The end-of-life issues raised by the Terri Schiavo case have long been discussed by thinkers in the major religions and at first glance, they seem to agree: Each faith emphasizes preserving life, though there is no mandate for prolonging it at all costs.
The problem comes in implementing that idea.
Each medical case raises its own questions about how close the person is to death and what would constitute an extraordinary or heroic treatment that would delay a death with no real benefit to the patient.
“Is there an appropriate time to pull the plug? There certainly can be, but the devil is within the details,” said John Jefferson Davis, who teaches Christian ethics at Gordon-Conwell Theological Seminary, an evangelical school in Hamilton, Massachusetts “Good medical ethics requires both good principles and good facts.”
With the facts in Schiavo’s case in dispute, determining what remains within ethical boundaries is difficult, several experts said.
Court-appointed doctors say Schiavo is in a persistent vegetative state, after her heart stopped beating temporarily 15 years ago, cutting off oxygen to her brain. Her parents, who are observant Roman Catholics, deny that she is in a vegetative state. Video broadcast nationally has shown her appearing to interact with her family. But a court-appointed doctor has said the reactions are merely reflexes.
Of the major faith traditions, the Catholic position on Schiavo’s care is the most definitive. The Vatican newspaper, L’Osservatore Romano, on Monday condemned the withdrawal of the feeding tube, saying only God can decide whether a person should live or die.
“Who can judge the dignity and sacredness of the life of a human being, made in the image and likeness of God? Who can decide to pull the plug as if we were talking about a broken or out-of-order household appliance?” the paper said in a commentary.
A year ago, Pope John Paul II said that feeding and hydrating a patient in a vegetative state was “morally obligatory” and called withdrawal of feeding tubes “euthanasia by omission.”
Some debate ensued among theologians about what the pope’s statement meant for Catholics who draft living wills. However, the pope’s position on Schiavo is unambiguous, since she is brain-damaged, not terminally ill, said John Grabowski, professor of moral theology at Catholic University in Washington.
“You’re not dealing with a person who is dying or facing imminent death,” Grabowski said. “The pope says it doesn’t matter if a person is unresponsive or comatose. They don’t lose their personal dignity.”
Dr. Shahid Athar, head of medical ethics for the Islamic Medical Association of North America and a professor at Indiana University School of Medicine, said Muslim teaching also requires that Schiavo continue to be fed through the tube, although no extraordinary steps should be taken to keep her alive.
“You cannot deny hydration or nutrition in a vegetative state,” Athar said. “It’s not a heroic measure.”
In Jewish teaching, however, there is no consensus on situations such as Schiavo’s.
Rabbi Elliott Dorff, author of “Matters of Life and Death: A Jewish Approach to Modern Medical Ethics,” said it appears there is no chance that Schiavo will recover, since she has spent more than a decade in a vegetative state, and therefore he concluded that the feeding tube amounted to an extraordinary measure. He acknowledged that some rabbis would disagree and would argue that providing food and water artificially was simply filling a basic human need.
“But I see artificial nutrition and hydration in this case as medicine,” said Dorff, vice president of the law committee for the Conservative Jewish movement. “At some point or another, we have to recognize that death has come and begin to deal with that appropriately, not medically, but through the mourning process.”