At 9:05 a.m. on March 31, 2005, Theresa Marie Schiavo – aged 41 years – died at The Hospice of the Florida Suncoast in Largo, Pinellas County, Florida. Terri, as the media called her, died of dehydration when food and water were denied her by court order. Her death marked the culmination of a sustained effort by her husband, Michael, to remove his wife’s feeding tube.

    In the course of protracted court battles, Terri’s feeding tube had been removed twice before by order of Pinellas-Pasco County Circuit Court Judge George Greer – from April 24 to 26, 2001, and from October 15 to 21, 2003. The long and determined efforts of her husband, Michael, to secure her death, and the opposing efforts of her parents to keep her alive, made headlines in the press throughout the world for weeks.

The controversy generated by this conflict reached from the highest echelons of government to the common man on the street. Many people had strong opinions on the rightness or wrongness of the way in which Terri died, and they expressed those opinions forcefully. New Order Catholics looked to their clergy for guidance and for leadership. Interestingly enough, the court did, also.

Fr. Murphy Testifies

    Michael Schiavo first petitioned the court to order the removal of his wife’s feeding tube (called a PEG, for percutaneous endoscopic gastrostomy) in May of 1998. When the trial of this petition finally began on January 24, 2000, Mr. Schiavo’s attorney, named George Felos, called upon a priest of the diocese of St. Petersburg, Florida, to testify as an expert witness concerning the modern Catholic Church’s teaching about end of life care and treatment issues in general, and about the application of those teachings to the case of Theresa Marie Schiavo in particular. The priest’s name was Fr. Gerard Murphy. Fr. Murphy stated under oath that he was at that time both diocesan chaplain and statewide chaplain for the Catholic Medical Association, formerly certified as a national chaplain, and he claimed extensive training and experience in pastoral care.

What is remarkable is that Fr. Murphy was one of the first persons that attorney George Felos, and the court itself, turned to for information and guidance. They wanted to know the Catholic Church’s assessment of Michael Schiavo’s petition to remove his wife’s PEG and thus end her life. Excerpts from the clergyman’s testimony in the official court transcripts are enlightening. Quoting below from the court transcript, “Q” introduces a question from Attorney George Felos, while “A” denotes the answer of Fr. Murphy:

Q What factors does the Catholic Church take into consideration in determining whether a treatment is an ordinary action as opposed to extraordinary or proportionate as opposed to disproportionate?

A It’s not the procedure. It’s the perception of the patient. Is the procedure, is it too emotionally draining? Is it too psychologically repugnant? Is it too expensive? Does it offer no hope of treatment – of recovery or little or no hope? Based upon all those factors, then you make your moral decision based upon those issues.

Q In some of the literature I’ve read, I come across the terms burdensome and useless. That is a Catholic is not required to have a medical treatment if it is burdensome or useless. How do those concepts fit in with the ones with what you just mentioned?

A Maybe if I gave an example it might be easier. You look like kind of a healthy guy. Say you caught pneumonia this flu season. You go to your doctor. He would prescribe a course of antibiotics for you. You would be better soon and back on the road. But as a case I actually handled in Bayfront, St. Petersburg, many years ago, a woman in her late seventies was filled with cancer in the bronchial tree. She was dying. She came down with that pneumonia and the daughter insisted that the mother be treated for that pneumonia. I said why are you doing this? What do you hope to accomplish?

Q Does the Church then permit the consideration of whether or not the patient has any hope of recovery in whether the treatment may help the patient recover in considering whether it is ordinary or extraordinary?

A Yes.

Q Let’s take a case that medical treatment, or artificial life support may be medically beneficial. If artificial life support may be medically beneficial, if the patient deemed it too psychologically or emotionally burdensome for himself or herself, could such a patient refuse artificial life support and still be in compliance with the Church’s teachings?

A Yes. ...

Q I want you to assume, Father Murphy, for the purposes of this question that Theresa Schiavo told her husband that if she were dependent on the care of others she would not want to live like that. And also Theresa Schiavo mentioned to her husband and to her brother and sister-in-law that she would not want to be kept alive artificially. Assuming that information to be correct, father [sic], would the removal of Theresa Schiavo’s feeding tube be consistent or inconsistent with the position of the Catholic Church?

A After all that has transpired, I believe, yes, it would be consistent with the teaching of the Catholic church [sic].

Q How would you define, Father Murphy, a practicing Catholic?

A Off, that’s a tough one.

Q Let me rephrase it. Does the church have any particular definition of what a practicing Catholic is?

A Certainly. We have what we call Easter duty, which means sometime from Lent to Trinity Sunday, in that three or four month window, a Catholic is required to receive holy communion. If necessary, confession. Catholics are mortally [sic] bound to assist at mass. Attend mass every Sunday. Every holy day of obligation. Certainly those are all criteria for a practicing Catholic.

[Note: According to Father Murphy’s own criteria, about 80% of modern church members are not practicing Catholics.] ...

Q Now Father Murphy, if a patient is in a permanent vegetative condition, maintained by artificial life support, and the patient’s intent is not known, can a loved one who has the best interest of the patient at heart authorize removal of artificial life support consistent with church teachings?

A I think in a case like this where so much time and effort has elapsed, I think, yes, it would be consistent. You have to remember, the church will always uphold the ideal. One of the things they will do is hit the brakes, as it were, to make sure nobody is rushing into judgment. Trying to push the patient out of the picture. In view of the length and effort here, I would say yes. What you would hope for is somebody who cared about the best interest of the patient to make the decision for them.

Q And such a decision by that – a decision to remove the feeding tube by such a person would be consistent with the church teachings?

A I believe so from my understanding of the church teachings.

Q Isn’t it true that feeding tubes are routinely removed from unconscious patients in hospitals and nursing homes?

A Definitely hospitals. I’m not certain about every nursing home. Definitely hospitals.

(Taken from proceedings of the Sixth Judicial Circuit State Florida in and for Pinellas County Probate Division, Case No. 90-2908-GD3 1)

Eighteen days after hearing Fr. Murphy’s testimony, on February 11, 2000, Judge Greer ruled that Theresa Schiavo would have chosen to have the PEG tube removed, and he ordered it removed. According to doctors, this would cause her death in approximately one to two weeks.

Bishop Lynch Makes a Statement

    Many people blamed Judge Greer for ordering the death of Theresa Marie Schiavo. One man has been charged with offering $50,000 to anyone who would kill the judge. Yet, considering the fact that this judge turned, even from the start, to a modern Catholic clergyman as an expert witness to instruct the court as to the application of the Catholic Church’s teaching with regard to the Theresa Schiavo case, it is small wonder that the judge ruled as he did. In fact, is it not more remarkable that he so often stayed his own order to remove the feeding tube to afford Theresa’s parents the opportunity to appeal his decision? Now, I do not mean to justify Judge Greer’s decision; I am convinced it was a grave miscarriage of justice. But I hold the modernist church and its clergy most responsible for the fate of Terri Schiavo.

The testimony of Fr. Murphy coincides with the conduct of Bishop Robert Lynch of the Diocese of Saint Petersburg. Pro-life groups had sought for years to induce Bishop Lynch to issue a statement in defense of Theresa Schiavo. When he finally did so, on August 12, 2003, they regretted that he had not remained silent. His message was not the clear call to preserve her life which they had expected. Rather, as is often the case with the modernist clergy, Bishop Lynch straddles the issue.

Here is the text of Bishop Robert Lynch’s statement which appeared in the diocesan newspaper:

STATEMENT OF BISHOP ROBERT N. LYNCH CONCERNING THE TERRI SCHIAVO CASE

    In this nation, many families face end-of-life issues each day involving loved ones and family members. Most of these decisions are made quietly with the assistance not only of medical doctors and health care professionals but often with the advice of members of the clergy and counselors. Few decisions reach the level of public notice as the case involving Terri Schiavo. Despite the prayers of many, myself included, her family has not been able to come together to make a single, unified, mutually agreed upon decision concerning Terri’s situation. Now the matter is approaching a legal climax with judges making decisions properly reserved for families. How sad.

    Some in Terri’s family believe that her condition calls for the removal of her feeding tube and others do not. Even physicians, who have evaluated Terri’s condition, with varying degrees of access for clinical analysis, disagree on her condition. In Florida, when families cannot agree, trial judges are permitted to act as proxies and make decisions about life-prolonging procedures. In so doing, we ask our judges to make decisions that they might not make for themselves or their loved ones, but ones that clear and convincing evidence shows the individual would make for herself or himself.

    Proper care of our lives requires that we seek necessary medical care from others but we are not required to use every possible remedy in every circumstance. We are obliged to preserve our own lives, and help others preserve theirs, by use of means that have a reasonable hope of sustaining life without imposing unreasonable burdens on those we seek to help, that is, on the patient and his or her family and community. In general, we are only required to use ordinary means that do not involve an excessive burden, for others or for our ourselves. What may be too difficult for some may not be for others.

    Our Catholic Church has traditionally viewed medical treatment as excessively burdensome if it is “too painful, too damaging to the patient’s bodily self and functioning, too psychologically repugnant to the patient, too suppressive of the patient’s mental life, or too expensive.” [cf. “Life, Death and Treatment of Dying Patients: Pastoral Statement of the Catholic Bishops of Florida, 1989]

    In these most difficult cases, our Church teaching is that there should be a presumption in favor of providing medically assisted nutrition and hydration to all patients as long as it is of sufficient benefit to outweigh the burdens involved to the patient.

    If Terri’s feeding tube is removed, it will undoubtedly be followed by her death. If it were to be removed because the nutrition which she receives from it is of no use to her, or because it is unreasonably burdensome for her and her family or her caregivers, it could be seen as permissible. But if it were to be removed simply because she is not dying quickly enough and some believe she would be better off because of her low quality of life, this would be wrong.

This situation is tragic. I strongly recommend that

1. in the presence of so much uncertainty and dispute about her actual physical state, all parties pursue a clearer understanding of her actual physical condition;

2. Terri’s family be allowed to attempt a medical protocol which they feel would improve her condition;

3. Excessive rhetoric like the use of “murder” or the designation of the trial judge or appellate judges as “murderers” not be used by anyone from our Judeo-Christian tradition. This is a much harder case than those who use facile language might know.

Please join me in praying for a peaceful, moral, legal and just resolution of this case.

    At some point in time, we will all face “end of life.” Each person has an uncertain future and we live in a world of constant technological changes and developments. When a person is not competent to make his or her own decisions, it is very appropriate for a family member or guardian to be designated as a proxy to represent the patient’s interests and interpret his or her wishes. Decisions made by those legally entitled to act for the patient must always be respected. For this reason, I wish to use this moment to remind all our Catholic people that it is extremely important for all to have designated a medical proxy to someone who is trusted and to leave a “living will” in which you indicate your wishes. It is also important to note that such proxies and medical directions can never “trump” or override appropriate moral considerations. In this regard, Catholic teaching notes that the proxy may not deliberately cause a patient’s death or refuse ordinary and normal treatment, even if he or she believes a patient would have made such a decision. I encourage everyone to

1. Become informed about the complexities surrounding end of life issues, discuss them with your families and doctors, and formulate your own wishes that could direct treatment;

2. Designate a medical surrogate to act on your behalf in the eventuality that your own competence is impeded at some time in the future.

