Schiavo — The Real "Real Issue" — Personhood, the Pope, and PVS

A recent post at Blogodoxy, picked up by Jollyblogger, suggests that the “real issue” in the Schiavo case is the definition of personhood. I think Blogodoxy is partly right. The definition of personhood is critical for clear ethical reflection on the withdrawal of artificial nutrition and hydration (ANH) from a person in a persistent vegitative state (PVS). The uproar over the Schiavo case, however, is driven, I think, more by politics and conservative Catholic teaching rather than by independent ethical reflection.

Perhaps unwittingly, many Evangelical and Reformed bloggers and activists are advocating a hard-line position on the withdrawal of ANH that ultimately traces back to the Catholic Magesterial teaching and a recent Address given by Pope John Paul II. While I respect this Pope greatly, I’d like to examine this question a bit more closely, and suggest that a balanced Christian perspective should be less dogmatic about whether ANH can be withdrawn from a PVS patient.

There is an outstanding summary of the Catholic Church’s views on ANH at catholicculture.org.

The basis for the Catholic position is found in official Church teaching such the Sacred Declaration for the Congregation of the Faith, Declaration on Euthanasia (1980). The Declaration states that it is legitimate to “avoid the application of a medical procedure disproportionate to the results that can be expected. . . .” In particular,

When inevitable death is imminent in spite of the means used, it is permitted in conscience to take the decision to refuse forms of treatment that would only secure a precarious and burdensome prolongation of life, so long as the normal care due to the sick person in similar cases is not interrupted.

Catholic leaders have not always agreed about whether providing ANH to a PVS patient can constitute “disproportionate” treatment. As late as 1992, the U.S. National Conference of Catholic Bishops stated that “the morality of withdrawing medically assisted hydration and nutrition from a person who is in the condition which is recognized by physicians as “the Persistent Vegetative State (PVS)” was a matter that required “further reflection” in light of existing Magesterial teaching. Some of the Bishops believed ANH could be withdrawn under these circumstances, while others did not. Significant debate ensued.

On March 20, 2004, however, the Pope issued an Address in which he stated that “the administration of water and food, even when provided by artificial means, always represents a natural means of preserving life, not a medical act,” that patients in a PVS “retain their human dignity in all its fullness,” and that ANH should be considered a proportionate response to a patient in a PVS. For most conservative Catholics, this settled the issue.

This brief history is useful, I think, because it illustrates why so many conservative Catholics are in arms about the Schiavo case. For them, it is not merely a matter of ethics. It is a matter of official Church teaching.

As I’ve said, I greatly respect this Pope, and I appreciate the Catholic social tradition and the genuine zeal of those who seek to uphold it. However, as a protestant I feel that I can, and should, examine this difficult ethical issue carefully myself. Unfortunately, it seems to me that many protestants have failed to do so, and are merely joining in the rhetoric about “starvation” and “murder.”

What might some of those ethical issues entail from an evangelical protestant perspective? The best summary I’ve found so far is an article that was published by the Journal of the Evangelical Theological Society in 1992, written by Robert Rakestraw, a professor at Bethel Seminary.

Rakestraw surveys the Christian theology of personhood, which is rooted in the concept that humans are created in the image of God. He states that

A human person is a unique individual, made as God’s image, known and cared for by God at every stage of life, with the actual ability or potential to be aware of oneself and to relate in some way to one’s environment, to other human beings, and to God. The earthly life of a person thus begins at conception and ends when this ability or potential ceases.

Rakestraw then surveys medical evidence about the nature of the PVS, which suggests that for a patient in a PVS, the neocortex is irreversibly ruined. He states that, under the definition of personhood he proposes,

the baby in the womb as well as the comatose patient is a person, whereas the PVS individual, as defined with the precision that now appears to be possible, is not. His or her potential for self-awareness, social interaction, and communication with God is irreversibly lost. This is not the case with handicapped fetuses or newborns, with Alzheimer’s patients, or with the comatose. Some capacity and potential—however slight—for imaging God is present in these cases. The absence of or damage to cerebral functioning is neither total nor necessarily irreversible. In true PVS cases, however, the neocortex is completely and permanently destroyed.

My current feeling is that Rakestraw is largely correct. The scientific data concerning PVS, combined with a Biblical view of personhood, suggest that withdrawing ANH from a PVS patient is not euthanasia. The person has moved on to the intermediate state before the eschaton. What is left is only, sadly, a body being kept artificially alive.

None of this, of course, answers the factual question whether Terry Schiavo is truly in a PVS. There seems to be conflicting evidence on this point. If she is not truly in a PVS, or if there is material doubt about her condition, ANH should not be withdrawn. This, however, would present a compelling individual tragedy rather than a failure of public policy about PVS and ANH.