Are feeding tubes Ordinary or Extraordinary treatment?

[awkward customer]

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.

Do ice chips and Jell-O constitute fluid and food?  Or are they given to a patient in a coma in order to keep the mouth and lips moist?

Chips of ice dropped into a comatose patients mouth for the purpose of keeping the patient's mouth moist are not fluid and as for the Jell-O - how much was given?  A teaspoonful or less?  To help keep the mouth moist and maybe provide a bit of variety.

But this is not food and fluid.  I hope this is not being used to claim that Terri Schiavo was able to take food and fluid orally.

It is essential to keep a comatose patient's mouth moist by these and other means.

Meanwhile, if Terri Schiavo has been able to eat and drink, she wouldn't have needed the feeding tube.

[Baylee]

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. 

Agreed.  You posted this:

"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

I'm not sure what the "Fr Kelly Manual" is, but assuming it's a pre-Vatican II moral theology manual (because I couldn't care less what JPII or the post Vatican II church says about anything), this in and of itself shows that one can have differing opinions on any given case.  In this case, Fr Cekada happened to have a different, minority opinion. I appreciate that you can discuss him and his position without demonizing him (or anyone who might agree with him).  I do have a request though:  can you format your comments with italics, so it is easier to distinguish them from the other quotes?

I actually do not know where I stand on this case at this time.  When this was happening, I was still a NO dupe, and I was completely against the tube removal.  After considering Fr C's points, I realized that perhaps I should take a much closer look at it than I did when my emotions were running wild years ago. I have to admit that there does seem to be quite a bit to consider, but as of now I lean towards this being extraordinary means.

I happen to know a Bishop who disagreed with Father, but he remains respectful of Fr C and his opinion noting that theological disagreements such as this is just more proof that we do not have a pope who is the only one who can definitively rule on them.

[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. 

Agreed.  You posted this:

"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

I'm not sure what the "Fr Kelly Manual" is, but assuming it's a pre-Vatican II moral theology manual (because I couldn't care less what JPII or the post Vatican II church says about anything), this in and of itself shows that one can have differing opinions on any given case.  In this case, Fr Cekada happened to have a different, minority opinion. I appreciate that you can discuss him and his position without demonizing him (or anyone who might agree with him). 

I actually do not know where I stand on this case at this time.  When this was happening, I was still a NO dupe, and I was completely against the tube removal.  After considering Fr C's points, I realized that perhaps I should take a much closer look at it than I did when my emotions were running wild years ago. I have to admit that there does seem to be quite a bit to consider, but as of now I lean towards this being extraordinary means.

I happen to know a Bishop who disagreed with Father, but he remains respectful of Fr C and his opinion noting that theological disagreements such as this is just more proof that we do not have a pope who is the only one who can definitively rule on them.

Yes, as I said (not to you) in the other thread, "perhaps look into the actual facts of the case" first.

That's a reasonable place to start for anyone and I don't mean it in a snarky way at all. We all sometimes jump into things.

So far there are statements about "cruel and unusual punishment" from someone who doesn't even know basic facts about the case such as that the woman in question was able to breathe perfectly, was not in a coma, was not experiencing any pain from her treatment, and was subsequently denied even basic hydration for two weeks, by court order, which was ultimately put down as the official "cause of death".

Since the thread started by Fr. Cekada himself, the same person has been using the terms "ordinary" and "extraordinary" means all while admitting they have not read the excerpts from the moral manuals cited by Frs. Cekada and Jenkins explaining these terms.

If anyone will take the time to actually read the debate posted multiple times

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

they would see that Fr. Cekada himself has to basically admit in the end that his arguments do not actually apply to the case of Terri Schiavo, and he changes the argument to whether or not a feeding tube is ALWAYS ordinary means, when the actual question was not that, but rather whether it was ordinary means in this particular case.

What Fr. Jenkins and others clearly also showed was that even outside the question of the feeding tube- in this particular case- all the elements of "euthanasia" as defined by Fr. Cekada's own sources, were present.

