The pope on PVS
Tuohey, John F.
John F. Tuohey THE POPE ON PVS Does JP II's statement make the grade? recent address by Pope John Paul II regarding the care of patients in a persistent vegetative state (PVS) has left many...
...The Declaration speaks of "techniques" and "remedies," not the "medical act/natural means" distinction you propose...
...In other words, the patient's prognosis and medical condition...
...Volpi, 1899 But what tears I spent on a china doll's shattering, the loss of a hat...
...If foreign prisoners abroad possess constitutional rights, then courts will prevent the military from keeping order in war zones...
...courts, the administration asserts,would extend full constitutional protection to anyone in a country under U.S...
...citizens...
...As the administration frames these two groups of cases, they would appear to have relatively little in common...
...We suggest, first, that it may be helpful for you to describe in detail the different methods of meeting nutritional needs artificially, such as hyperalimentation, nasal-gastric tube, peg or J-tube, or IV...
...You describe it as "a natural means of preserving life" when it is capable of achieving its own proper finality of providing nourishment—when it achieves its purpose...
...Sincerely, Your Thesis Committee ^ Reverend John F. Tuohey holds the endowed chair in applied health-care ethics at Providence St...
...The ongoing case of Terri Schiavo in Florida is just one example...
...Instead, in the Guantanamo cases, it cites a difT Commonweal 12 June 18, 2004...
...Kelly is particularly important in this discussion since he played a significant role in developing the concepts of "ordinary" and "proportionate" care...
...This possibility is a key part of your argument that we must not forgo nutritional support...
...You seem to suggest that if there is doubt regarding the prognosis, the ethical thing to do is to take the safest approach: care for the person as if he or she may recover...
...But this need not lead to the conclusion that one may never forgo artificially administered nutrition/hydration...
...We are hopeful that you will find these comments useful as you continue your work...
...Each of these entails invasiveness, risks, and limitations on usefulness, as well as such medical expertise as anesthesiology, surgery, radiology, dietary, and general nursing...
...Ultimately, however, the administration insists that military detention of Hamdi and Padilla does not require congressional authorization...
...The Declaration makes this same point stating, "it is also permitted to interrupt these means where the results fall short of expectations," not simply because they fail to achieve their purpose or are burdensome (emphases ours...
...Your final project will therefore need to include a thorough analysis of the work of Aquinas and Alphonsus Liguori in this regard...
...PVS includes periods of arousal and the return of sleep-and-wake cycles, when the patient seems "awake" but unfortunately is never aware...
...To the claimants' contention that Guantanamo Bay is U.S...
...In both, the administration casts the courts and judicial process as the enemies of national security...
...Finally, we would like to make one comment on your use of sources...
...In the 1950s, the moralist Gerald Kelly, SJ, concluded that forgoing nutrition/ hydration was permissible when a patient was in a condition described at the time as a terminal coma: a condition from which he or she was unlikely to recover...
...More problematic is your reference to the Charter, which you cite as stating, "normal care...includes, in fact, the use of nutrition and hydration...
...If she burns bright in Purgatory that is my fault...
...The 1995 Pontifical Council's Charter actually reads, "administration of food and liquids, even artificially, is part of the normal treatment always due to the patient when this is not burdensome for him" (emphases ours...
...Constitution...
...For more than two years, the military has held Hamdi and Padilla in South Carolina...
...Within a few weeks we will learn whether the shadow of Abu Ghraib extends as far as the United States Supreme Court...
...What immediate impact will this statement have on Catholic hospitals, for both Catholic and non-Catholic patients...
...The military has held these men for more than eighteen months without charging them, only recently permitting them limited contact with lawyers...
...base in Guantanamo Bay, Cuba...
...One also thinks of Pope John Paul II's 1992 discussion of "therapeutic tyranny," which cautioned against condemning a patient "to an artificially prolonged agony...
...Gregory P. Magarian ABOVE THE LAW President Bush & the Constitution he Abu Ghraib prison scandal casts a long shad-ow...
...Even now, if I turn my head, I hear the Lord saying again and again, Monsignor, come see the blood coins Christ minted in my hands, tell me: Are they counterfeit or not...
...Notwithstanding the authority of the messenger, the message deserves examination on its own terms...
...Somewhat ironically, the administration's assault on judicial authority mines a strong vein of judicial precedent...
...That is, it is "basic care," and hence "ordinary and proportionate," " and obligatory, when it maintains life by sustaining adequate nutrition and hydration...
