In the end, they died just two days apart: Terri Schiavo, on March 31st, a Thursday morning; and Pope John Paul II, on April 2nd, a Saturday afternoon (our time).
So, given all the news coverage, both leading up to these events and following them, the subject of death and dying has been very much on our minds and hearts these past several weeks.
Of course, normally we would much prefer to consign the topic of death to the farthest corners of our awareness, even though the truth lying at the heart of our Easter faith is the affirmation that death cannot separate us from the love of God. Oh, when Jesus's disciples were confronted by the specter of his impending death, he did say to them, "Do not let your hearts be troubled" (John 14:1a), but the fact of the matter is that when we are faced with death, whether our own or that of a loved one, fearful anxiety comes to us quite easily, whereas calm courage comes to us only with difficulty.
Now, leading up to Terri's death, it was her body that was sound but her brain that was persistently vegetative. So she was incapable of either thought or emotion, her brain having been damaged by an oxygen deficiency when her heart stopped beating for a time one night fifteen years ago.
Whereas leading up to John Paul's death, his brain was alert and conscious. It was the systems of his body that were collapsing, through the decade-long effects of Parkinson's disease, some heart damage, an enlarged prostate gland, a constriction of his trachea, plus the presenting cause of a urinary infection and septic shock.
When Terri died, she had been disconnected from her feeding tube. When John Paul died, he was still connected to his feeding tube, but, in the face of his continuing high fever and breathing difficulties, he had specifically turned down the opportunity to return to a hospital for more aggressive forms of medical intervention. Terri was not at all able, of course, to express her medical wishes, and sadly she had left in writing no living will. But John Paul was fully able to express his medical wishes, and no one doubts that his death came just as he wanted it—at home among friends and without any burdensome, disproportionate, or overzealous medical treatment.
Terri at her death was surrounded by her family's bitter strife and by intense moral controversy. Tragically, her mother had become so physically disabled by anger over the removal of Terri's feeding tube that she was unable at the end even to enter her daughter's room in order to pray with her and to offer her final goodbyes.
John Paul at his death was attended both by his own remarkable inner peace about his passing away and by the calm, trust-filled presence and prayers of his closest friends. And the moment of his death was completely free of any ethical arguments.
Now, the circumstances of these two deaths—marked by John Paul's opposition in principle to the withdrawal of feeding tubes, but also by his rejection in his own case of any other form of medical intervention—the circumstances of these two deaths, when taken together, frame for us an important set of ethical questions about death and dying. And among those questions are these:
First, where does one draw the line in medical treatment between "essential basic care" and "exceptional intervention"?
Second, what constitutes—in this modern world of ours, where medical technology has developed to the point where the moment of a person's last breath can often be staved off for days, or weeks, or months, or even years—what constitutes a "natural" death?
And third, we all, of course, know that "breath death" is the end of life in this world, but is it possible that having a brain that is in a persistently vegetative state or a brain that is suffering from quite advanced Alzheimer's disease is also a version of the end of life in this world, in the face of which the "release" of a person to God by withdrawing forms of medical intervention becomes morally permissible?
Now, prior to 20th-century advances in medical technology, a person in the condition of Terri Sciavo probably would not have survived her original heart failure; but even if she had, she most assuredly would not have survived for very long after that, since she would not have been able to ingest food and water. What everyone back then would have seen as a "natural" death would have come rather soon. It is only the modern feeding tube that enabled Terri's body to function for any length of time at all after her brain turned vegetative.
An article in the science section of this past Tuesday's New York Times (pp. F1, 6) describes a distinction that doctors began to make just three years ago, in 2002, between the two forms of unconsciousness that are now called the "vegetative" state and the "minimally conscious" state. From the "minimally conscious" state, some "re-awakenings" do occur, even after many, many years. But from a "vegetative" state caused by oxygen deprivation, "re-awakenings" seem not at all to occur after the end of the second year following onset. Well, Terri Sciavo's case was fifteen years old, and over the past three years since 2002 it was the consistent judgment of those doctors who thoroughly studied her condition that hers was not a "minimally conscious" state but a "vegetative" state, and that she therefore had no real chance at all of re-awakening.
So one may ask: since in an earlier era Terri would have been long dead, and since after fifteen years there was no hope at all that she would ever come out of her state of vegetative unconsciousness, is it immoral to remove her feeding tube and let her body die? And since the part of her personhood that is capable of recognizing and worshiping God has been permanently lost to her, is it ethically wrong to entrust this dear person in her persistent vegatative state to God, letting her journey peacefully into her next life?
