When life becomes optional: a comment on Kevin O'Rourke's approach to forgoing life support.

• Author: Mikochik, Stephen L.
• Position: Linacre Quarterly, vol. 58, p. 12, May 1991

This article is my attempt to more clearly understand the euthanasia debate. As a blind person, I have long worried that "quality of life" could be used as a vehicle for invidious discrimination. As a lawyer, I have found much legal commentary on euthanasia unenlightening, as more polemic than analysis. As a Catholic, I have turned to explore what light that tradition could shed on the issues at hand. This article focuses specifically on arguments some Catholic theologians have offered in the current debate over forgoing life support for persons in a persistent vegetative state.

Rev. Kevin O'Rourke, an influential medical ethicist, has offered an approach for determining when life support, including the provision of food and fluids, can be withheld or withdrawn from persons in a persistent vegetative state.(1) Simply put, O'Rourke considers such therapy optional when it is ineffective or a grave burden in helping a person "strive for the spiritual purpose of life."(2) As he elaborated in a 1991 response to William May:

[M]y interpretation of Catholic teaching is based upon the realization that any effort to prolong one's own life or the life of antoehr must be evaluated in regard to the ultimate purpose of human life .... Prolonging life is not the ultimate nor absolute goal of life. If it were, there would be a moral obligation to prolong human life under all circumstances .... In Catholic teaching, the goal of life is eternal life. In order to strive for eternal life, we must perform human acts, (acts of intellect and will) under the influence of charity. Acts of man (vegetative and animal acts) of themselves do not bespeak the power to strive for the goal of human life. Hence, if medical therapy will not restore a person to a condition where human acts can be performed by the person, then that therapy would be ineffective or extraordinary. If the therapy would restore or maintain a person to a condition in which the person could strive for the purpose of life only with excess burden, then it is extraordinary from a moral point of view.(3)

O'Rourke defended this position principally by reference to a 1957 address in which Pius XII gave general guidance on the propriety of forgoing medical care.(4) "Life, health, all temporal activities," the Pope declared, "are in fact subordinated to spiritual ends."(5) Applying this standard, he concluded that "normally one is held to use only ordinary means [to prolong life]," since "[a] more strict obligation would ... render attainment of . . . [that] higher, more important good too difficult."(6) However, he added that "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 important duty."(7)

William May, another influential Catholic scholar on medical ethics, has pointed out some apparent consequences of O'Rourke's position. As a result of mental impairments, many persons are not able to make judgments and free choices and are thus incapable of pursuing spiritual ends. As May viewed O'Rourke's position, therapy that was ineffective for such conditions was optional even though itself lifesaving. He conjectured that,

for example, if an elderly individual ... whom everyone would regard as a noncompetent person ... should suffer a cut artery and be in danger of dying because of loss of blood, ... on O'Rourke's analysis, ... [treatment] would not [be obligatory] for ... [it] would not be effective in helping this person to 'strive for the spiritual purpose of life.'(8)

And May concluded that O'Rourke's position would "logically lead to a quality of life ethic"(9) that he believed "the Catholic tradition has repudiated ... [since it] would deny persons needed medical care simply on the basis of the quality of their lives."(10)

In response, O'Rourke criticizes May for using the term quality of life univocally.(11) Instead, he contends that the term is analogous--its meaning will vary with the context.(12) In that regard, he ascribes three meanings to quality of life:

In one sense of the term persons with genetic or acquired disabilities are said to have a 'diminished quality of life' because they cannot perform actions in a 'normal' manner. Even though these persons have physical or mental disabilities they are not necessarily suffering from a fatal pathology. The term quality of life is also used to refer to people who have impaired function precisely because they are suffering from a fatal pathology .... Thirdly, quality of life is used when referring to people who have less than normal function, who also have a fatal pathology, but whose impaired function is not the result of the fatal pathology.(13)

O'Rourke maintains that life support decisions...