...Most notoriously, in the 1944 case of Korematsu v. United States, the Supreme Court deferred to military discretion in refusing to interfere with the government's wholesale internment of Japanese Americans...
...In fact, what is misleading about PVS is that the opposite istrue: although they remain unconscious and unaware, PVS patients may appear to be interacting...
...Other sources will, of course, also need to be explored as you continue your work...
...Dear Student: We have read your proposal with great interest, as it ad-dresses a topic about which there is much public debate...
...You may find you want to nuance your argument to include only some forms of artificial administration as "basic care...
...Your proposal, as now written, might be taken to suggest that a person's diagnosis—which is distinct from his or her medical condition and prognosis—is the key in deciding whether to continue or to forgo nutrition/hydration...
...The Bush administration defends the indefinite detentions on the ground that these men, as foreign nationals captured and detained abroad, have no rights under the U.S...
...Since a person in PVS is not, it would seem, terminally ill, administering nutrition/hydration would be considered "ordinary and proportionate," and forgoing it would constitute "euthanasia by omission...
...It was there I held all my accounts—Mother said, You are never to touch them to buy something for yourself Suffering's the currency that counts...
...territory, the administration responds that the Cuban government, not the U.S., holds sovereignty in Guantanamo...
...As a child, I knew grief as a bank in the business of salvation...
...In brief, you propose to show there is a moral obligation to maintain nutrition and hydration, "even artificially ad-ministered," for the PVS patient, saying that doing so is "necessarily ordinary and proportionate...
...Recovery is clinA Commonweal I 0 June 18, 2004 I do not wish to deceive: Letter from Gemma Galgani to Msgr...
...Another challenge to this argument will stem from the tradition's usual understanding of ordinary and proportion-ate care as referring not to the ability of some intervention to achieve its purpose, but to its ability to offer what McFadden called "the sound hope of providing benefit" by doing so...
...Clinically speaking, patients in PVS today can be said to be in tez munal comas...
...From the prisoners' standpoint, however, both groups of cases arise from unjust denials of liberty, and closer scrutiny of the administration's arguments reveals the cases' essential similarity...
...Part of the difficulty in determining the weight and moral authority of the statement is that it comes from John Paul II himself, and it can be hard to separate the message from the messenger...
...and the Declaration's own affirmation that a person's "moral resources," his or her ability to cope with illness and its treatment, must be considered as part of the moral analysis...
...The argument relies heavily on Congress's 2001 authorization for President George W. Bush to use "all necessary force" to fight the terrorist threat...
...The state of war, the administration argues, activates "inherent powers" that the Constitution grants the president as commander-in-chief, including the authority to identify and detain citizens who threaten national security...
...Federal courts traditionally have shown great reluctance to interfere with presidential decisions to imprison people during wartime...
...You will want to use greater care in your final project...
...Our brief comments below will refer only to the 1980 Declaration on Euthanasia, the most authoritative statement by the church to date on the topic...
...When she died, I'd saved nothing, not even one sorrow, to buy-off the few sins mama forgot to confess...
...military control...
...borders...
...The government arrested Yaser Esam Hamdi and Jose Padilla on suspicion of planning terrorist actions on behalf of Al Qaeda and designated them–enemy combatants...
...That is, if there is legitimate clinical doubt that a person in PVS will recover, or if it is unreasonable to expect that the per-son will recover, it is ethical to make decisions with "moral certainty" that the person will probably not recover—what the tradition has called probabilism...
...The justices soon will announce decisions in two groups of cases that challenge the government's confinement of alleged "enemy combatants...
...Another highly regarded traditional source of that time, Charles McFadden, noted that it would be a great hardship to be sustained indefinitely by artificially administered nutrition/hydration...
...The prisoners challenge their detention as legally baseless, emphasizing that no neutral authority has reviewed the administration's unilateral decision to deprive them of liberty...
...The administration's plea boils down to three words: Trust the president...
...In short, you say it is required whenever it works to maintain life...
...More specifically, the person would seem to need to have a diagnosis of a terminal disease...
...The government declares that our nation's present "war on terrorism" em-powers the president to identify and detain "enemy combatants" without any procedural checks...
...But Jesus is merciful...
...You then go on to suggest the possibility that PVS patients may recover from their condition...
...The second group of cases, unlike the first, involves the rights of U.S...
...First, you summarize the clinical reality of PVS by stating that PVS is not a diagnosis, but "only a conventional prognostic judgment...
