Are feeding tubes Ordinary or Extraordinary treatment?

[awkward customer]

A discussion about the Terri Schiavo case has emerged in the 'Sedevacantism and Akita' thread in the Sede subforum.  Since I have been a major participant in this discussion, I'm starting a new thread because the issue of the Ordinary/Extraordinary nature of feeding tubes is an important one and so as not to keep derailing the thread.  I also feel obliged to defend the late Fr Anthony Cekada against accusations of promoting murder etc etc.

So here goes.  I maintain that feeding tubes are Extraordinary treatment and that Terri Shiavo was kept alive for 15 years in conditions that could easily be described as cruel and usual punishment.

But there are others who disagree.

So what does the Church say?  Are feeding tubes Ordinary or Extraordinary treatment?

[LausTibiChriste]

I know nothing about the Schiavo case nor the Church teaching on the matter, but since we're on a forum and my $0.02 is there for the taking....

You would have to think it's extraordinary, no? Unless feeding tubes have been around for centuries (doubt it), then it's a relatively modern means of keeping a person alive. In which case, it's extraordinary.

Seems like (I have nothing to back this up with) that prior to the 20th century, or whenever feeding tubes were invented, you'd just let them die.

[crossingtherubicon]

I was surprised to hear the other day that the sacraments work as intended even if the person is in a coma.  Or in other words the person can get full pardon even if in a coma.  The world is on this obsession of keeping the consciousness alive in a physical body or robotic body eternally, which of course is completely unnecessary because the consciousness will stay alive anyway and in fact damned or saved will get a brand new body regardless.  So keeping someone on a feeding tube for 15 years is pointless.

[Miriam_M]

Perhaps Bonaventure would be willing to migrate the relevant posts on the other thread to this one.

[ChairmanJoeAintMyPrez]

https://www.ncbcenter.org/resources-and-statements-cms/summary-nutrition-and-hydration-anh

I don't agree with the NCBC on everything, but they didn't come up with this themselves and are just elaborating on what was taught by Pope Benedict's CDF.

[awkward customer]

Here's a link to info that Bonaventure first posted.

https://www.wcbohio.com/articles/the-execution-of-terri-schiavo-1

And since Fr Anthony Cekada has bee accused of supporting murder, here's his argument, lifted from the above site.

[1] Rev. Cekada's Original Statement: April of 2005

The Terri Schiavo Case and Extraordinary Means

by Father Anthony Cekada

I HAVE BEEN repeatedly asked for my thoughts on the Terri Schiavo case. Here, for the record, is a brief summary of my opinion.

Many traditional and "conservative" Catholics were misled by unprincipled politicians and pseudo-conservative talk-show hosts into thinking of it as a pro-life or anti-euthanasia case.

It was no such thing – and this demonstrates how wary one should be of turning for moral guidance to the advertiser-shilling blowhards of Fox News and the EIB Network.

Instead as Catholics we must turn to the teaching of theologians and the magisterium.

Here, the key issue is preserving a life by "extraordinary means," a concept first developed by the 16th-century Dominican theologian Vittoria as follows:

"If a sick man can take food or nourishment with a certain hope of life, he is required to take food as he would be required to give it to one who is sick. However, if the depression of spirits is so severe and there is present grave consternation in the appetitive power so that only with the greatest effort and as though through torture can the sick man take food, this is to be reckoned as an impossibility and therefore, he is excused, at least from mortal sin."

"It is one thing not to protect life and it is another not to destroy it. One is not held to protect his life as much as he can. Thus one is not held to use foods which are the best or most expensive even though those foods are the most healthful. Just as one is not held to live in the most healthful place, neither must one use the most healthful foods. If one uses food which men commonly use and in quantity which customarily suffices for the preservation of strength, even though one's life is shortened considerably, one would not sin. One is not held to employ all means to conserve life, but it is sufficient to employ the means which are intended for this purpose and which are congruous."

Other theologians subsequently refined and developed this teaching, until in 1957, we find Pope Pius XII explaining its application as follows:

"Normally [when prolonging life] one is held to use only ordinary means according to the circumstances of persons, places, times and cultures -- that is to say, means that do not involve any grave burdens for oneself or another. A more strict obligation would be too burdensome for most people and would render the attainment of a higher, more important good too difficult. Life, health, all temporal activities are in fact subordinated to spiritual ends. On the other hand, one is not forbidden to take more than the strictly necessary steps to preserve life and health, as long as he does not fail in some more serious duty."

