McMahon, Kevin T.

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The Linacre QuarterlyVolume 59 | Number 3 Article 3August 1992What the Pennsylvania Bishops Really Said (AReply To Rev. Richard A. McCormick, S.J.)Kevin T. McMahonFollow this and additional works at: http://epublications.marquette.edu/lnqRecommended CitationMcMahon, Kevin T. (1992) "What the Pennsylvania Bishops Really Said (A Reply To Rev. Richard A. McCormick, S.J.)," The LinacreQuarterly: Vol. 59: No. 3, Article 3.Available at: http://epublications.marquette.edu/lnq/vol59/iss3/3What the Pennsylvania Bishops Really Said (A Reply To Rev. Richard A. McCormick, S.J.) by Rev. Kevin T. McMahon, STD Introduction While it would be too much to expect Fr. McCormick to offer a full analysis of the Pennsylvania bishops' statement "Nutrition and Hydration: Moral Considerations" (Origins, Jan. 30, 1992) in the America format, it would surely not be considered unfair to expect that, in offering his criticism, he be accurate and objective. Nevertheless, Fr. McCormick's " 'Moral Considerations' III Considered" (America, March 14, 1992), while rhetorically clever, falls short in these respects. It is unfortunate that rhetoric which unfairly characterizes the bishops' statement as an authoritarian imposition of a questionable moral teaching might discourage the readers of America from examining the statement itself. I say unfortunate because the statement is, as one physician active in the debate remarks, "the most helpful yet published as a set of guidelines for conscientious practitioners." (Eugene Diamond, M.D., Linacre Quarterly, February, 1992). Since they are neither documented nor particularly relevant, I will not comment on Fr. McCormick's use of personally conducted informal surveys, nor on his suggestion that Jesuit Father John Connery reversed his opinion shortly before his death. Since it is not the topic at hand, I will prescind from a discussion of Fr. McCormick's views on the teaching role of the theologian and that of the magisterium, the prerogatives of each and their interrelatedness. I wish instead to point out certain significant inaccuracies in his reading of the P A statement, and the tendentious argumentation that brought them about. A brief summary of the PA statement will help to clarify the bishops' actual position and demonstrate why particular points Fr. McCormick highlights for criticism are simply not found there. The Pennsylvania Bishops' Statement Purpose In their discussion of the moral question about withdrawing nutrition and hydration (NH) from patients who are in what is termed a persistent vegetative 6 Linacre Quarterly state (PVS), the bishops begin by presenting the "State ofthe Question." They point out the absence of a universal teaching of the magisterium on this issue and that it is theologically controverted. They note that this climate of controversy is reflected in the confusion that Catholics and others experience with regard to this issue, and the reason so many need and seek moral guidance. The need for such guidance, the bishops suggest, has been intensified by some pressing questions regarding advance medical directives occasioned by the December 1, 1991 federal regulation, "The Patient Self-Determination Act." Consequently, while they undoubtedly know that the controversy may go on for many years on the academic level, they know also that some practical prudential judgment must be offered now. As they put it: "We, as Catholic Bishops and fellow Pennsylvanians, hope that what follows will be of help to those who are confused about the present situation, but we especially seek to offer guidance to the Catholic faithful entrusted to our pastoral care." In light of this intention and that expressed by Anthony Cardinal Bevilacqua in the Forword· "Our statement is intended to express, as well as we are cu"ently able, the teaching of the Catholic Church as it affects these admittedly diffiCUlt cases" (emphasis added), Fr. McCormick's accusation that the bishops' teaching is an "authoritarian imposition" is inaccurate. Place In The Controversy The PA bishops are neither alone in offering guidance, nor peculiarly rigorist in offering it. In fact a passing examination of the literature on the topic will reveal many such judgments representing two contradictory views. First, that the supply ofNH to the PVS patient is of no real benefit to the patient since it merely preserves the physical life of someone unable to pursue truly human activities, i.e., the pursuit of the higher goals of life through human acts which require cognitive ability. Because of