3. Have in place and on file, with your family, medical surrogate, attorney, or perhaps even your pastor, a “living will.”

My prayer is that these words will help others in the future avoid the situation that surrounds the case of Terri Schiavo.

    When the feeding tube was removed from Terri for the third and final time, on March 18, 2005, Bishop Lynch was absent from his diocese. He was in Asia surveying the damage of the tidal wave. Before he left, he issued strict orders that none of his diocesan clergy was to go to the hospice where Theresa lay dying of dehydration. When Bishop Lynch returned after Terri died, he transferred out of his parish the priest who had conducted her funeral service.

Pastor Rice Urges the Judge to Leave

That George Felos, Michael Schiavo’s lawyer, called on a priest to offer expert testimony in favor of withdrawing Theresa Schiavo’s feeding tube is the third most ironic aspect of the case. The second most ironic development in this case, however, is this: Judge Greer is/was a Baptist who elected to follow the counsel of the new order catholic clergy. Because of his decision in this case, he was urged to leave Calvary Baptist Church in Clearwater, Florida, by the church’s leader, Pastor William Rice, who found Judge Greer’s decision reprehensible. Here are some of Pastor Rice’s comments to the judge:

    "Like evangelicals across the world, we are horrified at the thought that a handicapped woman could be, in effect, starved to death before a watching world,"

    "I know right from wrong. I know what God thinks about human life. I know there is only one way to describe the prospect of starving a woman to death because she cannot feed herself. It is wrong."

    "Morality and truth must serve as our guide. Terri Schiavo is not on life support. She is not dying. Good evidence exists to suggest that she is responsive. All she receives is food and water, the same as you and me. Are we to conclude that she is less than human because she cannot feed herself? Can a month-old child feed himself? Is an elderly patient stricken with some debilitating disease and unable to feed herself suddenly less human? Do we now use an IQ test to determine if someone possesses the right to live? Isn't that God's choice? Only God can give life, and only He should take it away."

    "Tread carefully if you think this is simply about a dying woman being allowed to die peacefully. Remember when we were told that Roe v. Wade was simply about helping women who had been raped or whose lives were imminently threatened? Today, few abortions fall into that category, but millions of human lives have been sacrificed upon the altar of selfishness. And the slide down the slippery slope continues."

    "This case seems complex, but it is as simple as four words: 'Thou shalt not kill.' If you need a compass for this complex case, you'll find it there."

    There is one development even more ironic than Judge Greer’s “excommunication” by his Baptist pastor. Remarkably, some traditional priests have recently announced their approval of the court decision to kill Terri Schiavo by dehydration and starvation. They said that it was morally permissible for the court, at Terri’s husband’s instance, to deny her water and food unto death, because the PEG tube through which she had been nourished since her brain injury 15 years before was an extraordinary means of preserving her life. Thus, they said, the Terri Schiavo case was not a question of euthanasia, nor was it a prolife concern, but simply a matter of applying traditional Catholic moral principles. According to them, those Catholic moral principles judged her feeding tube to be an extraordinary means of preserving her life and so it was perfectly right to terminate her life by denying her such access to food and water.

False Traditional Clergymen Approve Terri’s Death

    This pronouncement sparked an explosion of protests from the pro-lifers. The more conservative new order catholics have seized the opportunity to heap ridicule upon traditional Catholics, citing these few clerics and their approval of Terri’s death as examples of the consequences of “rebellion against the hierarchy” and “sedevacantism”. Before throwing stones, however, they should be mindful of their own glass house; their own American bishops did precious little to save Terri Schiavo’s life. Bishop Lynch had much company.

Traditional Catholics were thunderstruck. They were utterly astonished that anyone professing to be a traditional Catholic priest could hold such a view. It is true that a few loyalists had fallen into the habit over the years of accepting uncritically whatever these clergymen said, and they simply acquiesced to their judgment of Terri Schiavo’s death seemingly without a ripple of conscience or concern. But most traditional Catholics were shocked by these priests’ stamp of approval on what they considered to be Theresa Schiavo’s execution.

What are we to make of this? In order to answer that question, it is necessary to read the principal statements with responses. I offer these statements reluctantly, partly because the quality of the initial statement is so cavalier, and the tenor of the responses so spiteful as to be embarrassing, and partly because by replying to them I seem to invite a still more shrill and vitriolic reaction. Nonetheless, the issue is of great importance and demands a response. Fortunately, others have already responded very capably, and to their words I will not have much to add but for a few comments toward the end.

The remainder of this editorial will present the following texts:

[1] Rev. Cekada’s original statement, without his footnote references.

[2] Rev. Cekada’s “clarification” without his footnote references.

[3] Dr. James Gebel’s report in response to Rev Cekada’s statements.

[4] Rev. Cekada’s response to Dr. Gebel.

[5] my assessment of this exchange ...

- Jim Urling’s note

- Rev. Cekada’s concession

- Rev. Cekada’s deception by switching question ...

- Rev. Cekada’s deception by misrepresenting Fr. McFadden (1956 or 1958?)

- the N.O. blog’s stone throwing ... vs. sedevacantists

[6] Text of Fr. McFadden and Fr. Kelly on extraordinary/ordinary means to preserve life of dying persons

[7] application to Theresa M. Schiavo

[8] living wills v. durable power of attorney for medical care

[1] Rev. Cekada’s Original Statement: April of 2005

The Terri Schiavo Case and Extraordinary Means

by Father Anthony Cekada

I HAVE BEEN repeatedly asked for my thoughts on the Terri Schiavo case. Here, for the record, is a brief summary of my opinion.

Many traditional and "conservative" Catholics were misled by unprincipled politicians and pseudo-conservative talk-show hosts into thinking of it as a pro-life or anti-euthanasia case.

It was no such thing – and this demonstrates how wary one should be of turning for moral guidance to the advertiser-shilling blowhards of Fox News and the EIB Network.

Instead as Catholics we must turn to the teaching of theologians and the magisterium.

Here, the key issue is preserving a life by "extraordinary means,” a concept first developed by the 16th-century Dominican theologian Vittoria as follows:

"If a sick man can take food or nourishment with a certain hope of life, he is required to take food as he would be required to give it to one who is sick. However, if the depression of spirits is so severe and there is present grave consternation in the appetitive power so that only with the greatest effort and as though through torture can the sick man take food, this is to be reckoned as an impossibility and therefore, he is excused, at least from mortal sin."

"It is one thing not to protect life and it is another not to destroy it. One is not held to protect his life as much as he can. Thus one is not held to use foods which are the best or most expensive even though those foods are the most healthful. Just as one is not held to live in the most healthful place, neither must one use the most healthful foods. If one uses food which men commonly use and in quantity which customarily suffices for the preservation of strength, even though one's life is shortened considerably, one would not sin. One is not held to employ all means to conserve life, but it is sufficient to employ the means which are intended for this purpose and which are congruous."

Other theologians subsequently refined and developed this teaching, until in 1957, we find Pope Pius XII explaining its application as follows:

"Normally [when prolonging life] one is held to use only ordinary means according to the circumstances of persons, places, times and cultures -- that is to say, means that do not involve any grave burdens for oneself or another. A more strict obligation would be too burdensome for most people and would render the attainment of a higher, more important good too difficult. Life, health, all temporal activities are in fact subordinated to spiritual ends. On the other hand, one is not forbidden to take more than the strictly necessary steps to preserve life and health, as long as he does not fail in some more serious duty."

These and similar passages in other authors led me to conclude that in the case of Terri Schiavo, the feeding tube, etc. constituted extraordinary means.

(Consider the “grave burdens” that such means would increasingly impose on society, now that medical science can keep the dying and unconscious going for years.)

This was also the conclusion of Bishop Donald Sanborn, who teaches moral theology – the branch of theology that deals with ascertaining whether specific human acts are morally good or morally evil.

Accordingly, as regards applying the principles of Catholic moral theology: (1) One could have continued to employ these extraordinary means to maintain Terri Schiavo’s life; however (2) one would not have been obliged to do so.

It is false therefore to claim that Terri Schiavo was the victim of “euthanasia” or “murder.” Further, in my opinion, Mrs. Schiavo’s husband (as horrible a person as he seems to be) - and not her parents - had the sole right before God to determine whether these means should have continued to be used.

My comments here, like those on the Iraq War, may cause consternation for some good lay people. But when it comes to contemporary issues, my duty as a priest is to research the Church’s teaching, tell you what it is, and tell you how to apply it.

May Terri Schiavo rest in peace.

In April of 2005, Rev. Cekada’s article was printed in The Remnant as a letter. The appearance of the letter evidently provoked a hefty negative reaction. Soon thereafter Rev. Cekada sent to The Remnant a follow-up article. Here is the text of that article:

Rev. Cekada's Follow-Up Letter to in The Remnant: May of 2005

To the Editor,

My letter on the Terri Schiavo case that appeared in your previous issue was widely circulated and prompted many comments from traditionalists - nearly all negative and emotional.

Most objections were rooted in misconceptions about extraordinary means, or in a disgust with the actions of Terri Schiavo's husband.

I would appreciate the opportunity to expand upon both these points, and then add a more general observation.

1. EXTRAORDINARY MEANS. The resolution of the moral issue in the case hinges upon the definition of the term "extraordinary" - not as the term is defined by medical science, but rather as it is defined by moral theologians.

Pius XII's statement defines extraordinary means as those which "involve any grave burdens for oneself or another."

The emphasis, then, is not on the specific procedure that is performed, but rather upon the burden that results from performing it.

Moral theologians categorize as extraordinary those treatments that are physically painful, invasive, repulsive, emotionally disturbing, dangerous, rarely successful, expensive, etc.

Nowadays the latter burden - extraordinary expense - is mostly hidden, because "someone else pays for it" - i.e., you and I and everyone else foot the bills through health insurance premiums, doctor malpractice premiums and high taxes.

This is now a grave burden on society. If someone wants to make every effort to sustain life for as long as possible in a body that is obviously shutting down for good, he is free to pay for extraordinary means himself - but it is wrong for him to impose this burden on everyone else.

Had Terri Schiavo not received a $750,000 malpractice settlement - i.e., some trial lawyers shook down an insurance company, which in turn calculated that it would be cheaper to pay them and the Schiavos off, rather than gamble with the Oprah-watching idiots in the average jury pool - you can bet that her husband and parents would not have sold off their own houses to sustain her for all this time.

Instead, you and I - not merely the Schiavos or the Schindlers - got stuck with the "grave burden" of paying for it.

If something is immoral in the whole affair, it is surely this.

2. WHO DECIDES? Mrs. Schiavo's husband (as horrible a person as he seems to be) - and not her parents - had the right before God to determine whether these means should have continued to be used.

A husband does not somehow automatically lose his headship of the household or his God-given "domestic and paternal authority" if he becomes a moral reprobate.

An ecclesiastical or civil court may for a grave reason, of course, prevent him from exercising his authority.

