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Catholic Stance on Tube-Feeding Is Evolving

Terri Schiavo Case Reopens International Debate on Ethics and the End of Life

By Manuel Roig-Franzia
Washington Post Staff Writer
Sunday, March 27, 2005; Page A07

PINELLAS PARK, Fla. -- The Terri Schiavo case, for all its legal and political wranglings, is also churning up spiritual questions, ones with particular relevance for Catholics during the holiest days of the church calendar this weekend.

The Roman Catholic Church has taken a strong stance in the saga of Schiavo, the brain-damaged woman whose parents are fighting to keep her alive. Her Catholic faith has been such an important issue in the case that a court ordered doctors to deliver the sacrament of Holy Communion through her feeding tube before it was removed March 18. Pope John Paul II has said feeding tubes are "morally obligatory" for most patients in vegetative states, and high-ranking cardinals have followed up by referring to Schiavo, saying that removing her feeding tube could lead to legalized euthanasia.

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Theologians disagree about whether the pope is altering Catholic tradition, but there is consensus across the ideological spectrum that the Vatican's position in the Schiavo case has given Roman Catholics a new calculus for end-of-life decision making.

"This is the most authoritative statement we have to date," said Richard M. Doerflinger, vice president of the Pro-Life Secretariat of the U.S. Conference of Catholic Bishops and an opponent of ending Schiavo's feeding.

Before this case, before the pope's statement, even conservatives such as Doerflinger say there was enough of a debate about the Catholic position that a person could choose which side to take: continue or discontinue tube-feeding. But now the pope and the cardinals have made much more definitive statements that Doerflinger and his polar opposites agree seem to require Catholics to continue with tube-feeding, as long as it "provides nourishment" and "alleviates suffering."

The debate is far from an academic exercise. Its ultimate answers could affect how Catholics draw up their living wills and influence the decisions at the end of life now being faced by Schiavo's deeply divided family. And the church's evolving stance on feeding-tube cases may end up as one of the most lasting legacies of the Schiavo controversy.

Some prominent theologians argue that the pope is contradicting his recent predecessors by declaring that food and water are morally obligatory "basic care" and, as the Rev. John Paris, a bioethicist at Boston College, put it, "wholly upending four centuries of consistent Catholic moral analysis." Other prominent Catholic thinkers believe the Vatican is merely updating the church's position to reflect modern medical advances.

Catholics have been wrestling with the ethics and obligations of technologically advanced life-sustaining treatment for decades, a debate that surged with the cases of Nancy Cruzan, Karen Ann Quinlan and others whose court fights established much of the legal precedent being applied to Schiavo. Conservative Catholics, such as Doerflinger, argued that patients should not be disconnected, except in rare instances. Others argued that centuries of Roman Catholic tradition allowed patients to be disconnected if they had no hope of recovery.

That uncertainty left Catholics free to decide: disconnect or don't disconnect. Either way, they would not have sinned, Doerflinger said, as long as they "prayerfully considered" the dilemma and followed the moral argument they felt was most persuasive. Before the pope made his statement about feeding-tube cases at a conference last year, Doerflinger said there was enough uncertainty about the church's position that Catholics could remove feeding tubes without fear of committing a sin.

"No one could fairly have said to you that you were dissenting from clear Catholic teaching," Doerflinger said. "Now you would have to say, 'Yes, you are.' "

On this point, Doerflinger's ideological opposites agree with him, saying the pope's stance has greatly narrowed the morally acceptable conditions under which Catholic patients and their families can remove life-sustaining care. "He's overshot the mark by drawing a line in the sand on withdrawing nutrition," said James J. Walter, a bioethicist at Loyola Marymount University in Los Angeles who has written extensively about the Catholic tradition in end-of-life cases.

Catholics abound in the Schiavo case. Schiavo, now 41, was a practicing Catholic. Her parents, Robert and Mary Schindler, are Catholics and have been surrounded by sympathetic priests during public appearances. Gov. Jeb Bush (R), who has been rebuffed by the courts for taking unprecedented steps to preserve her life, converted to Catholicism after his marriage.

Almost from the beginning, both sides -- Schiavo's parents and her husband, Michael Schiavo -- have mixed religion into the process. Initially, the spiritual mantle seemed to tilt in favor of Michael Schiavo, who says his wife would have wanted him to remove the feeding tube that has kept her alive since her brain was damaged from lack of oxygen after a heart attack 15 years ago. A Catholic priest testified on Michael Schiavo's behalf at a trial in 2000.

Around the same time, the Schindlers were striking out with the Catholic hierarchy. They pleaded with the Diocese of St. Petersburg to intervene after Michael Schiavo won a court ruling that allowed him to briefly remove his wife's feeding tube in 2001. Bishop Robert Lynch refused.

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