"Euthanasia usually implies the use of some positive means to end life: e.g., taking poison, a lethal dose of some drug, and so forth. But death can also be brought about in a negative way: i.e., by not taking or giving something which is necessary for sustaining life; and in some cases this failure to take or give what is necessary for preserving life is equivalently euthanasia."

"Every individual has the obligation to take the ordinary means of preserving his life. Deliberate neglect of such means is tantamount to suicide. Consequently, every patient has the duty to submit to any treatment which is clearly an ordinary means; and his doctor, as well as the nurses and hospital personnel, has the duty to use such means in treating the patient. To do less than this is equivalently euthanasia."

"The failure to supply the ordinary means of preserving life is equivalent to euthanasia."

[Baylee]

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. 

Agreed.  You posted this:

"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

I'm not sure what the "Fr Kelly Manual" is, but assuming it's a pre-Vatican II moral theology manual (because I couldn't care less what JPII or the post Vatican II church says about anything), this in and of itself shows that one can have differing opinions on any given case.  In this case, Fr Cekada happened to have a different, minority opinion. I appreciate that you can discuss him and his position without demonizing him (or anyone who might agree with him). 

I actually do not know where I stand on this case at this time.  When this was happening, I was still a NO dupe, and I was completely against the tube removal.  After considering Fr C's points, I realized that perhaps I should take a much closer look at it than I did when my emotions were running wild years ago. I have to admit that there does seem to be quite a bit to consider, but as of now I lean towards this being extraordinary means.

I happen to know a Bishop who disagreed with Father, but he remains respectful of Fr C and his opinion noting that theological disagreements such as this is just more proof that we do not have a pope who is the only one who can definitively rule on them.

Yes, as I said (not to you) in the other thread, "perhaps look into the actual facts of the case" first.

That's a reasonable place to start for anyone and I don't mean it in a snarky way at all. We all sometimes jump into things.

So far there are statements about "cruel and unusual punishment" from someone who doesn't even know basic facts about the case such as that the woman in question was able to breathe perfectly, was not in a coma, was not experiencing any pain from her treatment, and was subsequently denied even basic hydration for two weeks, by court order, which was ultimately put down as the official "cause of death".

Since the thread started by Fr. Cekada himself, the same person has been using the terms "ordinary" and "extraordinary" means all while admitting they have not read the excerpts from the moral manuals cited by Frs. Cekada and Jenkins explaining these terms.

If anyone will take the time to actually read the debate posted multiple times

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

they would see that Fr. Cekada himself has to basically admit in the end that his arguments do not actually apply to the case of Terri Schiavo, and he changes the argument to whether or not a feeding tube is ALWAYS ordinary means, when the actual question was not that, but rather whether it was ordinary means in this particular case.

What Fr. Jenkins and others clearly also showed was that even outside the question of the feeding tube- in this particular case- all the elements of "euthanasia" as defined by Fr. Cekada's own sources, were present.

"Euthanasia usually implies the use of some positive means to end life: e.g., taking poison, a lethal dose of some drug, and so forth. But death can also be brought about in a negative way: i.e., by not taking or giving something which is necessary for sustaining life; and in some cases this failure to take or give what is necessary for preserving life is equivalently euthanasia."

"Every individual has the obligation to take the ordinary means of preserving his life. Deliberate neglect of such means is tantamount to suicide. Consequently, every patient has the duty to submit to any treatment which is clearly an ordinary means; and his doctor, as well as the nurses and hospital personnel, has the duty to use such means in treating the patient. To do less than this is equivalently euthanasia."

"The failure to supply the ordinary means of preserving life is equivalent to euthanasia."

Please quote where he does the bolded.

[queen.saints]

"However, my writings on the Schiavo case centered on something else: the principles that Catholic moral theology would apply to removing a feeding tube.

I do not want my parishioners to be left with the impression -- due to the high emotions and bitter controversy fanned by the morally bankrupt media and by various lay and clerical grandstanders -- that something is a mortal sin when it is not.

Who knows when any one of my flock may be called upon to deal with the issue of a feeding tube for himself or a family member?