In the Schiavo case, however, the civil courts examined the matter and repeatedly reaffirmed Mr. Schiavo's rights.

The alternative to this is what? Allow in-laws automatic headship over the wife when they believe the husband is a "moral reprobate"? Have those paragons of family values - congressmen - legislate the rules? Assign headship of the wife to the relative deemed most worthy by the majority of members of an Internet chat room?

Even a wicked husband retains certain rights before God.

3. EMOTION OR PRINCIPLE? The negative response to both these points was almost without exception based on emotion.

This I find very disturbing - because the first reaction a Catholic - lay or clerical - should have when confronted with a complex moral or theological problem is to find the principle that applies - what, in other words, is the standard the Church (not my emotions, directed by Michael Savage) uses to separate virtue from sin, or truth from error, on any particular issue.

In most cases, the right principle and the correct definition of its terms can be found in a theology book somewhere, even though it may take some time and priest with good Latin to find it.

The tendency of so many traditionalists to resolve moral or theological questions - be it the Schiavo case, the Indult, excommunications, schism, heresy, the Fatima consecration, the sede vacante dispute, etc. - by following emotional reactions, rather than by seeking out an objective principle that the Church has laid down, makes them ripe for deception by the ignorant and manipulation by the cynical.

The reactions of so many in the Schiavo case make me fear that when it comes to deceiving the elect, the Antichrist won’t have to work too hard.

___

Dr. James Gebel, Jr., a neurologist conversant with the medical and legal aspects of braindamage cases, responded to Rev. Cekada’s statements by conducting an investigation and issuing a report concerning the Terri Schiavo case. In light of the controversy generated by the pronouncements of Rev. Cekada, I sought and obtained the permission of Dr. Gebel to publicize his report. I then sent the following message to the moderator of a traditional Catholic internet radio station, Wes Steele at WFTSRADIO.COM, asking him to post the report by Dr. Gebel at the WFTSRADIO website. From there the report was picked up and disseminated by other sites. Here is the message I sent to Mr. Steele, followed by the text of Dr. Gebel’s report:

A noted neurologist, Dr. James Gebel, has concluded a study of the medical evidence pertinent to the case of Theresa Marie Schiavo – or Terri Schiavo, as the world has come to know of her. Terri was the 41-year-old Florida woman who had suffered a brain injury in 1990 and who just recently was put to death by a court order obtained by her adulterer husband. Dr. Gebel has graciously granted permission allowing his analysis to be posted on the WFTSRADIO website. May God bless Dr. Gebel for providing this information.

And I thank you, Wes, for making this study available to your listeners.

In the Sacred and Immaculate Hearts,

Fr. Wm. Jenkins

Dr. James Gebel, Jr. Issues a Report

In Response to Fr. Cekada

THE TERRI SCHIAVO CASE: A CATHOLIC NEUROLOGIST’S PERSPECTIVE

Over the past several weeks, it has come to my attention that significant debate has developed regarding the Terri Schiavo case. I have read various e-mail messages between Cathy Beal, Father Cekada, Father Dardis, Bishop Sanborn, and two letters appearing in the St. Gertrude the Great Church bulletin.

Let me begin by stating that I do not feel I have either the theological expertise (mine is limited to a minor in theology at Xavier University, a Jesuit college in Cincinnati) or moral authority to adequately address the theological aspects of this case. However, I do feel that my background as a neurologist with additional specialized “fellowship” training in both neurological critical care (the subspecialty of neurology which deals with patients in comas and other critical neurological illnesses) and stroke, at the Cleveland Clinic and University of Cincinnati respectively, put me in a position to contribute some thoughts on the medical aspects of her case. Since completing medical school, I have over 15 years of experience training, practicing, and doing research in these areas. I have also had the opportunity as the result of my training and expertise in these areas to testify as an expert witness in such matters in medical malpractice and pharmacological product liability lawsuits. I state the above not to be prideful, but to give you some tangible appreciation of the fact that, simply speaking, there are few people in the country with any better training background or practical expertise to understand in detail the scientific and medical aspects of the care of patients like Terri Schiavo, whom I deal with on literally an almost daily basis.

I have reviewed the CT scan images of Terri Schiavo’s brain, watched the video of her taken by her family members, and also reviewed some summary comments/ excerpts regarding testimony given in deposition transcripts in her medical malpractice case. These again are all things I do on a very frequent basis. They are, to be frank, part of how I make my living. Having clarified the context in which I share my thoughts with you, I offer the following thoughts on this matter:

1) Terri Schiavo was NOT in a persistent vegetative state. The video taken of her clearly and unequivocally demonstrates that, at least at times, she is in a minimally conscious state and capable of interacting in a rudimentary way with her family and environment, which by definition excludes her from being medically classified as comatose or in a persistent vegetative state.

2) The parts of Terri Schiavo’s brain which would allow her to perceive pain, her thalami, were clearly intact and visible on her CT scan images shown by her husband, Michael Schiavo, on national television (which I rarely watch, and by the way, I have never voluntarily watched “Oprah”)

3) The parts of Terri Schiavo’s brain which would allow her to perform complex cognitive function, or which would enable her to speak or understand speech, were clearly damaged.

4) The parts of Terri Schiavo’s brain which would allow her to swallow on her own were intact and, in fact, she did not suffer from medically significant dysphagia (swallowing difficulty). If she had, she would have been dead long ago from a condition known as aspiration pneumonia, an infection in the lungs which is the result of inhaling one’s own saliva.

5) The parts of Terri Schiavo’s brain which would allow her to move her arms and hands to feed or hydrate herself were clearly damaged.

6) The parts of Terri Schiavo’s brain which would allow her to experience discomfort and/or pain due to hunger were undamaged.

7) Other tests were available to better clarify the full extent of Terri Schiavo’s awareness or lack thereof, such as MRI scanning of her brain ( a more detailed picture of the brain than a CT (CAT) scan, EEG (a brainwave test), and evoked potential studies, which could decipher the extent to which she could hear or see. These studies were refused by her husband, Michael Schiavo.

8) Terri Schiavo did not receive or require intravenous hydration or nutrition (so-called “TPN”) or total parenteral nutrition.

9) Oral or stomach tube feeding via an “NG” (nasogastric tube) (a tube put down one’s throat to the stomach) or (more commonly) via a “G-tube” are routinely used to feed stroke victims, both temporarily and indefinitely in patients with stroke or other brain injuries who cannot feed themselves, whether due to swallowing problems (which occur at least temporarily in most stroke victims). Such feeding and hydration are by modern medical standards considered as ordinary and unburdensome as eating and drinking on one’s own. Such feedings are, in fact, less expensive than what an average American spends on food and water, and are easily administered a few times a day by a family member, requiring much less effort than cooking three meals a day. Terri Schiavo’s husband, parents, or siblings could easily administer such feedings. They are by no logical measure extraordinary or unduly burdensome by any reasonable standard (moral, medical, or economic).

10) Terri Schiavo could have been cared for at home with some home health care assistance at modest to at most moderate expense which would not by any common sense standard be deemed economically burdensome.

11) Terri Schiavo’s stomach and intestines were fully functional and capable of digesting food, even normal food if it was placed in her G-tube.

12) Terri Schiavo could have received sequential neurostimulation therapy to her throat muscles, which may have further improved her swallowing function to the point that she may have been able to chew or swallow at least some types of normal food and/or liquid if placed in her mouth. This and other similar available measures were denied to her by her husband.

13) Terri Schiavo’s brain, while severely damaged, had not “failed”. When someone’s brain “fails,” i.e. is irreparably and totally damaged, they are, by definition, dead. While we can keep people alive when other vital organs such as the liver, kidneys, lungs, and even heart fail (via dialysis, organ transplantation, etc.), not even 2005 era medicine can keep one alive if one’s brain has failed, because all other organs shut down within 5 days when this occurs, even when every maximal effort possible is made.

14) Terri Schiavo did not require, nor to the best of my knowledge did she ever receive intravenous nutrition (TPN), as was suggested in one of Father Cekada’s e-mail messages. Lifelong TPN, in contrast to tube feeds, is widely considered to be an extraordinary, burdensome, and expensive means of prolonging life, and are comparable to a respirator in that regard.

15) Terri Schiavo’s doctors did, in my opinion, probably commit malpractice by failing to order routine pre- procedure labs which would have disclosed severe electrolyte disturbances secondary to her bulimia.

16) Medical malpractice care awards/settlements are often grossly overinflated due to plaintiff’s attorneys hiring so-called “life care planners” who add up every conceivable convenience and treatment imaginable as “necessary” for the rest of the patient’s life. Their overestimates are typically further compounded by overestimating the patient’s life expectancy. Furthermore, all the money is paid in advance at today’s dollars, meaning the real money value of the award is much higher than the actual cost of such care in the vast majority of such cases. Terri Schiavo’s true care needs would certainly be far less than 750,000 or 1,000,000 dollars.

17) Attorneys representing patients and defendants in medical malpractice and other medicolegal matters often “shop around” for expert witnesses until they find experts who will give an opinion which suits their client’s needs. Thus, it is no surprise that George Felos, a well-connected euthanasia advocate, was able to find three physicians to testify that Mrs. Schiavo was in a persistent vegetative state. In fairness, likewise it is no surprise that Terri Schiavo’s parents and siblings’ attorneys found expert witnesses who testified that she was not. One should certainly be suspect of the testimony of an expert witness who has spoken to the Hemlock Society and concludes that Terri Schiavo is in a persistent vegetative state.

18) Terri Schiavo died of dehydration, not starvation. Dehydration kills one much faster than starvation, barring the exception of extreme malnourishment, which was not the case here.

19) Terri Schiavo had an average life expectancy despite her brain injury, and would not have died were it not for her being deprived of nutrition and hydration. The proximate legal and medical cause of her death in my opinion was dehydration.

20) Laws regarding who has legal authority over health care decisions vary greatly by state. In Pennsylvania, for instance, children and siblings have as much right to make medical decisions as spouses, unless a pre-specified durable power of attorney designating one of them pre- exists the illness, or unless a living will was written by the patient. Other states require a durable power of attorney to be obtained no matter what. Ex- spouses, unless they are made durable power of attorney, have no legal right to make medical care decisions in any state.

21) Discontinuation of tube feeds or any form of food in general causes intense hunger pains for 2-3 days, which Terri Schiavo would have had the capacity to feel and suffer.

22) Death by dehydration occurs slowly, eventually causing hyperosmolarity often resulting in shriveling, cracking, and bleeding of the mucous membranes. This causes pain, nosebleeds, and as consciousness begins to wane, patients often begin aspirating blood from the nosebleeds, thickened, mucus or saliva, or both, causing aspiration pneumonitis. The aspiration along with accumulation of unsecreted organic acids results in progressive shortness of breath which further compounds the mucus membrane injury. Observing this struggling to breath and choking is often very disconcerting to family members as well as potentially painful and discomforting to the patient. This is why such patients are often administered morphine, which both relieves pain and suppresses this so- called “air hunger.” This is also I suspect why the judge in the Terri Schiavo case barred pictures or video of her being taken while she dehydrated and starved. Much as those who are proabortion most detest the one thing which actually shows people what happens in the case of abortion (pictures of aborted babies), euthanasia advocates do not want people to see the visible suffering which often occurs in cases like Terri Schiavo’s.

