The Easter triduum is good for a lot of conversation between me and my husband. You see, we still are in the choir of the parish we joined when we first moved to New Hampshire - even though we now live 15 miles away. We do a lot of talking during the drive. These last few days, as it has become increasingly obvious that Terri Schiavo will be put to death by starvation (barring of course a miracle of divine intervention) this has been the major topic of our conversations. A few themes keep emerging as we consider what is happening. One of the hardest things for both of us to cope with is that what seems to obvious to us seems to be obscured from the view of most of the rest of the world.
We have a couple of major disadvantages should we have desired to remain in ignorance about the whole fiasco. He works in radio, not in any way responsible for or able to have an effect on content, but still a part of the mainstream media. I'll let him speak to how this has affected him. (He blogs very occasionally over at Fathers Know Best).
I work within the chaos that is healthcare in the USA, and have studied (formally and informally) biomedical ethics. In a presentation on biomedical ethics and midwifery that I originally gave in 2000, I observed that the principle of autonomy was running rampant. The dominant model of biomedical ethics in the USA is based upon the ideal of balancing 4 principles - patient autonomy, provider beneficence, provider non-maleficence, and societal justice. Autonomy is basically self-determination. Beneficence is the duty of a health care provider (nurse, physician, pharmacist, etc.) to do good. Non-maleficence is the duty to do no harm. Justice looks at the effect of a medical decision on society as a whole, and includes financial as well as moral considerations. While there are some advantages to looking at decision-making using these concepts, the really big disadvantage is that it is a form of moral relativism. Without an absolute value for good and evil, using these principles to make life and death decisions can be like trying to pay your mortgage with a mixture of real and counterfeit currency.
As Catholic Christians, we have a foundation of absolute values to make use of, and an ethical/philosophical framework (natural law) to interpret these values for use in everyday life, in both ordinary and extraordinary circumstances. But the culture in which we live in the USA does not recognize either the existence of absolute values nor the proper use of the natural law. There is a big difference between 'natural law' and the 'law' that we keep hearing has been properly followed in condemning Terri to a slow death by dehydration.
Among the main contentions of Michael Schiavo is that Terri made the autonomous decision, when she was of sound and whole mind, that she would not want to remain in the situation where her physical sustenance would come through a tube. I recognize that there is (to some of us at least) a bit of a question as to the truth of this contention. But let us, for the sake of discussion, grant that he is indeed accurately rendering a fragment of a conversation from nearly 20 years ago. If we did not as a culture have an unholy admiration for autonomy, it would be obvious that a desire to be allowed to starve to death is not morally right. It violates the natural law, written in our bodies by our Creator, that life is a precious gift and worthy of being sustained.
Beneficence is often interpreted (unfavorably) these days as being patronizing. It brings up images of the elderly physician patting the young woman on her head and saying, "don't you worry your pretty little head about a thing". But that isn't what it is at all. It is taking the responsibility to do what it right, what is moral, what is best for a given individual.
These days,what passes for non-maleficence are the behaviours and choices made in the effort to avoid a malpractice suit. Some of these are worthy for the attempt to provide the highest quality of care, but much of it comes down to CYA documentation and bureaucratic red tape. Independant accrediting agencies like JCAHCO and OSHA have increasingly demanded behavioural changes like taking a 'time out' just as a baby is being born to verify that this is in fact the person the midwife, nurses, doctors, are there to deliver. I know of a low-income clinic who was forced to replace all their rolling stools because the ones they had only had 4 wheels, and the OSHA inspector told them that safety standards demanded 5 wheels.
Justice, which I think was originally intended to see to it that the risk and the poor were provided the same quality of care, has morphed into a kind of utilitarian ethic. Some commenters on Terri's case have made the argument that the $$$$ spent over the last several years to maintain her in the hospice, would have provided much sorely needed health care to others like pregnant moms, infants and children, etc. The argument goes that tube feeding and such care is futile, as it simply prolongs dying at an enormous financial cost. If the tube feeding would enable the person to become a useful member of society, well, that would be a different story.
Without a bedrock of absolute values, the "4 principles" balancing theory of medical ethics goes horribly astray.
Without that bedrock we are left with Pilate's question. And we will continue to sacrifice more innocent disabled persons, in the womb and outside, on the altar of autonomy (or its surrogate, substitutive judgement).
May God have mercy on us all.