Here, put very bluntly, are the two essential questions in moral theology that I have sought to resolve:

(1) Does the Fifth Commandment under pain of mortal sin always require a sick person who is unable to eat or drink by natural means to have a doctor shove a tube into his nose or poke a hole into his stomach in order to provide food and water?

(2) Does the Fifth Commandment under pain of mortal sin then always forbid such a person to have these tubes removed, no matter what grave burdens -- pain, revulsion, depression, expense, etc. -- their continued use may impose on him or another?"


This was not what his original statement said. The original question was whether or not this particular woman was euthanized.

[Baylee]

"However, my writings on the Schiavo case centered on something else: the principles that Catholic moral theology would apply to removing a feeding tube.

I do not want my parishioners to be left with the impression -- due to the high emotions and bitter controversy fanned by the morally bankrupt media and by various lay and clerical grandstanders -- that something is a mortal sin when it is not.

Who knows when any one of my flock may be called upon to deal with the issue of a feeding tube for himself or a family member?

Here, put very bluntly, are the two essential questions in moral theology that I have sought to resolve:

(1) Does the Fifth Commandment under pain of mortal sin always require a sick person who is unable to eat or drink by natural means to have a doctor shove a tube into his nose or poke a hole into his stomach in order to provide food and water?

(2) Does the Fifth Commandment under pain of mortal sin then always forbid such a person to have these tubes removed, no matter what grave burdens -- pain, revulsion, depression, expense, etc. -- their continued use may impose on him or another?"


This was not what his original statement said. The original question was whether or not this particular woman was euthanized.

I don't see a shift at all. His original statement was the following:

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".

It seems to me that he is still considering the same issue of murder (euthanasia) in this particular case by discussing the Fifth Commandment (i.e.. whether inserting/keeping/removing a feeding tube constitutes murder), but tries to make it clearer.  I see nowhere that he is "admitting" his arguments don't apply nor "changing" his arguments.

Again, what I see is that it is possible to have different opinions on how to apply Catholic moral theology in this case.

[Bernadette]

I remember hearing one of the Audio Sancto priests preach on this topic. Very sobering.

[awkward customer]

So far there are statements about "cruel and unusual punishment" from someone who doesn't even know basic facts about the case such as that the woman in question was able to breathe perfectly, was not in a coma, was not experiencing any pain from her treatment, and was subsequently denied even basic hydration for two weeks, by court order, which was ultimately put down as the official "cause of death".

So, what are the basic facts of the case?

Terri Schiavo suffered severe brain damage following a cardiac arrest at her home which was likely brought on by her bulimia and the constant binge/vomit cycle that causes so much damage to the body.  Bulimics I have known confirm how dangerous this is.

She couldn't drink or eat - but her mouth had to be kept moist, hence the slivers of ice and Jell-O. 

And she couldn't communicate.

After 15 years in this state, immobile in a hospital bed, being fed through a tube in her stomach, unable to communicate and showing no signs of recovery, her husband and doctors decided, in the face of massive protests, to remove the feeding tubes and let her body die.

And the accusations of murder and euthanasia have not stopped since.  So I would like to ask you, queen.saints, why you are so certain that Terri Schiavo was not in distress and that her treatment was not troubling for her?

The doctor referred to in Bonaventure's post had never examined Terri Schiavo in person and only relied on the notes and scans.  Claims that Terri Schiavo could eat and drink turn out to refer to slivers of ice and Jello used the moisten the mouth of anyone in a coma or a prolonged unconscious state.

You talk blithely of tube feeding as if it was just another Ordinary treatment without apparently considering how distressing it could be, especially for someone with an eating disorder.

I agree that for someone with brain damage in an unconscious state, with a reasonable hope of recovery and for a limited period, a feeding tube would definitely be appropriate Extraordinary treatment  But Terri Schiavo had no hope of recovery and had been in that situation for 15 years.

Feeding tubes should never be considered Ordinary treatment - because they aren't.  And to keep someone in that state for 15 years when there is no hope of recovery is definitely, to my mind, cruel and unusual punishment.

But that could be because I have a 'subjective repugnance' towards being immobile and unable to communicate in a hospital bed while food is pumped into by stomach via a feeding tube - for 15 years.

