Melbourne bioethicist Fr Kevin McGovern is uncertain how he would handle being in Christian Rossiter’s place, but a comparable predicament experienced by his own father helps focus his thoughts.
The case of Christian Rossiter reveals the difference between secular ethics which allows people to refuse tube feeding, and Catholic ethics which holds as a general rule that we have a duty to preserve our life and that we therefore should not refuse tube feeding.
After being hit by a car in 2004 and suffering two falls in 2008, Mr Rossiter has quadriplegia, the same condition that actor Christopher Reeve lived with from his horse-riding accident in 1995 until his death nine years later in 2004.
Wanting to die, Mr Rossiter told his carers to stop giving him food down his feeding tube. On 14 August, Chief Justice Wayne Martin of Western Australia’s Supreme Court confirmed his right to refuse tube feeding. This legal decision is based ultimately on the secular ethics which developed in an era called the
Enlightenment at the beginning of the modern period in the eighteenth and nineteenth centuries.
By contrast, Catholic ethics upholds the traditional morality which developed from the very beginning of Western civilisation.
Perhaps the two major differences between these systems of ethics is that the secular ethics offers people an unlimited choice to refuse treatment, and also encourages them to make quality of life judgements. In other words, it invites people to refuse any treatment at all and so to die, on the grounds that their quality of life after treatment would be unacceptable to them.
I believe that quality of life judgements are very dangerous.
I learnt this above all from my own father who, though he was not paralysed, was fed through a tube for the last four years of his life.
I asked Dad once whether he regretted the cancer treatment which left him unable to swallow.
He thought for a while, and then said, “To be honest, if I’d known ahead of time that I’d end up like this, I don’t know that I would have chosen it.”
He then looked directly at me, and said with conviction, “But now that I’m in this situation, I have to tell you: life is still sweet!”
These quality of life judgements are even more dangerous if we are unable to speak for ourselves and they are made for us by someone else. Especially if they are young and strong, they might think that they could never live like this, and they might then refuse treatment for us which we ourselves would have chosen.
Catholic ethics advises us not to try to make these dangerous quality of life judgements. Even if we are frail or sick or profoundly disabled, it is still good to be alive.
For example, Pope John Paul II – who himself knew such suffering at the end of his own life – told us repeatedly that “life is always a good.” In the same way, the Code of Ethical Standards for Catholic Health and Aged Care Services in Australia states that “it is not consistent with the principle of the sanctity of life to claim that the value or worth of a human life can be in any way reduced by illness or disability.”
Unlike secular ethics, the traditional morality of Catholic ethics also holds that we have a duty to use ordinary or reasonable means to preserve our life. For this reason, our legitimate choice to refuse treatment is limited. We should refuse treatment only if it is either futile or too burdensome.
Treatment is futile if it provides no benefit at all. Treatment can be burdensome in many ways: it can be physically too painful, psychologically too distressing, socially too isolating, in some cases financially too expensive, or either morally or spiritually repugnant. But because of our duty to preserve our life, Catholic ethics holds that, if treatment is neither futile nor too burdensome, it should not be refused.
Catholic ethics also holds that as a general rule tube feeding is not futile and not overly burdensome. In 2004, John Paul II taught that “the administration of water and food, even when provided by artificial means, always represents a natural means of preserving life, not a medical act. Its use, furthermore, should be considered, in principle, ordinary and proportionate, and as such morally obligatory.”
I read recently a letter by an Englishman named Simon FitzGerald who is himself paralysed. He wrote about his injury, and his experience “as a 22-year-old man whose existence had suddenly become one of pain and suffering.” He recalled his anguish “when doctors tell you that you will be paralysed from the chest down for the rest of your life.”
But like my Dad and John Paul II, Simon FitzGerald learned that life is always a good. At the end of his letter, he wrote simply, “My experience of 25 years of paralysis is that, despite the anguish, sweat and tears, one can truly find a valuable meaning to one’s life.”
If I was in the same situation as Christian Rossiter or Simon FitzGerald, what would I do? To be honest, I do not know. I hope however that I would have the faith and courage to say, “Don’t stop giving me food down my tube! I want to live!”
– Fr Kevin McGovern is Director of the Caroline Chisholm Centre for Health Ethics, which is sponsored by the Catholic hospitals of Victoria.