Vatican focuses debate over the end of life
VATICAN CITY -- As Christians today commemorate the death of Jesus on the cross, theologians here say the confluence of the legal drama surrounding Terri Schiavo and the deteriorating health of Pope John Paul II shows how the suffering of Jesus nearly 2,000 years ago can also inform the modern debate on the end of life.
The Vatican this week publicly supported a plea to the courts from Schiavo's parents to allow her feeding tube to be reinserted, and observers here described it as a highly unusual step for the hierarchy of the Catholic Church to jump into the fray of a legal case that is riveting the media.
The Vatican took this uncharacteristic approach, the observers said, because the struggle of the family of Schiavo, a Catholic from Pennsylvania, has similarities -- as well as important differences -- with the agonizing decisions that the family of the Catholic Church may soon face with its spiritual father, the pope.
Both the Schiavo case and the frail health of the ailing, 84-year-old pope have brought into sharp focus a confounding question of morality and modern medicine: When does the Catholic Church give its blessing to pull the plug?
''Holy Friday is not just a memory of an event 2,000 years ago. It is a liturgical event, a sense that Christ is present with us. Through his suffering, we can see the suffering in the world -- in Iraq, in Darfur -- or in the suffering of the elderly at a hospital, or Terri Schiavo, or the suffering of the Holy Father, the pope," said Monsignor Ignacio Carrasco de Paula, director of the Institute of
''This is the day we devote to pondering this, and on this Holy Friday in particular, all of these issues have become somehow dramatized, or maybe more relevant in our own lives. It makes this Holy Friday very special," added de Paula, who is also in administrative charge of the Pontifical Council for Life, in which the Vatican has brought together its best medical and theological minds on these issues.
Yesterday, as the church observed Holy Thursday, Cardinal Giovanni Battista Re, prefect of the Congregation for Bishops, commented on this connection, thanking the pope for what he described as the ''serene abandonment to God, which unites him to the mystery of the cross."
Good Friday commemorates the suffering of Jesus, who Christians believe was crucified and died under the order of the Roman ruler Pontius Pilate in Jerusalem and then rose again in the Resurrection, which is celebrated on Easter Sunday.
John Paul II has emphasized the need for Catholics to understand the universal meaning of Jesus' suffering by taking part in an elaborate and theatrical reenactment of the crucifixion in the Roman Colosseum, where many Christian martyrs were killed for practicing their faith in the first and second centuries AD.
Until his Parkinson's disease worsened, the pope carried the wooden cross himself in the reenactment. This year, Vatican officials say, will mark the first year that the pope will not preside, although he might take part via a live video link from his Vatican residence, where he is recovering from two recent hospitalizations and an emergency tracheotomy.
The Rev. Robert Gahl, 40, a theologian and professor of ethics at the Pontifical University of the Holy Cross, which is governed by Opus Dei, a conservative religious prelature, said: ''The pope started this practice of carrying the cross himself. . . . He has always wanted to stress the suffering of Jesus. The lesson of that suffering is that when we encounter suffering in our own path, we should embrace it as the cross in our life. We should help people to alleviate suffering, but we should never use suffering itself as a reason to take a life.
''Jesus chose to suffer on the cross for our salvation. So how would we have handled that today? Would it have been good to do something to put him out of his misery?"
Brian Johnstone, professor of moral theology at the Alphonsianum Academy in Rome, has written for 30 years on end-of-life issues and teaches students about the human and ethical dilemmas in the last phase of a person's life. He also lives with the realities every day. Johnstone, 66, is also a chaplain at the Hospice of Sacred Heart in Rome, where he ministers to dying cancer patients and their families who face hard decisions about when to withdraw life support from a patient. He said many families experience agony that is not unlike that suffered by Schiavo's family.
Johnstone said it was highly unusual for the Vatican to comment on an individual case, and unprecedented for it to issue statements so quickly.
''There is an intensity to the debate, an urgency, about this case that is unprecedented," he said, in part because the church could face similar issues in the event the pope's illness led to him being declared incapacitated.
''You can't help making the connection," Johnstone said. ''The Holy Father is not in the state now where these decisions are necessary, but it is quite possible he could be."
One of the Vatican's more definitive statements on the end of life is a 1951 document by Pope Pius XII, declaring that the Catholic Church holds that a person is obliged to always preserve life, but that obligation was not ''absolute." Pius wrote that a person should accept ''ordinary means" to save his or her life, but not ''extraordinary means."
For the last half century, the church has struggled to decipher what those terms mean in the context of the advances of modern medicine. What was once extraordinary has in many cases become ordinary, Johnstone said. For example, many Catholic hospitals once considered a tracheotomy an extraordinary means to preserve life, but now it is widely accepted as routine. Another practice considered routine and accepted by the church is the jejunostomy, a feeding tube inserted directly into the stomach of a patient.
One issue John Paul has addressed clearly is the use of feeding tubes. In March 2004, the pope stunned a conference of Catholic healthcare providers, ethicists, and theologians by announcing that it was ''morally obligatory" to continue artificial feeding and hydration for people in a persistent vegetative state, even if they remain so for years.
Before the pope's edict, Catholic hospitals considered feeding tubes a medical treatment that could be viewed as an extraordinary measure and discontinued, based on an evaluation of the benefits and burdens on patient and family.
The impact of the Vatican's rulings goes far beyond the 1 billion Catholics in the world because they extend to Catholic hospitals that treat Catholics and non-Catholics alike.
In the United States, more than 550 hospitals, or about 1 in 10, are affiliated with the church and, therefore, operate under the guidelines of the Catholic Hospital Association.
The most important area that the church has not defined is the point of incapacity, and who would make a decision at that point to put an end to all means of preserving life, whether ordinary or extraordinary, and in effect allow the pope to die on his own.
''Who will make these decisions?" Johnstone said. ''There is no provision for it in canon law. It is clearly not a problem yet, but it could a very big problem."
