Persistent Vegetative States

February 22, 2010 at 1:13 pm | Posted in Uncategorized | 1 Comment
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 I lied. I said I would make a new prediction on Sunday, but here it is Monday and I’m only just now doing it…

My prediction grows out of an article by Benedict Carey in the February 3 Health section of the New York Times. It concerns  a scientific discovery about people in persistent vegetative states. The article reports that a 29-year-old patient apparently in a persistent vegetative state in a clinic in Liege, Belgium, has been responding to yes-no questions presented via an MRI. 

The piece draws on an article in the New England Journal of Medicine  and indicates the limits of the findings.  The study:

“does not suggest that most apparently unresponsive patients can communicate or are likely to recover. The hidden ability displayed by the young accident victim is rare, the study suggested. …Nor does the finding apply to victims of severe oxygen depletion, like Terri Schiavo, the Florida woman who became unresponsive after her heart stopped and who was taken off life support in 2005 during an explosive controversy over patients’ rights. …Moreover, experts said the new test was not ready for wide use; serious technical challenges remain to be worked out. …The hidden ability displayed by the young accident victim is rare…”

Despite all these qualifications, the article suggests this new limited two-way channel opens up a world of ethical challenges. “We know (the patients ) are responding, but they may not understand the question,” an ethicist at Weil Cornell Medical College observed.“Physicians and society are not ready for ‘I have brain activation, therefore I am,’ ” another physician added.

So here’s my prediction: before very long, the Vatican, or the US Catholic bishops, or certainly some of those bishops, will use this study to argue that everyone in a persistent vegetative state must be kept alive by artificial means. In point of fact, Pope John Paul II already more or less made such an argument, asserting  that not to use artificial feeding and hydration to keep patients alive constitutes “passive euthanasia.” In his 2004 papal allocution, “Care for Patients in a Permanent Vegetative State,” the Pope stated, “Administration of water and food, even when provided by artificial means, always represents a natural means of preserving life, not a medical act.”  (Continue reading; do not pause to consider what it means that something artificial is always natural.)

As the Jesuit ethicists Peter Clark argues, however, this position is a clear reversal of Catholic teaching on the question dating back at least to the 16th century and perhaps to Thomas Aquinas. Clark writes, “Traditional moralists made a clear distinction between allowing to die and direct killing or euthanasia. The former was always morally permissible; the later was forbidden. Allowing to die included the refusal of nutrition and hydration if they were considered burdensome and nonbeneficial to the patient.”  

Clark  also points out that such a revision of traditional teaching, forcing Catholics to use extraordinary means to keep alive those who would not survive by ordinary means, places on them potentially extreme moral, legal and financial burdens. These include the obligation to provide expensive care not covered by health insurance or that violates a “do not resuscitate” order;  another danger is that those who previously did not sustain a loved one by extraordinary means will now fear that they murdered him or her. Finally, in a country where more than 40 million people are uninsured or underinsured, the investment of billions of dollars a year in artificially prolonging the lives of those in persistent vegetative states is ethically troubling at best. (Clark, “Tube Feeding and Persistent Vegetative State Patients: Ordinary or Extraordinary Means” Christian Bioethics 12: 43-64, 2006).

Nonetheless, I predict that some branch of the institutional Roman Catholic Church will, probably in the near future, use the recent study to restate its claim that the use of “natural” artificial  means to keep alive those in a persistent vegetative state is a moral obligation. Stay tuned.

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