23) Cases like Terri Schiavo’s are, thankfully, rare. This is why when they occur and ultimately result in legal battles, we hear about them on the media. Collectively, even if one were to assume each and every one of them were to result in a lifetime of tube feedings, would be far less of an economic burden on society than a new football stadium.

Cases like Terri Schiavo’s understandably evoke a wide range of emotional responses and theological arguments. Unfortunately, the Catholic Church, theologians, and bioethicists in general lag far behind in their scientific understanding of the rapid and increasingly complex advances in medical care, which often occur literally even prior to our ever having the opportunity to contemplate their moral and theological implications. It is in the spirit of attempting to help simplify and clarify some of the medical aspects of the Schiavo case that I share the above thoughts with those who are inclined to read them. Finally, I would advise each and every person to prepare a living will as you would a normal will so that your families might be spared the pain and anguish of having to decide what care measures you would want should a grave or terminal illness occur. Had Terri Schiavo done so, her family and many others would have been spared from the bitter, divisive, and expensive series of legal battles which followed, which were the real extraordinary burden to society in her case.

Respectfully,

James M. Gebel, Jr., M.D., M.S., F.A.H.A.

Fr. Cekada Makes Retort to Dr. Gebel

About a week after Dr. Gebel’s report was first posted, Rev. Cekada issued a response. That reply appeared (without the text of Dr. Gebel’s report) in the St. Gertrude Church Sunday bulletin. Here is that response:

Dear Dr. Gebel,

Someone forwarded to me your comments about my articles on the Schiavo case..

A number of other people involved in health care have written to me about the medical aspects of the case.

I not qualified to decide whether your medical opinion or other conflicting medical opinions about PVS, therapy, etc. are more in accord with the principles of medical science.

But common sense tells me that the method you used to arrive at your opinion -- reviewing CT images, watching a video and reviewing summary/excerpts regarding testimony given in deposition transcripts -- is no substitute for examining a live patient.

Unlike other doctors directly involved in the case, moreover, you have not been cross-examined on either your methods or your conclusions. Be that as it may, I am qualified to speak about the moral issues in the case, and indeed, I am also obliged to do so.

If what you seem to be claiming is true and Terri Schiavo was somehow able to eat and drink by natural means, there is no dispute that those who cared for her would have been obliged to provide her with food and drink. To have withheld these would have been a mortal sin (unjust direct homicide) against the Fifth Commandment.

However, my writings on the Schiavo case centered on something else: the principles that Catholic moral theology would apply to removing a feeding tube.

I do not want my parishioners to be left with the impression -- due to the high emotions and bitter controversy fanned by the morally bankrupt media and by various lay and clerical grandstanders -- that something is a mortal sin when it is not.

Who knows when any one of my flock may be called upon to deal with the issue of a feeding tube for himself or a family member?

Here, put very bluntly, are the two essential questions in moral theology that I have sought to resolve:

(1) Does the Fifth Commandment under pain of mortal sin always require a sick person who is unable to eat or drink by natural means to have a doctor shove a tube into his nose or poke a hole into his stomach in order to provide food and water?

(2) Does the Fifth Commandment under pain of mortal sin then always forbid such a person to have these tubes removed, no matter what grave burdens -- pain, revulsion, depression, expense, etc. -- their continued use may impose on him or another?

The answer to both questions is no.

Having a hole poked in you, a tube shoved in and then having to eat and drink that way would be burdensome for any normal man.

Like the IV drip mentioned by the moral theologian McFadden (whom I quoted elsewhere), one could maintain this procedure would be morally compulsory “as a temporary means of carrying a person through a critical period.”

“Surely,” however, “any effort to sustain life permanently in this fashion would constitute a grave hardship.” (Medical Ethics, 1958, p.269.)

(Perhaps some priest, layman or doctor who rejects this conclusion could get his own feeding tube inserted, live that way for fifteen years, and let us all know in 2020 whether the experience was a grave hardship or not. Any takers?)

Insisting (as some have done in the Schiavo case) that one is bound to this under pain of mortal sin (otherwise, euthanasia! murder!) contradicts Pius XII’s teaching that one is bound only to use “ordinary means,” which he defined as those “that do not involve any grave burdens for oneself or another.”

Imposing “a more strict obligation,” the pontiff warned, “would be too burdensome for most people and would render the attainment of a higher, more important good too difficult.”

So, even though as a doctor you may well consider poking holes into people and inserting permanent feeding tubes “by no logical measure extraordinary or unduly burdensome by any reasonable standard, moral, medical or economic,” Catholics must nevertheless draw their understanding of extraordinary means from the Church’s moral teachings -- rather than from the practices and pronouncements of the medical-industrial complex.

In sum, by the standards of Catholic moral theology, the permanent use of a feeding tube constitutes extraordinary means and is therefore not obligatory. Like all such means, one is free to use it, “as long as one does not fail in some more serious duty.” (Pius XII)

But one cannot maintain that a Catholic is always bound to use a feeding tube under pain of mortal sin – still less, that the refusal to do so constitutes “murder.”

Don’t try to invent a mortal sin where there is none.

In Christ,

The Rev. Anthony Cekada

My Assessment of Fr. Cekada’s Argument

In his three statements given above (there are others, as well, since the controversy continues unabated), Rev. Cekada has given us ample evidence of his viewpoint on the matter of ordinary and extraordinary means of preserving life and how these apply to the case of Theresa Schiavo. His understanding of the case requires some serious evaluation. Below I excerpt some of Fr. Cekada’s statements (in italics), and offer some commentary.

Many traditional and "conservative" Catholics were misled by unprincipled politicians and pseudo-conservative talk-show hosts into thinking of it as a pro-life or anti-euthanasia case.

It was no such thing – and this demonstrates how wary one should be of turning for moral guidance to the advertiser-shilling blowhards of Fox News and the EIB Network.

...

It is false therefore to claim that Terri Schiavo was the victim of “euthanasia” or “murder.”

This is an astonishing statement. Rev. Cekada has missed the central point of this entire affair. In fact, the legal and moral struggle by some to secure Theresa Schiavo’s death and by others to rescue her was “a pro-life or euthanasia case” from beginning to end. It was not mere coincidence which moved Michael Schiavo to choose as his point-men Dr. Ronald Cranford, a featured speaker for the euthanasia-promoting Hemlock Society, and Attorney George Felos, whose book Litigation as Spiritual Practice was a milestone in promoting the pro-euthanasia program for America.

Furthermore, consider the fact that after Theresa Schiavo’s feeding tube was removed, even young children were arrested for attempting to provide ice chips for her dried lips and tongue. In other words, she was not only denied food and water by tube – she was denied food and water orally, as well. She was, in fact, denied access to food and water in any manner whatsoever. The issue was not that Theresa Schiavo was receiving food and water by the “extraordinary means” of a tube – the issue was that Theresa Schiavo was receiving food and water at all! The court ordered the removal of the tube, but law enforcement cut her off from any and all access to food and water. The intent was to kill her.

Why can’t Rev. Cekada understand that the presence of a feeding tube was purely accidental – that the essential purpose of the court’s decision and law enforcement’s blockade of the hospice was to ensure Theresa Schiavo’s death by dehydration?

Read the testimony of Fr. Frank Pavone, President of Priests for Life and an eye-witness to Theresa Schiavo’s last 14 hours of life:

“Now, the night before she died I was in the room for probably a total of 3-4 hours, and then for another hour the next morning -- her final hour. Brothers and sisters to describe the way she looked as peaceful is a total distortion of what I saw. Here now was a person, who for thirteen days had no food or water. She was, as you would expect, very drawn in her appearance as opposed to when I had seen her before. Her eyes were open but they were going from one side to the next, constantly oscillating back and forth, back and forth. The look on her face (I was staring at her for three and a half-hours) I can only describe as a combination of fear and sadness … a combination of dreaded fear and sadness.

Her mouth was open the whole time. It looked like it was frozen open. She was panting rapidly. It wasn't peaceful in any sense of the word. She was panting as if she had just run a hundred miles. But a shallow panting. Her brother Bobby was sitting opposite me. He was on one side of the bed I was on the other facing him. Terri's head in between us and her sister Suzanne was on my left. We sat there and we had a very intense time of prayer. And we were talking to Terri, urging her to entrust herself completely to the Savior. I assured her repeatedly of the love and prayers and concern of so many people. We held her hand and stroked her head. During those hours, one of the things I did was to chant, in Latin, some of the most ancient hymns of the Church. One of the chants I used was the "Victimae Paschali Laudis," which is the ancient proclamation of the resurrection of Christ. There, as I saw before my eyes the deadly work of the Culture of Death, I proclaimed the victory of life. "Life and death were locked in a wondrous struggle," the hymn declares. "Life's Captain died, but now lives and reigns forevermore!"

And then we had just times of silence … just sitting there in silence trying to absorb what was happening.

But besides Bobby and his sister and Terri herself, you know who else was in the room with us? A police officer. The whole time. At least one. Sometimes two. Sometimes three armed police officers in the room. You know why they were in the room? They wanted to make sure that we didn't do anything that we weren't supposed to do, like give her communion or maybe a glass of water. In fact, Bobby, sitting on the other side of the bed, would occasionally stand up to lean over his sister. When he stood up and did that, the officer would change position. He would move around towards the foot of the bed so that he could have a direct line of sight on what we were doing. The morning that she died we went in there fairly early and I had to go back outside in front of the hospice to do an interview. In order to go out on time I had a little timepiece in my hand and at the beginning of our visit I put it in my left hand, leaned over Terri and extended my right to bless her and we began praying. I closed my eyes and I felt a tap on my left hand. It was the police officer who said, "Father, what do you have in your hand?" I said, "Oh, officer, it's a little time piece." "I'll have to hold it while you're here," he said. We couldn't have anything in our hands. He didn't even know what it was. Maybe I was going to try to give her communion. Maybe I was going to try to moisten her lips. Who knows what terrible thing I was about to do?

You know what the most ironic thing was? There was a little night table in the room. I could put my hand on the table and on Terri's head all within arms reach. You know what was on that table? A vase of flowers filled with water. And I looked at the flowers. They were beautiful. There were roses their and other types of flowers and there was another one on the other side of the room at the foot of the bed. Two beautiful bouquets of flowers filled with water. Fully nourished, living, beautiful. And I said to myself, this is absurd. This is absurd. These flowers are being treated better than this woman. She has not had a drop of water for almost two weeks. Why are those flowers there? What type of hypocrisy is this? The flowers were watered. Terri wasn't. The other irony is - had I dipped my hand in that water and put it on her tongue - the officer would have led me out probably under arrest. He would have certainly led me out of the room. Something is wrong here.”

Indeed, something is wrong here!

These and similar passages in other authors led me to conclude that in the case of Terri Schiavo, the feeding tube, etc. constituted extraordinary means.