And I'd put money on this being a lot worse for someone with an eating disorder.  Think about it.

[Baylee]

So far there are statements about "cruel and unusual punishment" from someone who doesn't even know basic facts about the case such as that the woman in question was able to breathe perfectly, was not in a coma, was not experiencing any pain from her treatment, and was subsequently denied even basic hydration for two weeks, by court order, which was ultimately put down as the official "cause of death".

So, what are the basic facts of the case?

Terri Schiavo suffered severe brain damage following a cardiac arrest at her home which was likely brought on by her bulimia and the constant binge/vomit cycle that causes so much damage to the body.  Bulimics I have known confirm how dangerous this is.

She couldn't drink or eat - but her mouth had to be kept moist, hence the slivers of ice and Jell-O. 

And she couldn't communicate.

After 15 years in this state, immobile in a hospital bed, being fed through a tube in her stomach, unable to communicate and showing no signs of recovery, her husband and doctors decided, in the face of massive protests, to remove the feeding tubes and let her body die.

And the accusations of murder and euthanasia have not stopped since.  So I would like to ask you, queen.saints, why you are so certain that Terri Schiavo was not in distress and that her treatment was not troubling for her?

The doctor referred to in Bonaventure's post had never examined Terri Schiavo in person and only relied on the notes and scans.  Claims that Terri Schiavo could eat and drink turn out to refer to slivers of ice and Jello used the moisten the mouth of anyone in a coma or a prolonged unconscious state.

You talk blithely of tube feeding as if it was just another Ordinary treatment without apparently considering how distressing it could be, especially for someone with an eating disorder.

I agree that for someone with brain damage in an unconscious state, with a reasonable hope of recovery and for a limited period, a feeding tube would definitely be appropriate Extraordinary treatment  But Terri Schiavo had no hope of recovery and had been in that situation for 15 years.

Feeding tubes should never be considered Ordinary treatment - because they aren't.  And to keep someone in that state for 15 years when there is no hope of recovery is definitely, to my mind, cruel and unusual punishment.

But that could be because I have a 'subjective repugnance' towards being immobile and unable to communicate in a hospital bed while food is pumped into by stomach via a feeding tube - for 15 years.

And I'd put money on this being a lot worse for someone with an eating disorder.  Think about it.

It would be interesting whether an expert in eating disorders (medical doctor, therapist, etc) ever chimed in on this case.

[Baylee]

Here's an article regarding what the medical examiner found during Terri's autopsy:

https://baptistnews.com/article/terri-schiavo-autopsy-says-she-was-brain-damaged-blind-not-abused/

[queen.saints]

I don't see a shift at all. His original statement was the following:

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".

It seems to me that he is still considering the same issue of murder (euthanasia) in this particular case by discussing the Fifth Commandment (i.e.. whether inserting/keeping/removing a feeding tube constitutes murder), but tries to make it clearer.  I see nowhere that he is "admitting" his arguments don't apply nor "changing" his arguments.

Again, what I see is that it is possible to have different opinions on how to apply Catholic moral theology in this case.

His original statement was that the Terri Shiavo case was not an anti-euthanisia issue.


Ordinary means were defined by Manuals that Fr. Cekada himself either used to be,

"all medicines, treatments, and operations, which offer a reasonable hope of benefit for the patient and which can be obtained and used without excessive expense, pain, or other inconvenience."

Fr. Cekada was under the impression that feeding tubes were excessively expensive and inconvenient, a burden on society. But it was shown that here (and in most cases) they are less expensive and inconvenient than even regular feeding, which we are bound to provide. They are certainly less expensive and burdensome than many treatments which are indisputably ordinary means. They could theoretically be excessively painful, but here (and in most cases) they were not. They were providing the benefit of keeping her alive and comfortable.


What, therefore, is the basis for claiming they are extraordinary? In some theoretical circumstance, in which it were excessively painful, expensive, or inconvenient, then, yes, one would not be obliged to accept such treatment and it would not be a mortal sin. But that was not the case here.

