Terri Schiavo: Killing or Letting Die or Letting
Live?
The tragic ordeal of Mrs. Terri Schiavo causes most of us to engage in
moral reflection on that borderland of human existence where there has to
be a decision about killing, letting die or letting live.
A fundamental moral principle consistent with faith in God revealed in
Jesus Christ is to always care rather than kill. In 1991 the Ramsey
Colloquium of the Institute on Religion and Public Life (named after the
late Paul Ramsey, a United Methodist ethicist) issued a declaration titled
"Always to Care, Never to Kill." The declaration says, "In relating to the
sick, the suffering, the incompetent, the disabled, and the dying, we must
learn again the wisdom that teaches us always to care, never to kill.
Although it may sometimes appear to be an act of compassion, killing is
never a means of caring."
On the basis of "always to care, never to kill" we would never give moral
approval of physician-assisted suicide or active euthanasia. Approval of
techniques to terminate the lives of the dying would distort the purpose
of physicians to care for persons and open the way to destroy the lives of
the disabled.
The principle of always caring does not prohibit letting the terminally
ill die in dignity and comfort. The hospice movement is based upon the
moral assumption that it is permissible to let the dying die as long as
they receive caring while they are dying. The statement on "Faithful Care
of the Dying" in the Social Principles of The United Methodist Church
expresses the moral wisdom of limiting the use of medical technologies in
caring for the dying: "The use of medical technologies to prolong terminal
illness requires responsible judgment about when life-sustaining
treatments truly support the goal of life, and when they have reached
their limits. There is no moral or religious obligation to use these when
they impose undue burdens or only extend the process of dying. Dying
persons and their families thus have the liberty to discontinue treatment
when they cease to be of benefit to the patient."
The extreme case of Mrs. Schiavo demonstrates how difficult it can be to
distinguish between killing and letting die or to choose between letting
die and letting live.
One concern is how to assess the technique of feeding a person through a
tube. Without the feeding tube Mrs. Schiavo would have died years ago.
There is a difference between eating and being fed by the insertion of a
tube into one's stomach. Mrs. Schiavo has been unable to eat ever since
she entered the "persistent vegetative state."
Some think that providing a feeding tube to a person in a "persistent
vegetative state" is an extraordinary medical intervention and that
removing the tube is not killing, but letting die. On the other hand,
there are those who say that providing fluids and food is not an
extraordinary medical intervention, but a necessary means of caring. There
are many disabled persons who live by means of a feeding tube. Therefore,
they say that to deprive a person of fluids and food would be killing not
letting die.
Another concern is how to characterize Mrs. Schiavo's condition. It is
morally permissible to allow the terminally ill to die, but can Mrs.
Schiavo be described as one who is terminally ill? As long as she received
fluids and food she would continue to live. It is more accurate to
describe her as a person who is severely disabled rather than one who is
terminally ill.
To make matters even more complex, there is the concern of how to define
"life." The simplest rule is that life is life: as long as a person is
alive, regardless of whether or not one's brain is dead, or the cortex of
the brain is dead, then that person should be allowed to live and she
should receive care.
Jews and Christians who consider the body an essential dimension of being
human should not place too much value upon one's capacity for
consciousness; to do so would imply a spiritualistic view of a human being
and pose a potential threat to the lives of the mentally incompetent. Yet,
even very conservative Jewish and Christian bio-ethicists think that brain
death should be viewed differently than other kinds of disabilities since
the cortex of the brain is the means through which a person expresses
herself.
Moreover, to make "life" per se an absolute category is to obscure the
value that should be placed upon "a way of life," i.e. an ability to
interact with the rest of the world and to relate to others. Indeed, there
is a spiritual danger in hypostatizing life, i.e. viewing life as
something that subsists in itself and thus makes moral claims upon us,
rather than viewing life as a gift of God offered to us under the
conditions of creaturely limits. It is not "life" itself, but God's
purposes for human beings that make the ultimate moral claims upon us.
Similarly, I would argue that the Christian protest against the violence
of abortion should not be based upon a "right to life," but upon God's
peaceable purposes and God's call for us to care for the most vulnerable.