Having cited words of the theologian Vittoria and of Pope Pius XII, Rev. Cekada simply makes the bald statement that he has concluded that for Terri Schiavo “the feeding tube, etc. constituted extraordinary means.” In no way does he justify this leap. By what process of logical thought he came to that conclusion he does not explain. He simply “concluded,” and because he has “concluded” it is so, and anyone who dissents from his “conclusion” is an “Oprah-watching idiot.” This is not a responsible approach to moral theology. One must justify his conclusions. Has Reverend Cekada provided that justification in subsequent writings? We consider.

(Consider the “grave burdens” that such means would increasingly impose on society, now that medical science can keep the dying and unconscious going for years.) ...

Moral theologians categorize as extraordinary those treatments that are physically painful, invasive, repulsive, emotionally disturbing, dangerous, rarely successful, expensive, etc.

Nowadays the latter burden - extraordinary expense - is mostly hidden, because "someone else pays for it" - i.e., you and I and everyone else foot the bills through health insurance premiums, doctor malpractice premiums and high taxes.

This is now a grave burden on society. If someone wants to make every effort to sustain life for as long as possible in a body that is obviously shutting down for good, he is free to pay for extraordinary means himself - but it is wrong for him to impose this burden on everyone else.

Had Terri Schiavo not received a $750,000 malpractice settlement - i.e., some trial lawyers shook down an insurance company, which in turn calculated that it would be cheaper to pay them and the Schiavos off, rather than gamble with the Oprah-watching idiots in the average jury pool - you can bet that her husband and parents would not have sold off their own houses to sustain her for all this time.

Instead, you and I - not merely the Schiavos or the Schindlers - got stuck with the "grave burden" of paying for it.

If something is immoral in the whole affair, it is surely this.

The primary reason for considering the feeding tube to be “extraordinary means” of preserving life seems to be, in Rev. Cekada’s mind, money. The expense in Theresa Schiavo’s case should not have been a factor, since her parents were pleading to be allowed to bear the burden of the expense of keeping her alive. Still, it is the principal reason Rev. Cekada gives for justifying her death by starvation and dehydration.

Sadly enough, it is also the principal reason given by Rev. Donald Sanborn in his declaration that Theresa’s PEG constituted “extraordinary means” of preserving her life. Is it not peculiar to find those posing as traditional Catholic clergymen arguing that “the expense to society” justifies cutting off access to food and water to those who are impaired? Considering all the other useless and foolish and sinful things our society wastes money on, one would expect priests to rejoice that some of that money was being spent for a worthy cause – not calling it “immoral” that they have to “foot the bills.”

Further, in my opinion, Mrs. Schiavo’s husband (as horrible a person as he seems to be) - and not her parents - had the sole right before God to determine whether these means should have continued to be used. ...

WHO DECIDES? Mrs. Schiavo¹s husband (as horrible a person as he seems to be) - and not her parents - had the right before God to determine whether these means should have continued to be used.

A husband does not somehow automatically lose his headship of the household or his God-given "domestic and paternal authority" if he becomes a moral reprobate.

An ecclesiastical or civil court may for a grave reason, of course, prevent him from exercising his authority.

In the Schiavo case, however, the civil courts examined the matter and repeatedly reaffirmed Mr. Schiavo's rights.

First of all, it was not Mr. Schiavo who decided that his wife’s feeding tube should be withdrawn and all food and water denied to her – even by mouth. It was the court that decided. Michael Schiavo had to petition the court, and the court could have refused his petition.

Secondly, the court did not uphold Michael Schiavo’s right as a husband. Florida law allows the court to appoint whatever person as guardian the judge chooses, whether a spouse, a friend or a complete stranger. In fact, early in the proceedings, Judge Greer appointed successively two guardians ad litem to examine Mr. Schiavo’s care of Theresa.

Thirdly, Rev. Cekada certainly knows that the Catholic Church grants to a spouse the right to separate from an adulterous spouse and to refuse him any marital rights. The point was well-made that, had Mrs. Schiavo been able to respond to the fact that her husband was living in adultery and had two illegitimate children, she would have refused him any legal power to make life or death decisions for her. The court should have made that reasonable ruling on her behalf.

In most cases, the right principle and the correct definition of its terms can be found in a theology book somewhere, even though it may take some time and priest with good Latin to find it.

The tendency of so many traditionalists to resolve moral or theological questions - be it the Schiavo case, the Indult, excommunications, schism, heresy, the Fatima consecration, the sede vacante dispute, etc. - by following emotional reactions, rather than by seeking out an objective principle that the Church has laid down, makes them ripe for deception by the ignorant and manipulation by the cynical.

In the first place, if anything is to be considered “cynical” and “:emotional” it would seem to be the previous contention that the feeding tube for Theresa Schiavo was an immoral expense to society.

In the second place, the “right principle” and the “correct definition” require more than a sufficient knowledge of Latin. Such principles are safe only in the care of those with the prudence and wisdom to apply them accurately. This is not the case with Rev. Cekada’s cavalier, shallow and reckless treatment of Catholic moral principles.

But common sense tells me that the method you used to arrive at your opinion -- reviewing CT images, watching a video and reviewing summary/excerpts regarding testimony given in deposition transcripts -- is no substitute for examining a live patient.

James Urling, Esq., an attorney with several years experience in litigating insurance cases due to injuries has commented on the above statement by Rev. Cekada:

“Fr. Cekada should know that medical experts regularly testify in court without having conducted a physical examination of the patient in question. A peer review of objective evidence such as the results of diagnostics tests and subjective evidence such as the treating physician’s office notes permits one to give a very comprehensive opinion. In the case of Terry Schiavo, Dr. Gebel’s position was superior to even Schiavo’s own treating doctors because he had the advantage of reviewing post-mortem data unavailable at the time. Furthermore, having conducted direct and cross examinations of multiple neurosurgeons neurologists in a trial setting, I can say from personal experience that the opinions they offer are based more on diagnostic and clinical tests than physical examinations of a patient. “

If what you seem to be claiming is true and Terri Schiavo was somehow able to eat and drink by natural means, there is no dispute that those who cared for her would have been obliged to provide her with food and drink. To have withheld these would have been a mortal sin (unjust direct homicide) against the Fifth Commandment.

Here Reverend Cekada actually concedes the main implication of Dr. Gebel’s report: that Theresa Schiavo was able to swallow, and thus should have been capable of taking food and water by mouth. In other words, the feeding tube should have been unnecessary.

But this is exactly what nurses who cared for Terri were claiming all along. They insisted that they had been feeding her orally and that she was swallowing without problem. They were forced to stop feeding her by mouth and a PEG was inserted at the insistence, reinforced by the threats, of Michael Schiavo.

The fact that Theresa could have taken water by mouth is also evident from the fact that she was swallowing her own saliva without assistance. Had she not been able to do so, she would have aspirated her saliva over time and would have fallen gravely ill of lung problems.

Also, the absolute prohibition of placing so much as ice chips on her tongue is a fairly clear indication of the concern that she could benefit from that hydration to prolong her life. The purpose was not protect her from aspirating the water she could not swallow. The purpose was to prevent her from swallowing the water and remaining alive.

However, my writings on the Schiavo case centered on something else: the principles that Catholic moral theology would apply to removing a feeding tube. ...

Here, put very bluntly, are the two essential questions in moral theology that I have sought to resolve:

(1) Does the Fifth Commandment under pain of mortal sin always require a sick person who is unable to eat or drink by natural means to have a doctor shove a tube into his nose or poke a hole into his stomach in order to provide food and water?

(2) Does the Fifth Commandment under pain of mortal sin then always forbid such a person to have these tubes removed, no matter what grave burdens -- pain, revulsion, depression, expense, etc. -- their continued use may impose on him or another?

The answer to both questions is no. ...

But one cannot maintain that a Catholic is always bound to use a feeding tube under pain of mortal sin – still less, that the refusal to do so constitutes “murder.”

These statements are patently false, and demonstrate a deliberate effort to change the subject. The issue from the beginning was Reverend Cekada’s flat judgment that the killing of Theresa Schiavo by denying her food and water was justified by the principles of Catholic moral theology. If he now wants to sweep that claim under the table or admit that he was wrong, he is free to do so. But it is dishonest to substitute that with a different issue – two questions which were not under dispute. As Attorney James Urling comments: “Finally, Fr. Cekada’s use of “always require” and “always forbid” intentionally and wrongly frames the debate. His style for arguing his point is crude, juvenile, and disingenuous.”

Of course, the employment of a feeding tube can be, under certain circumstances, an extraordinary means if preserving life. Everyone agrees that if the nourishment provided through a feeding tube is not helping sustain life, then it is useless, provides no benefit and the tube is extraordinary means. That was never in question. Theresa Schiavo had been successfully nourished for fifteen years. The feeding tube was manifestly benefitting her, although she probably did not need it. She certainly was not dying, and she was not suffering from the tube. It was the withdrawal of the tube which inflicted intense suffering on her.

Having a hole poked in you, a tube shoved in and then having to eat and drink that way would be burdensome for any normal man.

So, even though as a doctor you may well consider poking holes into people and inserting permanent feeding tubes “by no logical measure extraordinary or unduly burdensome by any reasonable standard, moral, medical or economic,” Catholics must nevertheless draw their understanding of extraordinary means from the Church’s moral teachings -- rather than from the practices and pronouncements of the medical-industrial complex.

The insertion and use of a PEG is so simple and safe that it is generally considered routine care today. Whereas 50 years ago, such means would involve serious surgery, and even a nasal tube for feeding was dangerous and burdensome, in our day the PEG is on the level of out-patient surgery.

The purpose of a percutaneous endoscopic gastrostomy (PEG) is to feed those who cannot swallow. Regardless of the age of the patient or his medical condition, the purpose of PEG is to provide fluids and nutrition directly into the stomach.

PEG is done by a doctor in a hospital or outpatient surgical facility. Local anesthesia is used to anesthetize the throat. An endoscope (a flexible, lighted instrument) is passed through the mouth, throat and esophagus to the stomach. The doctor then makes a small incision in the skin of the abdomen and inserts an IV tube through the skin into the stomach and ties it in place.

The patient can usually go home the same day or the next morning. Once in place, the PEG can serve for years without problems. It is so non-invasive that it can even occasionally fall out, in which case it can simply be put back in place. All the patient then needs is access to nutrients, usually in a liquid form similar to Ensure.

No matter what other maladies or hardships a patient may suffer from, the use of a feeding tube is a simple, common and highly successful procedure. It can rarely constitute an extraordinary, i.e. excessively burdensome, means of sustaining life. It was certainly not so in Theresa Schiavo’s case.

Like the IV drip mentioned by the moral theologian McFadden (whom I quoted elsewhere), one could maintain this procedure would be morally compulsory “as a temporary means of carrying a person through a critical period.”

“Surely,” however, “any effort to sustain life permanently in this fashion would constitute a grave hardship.” (Medical Ethics, 1958, p.269.)

Reverend Cekada seriously misrepresents Fr. McFadden’s true position on the matter of feeding a patient in need. In the first place, Fr. McFadden was writing about an intravenous drip inserted by needle into a patient’s vein, not a PEG. Secondly, he was considering this procedure as it was inflicted 50 years ago, when such means were much more complicated and problem-prone.

