I just have read in America magazine (August 4, 2008) the article "Human Dignity and the End of Life" by Cardinal Rigali and Bishop Lori. The authors respond to two recent America articles, "On Church Teaching and My Father’s Choice," by John J. Hardt (1/21), and "At the End of Life," by Thomas A. Shannon (2/18) on providing artificial nutrition and hydration to PVS patients. Shannon and Hardt, according to the article, "appear to misunderstand and subsequently misrepresent the substance of church teaching on these difficult and important ethical questions."

It seems to me - as the title suggests - Cardinal Rigali and Bishop Lori touch a wider area of concern for human dignity, euthanasia, end-of-life and right-to-life issues. Their concern is not just the PVS patients’ situation but anybody who needs help for survival (little children, very weak, old or mentally ill persons for example): "Pope John Paul II and his successor held that food and water, even when their provision may require technical medical assistance, constitute the "basic care" that patients should receive. The value of such medical assistance is not to be judged by its efficacy in curing the patient or improving the patient’s condition."

I have the impression that while Cardinal Rigali and Bishop Lori explain the Church's position on this issue and point out some errors in the Shannon and Hardt articles, in their writing too could be seen points that are not clear or might be misunderstood. For example thay acknowledge "that this obligation to provide basic care can be exhausted when such assistance can no longer fulfill its basic purpose or finality" that is…when food and water "cannot be assimilated by the patient’s body or cannot be administered to the patient without causing significant physical discomfort". The question remains who will decide that this physical discomfort is ‘significant’ – since the patient is in PVS, does it leave the decision for the medical professionals? For relatives, if there are any?

Then the article speaks about the confusion created by Shannon and Hardt in their respective writings regarding the three exceptions recognized in the C.D.F. Commentary. It would have been good if Cardinal Rigali and Bishop Lori articulate these three exceptions as they see them to be understood correctly. Instead they go on to the question when the treatment is impossible, and they mention the case of poor and undeveloped countries, where the resources are not available. They forget to mention that also in our country, in our developed western society are many for whom this kind of treatment is "impossible". I don’t think only of the homeless (who are maybe just dumped from the hospitals), but many others without health-insurance maybe don’t even arrive to pose the question of how long to live in PVS, since they die before they reach this condition.

Cardinal Rigali and Bishop Lori treat the concept of "burden" that such a care might represent for the patient and they affirm that the "subjective category of burden" is equivalent with dislike for helpless state of life. What if somebody fully appreciates life, yet does not desire this treatment for a motive of solidarity with the before-mentioned poor? The treatment, although not necessary the feeding procedure but the general nursing care is in reality expensive and one might not want it for these reason. Of course, issues of human life never should be pondered on grounds of economical burden, or use death (hastening of death) as a solution for financial problems and so any form of euthanasia is to be avoided. Yet someone might just desire not to receive endless life-support on earth – since as the authors too pointed out "Earthly life is not the highest of all goods, and our hope in eternal life puts in proper perspective all disproportionate and burdensome efforts to sustain life."

At the end I came to the conclusion that in this area probably there is no possibility of giving general rules that embrace every situation – except some very general statement about the value of human life that needs to be protected, like this statement from the article: "Life is, however, the first and most basic good of the human person, the condition for all others: "Life is always a good" (Evangelium Vitae, No. 34). The way we treat this life here and now—especially the life of those who are most helpless and least able to care for themselves—has consequences for our own eternal destiny." It seems like somebody always will need to take the risk of a personal decision how long and what care to provide and bear the moral weight on his/her conscience for this decision. There is no way around, we need to decide always individually, in each unique case in the light of the general guideline about the value of human life.

Link to the article: http://www.americamagazine.org/content/article.cfm?article_id=10952