These and similar passages in other authors led me to conclude that in the case of Terri Schiavo, the feeding tube, etc. constituted extraordinary means.

(Consider the "grave burdens" that such means would increasingly impose on society, now that medical science can keep the dying and unconscious going for years.)

This was also the conclusion of Bishop Donald Sanborn, who teaches moral theology – the branch of theology that deals with ascertaining whether specific human acts are morally good or morally evil.

Accordingly, as regards applying the principles of Catholic moral theology: (1) One could have continued to employ these extraordinary means to maintain Terri Schiavo's life; however (2) one would not have been obliged to do so.

It is false therefore to claim that Terri Schiavo was the victim of "euthanasia" or "murder." Further, in my opinion, Mrs. Schiavo's husband (as horrible a person as he seems to be) - and not her parents - had the sole right before God to determine whether these means should have continued to be used.

My comments here, like those on the Iraq War, may cause consternation for some good lay people. But when it comes to contemporary issues, my duty as a priest is to research the Church's teaching, tell you what it is, and tell you how to apply it.

[awkward customer]

I know nothing about the Schiavo case nor the Church teaching on the matter, but since we're on a forum and my $0.02 is there for the taking....

You would have to think it's extraordinary, no? Unless feeding tubes have been around for centuries (doubt it), then it's a relatively modern means of keeping a person alive. In which case, it's extraordinary.

Seems like (I have nothing to back this up with) that prior to the 20th century, or whenever feeding tubes were invented, you'd just let them die.

This makes complete sense.

But not to those who argue that feeding tubes are Ordinary treatment. They say that removing Terri Schiavo's feeding tubes after she had spent 15 years immobile in a hospital bed as a result of extensive brain damage following a cardiac arrest and having to be fed by a tube inserted directly into her stomach, was an execution, or an act of murder.

[LausTibiChriste]

Nonsense.

I'd be willing to bet that any artificial means of keeping a person a live is de facto extraordinary.

15 years is insane.

[queen.saints]

Fr. Cekada breaks down his arguments into three main points as to why he believes Terri Schiavo was not euthanized.

https://www.wcbohio.com/articles/the-execution-of-terri-schiavo-1


1) EXTRAORDINARY MEANS

2) WHO DECIDES


3) EMOTION OR PRINCIPLE?


It is also necessary to add a point 4 highlighting that even extraordinary means (not relevant to this case, but in case anyone maintains they are) are often morally required and the issue is nuanced and more than a question of simply ordinary vs extraordinary.


1) 1) "the feeding tube... constituted extraordinary means."




"Normally [when prolonging life] one is held to use only ordinary means according to the circumstances of persons, places, times and cultures -- that is to say, means that do not involve any grave burdens for oneself or another... the strictly necessary steps to preserve life and health." Pope Pius XII

"A medicine, treatment, etc., is to be considered an ordinary means if it can be obtained and used with relative convenience and if it offers reasonable hope of benefit...

It is important to note that, though the notions of ordinary and extraordinary remain the same, their applications can vary with changing circumstances. For example, major operations used to be considered extraordinary means of preserving life on two counts: first, because the pain was practically unbearable for most people; and secondly, because the outcome was often very uncertain, e.g., because of the danger of infection. Today we have the means of controlling both the pain and the danger of infection; hence, many operations that would have been extraordinary in former times have now become ordinary means of preserving life."

"In concrete cases it is not always easy to determine when a given procedure is an extraordinary means. It is not computed according to a mathematical formula, but according to the reasonable judgment of prudent and conscientious men." Fr. Kelly Manual


This case involves persons living in the United States in 2005 in one of many a worldwide "culture"
where feeding tubes are much less "burdensome" than any other means "to preserve health and life".

It is much less burdensome than cooking three wholesome meals a day and then trying to spoon feed it to a handicapped person. These particular persons even had $750,000 in "means" set aside for the sole purpose of alleviating any burden in preserving her health. Fr. Cekada puts forward the argument of the burden and expense to society, but every other form of care, no matter how ordinary, is much more burdensome, expensive, and less "convenient"


2) "Mrs. Schiavo's husband (as horrible a person as he seems to be) - and not her parents - had the sole right before God to determine whether these means should have continued to be used."