But most importantly, Fr. McFadden goes on to state his position about removing such an IV line which is already in place and serving the patient. When considering the case of a terminally ill cancer patient with an IV already in place (note that Theresa Schiavo was not terminally ill), Fr. McFadden says:

In actual medical practice, however, I would be very much opposed to any cessation of intravenous feeding in the above case. The fact that this form of nourishment has already been in use in this case necessitates a different outlook on the problem. First, the danger of scandal would be very real: members of a family who know that their loved one is expected to live several weeks and who then witness the withdrawal of nourishment, followed by death within a day, would almost surely believe that the patient had been deliberately killed in order to avert further suffering. Second, doctors who received permission, possibly from a hospital chaplain, to act in this fashion in this specific type of case would not appreciate all of the fine moral distinctions involved, and soon they would be carrying over the practice to countless cases wherein they regarded the preservation of a life as useless. Third, it is fundamentally the patient himself who has the right to decide whether or not he shall continue with a useless and extraordinary means which will prolong his intense suffering. It would be rash, indeed, to pose the question to him in his present condition, and it might be equally rash for others to make the decision for him. Who but God knows what goes on in the mind of such a person? Who but God knows what spiritual benefit such suffering may hold for the patient– on the basis of intentions made before the suffering became so intense but at a time when the patient anticipated them as a proximate reality. Finally, who is willing to assume the responsibility for acting as if the patient has spiritually prepared himself for death? If medical opinion believes that the patient could survive a few weeks, it may very well be that the patient himself believes that he will completely recover. If such be the case, even the fact that the person has received the Last Sacraments is no guarantee that they have been rightly and fruitfully received. (Fr. Joseph McFadden, Medical Ethics, 1958 edition, pages 273-274)

Thus, Fr. McFadden predicted in his second point above exactly what has come to pass today, i.e. that doctors would become accustomed to withdrawing food and water from patients whose lives they deem not worth prolonging. It is amazing – literally incredible – that Reverend Cekada could overlook this conclusion of his own source, Fr. McFadden.

(Perhaps some priest, layman or doctor who rejects this conclusion could get his own feeding tube inserted, live that way for fifteen years, and let us all know in 2020 whether the experience was a grave hardship or not. Any takers?)

And here we have a common emotional argument. Faced with the serious debilities of Terri Shiavo, people were asking: “Would you want to live like that? How would you like to be kept alive in that condition?” The only sensible answer is: “Of course I would not want to have to live like that! No one would want to have to live like that.”

The question and the answer are dangerous, however. Today they are loaded questions.

There are many people I know who suffer great hardships in life: debilitating illness, poverty, divorces, handicaps of all sorts. Also, as I look back in history, I recall many suffering souls whose life I would not want. In the 1930's, millions of poor people in the Ukraine suffered terrible privations under Joseph Stalin. I certainly would not want to have to live as they did. But that does not give me the right to kill them. And it would not have given me the right to kill myself.

Yet, some of our own people remarked that, as far as they were concerned, it was alright to deny Terri Schiavo food and water unto death, because they would not have wanted to live like that, and she should not have to live like that, either.

But what if the court was right in saying that Theresa Schiavo would not have wanted to live under the circumstance? That is still a far cry from claiming that she would have chosen to be starved and dehydrated to death. And if she had, it would have been suicide – simply physician assisted suicide, which Catholic moral principles condemn.

Are Living Wills the Answer?

Finally, I would like to address the big push for living wills. Living wills were first proposed by a coalition of euthanasia societies in America. They saw the living will as a first step toward their ultimate goal of convincing Americans to legalize euthanasia. Proponents of living wills sold the idea to doctors in the 1980's as a means, not so much of protecting the patient against excessive treatment, but rather of protecting doctors from lawsuits.

Living wills are extremely general and vague in their language. What constitutes “heroic measures” and “artificial means” and “reasonable treatment” and “hope of recovery” and “substantial benefit” is wide open to interpretation by medical staff. No living will can possibly take into consideration all of the factors involved in a real life situation or whether or not a person is willing and prepared to die.

Also, living wills are not legally enforceable in all states; the National Right to Life Committee warns that living wills have legal standing in only ten states in this country. Recall the recent case in Georgia of the grandmother who entered the hospital for surgery, only to wind up being starved to death in hospice. Her granddaughter had her transferred there following surgery because, the young woman said, Jesus had told her that grandmother to too old and that it was time for her to go. The granddaughter almost succeeded in having her grandmother put to death despite the fact that the grandmother had a living will requiring that she receive food and water.

Furthermore, living wills effectively take a person’s fate out of the realm of morality and transfer the life or death decision to a physician or committee with no notion of Catholic moral principles of right and wrong. It can be immoral for a Catholic to sign such a living will.

A much better choice would be the appointment of a durable medical power of attorney – a living person of your choice who is legally authorized to answer for you when you cannot answer for yourself. Such appointments have different titles in the various states, but they all amount to the same thing, i.e. the presence of a person who can represent your best interests, not merely a pliable document subject to arbitrary interpretation.

If a court can set aside a living will, could the court also set aside a durable power of attorney for health care decisions? Yes, the courts have enormous discretionary powers and some judges abuse their authority like arbitrary despots. But a piece of paper cannot respond by enlisting a lawyer to engage a legal battle for your rights, whereas a living person with power of attorney can do so.

Some states and some lawyers try to have people enact both a living will and a durable power of attorney. This is odd, since the two can wind up being used against each other, the living will invoked to defy the voice of the living representative. A Catholic doctor’s advice: get rid of the living will and keep the person as your durable power of attorney. Just make sure that the person (or persons – a primary and two alternates) you empower knows what you want, is also conversant with Catholic moral principles or can be trusted to consult with a traditional priest, and has the courage to resist pressures from hostile forces. You should pray for guidance and consult with your own traditional priest in selecting someone to represent you in matters of life or death.

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For the information of the reader, I include here substantial excerpts from two books: Medico-Moral Problems by Fr. Gerald Kelly, S.J. (published by The Catholic Hospital Association of the United States and Canada (St. Louis, Missouri), imprimatur 1957, copyrighted 1958, fourth printing 1963) and Medical Ethics by Fr. Joseph McFadden, 1958 edition..

Medico-Moral Problems by Fr. Gerald Kelly, S.J. (Pp. 128-137)

Chapter 17: Preserving Life

“1. The Ordinary Means of Preserving Life

Euthanasia usually implies the use of some positive means to end life: e.g., taking poison, a lethal dose of some drug, and so forth. But death can also be brought about in a negative way: i.e., by not taking or giving something which is necessary for sustaining life; and in some cases this failure to take or give what is necessary for preserving life is equivalently euthanasia. That is the general meaning of directive 22:

The failure to supply the ordinary means of preserving life is equivalent to euthanasia.

Meaning of Terms

A complete explanation of this directive calls for an explanation of ordinary and extraordinary means of preserving life, as theologians use these terms, and also for an explanation of the duties of patients and doctors regarding the use of these means. ... (P. 128)

Theologians use these terms in a different sense; and it is important to note this because the directive follows the theological meaning. As regards various hospital procedures, the theologian would say that ordinary means of preserving life are all medicines, treatments, and operations, which offer a reasonable hope of benefit for the patient and which can be obtained and used without excessive expense, pain, or other inconvenience. For example, suppose that a patient whose health is normally good has pneumonia. This patient is now facing a crisis; but from our experience we have every reason to believe that we can bring him through the crisis by means of certain drugs, such as penicillin, and the use of oxygen for a time. Once he passed the crisis he would be well on the way to complete recovery. Here we seem clearly to be dealing with ordinary means; for the use of the drugs and oxygen in these circumstances does not involve excessive inconvenience, and there is a very reasonable hope of success.

In contradistinction to ordinary are extraordinary means of preserving life. By these we mean all medicines, treatments, and operations, which cannot be obtained or used without excessive expense, pain, or other inconvenience, or which, if used, would not offer a reasonable hope of benefit. For example, consider a case like this. A young woman has a rare cardiac ailment. There is a chance of curing her with an extremely delicate operation; but it is only a chance. Without the operation, she can hardly live a year. With the operation, she may die on the table or shortly afterwards: but she also has a chance, though considerably less than an even chance, of surviving and of being at least comparatively cured. This operation seems to be a clear example of an extraordinary means of preserving life, especially because of the risk and uncertainty that it involves. ... (p. 129)

The Duty

Every individual has the obligation to take the ordinary means of preserving his life. Deliberate neglect of such means is tantamount to suicide. Consequently, every patient has the duty to submit to any treatment which is clearly an ordinary means; and his doctor, as well as the nurses and hospital personnel, has the duty to use such means in treating the patient. To do less than this is equivalently euthanasia – as is stated in directive 22.

It should be noted, however, that the directive is here enunciating only a minimum: this is the least that must be done for any patient. As a matter of fact, there are some cases in which a patient might be obliged to use extraordinary means; and there are many cases in which the doctor is obliged to use them. In the next section, I shall try to indicate some norms for the use of extraordinary means in the care of patients. For the present, it seems sufficient merely to state the fact that the use of extraordinary means is sometimes obligatory. ... (p.130)

We can apply them to the vast number of artificial life-sustainers now at the disposal of the medical profession by judging two elements, convenience and utility. A medicine, treatment, etc., is to be considered an ordinary means if it can be obtained and used with relative convenience and if it offers reasonable hope of benefit. When either of these conditions is lacking, the means is extraordinary.

It should also be noted that the moralists were primarily concerned with the duty of the individual (i.e, the patient), not his doctor. They thus chose the easier course, because the doctor’s problem is much more complicated. The patient is obliged to use ordinary means; as for extraordinary means, he may use them if he wishes, but, apart from very special circumstances, he is not obliged to do so.

I have heard it said that the doctor’s duty is exactly the same as the patient’s. This is not correct. The doctor (as well as nurses and hospital authorities and personnel) must do not only what the patient is obliged to do but also what the patient reasonably wants and what the recognized standards of the medical profession require. I shall discuss these points in the next section.

It is important to note that, though the notions of ordinary and extraordinary remain the same, their applications can vary with changing circumstances. For example, major operations used to be considered extraordinary means of preserving life on two counts: first, because the pain was practically unbearable for most people; and secondly, because the outcome was often very uncertain, e.g., because of the danger of infection. Today we have the means of controlling both the pain and the danger of infection; hence, many operations that would have been extraordinary in former times have now become ordinary means of preserving life. ... (p. 134)

In the preceding section it was pointed out that, in terms of modern medical procedures, extraordinary means of preserving life are all medicines, treatments, and operations, which cannot be obtained or used without excessive expense, pain, or other inconvenience for the patient or for others, or which, if used, would not offer a reasonable hope of benefit to the patient. One example given was that of a very dangerous and uncertain operation; another was the use of such things as intravenous feeding to prolong life in a terminal coma. Still another example, culled from medical literature, is the case “when life can be somewhat prolonged by a gastroenterostomy or an enteroanastomosis,” as mentioned by Walter C. Alvarez, M. D.