this judged lack of benefit to the patient, the proponents ofthis opinion conclude that the supply ofNH for such patients is extraordinary means and not morally obligatory. Moreover, they judge the PVS patient to suffer from a fatal pathology which one has no reason to circumvent. (This is the position of Kevin O'Rourke, OP, et aL, and those Texas bishops who signed the Texas Bishops' Statement.) Second, that the supply of NH which sustains the life of the PVS patient is a real benefit to the patient since life, irrespective of its quality, is a personal good with inherent value. Moreover, this opinion argues that a condition which causes only unconsciousness is not per se a fatal pathology, and that the PVS patient-without any such fatal pathology - will live for an indeterminate period of time as long as he or she is given nutrition and hydration, along with other nursing care. They note further that to withdraw NH from patients who are not dying constitutes an explicit choice to end their lives. This they judge to be a violation of the absolute prohibition against the taking of innocent human life - a case of passive euthanasia. (This is the position of William E. May, et aL Its concluSions are supported, in varying degrees, by the bishops of Florida, New Jersey, August, 1992 7 wasbingtonlOregon, and Penmylvania) Fr. McCormick's infereoce that the PA bishop;aresiogular in wbatthey teach is inaa:urate.. For, while the PA statement ditIers from that of the Texas bishops, its conclusion that there is a presumption in favor of supplying NH to PVS patients - .except for when it is dearly extruordinmy means - joins the positions taken by the bishops of Florida, New Jersey (which he omits), and WasbingtonlOregon. These conferences are now joined by the NCCB Pro-life Committee's stak:meotNutrition andHydration: MoralandPastoralRejIections (April, 1992). Ratioo-The PA statement does not appeal to the authority of the bishops for its validity, but demom1rates the reasonablenC3 of its judgment and guidance by offering a compreiIeI9ve examination of medical facts concerning "States of Unconsciousness" and "Methods of Supplying NIl" to patients who are in such states. This examination is conducted in light of two fundamental principles of the Catholic IIlOI3l tradition: (1) the non-absolute duty to preserve human life; (2) the absolute proscription against the intentional taking of innocent human life. These principles preclude yikzIism. which considers life an absolute good; they also preclude "an action which of itself or by intention causes death" (SCDF, Jura et BoruJ. May 5, 1980) for any reason. The bishop; then carefully detail and explain the distinction between ordinmy and extmonlinary means as defined by the Catholic moral tradition. They evaluate the supply ofNH to unconscious patients, especially to those diagnosed as being in a PVs. Their conclusion is that unlC3 it can be shown that the supply ofNH to a partiaJlar patient is extmonlinary and morally non-obligatory, either because it provides no benefit to the patient or does so only by causing excessive bunIens, it is to be considen:d ordinmy and morally obligatory. In their resolute defeme of the absolute right of all innocent persons. especially those who are most vnlnerable, not to be IciIIed. the PA bishops see the burden of proof resting on those who maintain that a means is extruordinmy. The bishops state: "We find no moral problem in the withdrawing even of nutrition and hydration from the patient if the supplying of them is futile or exa:ssivdy burdemome.. .. In the aaxJmpanying footnote 36, the bishops go on to pn:sent two examples of cases in which it has been demonstrated that the supply ofNH is extIaoIdinaIy. They write: "The supply of nutrition and hydration can rightly be judged an emaonlinary means because of futility,Jor exmnple. when death is imminent (provided it no longer serves even as a palliative); and in cases where the patient is unable to as'limiIate what is being supplied" (emphasis added). Nowhere are these exmnp/es presented as exhaustive, and so Fr. McCormick's assertion that the bishops allow only two exceptions is a serious misrepresentation of their position. 