ANSWER:
YOU WRITE: In general, how should an Orthodox Christian view the current situation with Terry Schiavo?

RESPONSE: The principle affirmed by the Orthodox Church is that, while extraordinary/unnatural means should not be taken to prolong a life, especially in the case of brain death, it is also the case that extraordinary/unnatural means should not be taken to prematurely end it. The problem in the Schiavo case is that there is no real consensus, whether it be among her husband and parents and other family members or within the medical establishment, as to whether she is in fact brain dead. While I am certainly no specialist in this, from what I have seen she seems to be responsive on some level and is obviously not in a coma. As such, it would only be my opinion that to hasten her death would be morally and ethically wrong. I have seen people, including my own father, who were brain dead, and from my uneducated perspective his and their situations were quite different from that of Mrs. Schiavo.

YOU WRITE: I guess one of the issues is that of extraordinary means. Does the Church have a position on extraordinary means?

RESPONSE: Yes, as stated above. In the case of my father, whose heart had been stopped for over two hours - far longer than necessary for brain death - and who had been hooked up to a respirator with no chance of ever being able to breath or function on his own, the procedure was clearly extraordinary, and after two futile days, he was removed from support after it was clear that in no way would he be able to breath or function without assistance. Mrs. Schiavo, however, does not appear to be in this same vegetative state.

YOU WRITE: I presume it does but then what are extraordinary means?

RESPONSE: The example of my father would constitute extraordinary means. The respirator did not assist him in breathing; rather, it breathed for him. As the doctor himself opined at that time, one could hook up a child's inflatable swimming pool up to the respirator, and it would force it to "breathe." Pumping air into someone or something, and forcing the air out, in reality does not constitute "breathing." The doctor noted that if he were to be removed from the respirator, there would be no way that he could breathe on his own, since there was absolutely no brain activity.

The flip side of "extraordinary means" comes in bringing a life to a premature ending, as in the case of administering medications designed to literally kill a suffering person, a la Dr. Kevorkian.

And one must always be concerned with such buzz terms and concepts as "quality of life," "death with dignity," and so on. "Quality of life" is a highly subjective term, while "death with dignity," depending on its precise meaning, stands in conflict with the Orthodox Christian belief that death is always a tragedy, that death, not being part of God's creation, is always "unnatural," inasmuch as we were not initially created to die. [Here we're reminded by Saint Paul that death came into the world as a consequence of sin, not by the express will of the Creator.]

YOU WRITE: Does the Church consider a feeding tube extraordinary means? 

RESPONSE: The answer is relative, depending on the condition of the individual. In my father's case, it - the respirator - was clearly an extraordinary/unnatural means, inasmuch as it was clear that he would never breathe or function in any way, due to brain death. In the case of Mrs. Schiavo, for whom no real consensus has been forthcoming yet who clearly is in a different "place" than one who is totally unresponsive on any level, the feeding tube would not be seen as extraordinary / unnatural means. What makes it even more complicated in the case of Mrs. Schiavo is that there are some who have opined that with appropriate therapy, she might return to her former state. While this clearly seems to be a "long shot," it is equally clear that she may be responsive on some level, and as such, it is impossible for anyone to know what is really and completely going on "in her head," so to speak.

YOU WRITE: Another related question would be: How does the Orthodox Church view the matter of a person's wishes in the event they ended up in a vegetative state? In other words, does anyone have the moral right to deny themselves food, water, etc. If they enter a vegetative state or would that be considered suicide.

RESPONSE: Based on the principle noted above, it would seem that one who requests that no extraordinary/unnatural means of prolong life, especially if brain death occurs, would not be .inappropriate and would not constitute suicide, strictly speaking. This is different than requesting a lethal injection of a death delivering substance should one be diagnosed with a terminal illness. For example, the cancer patient who, rather than facing his or her illness requests to be euthanized would not be acting morally or ethically, inasmuch as what he or she is requesting is essentially assisted suicide - which is, indeed, suicide.

YOU WRITE: I was reading in the paper today that doctors speak of a sort of spectrum here. On one end would be coma, then the vegetative state and finally brain death. Maybe you could comment on whether the Church would make a distinction between these states and what would be allowed or not allowed in each instance.

RESPONSE: Obviously, these matters, much less such distinctions, are not found in the traditional writings of the Holy Fathers; this is "new territory," so to speak. It is clear that coma is not synonymous with brain death, and there have been numerous cases - one just a few weeks ago - of individuals who have been in comas for years suddenly emerging from them, to the shock of family and physicians alike. Brain death is something completely different, from my uneducated perspective. Taking extraordinary means to prolong the life of a brain dead individual, on the notion that they might "snap out of it," as in the case of so many coma victims, is more than a "long shot." I must clarify that this is my opinion, and I must also note that it is a somewhat uneducated one, at best.

YOU WRITE: For example, I would guess that the Church would consider a person in a coma should be treated as any other living person and that a brain-dead person would be considered as having already died.

RESPONSE: This would be reasonable, given the Church's definition of death as the parting of the soul from the body.

YOU WRITE: But, where would a person in a vegetative state fall, in the Church's view?

RESPONSE: Again, the term "vegetative state" is somewhat subjective. One can say that Mrs. Schiavo is in such a state because she is completely dependent on others; at the same time, one could say that my father was in such a state as, being brain dead, he was completely dependent on others. For that matter, one could say that a newborn infant is also totally dependent on others - "vegetative" in a different sense of the word. This would seem to indicate that there can be different "shades" of the vegetative state -- but I do not
want to delve into the area of pure speculation, other than to observe that there is a lot of "gray area" here.

YOU WRITE: And does it depend at all on the factors listed above e.g. so-called quality of life, prognosis of recovery, length of time in the state or whatever? 

RESPONSE: Each case would have to be evaluated on its own merits from the pastoral as well as medical perspectives.

Hope this helps.

In Christ,

Father John Matusiak
OCA Communications Director


Reprinted with permission from the official website of the Orthodox Church in America, copyright 2005.