The case of Scott Routley is an example in advances in medicine which raise dilemmas and can have an implication for future developments and necessitate changes to ethical reflection. Before discussing this case it is important to clarify some issues:
- A persistent vegetative state needs to be distinguished from Coma or minimally conscious states. A PVS is a diagnosis made over time with special scans and should show that there is no effective cortical functioning (as opposed to this case)
- A PVS is always a side effect of modern medicine.
- The Catholic Church, during the tenure of Pope John Paul VI had expressed that over-treating patients and sending them into vegetative states (which at that stage cannot therefore exclude minimally conscious states) is considered immoral.
In the UK, people are treated for up to six months as they study these states very actively. Up to six months they have had successes of 50% in adult and 51 % in children in reverting the pathology, using such drugs as dopamine. After six months the success rate is zero and after one year the doctors, along with the family make a decision about the patient.
Locally we have no laws but we follow moral teaching which is usually of course in agreement with the Catholic normative values of the country, even if experience is showing that some doctors would still continue to treat and do not discuss the options with relatives. Although no studies have been done it is doubtful how much the spiritual counsellors counsel families that extraordinary treatment is not necessary. Families today find it difficult to decide what is and what is not extraordinary, which, as defined by Pope Pius XII should not be defined by the state of the art of the treatment but by the wishes of the patient, and in the absence of this, by taking into consideration the wishes of the family. Along with this Pius XII affirmed the Catholic medical advice that treatment can never be given without consent of the patient (or family) and that futile treatment need not be given, affirming that there is a clear difference between killing and allowing to die.
The case of Karen Ann Quinlan clearly showed that Catholic faith allows people to be removed from life support equipment, even before brain death has occurred. The case of McAffee in Atlanta was even more controversial where the local Bishop allowed the removal of life saving respiratory equipment from the patient who remained totally paralysed but conscious following an accident. Of course he had to be sedated before his life support was removed. This contrasts to the more recent Welby case.
Following Terry Schiavo and Eluana Englaro we are now in a difficult situation in which patients who went into a PVS because, as in the case of Englaro, over-enthusiastic resuscitation, we find ourselves in difficulty to stop treatment, which at that stage can be considered only care. Whilst accepting that artificial nutrition and hydration should perhaps be given anyway once we have made the mistake, if a mistake it is, to send a patient into a vegetative state, many would say that other forms of treatment need not be given. To this author this is indeed contradictory; once you are keeping a person alive with artificial nutrition and hydration (which is indeed something which needs continuous assessment and expertise), one presumably does this, even for over fifteen years, because of the dignity of the person. Then why not give all other treatment such as physiotherapy and medical treatment of infection so that, as in the case of Routley, or in those who come back miraculously to life after so many years, at least find a healthy and functioning body and not one that has been neglected to a certain extent other than being fed, hydrated and washed?
The resolution to these dilemmas has not been assumed under Catholic teaching and in fact under normal circumstances food and water are now always considered necessary. But one must note that statements add ‘normal’ or ordinary circumstance. This means that if the heart stops beating, one may not give Cardiopulmonary rescusitation.
What probably should be the moral resolution to these questions is to apply more clearly, and indeed disseminate proper teaching of, the precept of 1951. Legislation in this regard is even easier than, say, for Invitro fertilization, as Catholic teaching here does not pose issues even to a more liberal world. We should be careful not to send patients into vegetative states and accept death how, when and where it comes after giving due attention. The moral implication of sending someone into a vegetative state should be burdened on medical teams and the relatives of patients. However it is the responsibility of the Church to answer the following question now that more than half a century of experience since 1952 have passed: If we can allow the removal of life support systems even before one is brain death, once in good faith such systems are not removed and the person goes into a vegetative state, why cannot we stop treatment at that stage. Secondly does the tenet that there is a moral equivalence between not starting treatment, and discontinuing treatment, hold here as well?