However, even if it were extraordinary, his second argument is that the husband has the right to make the decision to deny such treatment. (He also makes the remarkable claim that a husband can even deny forms of water, which is clearly  ordinary means, because of his headship.)

But this is false.

Only the individual has the right to accept or refuse even extraordinary means. Even extraordinary means that are useless and torturous (which these were not).

"it is fundamentally the patient himself who has the right to decide whether or not he shall continue with a useless and extraordinary means which will prolong his intense suffering. It would be rash, indeed, to pose the question to him in his present condition, and it might be equally rash for others to make the decision for him. Who but God knows what goes on in the mind of such a person? Who but God knows what spiritual benefit such suffering may hold for the patient." Fr. McFadden

As even pro-euthanasia advocates have pointed out, the wishes of Theresa were never seriously considered and no evidence presented suggesting she wanted to die the like of which wouldn't have been thrown out under all legal precedent. This was fundamentally a "quality of life" case, where the judge decided she should die, because she had no quality of life, not because she wanted it, or because the feeding tube was excessively burdensome on anyone.

https://scholarship.law.umn.edu/cgi/viewcontent.cgi?article=1038&context=concomm






But even if a feeding tube were somehow extraordinary means in this case, which it was not by any definition of the term used in Catholic theology

and even if it could have been ascertained that she would not have wanted to accept that extraordinary treatment, which it never was

and even if it were true that she could not eat orally, which many close to her deny

and even it were true that she had miraculously survived being unable to swallow her own saliva for 15 years

and could therefore not swallow even a tiny amount of water

This would still be a case of euthanasia.

Because whether or not any of that were true, the fact remains that she was denied even attempting ordinary means. The doctors never even tried to administer food normally to her. There was a court order in place  and an armed police man on guard at all times to make sure that no one could even try to give her water.

"The failure to supply the ordinary means of preserving life is equivalent to euthanasia."

[Baylee]

Question:  if Terri Schiavo could communicate that she wanted the feeding tube out, would she be forced to keep it in? Would those against her husband doing it still be against her doing it? Would the feeding tube still be considered "ordinary" means?

[awkward customer]

Question:  if Terri Schiavo could communicate that she wanted the feeding tube out, would she be forced to keep it in? Would those against her husband doing it still be against her doing it? Would the feeding tube still be considered "ordinary" means?

If feeding tubes were considered Ordinary treatment by the Church, then she would be obliged to keep it in.

But it's an academic question since she couldn't possibly communicate

[awkward customer]

According to the autopsy posted above by Baylee,

The autopsy results for Terri Schiavo, released by Florida officials June 15, conclude that she was not abused prior to collapsing and lapsing into an unconscious state 15 years ago, that she was blind at the time of her death, and that her brain had atrophied to half the normal size.

The report, released more than two months after her March 31 death, also concluded that the 41-year-old Florida woman could not have received enough food or hydration by mouth to sustain life.....

.....Schiavo had been in what court-appointed physicians diagnosed as a "persistent vegetative state" since 1990, when she collapsed from what was initially diagnosed as a heart attack brought on by an eating disorder. Her brain was denied oxygen for an extended period of time, leaving her with significant neurological damage.....

..... Doctors also concluded, while Schiavo was alive, that most of her cerebral cortex had ceased functioning. Her brain stem, they said, was reflexively regulating the bare essentials of life, such as her heartbeat, breathing and digestive processes.

https://baptistnews.com/article/terri-schiavo-autopsy-says-she-was-brain-damaged-blind-not-abused/

Remember, the doctors who diagnosed Terri Schiavo's "persistent vegetative state" had actually examined her in person, unlike Dr Greber who never met her.

[queen.saints]

Here's an article regarding what the medical examiner found during Terri's autopsy:

https://baptistnews.com/article/terri-schiavo-autopsy-says-she-was-brain-damaged-blind-not-abused/

The fact that they need to rely on an autopsy report to try to ascertain whether or not she could swallow, eat, and drink is simply highlighting the fact that she was not supplied the most ordinary means of preserving life (in accordance with the court order to cease all life-prolonging measures) and died an excruciating death without even a drop of water allowed to touch her lips for 13 days.