Well, the ethical argument against removing a feeding tube, the one made by John Paul himself, is that food and water are parts of the "essential basic care" that ought to be provided to persons so long as they draw breath. So, in the view of John Paul, feeding tubes are not optional instruments of medical intervention that one may decide to use or not use, to install or not install, or to even take out. Rather, feeding tubes administer the kind of basic sustenance that one ought never willfully to withhold from another and that one has a moral obligation to provide. According to John Paul, using a feeding tube is not in any sense a medical act. Rather, it is one of those natural means for preserving life, and removing such a tube is an act akin to taking food and water off a hungry person's kitchen table.
On the other hand, a person of my own moral viewpoint argues that a feeding tube is not an item of "essential basic care" but is in fact just another of the many instruments of medical technology available for postponing death—an instrument that it is morally obligatory to use if there's a reasonable prognosis for a patient's physical and mental survival, but an instrument that it is not obligatory to use if there is no such prognosis independent of that instrument's use. If there is not such a positive prognosis, then, in my judgment, the use of a feeding tube becomes a matter for personal moral choice. If a patient chooses to use it, it should be administered, but if a patient chooses not to use it, then it may in the first instance be withheld or, if already inserted, it may thereafter be removed. This, of course, is why I believe it is so very important for each of us to think through these issues and to make our choices clear by drawing up a living will and appointing a health proxy.
As for the moral question, "Is it possible that a brain that is in a persistently vegetative state or that is afflicted with quite advanced Alzheimer's disease is also a version of the end of life in this world?" let me share with you for your reflection parts of an op-ed piece by Elizabeth Cohen that appeared in the New York Times on March 23rd (p. A17). It's entitled, "Keeping Faith With My Father."
Cohen writes: "Late last November my sister and I made the decision to let my father die. It was a cold, dry day, and I still remember the way all the fallen leaves swished through the streets in great brown piles. We drove to the hospital... Neither of us spoke. We did not want to say what we both knew: that it was time.
"When we got to his room we saw what I can only describe as a version of our father. As time went on and his Alzheimer's disease progressed, it seemed as if we were continuously offered new versions of him... [T]he person who [now] lay [there] before us in the hospital bed ... I think of ... as absent-eyed daddy. He was there, he blinked, he coughed a bit because of the pneumonia he had contracted for the third time that year, but he did not seem actually there. It was as if he'd left and somehow, in keeping with the symptoms of his disease, forgotten to take his body along...."
Cohen continues, "For me, it all boils down to a simple question: when does saving a life mean stealing a death? For a year we allowed our father to be treated in hospitals for pneumonias that would have probably ended his life. But what life were we saving? Not one he would have wanted.... Alzheimer's stole my father's mind, and it was wrong to let anything cheat him of the death he would have wanted, too.... [Fortunately,] he had a living will and I [had been] appointed his medical proxy....
"[Since that day of our decision,] on my way to work I often drive by the hospital where my father died. All winter, as the snow cloaked the parking lot where I [had] left my car so many nights [in the past], the sight never once made me sad. We finally did what he wanted: we let him die. He would have been so proud."
Since reading that op-ed piece, I've wondered if the Cohen family has since then found any additional comfort in that marvelous verse from today's Old Testament Lesson that reads, "Precious in the sight of the LORD is the death of ones faithful." (Psalm 116:15)
On this Third Sunday of Easter, we are once again approaching the table at which Jesus addressed his disciples by saying, "In my Father's house there are many dwelling places. If it were not so, would I have told you that I go to prepare a place for you? And if I go and prepare a place for you, I will come again and will take you to myself, so that where I am, there you may be also.... Do not let your hearts be troubled, and do not let them be afraid." (John 14:2-3, 27b)
In the face of death and dying, whether that of ourselves or of others, we are called upon to discern when saving a life means stealing a death. John Paul recognized this in the case of his own dying, and he refused to let a hospital steal his death.
And I would argue that the removal of Terri Sciavo's feeding tube, contrary to the view held by John Paul—that that removal was also a morally acceptable act, an act of refusing to let medical technology any longer steal her death.
Both Terri and John Paul were Christians, and it is ever so important for us Christians as we confront these ethical issues of life and death to hold and affirm our Easter faith that death is not the end, that death is just a passageway from this life to the next, from this life to an eternity of community with God and of fellowship with Jesus. It was this Easter faith that informed and sustained John Paul as he was dying. May this same Easter faith inform and sustain us as well.
Let us pray:
O Risen Christ, our Savior and the Creator of this loving, sustaining community of faith, support us all the days of our life until the shadows lengthen and the evening comes and the busy world is hushed and our work is done. Then, in Your mercy, come to receive us into everlasting communion with You. Amen.