In concrete cases it is not always easy to determine when a given procedure is an extraordinary means. It is not computed according to a mathematical formula, but according to the reasonable judgment of prudent and conscientious men. Granted such a judgment, the patient himself is not generally obliged to use or to submit to the procedure. He may, with a good conscience, refuse it except in special cases when a prolongation of his life is necessary: (a) for the common good, as might happen in the case of a great soldier or statesman; and (b) for his own eternal welfare, as might be the case when he has not yet had the opportunity of receiving the Last Sacraments.

Here I want to consider the duty of the doctor to use extraordinary means of preserving life. Under the term “doctor,” I include not only the attending physician but also all who assist him in the care of the patient, i.e., nurses and hospital personnel. ... (p. 135)

How is the doctor to judge whether he is obliged to use an extraordinary means? The first rule for judging is indicated by Dr. Alvarez when he speaks of prolonging life somewhat by a gastroenterostomy or an enteroanastomosis: “ the wishes of the patient should be ascertained.” The words I have italicized contain the first rule concerning the doctor’s duty: he must do what the patient wishes. It is the patient who has the right to use or to refuse the extraordinary means; hence, it is primarily the patient who must be consulted. Obviously there are many cases in which it is impossible to consult the patient, e.g., when he is delirious or in a coma, or when he is a small child. In these cases the right to make the decision is vested in those who are closest to the patient, i.e., husband, wife, parents, guardians. Thus, Dr. Alvarez rightly says that the wishes of the family must be consulted when there is question of efforts at resuscitation by means of oxygen and “endless injections of stimulants” in the case of an old person who is close to death. I might add here that the relatives do not make this decision precisely in their own name, but rather as representing the patient; hence, they should try to determine what he would reasonably want done under the circumstances. ... (p. 136)

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Medical Ethics by Fr. Joseph McFadden (pp. 267-274) '

Ordinary and Extraordinary Means of Preserving Life

At this point we are in a position to state as a principle that man is morally obliged to adopt all ordinary means of preserving health and life. And – for the moment– we might briefly say that any means is to be classified as ordinary if its use does not entail grave hardships. In contrast, if the usage of the means would involve grave hardship, it would be classified as extraordinary and usually there would be no moral obligation to adopt it.

As is the case with many topics in Ethics, these principles are clear but their application can at times be difficult. It is, for example, quite possible that two informed and sincere persons will agree that all ordinary means must be adopted and yet disagree on whether a specific course of treatment would involve a reasonable or an unreasonable measure of hardship for the patient.

At the outset it is necessary to emphasize that often the physician and the moralist do not use the terms “ordinary’ and ‘extraordinary’ in the same sense. From the viewpoint of the physician, ordinary means of preserving life are “standard, recognized, orthodox, or established medicines or procedures of that time-period, at that level of medical practice, and within the limits of availability.” In contrast, the physician would classify a course of action as extraordinary only in so far as it would be “a medicament or procedure that might be fanciful, bizarre, experimental, incompletely established, unorthodox, or not recognized.” (J.A.M.A., Vol. 151, no. 9, p. 713)

From the viewpoint of the moralist, ordinary means of preserving life include not only normal food, drink and rest but also–from the viewpoint of hospital practice–“all medicines, treatments, and operations, which offer a reasonable hope of benefit for the patient and which can be obtained and used without excessive expense, pain, or other inconvenience.” In contrast, the moralist would hold that “extraordinary means of preserving life are all medicines, treatments, and operations, which cannot be obtained or used without excessive expense, pain, or other inconvenience for the patient or for others, or which, if used, would not offer a reasonable hope of benefit to the patient.” (G. Kelly, S.J., Medico-Moral Problems V, 6, 11.)

Almost daily, the phenomenal advances of medical science place in the hands of the doctor and surgeon some new drug, new technic, or new operation aimed at the conservation of man’s life. Insofar as these discoveries offer any hope for the suffering patient, the man of medical science is almost invariably inclined to use them in the patient’s behalf. Hence, whenever–in the estimation of medical science–a life is worth saving, the doctor rarely pauses to consider the measure of hardship involved in using a means which will attain his goal. His concern is only with the saving of a life–and the labor, the inconvenience, and the expense entailed seldom curb his determination. On the other hand, cases are occasionally encountered in which some medical men label a life as “not worth saving”–such as the infant born with a serious deformity, the extremely aged, the insane, or the incurable ill adult. In these latter cases, there is sometimes evident a reluctance to utilize even readily available measures to prolong the life at hand.

It is extremely important, therefore, to emphasize that those measures which are classified by the moralist as ordinary means of preserving life are morally binding on man. It is for this reason that the Code for Catholic Hospitals states that “the failure to supply the ordinary means of preserving life is equivalent to euthanasia.”

In contrast, if it is a question of using extraordinary measures to preserve life (in the moralist’s meaning of the term “extraordinary”) there is usually no obligation on the part of the patient to have recourse to them.

Two exceptions. It has been said that a patient usually does not need to adopt extraordinary measures to preserve health and life. Two exceptions to this general rule must be suggested:

(1) A patient who is not spiritually prepared for death would be bound to do all that he could to conserve his life until he had taken care of this all-important matter. Hence, if ordinary means would not gain this precious time for such a person, and extraordinary means would do so, it would be his obligation to have recourse to the latter until such time as he was spiritually prepared for death.

(2) A patient whose continued existence is vital to the common good, should adopt extraordinary means to preserve life so long as the above-mentioned dependence on him continues to exist. In times of national crisis, for example, the death of a great political or military leader might, on one hand, have tragic repercussions: chaos could result and the reins of leadership be seized by evil or incompetent persons. On the other hand, the continued life of such a great political or military leader might well provide the people with just the inspirations, confidence, and guidance which then need to overcome their problems.

As we remarked above, the almost unbelievable advances of medical science, have brought about the adoption of innumerable artificial means of preserving life. We are living in an era in which men use artificial legs, arms, hands, and kidneys, plastic heart valves and arteries, corneal and bone transplants from other persons, a mechanical heart and lungs during the course of an operation, blood transfusions (even to the point of replacing the total blood content in a person’s body), oxygen tents and masks to facilitate breathing, intravenous feeding to secure nourishment, and highly technical operations to overcome the countless physical misfortunes to which we succumb.

It is surely no surprise that the sincere doctor and the conscientious patient often wonder how much of all this tremendous effort to sustain life is morally binding on them.

It is with a deep appreciation of the difficulty of this task and of the legitimate differences of opinion which may exist on some of these matters that the following analysis of specific problems is presented.

A. Intravenous Feeding. Routine medical practice today utilizes intravenous feeding in a countless variety of cases. Certainly the physician regards this procedure as an ordinary means of safeguarding life. It is obviously capable of being carried out, under normal hospital conditions, without any notable inconvenience. For these reasons, I would regard recourse to intravenous feeding, in the case of typical hospitalized patients, as an ordinary and morally compulsory procedure.

The above statement applies, as stated, to routine hospital cases and where the procedure is envisioned as a temporary means of carrying a person through a critical period. Surely any effort to sustain life permanently in this fashion would constitute a grave hardship. Similarly, an attempt to maintain life by intravenous nourishment in an area devoid of hospitals and by persons untrained in medical technics would be extraordinary and morally unnecessary.

In reference to intravenous feeding in so-called “hopeless cases,” analysis of two contrasting cases should help to clarify man’s moral duties along these lines.

A very interesting case is suggested for moral evaluation in Fr. J. V. Sullivan’s Catholic Teaching on the Morality of Euthanasia (p. 72). The problem is presented as follows:

“A cancer patient is in extreme pain and his system has gradually established what physicians call ‘toleration’ of any drug, so that even increased doses give only brief respite from the ever-recurring pain. The attending physician knows that the person is slowly dying, but because of a good heart, it is possible that this agony will continue for several weeks. The physician then remembers that there is one thing he can do to end the suffering. He can cut off intravenous feeding and patient will surely die. He does this and before the next day the patient is dead.”

In his solution to this problem, Fr. Sullivan states that whether or not a specific means of prolonging life is ordinary or extraordinary is to be determined, at least partially, in the light of the patient’s condition. (He concludes that since this cancer patient is beyond all hope of recovery and is suffering extreme pain, the intravenous feeding should be classified as an extraordinary and, therefore, non-compulsory means of prolonging life.)

In an evaluation of a similar case presented in the Homiletic and Pastoral Review (Aug., 1949, p. 904), Fr. Joseph P. Donovan, C.M., maintained the opposite point of view. He insisted that recourse to intravenous feedings entails neither a physical or a moral impossibility–hence this manner of acquiring nourishment must be considered an ordinary means and its cessation would be tantamount to mercy-killing.

Fr. Gerald Kelly, S.J., has presented his analysis of the above case in Theological Studies (June, 1950, p. 218). After stating that he regards the use of intravenous feeding, even in the above case, as an ordinary means of preserving life, he then continues:

“To me, the mere prolonging of life in the given circumstances seems to be relatively useless, and I see no sound reason for saying that the patient is obliged to submit to it. But does the patient want it? Theoretically, if he is conscious and calm he should be allowed to answer the question for himself; practically, I would not ask him the question, but I would presume that he wants it unless he protests against it. If he is conscious, but constantly racked with pain to the extent that he is not spiritually profiting by it, relatives and physicians may reasonably presume that he does not want the intravenous feeding. (Granting this presumption, the relatives may licitly ask that the artificial feeding be discontinued and the physician may accede to this request or even take the initiative unless his professional standards dictate otherwise.) I think that on purely speculative grounds the analysis just given is valid. Yet I frankly hesitate to give a practical answer allowing the physician to discontinue the intravenous feeding as a means of putting an end to the suffering. I fear that the abrupt ceasing to nourish a conscious patient might appear to be a sort of ‘Catholic euthanasia’ to many who cannot appreciate (the fine distinction between omitting an ordinary means and omitting a useless ordinary means.) Moreover, doctors are discovering new methods of dealing with pain; and the use of one of these methods might be more in keeping with their professional ideal. It is hardly just to press this ideal to the point of imposing intolerable burdens on patients or relatives; yet the common good calls for great prudence whenever the preservation of the ideal is involved. Before giving a practical answer for a definite case, I should want to discuss points like these, not only in general, but also with reference to the circumstances of the case.”

Personally, in evaluating this problem, I should like to distinguish between this case considered theoretically as contrasted with the case considered in actual medical practice.

In agreement with Fr. Sullivan, I would hold that intravenous feeding to sustain life in this patient is an extraordinary means. This attitude is based on the fact that the means is both artificial and useless for the procurement of any notable permanent beneficial result. (Surely one could hardly call the prolongation of agony for a few weeks a “beneficial result”– and if there be no true hope of “beneficial result,” according to our original definition, a means is to be classified as extraordinary.) In theory, therefore, if this be a truly “hopeless” case, if sound medical judgment is to the effect that intravenous feeding cannot possible alter the inevitable onset of proximate death, it would seem morally permissible to cease the intravenous feeding. Incidentally, it would be these same considerations which would convince me that those in charge of a home for incurable cancer patients would be justified in a routine practice of never using artificial lifesustainers (oxygen tents and intravenous feeding) for truly “hopeless” cases.

