I want to bring to your attention a brief but extraordinarily valuable and insightful exchange regarding feeding tubes and end-of-life issues, to be found here, in the August/September 2004 issue of First Things. Among other things, it calls into question an unstated assumption that most of the parties to the Schiavo matter seem to share: that the prospect of the patient’s "not getting any better" should be regarded as dispositive in deciding whether that patient’s life should be sustained. It often seems to me that even some of Terri’s defenders may concede too much to that assumption.
I’m especially struck by these words of Gil Meilaender, which are addressed specifically to the question of providing feeding tubes to patients diagnosed as being in what is called a Persistent Vegetative State:
Is the treatment useless? Not, let us be clear, is the life a useless one to have, but is the treatment useless? As Dr. Orr notes—quite rightly, I think—patients “can live in this permanent vegetative state for many years.” So feeding may preserve for years the life of this living human being. Are we certain we want to call that useless? We are, of course, tempted to say that, in deciding not to feed, we are simply withdrawing treatment and letting these patients die. Yet, as Dr. Orr also notes, these patients “are not clearly dying.” And, despite the sloppy way we sometimes talk about these matters, you cannot “let die” a person who is not dying. It is hard, therefore, to make the case for treatment withdrawal in these cases on the ground of uselessness. We may use those words, but it is more likely that our target is a (supposed) useless life and not a useless treatment. And if that is our aim, we had better rethink it promptly.
Is the treatment excessively burdensome? Alas, if these patients could experience the feeding as a burden, they would not be diagnosed as being in a persistent vegetative state. We may wonder, of course, whether having such a life is itself a burden, but, again, if that is our reasoning, it will be clear that we take aim not at a burdensome treatment but at a (presumed) burdensome life. And, once more, if that is our aim, we had better rethink it promptly.
Hence, although these are troubling cases, Dr. Orr has not given us good or sufficient arguments to make the case for withdrawing feeding tubes from patients in a persistent vegetative state. I have not suggested that we have an obligation always and at any cost to preserve life. I have simply avoided all comparative judgments of the worth of human lives and have turned aside from any decisions which, when analyzed carefully, look as if they take aim not at a dispensable treatment but at a life. “Choosing life” does not mean doing whatever is needed to stay alive as long as possible. But choosing life clearly means never aiming at another’s death—even if only by withholding treatment. I am not persuaded that Dr. Orr has fully grasped or delineated what it means to choose life in the difficult circumstances he discusses.
Unfortunately, the assumption that some lives are too "useless" or "burdensome" to be sustained has already made deep inroads in our culture, and not least among our educated elites. We will see whether the now-imminent death of Terri Schiavo will serve merely to confirm that fact, or serve as an impetus for change, or at least for what Meilaender calls "rethinking." If the latter, one can hardly do better than to begin with these simple but potent words:
And, despite the sloppy way we sometimes talk about these matters, you cannot “let die” a person who is not dying.