of an operation to remove the dead fetus, Mrs...

...Jobes suffered irreversible brain damage...

...When he learned that Joseph and his sisters were thinking about returning their mother to the hospital, the uncle explained that this would not be the right thing to do...

...After more than six years of thoughtful and prayerful deliberation, Mrs...

...Many of the participants in the video were Catholic...

...Jobes's artificial hydration and nutrition was tantamount to murder by starvation...

...Critical people of all faiths realize the need to be watchful lest the dignity of human life become compromised, either intentionally or unintentionally, by the marvels of modern medical technology and the new ethical issues it creates...