To continue to acknowledge the complexity of a case such as Mrs. Schiavo's,
there is also the concern about the value of the person in a "persistent
vegetative state" to her loved ones. A person who is in a "persistent
vegetative state" is not a vegetable, especially not to those who know her
and love her. The love that Mrs. Schiavo's parents and siblings have
toward her and the care they display toward her is of immense value. It
should be humbly acknowledged that no one - no physician, no ethicist, no
judge, nor any other human being - can absolutely know the effect that the
power of love has upon someone even as severely disabled as Mrs. Schiavo.
Moreover, the love displayed by members of a family, friends, and
professionals and volunteers in a hospice adds immensely to the moral
dignity of our society. To Christians this kind of display of love is a
witness to the love of God revealed in Jesus Christ and poured into our
hearts by the Holy Spirit. Moral reflection should include consideration
of the value of the love of caregivers as well as the condition of the one
receiving care.
It seems to me that, all things considered, in the case of Mrs. Schiavo,
it would be better to allow her to live. I would not go so far as to say
that removing her tube is killing her. Since she is brain-dead it is
understandable why some think it would be merciful to let her die and to
entrust her to the care of the living God whose purposes for us transcend
this life. Here motives of the decision-makers are very important: it
makes a difference whether or not our motive is to release someone from
being bound to her severely impaired body or to get rid of her because she
is a burden. Yet, I believe it would be better to let her live because she
is the beneficiary of abundant love.
The decision is excruciating because of the complexity of the case. In my
view there is not much room for moral condemnation on either side of the
decision between letting die and letting live. Nevertheless, one must
judge, and I would decide for preserving her life primarily because of the
high value placed upon the self-giving love of those who want to care for
her.
Of course, the case of Mrs. Schiavo is a legal one, as well as a moral
one. The judges have ruled in accordance with the law of Florida that Mrs.
Schiavo should be allowed to die because her spouse is a witness to her
intention. The problem with the existing law is that (as far as I know) it
does not contain a provision that would allow the court to render a
judgment about whether the spouse should be the only witness where there
is no written will or if the spouse's witness is compromised by a conflict
of interest, such as living with another person with whom he is rearing
children. The existing law does not permit consideration of the testimony
or the moral claims of other members of the family who are willing to
provide the love and care the disabled person needs. If I understand the
law correctly, it seems to me there is a moral basis for modifying the
existing law.
In our society the usual assumption is that consideration of whether or
when to withhold life support to a person depends upon that person's own
preference. Surely, it matters whether or not we would want to live with
medical support if we were brain-dead. However, limiting moral
considerations to only the intention of the person is an individualistic
perspective that does not take into consideration the ability and
willingness of others to love and to care. At worst, such individualism in
moral deliberation and law can be an endorsement of absolute individual
autonomy and self-determination and thus of moral decisions and law that
could permit physician-assisted suicide and active euthanasia. It is
important to society, and especially to Christians in society, to also
introduce communitarian values into our moral deliberations as the basis
of both decision-making and legislating.
We are grateful that we live in a nation where we are given freedom. As
Christians we are especially grateful for the spiritual freedom given to
those of us who are justified by grace through faith in Jesus Christ. The
freedom we have received is not given to us for the sake of
self-determination, but for the sake of service. The apostle Paul wrote,
"you were called to be free; do not use your freedom as an opening for
self-indulgence, but be servants to one another in love, since the whole
of the Law is summarized in one commandment: You must love your neighbor
as yourself (Galatians 5:13-14, The New Jerusalem Bible)."
Serving others in love is possible only by participating in the love of
God. On Easter Christians heard again the proclamation that because of the
resurrection of Jesus Christ God's love is stronger than death. Unless
this proclamation is just a pious sentiment it creates a people whose
practices are different than those of the world. The church's mission is
not to be the chaplain to a culture of death, but to be a witness to the
love of God in the world. Rather than assisting people to make living
wills, wouldn't it be more fitting for the church to tell the stories of
those who have found new life in giving loving service to the disabled?
Their stories show us how to practice a way of life of participating in
the love of the Triune God, which is eternal life. T im
W. Whitaker
Florida Area Resident Bishop
The United Methodist Church |