1nf0l'lDed Conseut The bishops affirm that "Respect for personal autonomy is a basic principle of medical ethics.. This principle reinfom:s the duty ofOO;pital personnel to secure 8 tinacre Quarterly the consent of patients or their surrogates before initialing or discontinuing treatment.'" The bishops teach that this right i'i exen:i<ied properly only when it i'i informed and guided by moral principles.. They hold that it i'i not moraDy permiwble for any person to refuse onli1lary means of pre;erving life. Again. Fr. McCormic:k i'i inaccurate in paraphrasing their position when he 3S.'ieI1s "the bishops state that it i'i immoral to specify in one's living will or to one's durable attorney 'no artificial nutrition and hychtion if I am in a P.Vo8:" Rather, what the bishops say is that one is not free to make provision in an advance medical directive to fon:go means which are onlintuy, and the mere fact that one is in a PVS does not make NB or any means 1DIIo1llll1iaJlly extmonlintuy. T ...... .., .. ious Argt •• .., ... ' .... Fr. McCormick begins his aiticism of the PA bishops' statement demonstrating a degree of annoyanre with the reappearance of the ethical controversy about thesupply of medicaDy assisted nutrition and hydration to the patient in the persisteot vegetative state. Fr. McCormick consideIs this controversy settled and so its n:emergence is likened to recurrent house pests. Nevertheles5 he wi111ater chide the bishops for teaching a'i though to setde a legitimately debated question. Fr. McCormick neve.- does identify who, if anyone. has competence to seUle the ethical quesIion, but: he i'i vecy dear that the Pennsylvania bishops do not. Since Ihere i'i to date no universal teaching of the magisterium on this specific issue. and Fr. McCormick still considers the matter dosed, one can only wonder who might have dosed it. Since Fr. McCormic:kaccepts the oondusionsofsome theologians and some bishops, and locates these on the side of the setded question, they must be the ones with authority. But how could this be'! Why would O'Rourke et aL enjoy a competence that May et aL do not'! Why, in Fr. McCormick's eslimation, would Bishops LetlHdlt, Bullock, and those who signed the Texa.. statement have the authority that the Florida, Wasbington/ Oregon, and Pennsylvania bishops lack'! It seems that Fr. McCormick's standard for competent authority is agreement with him. With such a standard it is only natural that he indines to treat a reassertion of an opposing view a'i some annoying house pest in need of extennination. Fr. McCormick, it seems, wishes to exterminate disagreement. A New House Pest On April 2, 1992 the National Confen:nce of Catholic Bishops' Committee for Pro-life Activities published a n:soun:e paper entitled Nutrition mul Hydration: MomlandPasIomlRejledions..Inthisdocumentthebishopsrevisitthis"seUled" controversy; they give a careful exposition of the two opposing theological views on the supply of NB to those in a PV8, and reach the same oondusion a'i the bishops of Florida, New Jeney, Washington/Oregon and Pennsylvania. The bishops aca:pt what they identify a'i the "more carefully limited oondosion'" of those who hold that, abse:ntsome otherfactorWbich wonld render Augm1.1992 9 the supply ofNH to the PVS patient futile or excessively burdensome, it is to be considered ordinary means. They put it this way: "We reject any omission of nutrition and hydration intended to cause a patient's death. We hold for a presumption in favor of providing medically assisted nutrition and hydration to patients who need it, which presumption would yield in cases where such procedures have no medically reasonable hope of sustaining life or pose excessive risks or burdens" (page 32; emphasis added). With regard to the position Fr. McCormick favors, the bishops conclude: "While this rationale is convincing to some, it is not theologically conclusive and we are not persuaded by it" (pages 25-26; emphasis added). Conclusion The statement made by the Pennsylvania bishops last December is hardly an extremist position, which would have warranted the dismissal given it by Fr. McCormick. As a more objective reading of the statement will show, the guidance offered by the Pennsylvania bishops is faithful to the Catholic moral tradition, cognizant of the current medical state of affairs, resilient enough to be applied rationally and charitably in myriad sets of diverse circumstances, and pastoral in its orientation and expression. The bishops' words add a strong voice to those already raised for the protection of the lives of all vulnerable persons. Notwithstanding Fr. McCormick's disagreement and annoyance, this pastoral guidance merits careful and serious attention. 10 Linacre Quarterly 

What the Pennsylvania Bishops Really Said (A Reply To Rev. Richard A. McCormick, S.J.)

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What the Pennsylvania Bishops Really Said (A Reply To Rev. Richard A. McCormick, S.J.)

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