...Kelly maintained that the clinical certainty should be "reasonable," not absolute, in determining what constitutes "ordinary care...
...recent address by Pope John Paul II regarding the care of patients in a persistent vegetative state (PVS) has left many people—Catholics and others—scratching their heads...
...In fact, PVS refers to a medical condition, defined by specific clinical indications that make it possible to distinguish a person in PVS from someone who is temporarily unconscious or in another form of coma...
...But an emphasis on diagnosis in making these decisions will be difficult for you to argue, for the Declaration states that we must consider "the results that can be expected taking into account the state of the sick person...
...The first group of enemy-combatant cases presents claims by sixteen foreign nationals captured in Afghanistan and imprisoned at the U.S...
...In your final work, you will need to distinguish between "clinical certainty," which may not exist in a particular case, and what Aquinas de-scribed as "moral certainty," which up to now most writers on this topic have held does exist in most PVS cases...
...We would also call your attention to the language traditionally employed in such discussions...
...We believe that making this argument will be challenging...
...The Bush ad-ministration, understandably, does not purport to rely on Korematsu...
...The Declaration does not address this Commonweal I I June 18, 2004 issue, so your reference to it here may be misleading...
...if native "enemy combatants" can avail themselves of procedural protections, then courts will prevent the president from protecting the people...
...How might we read this text if it were, say, a thesis proposal submitted to an interdisciplinary committee for review at a Catholic university...
...To give these prisoners access to U.S...
...Catherine Sasanov from Reassembling the Bodily Relics of St...
...While we are pleased to accept your proposal, we would like to bring up some issues to which you will want to pay particular attention as you continue your work...
...Gemma Galgani ically very rare, particularly after three months for nontraumatic injury, such as drug use, and after one year for traumatic injury, such as a car accident...
...Your thesis is not that there is an obligation to provide normal care, which this reference would support, but that "normal care" includes artificially administered nutrition and hydration...
...Accordingly, the administration denies the federal courts' jurisdiction to even consider the claims...
...While these cases pre-sent complex and even arcane questions of law, they ultimately turn on a simple and very important question of democratic principle: To what extent should we trust the president to conduct military affairs without any legal check or oversight...
...Reports of American soldiers' atrocities against prisoners at Abu Ghraib, elsewhere in Iraq, and in Afghanistan have already eroded Americans' support for the Iraq war, emboldened opposition abroad to the "Bush Doctrine" of preemptive military action, and threatened the president's reelection campaign...
...You will need to frame your argument in light of these traditional understandings of the role of condition and prognosis...
...Other sources that have lent support to this approach are Pius XII's 1957 affirmation that life, health, and all temporal activities are subordinate to spiritual ends...
...You state the person "seems unable to interact with others...
...and some older traditional references that represent the long-held moral tradition on this subject...
...Here is one possibility...
...Your project will need to show how this new designation better serves a tradition that has not heretofore recognized the need for it...
...Although in theory recovery is possible, we know that someone with the medical condition of PVS has a very poor prognosis...
...Vincent Medical Center in Portland, Oregon...
...If the withdrawal of tube feeding or artificially administered hydration can be the equivalent of "euthanasia by omission," do we all need to rethink the decisions we have made in our advance directives and living wills...
...You affirm that this is "not a medical act," but a "natural means of preserving life...
...We now turn our attention to your central argument that nutrition/hydration is not a "medical act," but rather "normal care...
...You will want to be a little more precise here...
...The Guantanamo cases present the question whether and to what extent constitutional rights extend beyond U.S...
...You will also need to en-gage fully that part of the ethical tradition that speaks of moral certainty in the face of prognostic uncertainty...
...In one place you write, quoting the Declaration, that "there is an obligation to provide the 'normal care due to the sick in such cases.'" But citing "normal care" as obligatory is curious...
...Whatever the role of prognosis in decision making, you are clear that the lack of certainty for prognosis is important to your conclusion...
...This approach has traditionally been called tutiorism...
...the 1995 Pontifical Council's Charter of Health-Care Workers...
...Hamdi and Padilla, in contrast, present a question about the substantive limits, if any, to presidential power in wartime...
...It is true to some extent that science "is unable to predict with certainty who among patients in this condition will recover and who will not...
...In these cases, the administration warns that observing the ordinary niceties of criminal law in wartime would severely undermine efforts to protect the American people...
...The detainees' lawsuit asks the government to inform them of the charges against them and to allow them access to their families and to counsel...
Vol. 131 • June 2004 • No. 12