In actual medical practice, however, I would be very much opposed to any cessation of intravenous feeding in the above case. The fact that this form of nourishment has already been in use in this case necessitates a different outlook on the problem. First, the danger of scandal would be very real: members of a family who know that their loved one is expected to live several weeks and who then witness the withdrawal of nourishment, followed by death within a day, would almost surely believe that the patient had been deliberately killed in order to avert further suffering. Second, doctors who received permission, possibly from a hospital chaplain, to act in this fashion in this specific type of case would not appreciate all of the fine moral distinctions involved, and soon they would be carrying over the practice to countless cases wherein they regarded the preservation of a life as useless. Third, it is fundamentally the patient himself who has the right to decide whether or not he shall continue with a useless and extraordinary means which will prolong his intense suffering. It would be rash, indeed, to pose the question to him in his present condition, and it might be equally rash for others to make the decision for him. Who but God knows what goes on in the mind of such a person? Who but God knows what spiritual benefit such suffering may hold for the patient– on the basis of intentions made before the suffering became so intense but at a time when the patient anticipated them as a proximate reality. Finally, who is willing to assume the responsibility for acting as if the patient has spiritually prepared himself for death? If medical opinion believes that the patient could survive a few weeks, it may very well be that the patient himself believes that he will completely recover. If such be the case, even the fact that the person has received the Last Sacraments is no guarantee that they have been rightly and fruitfully received.

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For those interested in the case of Theresa Marie Schiavo, I also include the account of Terri’s final hours by Fr. Frank Pavone, who also explains the benefit of a medical power of attorney:

Terri Schiavo's Final Hours - An Eyewitness Account

Fr. Frank Pavone

National Director, Priests for Life

President, National Pro-life Religious Council

You may have seen on the news that I was at Terri Schiavo's bedside during the last 14 hours of her earthly life, right up until five minutes before her death. During that time with Terri, joined by her brother and sister, I expressed your care, concern, and prayers. I told Terri over and over that she had many friends around the country, many people who were praying for her and were on her side. I had also told her the same things during my visits to her in the months before her feeding tube was removed, and am convinced she understood.

I've known Terri's family for about six years now and they put me on the visitor's list. Terri was in a hospice but there were police officers stationed outside her room. If I were not on that visitor's list I could not get in that room beyond the armed guard because the visitor's list was kept very, very small and very well controlled. The reason? The euthanasia advocates had to be able to say that Terri was an unresponsive person in some kind of vegetative state, coma or whatever terminology they want to use to suggest that she was completely unresponsive. The only way to prove she was responsive was to see her for yourself.

I went down to see her in September 2004 and again in February 2005. When her mom first introduced her to me, she stared at me intently. She focused her eyes. She would focus her eyes on whoever was talking to her. If somebody spoke to her from the other part of the room she would turn her head and her eyes towards the person who was talking to her.

You know what some of the doctors have dared to say about this? "Oh, it's just reflex reactions. Unconscious reflex reactions." Interestingly, that's exactly the same thing they say about the unborn child when you look at the video The Silent Scream when the child opens his mouth and tries to move away from the instrument that is about to destroy him. They say, "Oh, that's just an automatic reflex." That's the phrase they always use to dehumanize the person.

I told Terri she has many people around the country and around the world who lover her and are praying for her. She looked at me attentively. I said, "Terri now we are going to pray together, I want to give you a blessing, let's say some prayers." So I laid my hand on her head. She closed her eyes. I said the prayer. She opened her eyes again at the end of the prayer. Her dad leaned over to her and said, "OK Terri now here comes the tickle," because he has a mustache. She would laugh and smile and after he kissed her I saw her return the kiss. Her mom asked her a question at a certain point and I heard her voice. She was trying to respond. She was making sounds in response to her mother's question, not just at odd times and meaningless moments. I heard her trying to say something but she was not, because of her disability, able to articulate the words. So she was responsive.

Now, the night before she died I was in the room for probably a total of 3-4 hours, and then for another hour the next morning -- her final hour. Brothers and sisters to describe the way she looked as peaceful is a total distortion of what I saw. Here now was a person, who for thirteen days had no food or water. She was, as you would expect, very drawn in her appearance as opposed to when I had seen her before. Her eyes were open but they were going from one side to the next, constantly oscillating back and forth, back and forth. The look on her face (I was staring at her for three and a half-hours) I can only describe as a combination of fear and sadness … a combination of dreaded fear and sadness.

Her mouth was open the whole time. It looked like it was frozen open. She was panting rapidly. It wasn't peaceful in any sense of the word. She was panting as if she had just run a hundred miles. But a shallow panting. Her brother Bobby was sitting opposite me. He was on one side of the bed I was on the other facing him. Terri's head in between us and her sister Suzanne was on my left. We sat there and we had a very intense time of prayer. And we were talking to Terri, urging her to entrust herself completely to the Savior. I assured her repeatedly of the love and prayers and concern of so many people.

We held her hand and stroked her head. During those hours, one of the things I did was to chant, in Latin, some of the most ancient hymns of the Church. One of the chants I used was the "Victimae Paschali Laudis," which is the ancient proclamation of the resurrection of Christ. There, as I saw before my eyes the deadly work of the Culture of Death, I proclaimed the victory of life. "Life and death were locked in a wondrous struggle," the hymn declares. "Life's Captain died, but now lives and reigns forevermore!"

And then we had just times of silence … just sitting there in silence trying to absorb what was happening.

But besides Bobby and his sister and Terri herself, you know who else was in the room with us? A police officer. The whole time. At least one. Sometimes two. Sometimes three armed police officers in the room. You know why they were in the room? They wanted to make sure that we didn't do anything that we weren't supposed to do, like give her communion or maybe a glass of water. In fact, Bobby, sitting on the other side of the bed, would occasionally stand up to lean over his sister. When he stood up and did that, the officer would change position. He would move around towards the foot of the bed so that he could have a direct line of sight on what we were doing. The morning that she died we went in there fairly early and I had to go back outside in front of the hospice to do an interview. In order to go out on time I had a little timepiece in my hand and at the beginning of our visit I put it in my left hand, leaned over Terri and extended my right to bless her and we began praying. I closed my eyes and I felt a tap on my left hand. It was the police officer who said, "Father, what do you have in your hand?" I said, "Oh, officer, it's a little time piece." "I'll have to hold it while you're here," he said. We couldn't have anything in our hands. He didn't even know what it was. Maybe I was going to try to give her communion. Maybe I was going to try to moisten her lips. Who knows what terrible thing I was about to do?

You know what the most ironic thing was? There was a little night table in the room. I could put my hand on the table and on Terri's head all within arms reach. You know what was on that table? A vase of flowers filled with water. And I looked at the flowers. They were beautiful. There were roses their and other types of flowers and there was another one on the other side of the room at the foot of the bed. Two beautiful bouquets of flowers filled with water. Fully nourished, living, beautiful. And I said to myself, this is absurd. This is absurd. These flowers are being treated better than this woman. She has not had a drop of water for almost two weeks. Why are those flowers there? What type of hypocrisy is this? The flowers were watered. Terri wasn't. The other irony is - had I dipped my hand in that water and put it on her tongue - the officer would have led me out probably under arrest. He would have certainly led me out of the room. Something is wrong here.

As you may have also seen, those who killed Terri were quite angry that I said so. The night before she died, I said to the media that her estranged husband Michael, his attorney Mr. Felos, and Judge Greer were murderers. I also pointed out, that night and the next morning, that contrary to Felos' description, Terri's death was not at all peaceful and beautiful. It was, on the contrary, quite horrifying. In my 16 years as a priest, I never saw anything like it before.

After I said these things, Mr. Felos and others in sympathy with him began attacking me in the press and before the cameras. Some news outlets began making a story out of their attacks and said I was "fanning the flames" of enmity and hatred.

Actually, there's a simple reason why they are so angry with me. They had hoped that they could present Terri's death as a merciful and gentle act. My words took the veil of euphemism away, calling this a killing, and giving eyewitness testimony to the fact that it was anything but gentle. Mr. Felos is a euthanasia advocate, and like all such advocates, he needs to manipulate the language, to sell death in an attractive package. Here he and his friends had a great opportunity to do so. But a priest, seeing their work close-up and then telling the world about it, just didn't fit into their plans.

One of the attacks they made was that a "spiritual person" like a priest should be speaking words of compassion and understanding, instead of venom. But compassion demands truth. A priest is also a prophet, and if he cannot cry out against evil, then he cannot bring about reconciliation. If there is going to be any healing between these families or in this nation, it must start with repentance on the part of those who murdered Terri and now try to cover it up with flowery language.

Another aspect of the Terri Schiavo tragedy is that many people misunderstand its cause and therefore its solution. They think the problem was that Terri did not leave any written instructions about whether she wanted to be kept alive. In order to avoid any such problem in their own lives, they are now told that they have to draw up a "living will." This is both erroneous and dangerous.

Terri's case is not about the withdrawal of life-saving medical treatment, but rather about the killing of a healthy person whose life some regarded as worthless. Terri was not dying, was not on life support, and did not have any terminal illness. Because some thought she would not want to live with her disability, they insisted on introducing the cause of death, namely, dehydration.

So what good is a living will supposed to accomplish, aside from saying, "Please don't argue about killing me, just kill me?"

The danger in our culture is not that we will be over-treated, but rather that we will be under-treated. We already have the right to refuse medical treatment. What we run the risk of losing is the right to receive the most basic humane care — like food and water — in the event we have a disability.

Our culture also promotes the idea that as long as we say we want to die, we have the right to do so. But we have a basic obligation to preserve our own life. A person who leaves clear instructions that they don’t want to be fed is breaking the moral law by requesting suicide. If you want to make plans for your future health care, do not do so by trying to predict the future. The reason you cannot indicate today what medical treatments you do or don't want tomorrow is that you don't know what medical condition you will have tomorrow, nor what treatments will be available to give you the help you need. Living wills try to predict the future, and people can argue over the interpretation of a piece of paper just as much as they argue about what they claim someone said in private.

The better solution is to appoint a health care proxy, who is authorized to speak for you if you are in a condition in which you cannot speak for yourself. This should be a person who knows your beliefs and values, and with whom you discuss these matters in detail. In case you cannot speak for yourself, your proxy can ask all the necessary questions of your doctors and clergy, and make an assessment when all the details of your condition and medical needs are actually known. That's much safer than predicting the future. Appointing a health care proxy in a way that safeguards your right to life is easy. In fact, the National Right to Life Committee has designed a "Will to Live," which can be found at www.nrlc.org and which I recommend highly.

I am in regular contact with Terri's parents, Bob and Mary Schindler, and her siblings, Bobby and Suzanne. They are strong Christians with a beautiful, gentle spirit. If you wish to relay a personal message to them, you can send it to terri@priestsforlife.org and I will pass it along to them myself.

Meanwhile, let us continue to commend Terri to the Lord, mindful of the equal value of every life, no matter how prominent or obscure, healthy or sick.