This is completely false and not based on any "principle", "Church standard" or "theology book"; it is his own invention.

Besides the numerous statements by the Church denying the pagan belief that the head of the family has authority to make life or death decisions over his wife and children, here is what the moral manuals say,


"It is fundamentally the patient himself who has the right to decide whether or not he shall continue with [even] a useless and extraordinary means which will prolong his intense suffering." Fr. McFadden


"the first rule concerning the doctor's duty: he must do what the patient wishes. It is the patient who has the right to use or to refuse the extraordinary means; hence, it is primarily the patient who must be consulted. Obviously there are many cases in which it is impossible to consult the patient, e.g., when he is delirious or in a coma, or when he is a small child. In these cases the right to make the decision is vested in those who are closest to the patient, i.e., husband, wife, parents, guardians... the relatives do not make this decision precisely in their own name, but rather as representing the patient; hence, they should try to determine what he would reasonably want done under the circumstances."

3) "The negative response to both these points was almost without exception based on emotion...
not...
principle...
the standard the Church...
a theology book"


Hopefully this post has only used principle, the standard the Church, and his own theology books to show that his points are false.




It is also important to point out to those unfamiliar with the case, that even the ordinary administration of food and water was forbidden by a court order and enforced by an armed police guard. Fr. Cekada does not contend that this was morally permissable. Yet it happened and it clearly shows that this was a case of euthanasia, which was his original point of contention.

[queen.saints]

I know nothing about the Schiavo case nor the Church teaching on the matter, but since we're on a forum and my $0.02 is there for the taking....

You would have to think it's extraordinary, no? Unless feeding tubes have been around for centuries (doubt it), then it's a relatively modern means of keeping a person alive. In which case, it's extraordinary.

Seems like (I have nothing to back this up with) that prior to the 20th century, or whenever feeding tubes were invented, you'd just let them die.

From Fr. Cekada's own source:

"It is important to note that... many operations that would have been extraordinary in former times have now become ordinary means of preserving life."

Also, in this particular case, her family and nurses claimed that she was able to be fed normally.

The claim by doctors at the time that she "couldn't swallow" is clearly a lie, because when someone can't swallow it's a big deal, like when someone can't breathe (which she could) and you can die within minutes. You swallow constantly to keep yourself alive and not choke on your own saliva.

[queen.saints]

I know nothing about the Schiavo case nor the Church teaching on the matter, but since we're on a forum and my $0.02 is there for the taking....

You would have to think it's extraordinary, no? Unless feeding tubes have been around for centuries (doubt it), then it's a relatively modern means of keeping a person alive. In which case, it's extraordinary.

Seems like (I have nothing to back this up with) that prior to the 20th century, or whenever feeding tubes were invented, you'd just let them die.

This makes complete sense.

But not according to...

... any "Catholic principles, Church teaching, or theology books."

Let's stick to the rules of the discussion as put forward by Fr. Cekada himself (who I have nothing against) and only use such sources, not our emotions. 

[queen.saints]

Perhaps Bonaventure would be willing to migrate the relevant posts on the other thread to this one.

Yes, I would appreciate that, because the original arguments are being somewhat misrepresented here.

[drummerboy]

Weren't her fluids withheld as well?  I can't remember the exact details, I was a wee lad at the time. 

[Bonaventure]

Weren't her fluids withheld as well?  I can't remember the exact details, I was a wee lad at the time. 

Yes, and Cekada references that:

"A wicked husband still maintains his headship over the wife before God and his "domestic and paternal authority.  He has the right to say yes or no to ice chips and Jello, unless and until an ecclesiastical or civil court, for a grave and just reason, legitimately impedes him from exercising his right."

The ice chips and Jell-O reference would only be for someone who could swallow.

[Bonaventure]

Perhaps Bonaventure would be willing to migrate the relevant posts on the other thread to this one.

Yes, I would appreciate that, because the original arguments are being somewhat misrepresented here.

I'm not sure how to do it. Perhaps @Kaesekopf knows how to merge posts to this thread from another thread.