Gleanings from the Pastor's Perspective: Bearers of God's Image

The Pastor’s Perspective

“Bearers of God’s Image”

First Published: May 16, 2005

Last week, we looked at the issues relating to the Terry Schiavo case (Is it sinning to withdraw nutrition and hydration (food and water) from a patient when death is not imminent? To what extent do human beings have autonomy over our bodies in relation to our own death, in light of the sovereignty of God and the sanctity of human life, at least with regard to refusing medical treatment? At what point does quality of life become so bad that ending life is justified?) via the lenses of the sixth commandment and the Larger Catechism.

Several things stood out to us in that study. First, the Catechism reminded us, in expounding the sixth commandment, that we have a duty “to preserve the life of ourselves and others.” This, of course, means that suicide and enthanasia are forbidden under the sixth commandment, but it also has implications for the question of withdrawing hydration and nutrition. Second, the Catechism explains that we are to avoid “all occasions, temptations, and practices, which tend to the unjust taking away the life of any.” Third, the Catechism reminds us that we have an obligation to comfort and aid the distressed. Fourth, the Catechism also tells us that “the neglecting or withdrawing the lawful and necessary means of preservation of life” is a violation of the sixth commandment. This principle is particularly relevant to the Schiavo case.

So what do these principles mean for the Schiavo case and others like it. Well, for one thing, the Catechism indicates that obedience to the sixth commandment, forbids the withdrawal of hydration and nutrition (food and water) unless death is imminent and inevitable. That is, the withdrawal of food and water must not be the proximate cause of death. Food and water are basic necessities of life (not “heroic” or “extraordinary measures”), and if we were to withdraw them from a perfectly healthy person for a time, he or she would die. Whether the means by which nutrition and hydration are provided (by spoon and fork, straw, enteral and parenteral, or other means) is immaterial to this fundamental to this obligation.

Secondly, even in cases of severe dementia, end-stage Alzheimer’s, or the patient’s own desire to end his life, such conditions are subordinate to the prior obligation of obedience to the sixth commandment. In such cases, our following God’s Word, is both an act of obedience to the sixth commandment and an act of love and compassion, regardless of the perception of an unbelieving world.

Thirdly, regarding the recent withdrawal of food and water from Terri Schiavo, and her subsequent death (a case that has received more attention across our nation than any medical ethical case in recent memory): though it is not the Church’s calling to engage in a post-mortem concerning who failed, how, and why, nevertheless, it has presented us with a teachable moment in our national life. There are circumstances in which Terri Schiavo’s food and water might morally and lawfully have been withdrawn: namely, if death had been imminent and inevitable and if the continued provision of food and water–within that specific context of imminence and inevitability–would have been determined to be excessively burdensome. However, the one thing certain about Terri Schiavo was that her death was not imminent and inevitable. On the contrary, she was quite persistent in living, and there is no reason to believe the loving care she was provided--specifically her nutrition and hydration–was burdensome. Rather, her physical condition was burdensome, while being completely compatible with life.

To accomplish her death required withdrawing the necessary means of the sustaining of her life with the direct intent of killing her, which it did. Consequently, her starvation was a violation of God’s Moral Law as revealed in Scripture, the Sixth Commandment, “Thou shall not murder” (Exodus 20:13). Terri Schiavo bore God’s image and was owed by all those involved the basic means necessary for the preservation and sustaining of her life–specifically, the provision of food and water.

Your friend,

Ligon Duncan

NOTE: I am indebted to Tim Bayley and the Ohio Valley Presbytery for many of the thoughts and words in this article.