For many years, the pro-life movement has emphasized that providing food and fluids is part of the normal care that every human being is entitled to receive. NRLC's Will to Live advance directive proclaims, "Food and water are not medical treatment, but basic necessities. I direct my health care provider(s) and health care agent to provide me with food and fluids orally, intravenously, by tube, or by other means to the full extent necessary both to preserve my life and to assure me the optimal health possible."
Whatever their religious affiliations or beliefs, pro-lifers can only be profoundly grateful to Pope John Paul II for his clear statement on the obligation to provide food and fluids. As more fully reported in Richard Doerflinger's article on page one, in a March 20 speech the Pope said:
"I should like particularly to underline how the administration of water and food, even when provided by artificial means, always represents a natural means of preserving life, not a medical act. Its use, furthermore, should be considered, in principle, ordinary and proportionate, and as such morally obligatory, insofar as and until it is seen to have attained its proper finality, which in the present case consists in providing nourishment to the patient and alleviation of his suffering.
"The obligation to provide the 'normal care due to the sick in such cases' includes, in fact, the use of nutrition and hydration. The evaluation of probabilities, founded on waning hopes for recovery when the vegetative state is prolonged beyond a year, cannot ethically justify the cessation or interruption of minimal care for the patient, including nutrition and hydration. Death by starvation or dehydration is, in fact, the only possible outcome as a result of their withdrawal. In this sense it ends up becoming, if done knowingly and willingly, true and proper euthanasia by omission." (Citations omitted.)
Tragically, in the United States, ever since the mid-1980s the overwhelming weight of court opinions, legislation, and medical practice in hospitals and other health care institutions - - including most Catholic facilities - - has been contrary to this fundamental principle. In the 1990 case of Cruzan v. Director, a majority of the U.S. Supreme Court concluded there is a constitutional right to reject artificially provided food and fluids. Since that decision, the balance of new Justices appointed (Souter, Thomas, Ginsburg and Breyer) has certainly not favored the pro-life viewpoint.
What Can Now Be Done?
First - - whatever one's religious views - - the papal statement should stimulate everyone who has not already done so to take the necessary action to protect family members from being starved and dehydrated. Because so many in the medical and legal fields are hostile to the provision of food and fluids for those they deem to have a poor "quality of life," it is essential that everyone complete a legal advance directive specifying, among other treatment decisions, that food and fluids be provided. The proper form for each state may be downloaded from www.nrlc.org/euthanasia/willtolive/index.html.
Second, pro-life organizations on a local level should promptly contact Catholic hospitals, nursing homes, and other appropriate facilities in their area to ask what steps they are taking to bring their ethics guidelines and facility practices in line with the papal statement on this point. (The complete text is available through a link on the home page of www.nrlc.org.)
Third comes the question of legislation. In pursuing protective statutes, we must be both determined and realistic.
In the encyclical Evangelium Vitae, §§ 73 & 90, Pope John Paul II stated, "[W]here a legislative vote would be decisive for the passage of a more restrictive law, aimed at limiting the number of authorized abortions, in place of a more permissive law already passed or ready to be voted on [,] ... when it is not possible to overturn or completely abrogate a pro-abortion law, an elected official, whose personal opposition to procured abortion was well known, could licitly support proposals aimed at limiting the harm done by such a law .... This does not in fact represent an illicit cooperation with an unjust law, but rather a legitimate and proper attempt to limit its evil aspects. ... The Church well knows that it is difficult to mount an effective legal defense of life in pluralistic democracies, because of the presence of strong cultural currents with differing outlooks. ... [T]he Church encourages political leaders, starting with those who are Christians, not to give in, but to make those choices which, taking into account what is realistically attainable, will lead to the re-establishment of a just order in the defense and promotion of the value of life."
What the encyclical says about abortion legislation of course also applies to euthanasia legislation. As mentioned earlier, in Cruzan v. Director, a majority of the U.S. Supreme Court stated that there is a constitutional right to reject artificially provided nutrition and hydration. Any bill that now sought to mandate provision of such food and fluids, regardless of the wishes of the patient, would be struck down as unconstitutional, and thus would be wholly ineffective - - its provisions would not be "realistically attainable."
However, in the Cruzan case the Supreme Court did hold that a state may require clear and convincing evidence, in the case of an incompetent patient, that the rejection of nutrition and hydration conforms to the patient's wishes while competent. In short, while laws cannot override the wishes of a competent person who knowingly and informedly rejects nutrition and hydration, they CAN constitutionally protect incompetent individuals from being starved and dehydrated to death as a result of choices made by surrogates, courts, or medical institutions.
Sadly, that is not now the case. Under the law now effective in virtually every state, whenever incompetent patients' wishes are unknown surrogates can, and routinely do, decide that they should not receive tube feeding.
Motivated by the Terri Schindler-Schiavo case, Florida State Senator Stephen Wise has proposed changing that by introducing S. 692, the Florida Starvation and Dehydration of Persons with Disabilities Prevention Act. The Wise bill creates a presumption for food and fluids that, to be overcome, requires either a formally executed legal document or "clear and convincing evidence that the person, when competent, gave express and informed consent to withdrawing or withholding nutrition or hydration in the applicable circumstances."
A casual, thoughtless comment should not bring a death sentence. The bill provides, "'Express and informed consent' means consent voluntarily given with sufficient knowledge of the subject matter involved to enable the person giving consent to make a knowing and understanding decision without any element of force, fraud, deceit, duress, or other form of constraint or coercion. Sufficient knowledge of the subject matter involved includes a general understanding of: (a) The proposed treatment or procedure for which consent is sought; (b) The medical condition of the person for whom consent for the proposed treatment is sought; (c) Any medically acceptable alternative treatment or procedure; and (d) The substantial risks and hazards inherent if the proposed treatment or procedure is carried out and if the proposed treatment or procedure is not carried out."
The casual and indefinite statements which Michael Schiavo claimed (and the courts accepted) had been made by Terri Schindler-Schiavo supposedly rejecting nutrition and hydration could not plausibly be said to have been made with a knowledge of the medical condition in which she now finds herself that was sufficient "to make a knowing and understanding decision" based on the "substantial risks and hazards inherent if the proposed treatment or procedure is carried out and if the proposed treatment or procedure is not carried out." Consequently, the presumption the bill creates for the provision of nutrition and hydration would apply to her.
Similar bills could be promoted in other states. When it is medically possible that feeding tubes or other means of medically assisted nutrition and hydration can sustain life or provide comfort, we should - - and constitutionally can - - create a legal presumption that patients should not be denied these means and starved or dehydrated to death.
With the impetus from the widely-publicized Schiavo case and now from the Pope's clear statement, it is critically important to redouble our efforts to protect the most vulnerable among us from death imposed by starvation and dehydration.