A Legal, Moral, and Ethical Debate
by Sherry A. Snyder
Originally published in Volume 6, Issue 4 of The Immaculate Conception Catholic Church of Dardenne Messenger, winter 2003
The right to die case of Florida resident Terri Schiavo has captured the hearts and minds of people throughout the country. At issue is whether it was legally and morally appropriate to remove the feeding tube providing Mrs. Schiavo with hydration and nutrition. Her husband believed that she would not have wanted to continue to live in her present condition, while her parents and her siblings felt just as strongly that the tube should remain in place. After much legal and political wrangling, Ms. Schiavo’s fate may rest in the hands of the judicial system. This unfortunate situation brings up a number of issues that everyone should think about. What would you want if you were in Ms. Schiavo’s situation? Do you have the legal and ethical information to make these types of decisions? If you do have strong beliefs, have you communicated your beliefs to those close to you? Have you taken the next step and actually executed a Health Care Directive, Living Will, or Durable Power of Attorney for Health Care?
As you consider this matter, it is important to examine it in the framework of your own beliefs, the state of the law in Missouri, and the teachings of your Catholic faith. This article is not intended to provide specific legal advice, nor to provide a definitive statement of the views of the Catholic Church. You should consult with both an attorney and clergy member of your choice to discuss your particular situation and the legal and ethical considerations.
While it is impossible to speculate about every medical situation that you or a loved one might find themselves facing in the future, it is vitally important that you examine these issues and inform those close to you of your beliefs. For many, the thought of death is frightening and is a topic often avoided. However, open and honest communication among family members can foster a greater understanding and appreciation of each person’s point of view. It is only with a thorough understanding of these complex issues and the beliefs of everyone involved, that a family can come together and support one another hen these difficult situations arise.
The best time to discuss these issues with those you love is NOW. Often, this subject is not considered or discussed until after a serious illness or accident has occurred. At that time, it may seem insensitive or discouraging for the family of a seriously ill individual to broach this topic. Likewise, an individual near death often cannot physically communicate his or her beliefs or may assume that family members know his or her wishes.
The State of the Law in Missouri
As a resident of Missouri, you must also consider the relevant laws. All fifty states have adopted either a living ill statute or a durable power of attorney for health care statute. The state of Missouri has both. Missouri’s Living Will Act recognizes that a competent adult has a right to decide to die by withholding or withdrawing of “death prolonging procedures.” However, this law specifically excludes “any procedure to provide nutrition or hydration” from the definition of death prolonging procedures. Furthermore, this law does not give someone else the ability to make those decisions for you if you are incompetent to do so yourself.
Another Missouri statute specifically addresses this issue of surrogate decision making; these statutes are collectively referred to as the Missouri Durable Power of Attorney Act. This Act provides a vehicle whereby you may empower another person (an “attorney-in-fact”) to step into your shoes and make every health care decision that you could make if you were physically or mentally able to do so. The Durable Power of Attorney for Health Care can include very broad powers and if desired, can permit the attorney-in-face to withdraw artificially supplied nutrition or hydration which the patient may ingest through natural means, “with the intent of causing the death of the patient…” The law also requires the attorney-in-fact to “consider appropriate measures in accord with current standards of medical practice to provide comfort to the patient” and analyze various kinds of medical information, diagnosis and prognosis.
The Catholic Church’s Teachings
Of course, any deliberation of these issues should also be looked at in the context of the teachings of the Church and the beliefs we hold as followers of the Catholic faith. A 1993 Statement on Euthanasia by the Administrative Committee of the National Conference of Catholic Bishops eloquently defines the framework of these ethical decisions, “We know that life is the most basic gift from a loving God, a gift over which we have stewardship by not absolute dominion. Although our tradition declares a moral obligation to care for our own life and health and to see such care from others, it also recognizes that we are not morally obligated to use all available medical procedures in every set of circumstances.”
The Catechism of the Catholic Church also addresses these issues in its teachings on both euthanasia and suicide. Sections 2277 – 2279 of the Catechism are often quoted in theological discussions of these issues. Section 2277 states that “discontinuing medical procedures that are burdensome, dangerous, extraordinary, or disproportionate to the expected outcome can be legitimate; it is the refusal of ‘over-zealous’ treatment…” One crucial distinction lies in whether the means of treatment being used are classified as either “ordinary” or “extraordinary” and whether the treatment is “disproportionate” to the expected outcome. This distinction is also referenced in the Fourth Edition of Ethical and Religious Directives for Catholic Health Care Services issued by the United States Conference of Catholic Bishops in 2001. Directive 32 states “while every person is obligated to use ordinary means to preserve his or her health, no person should be obligated to submit to a health care procedure that the person has judged, with a free and informed conscience, not to provide a reasonable hope of benefit without imposing excessive rights and burdens on the patient or excessive expense to family or community.”
Because we have no way of predicting these situations in advance, how can we possibly make these decisions now? First and foremost, make sure that you thoroughly understand all of the issues involved and spell out your wishes as accurately and as thoroughly as possible. While you cannot plan for every medical situation, you can provide your physicians and your loved ones a reasonable road map to follow. This “map” can include a provision that your family or attorney-in-fact consult with a clergy member before making any health care decisions if you are incapacitated and cannot participate in those decisions yourself.
It is also important to put your wishes in writing in a legally enforceable document. Either a Living Will or a Durable Power of Attorney for Health Care confirms your discussions with health care providers and loved ones. Weeks, months or years may pass before these issues arise. Memories fade and physicians and family members might be unclear on what your wishes truly were. It is important that you seek competent legal advice to ensure that your documents contain the proper procedural requirements to be enforceable. While courts can look to other evidence of your intent, such as discussions you have had or statements you have made, it would be a very unfortunate situation for all involved to leave these decisions in the hands of the courts. Once you have formulated your beliefs and relayed them to your loved ones, it is crucial that you take the next step and memorialize your wishes in a legally enforceable document.
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