Ronald HAMEL and James WALTER, editors, Artificial Nutrition and Hydration and the Permanently Unconscious Patient: The Catholic Debate. Washington, D.C.: Georgetown University Press, 2007. pp. 294. $29.95 pb. ISBN 9-781589-011786.
Reviewed by James T. BRETZKE, S.J. Marquette University, Milwaukee WI 53201-1881

Writing fully twenty years ago Thomas Shannon and James Walter observed that “[o]n both practical and theoretical levels, the question of forgoing or withdrawing medical nutrition and hydration from PVS patients appears to have reached no clear consensus inside or outside the Catholic community, although ... people are uncomfortable with continuing this technology when there is no reasonable hope of an improvement... .(p. 166).” That conclusion remains even more true today as evidence in the excellent collection of this and twenty other previously published essays and church documents which taken together give us a fine sketch of the status quaestionis of this moral conundrum. The collection is divided into six parts which are accompanied by a very brief overview supplied by the editors: Medical Perspectives, Catholic Tradition and Historical Perspectives, Ecclesiastical and Pastoral Perspectives, Ethical and Theological Perspectives, John Paul II’s [2004] Allocution and Responses, and Legal and Public Policy Perspectives.

Of necessity there is a considerable amount of overlap in treatment of both the history and recent developments in Church teaching as it relates to this area, but rather than being a defect this turns out to be an asset in most cases, as the reader is reminded not only of the basic facts of the moral principles, but more importantly how interpretation is key to the construction of concrete norms derived from these principles.

In general the level of the essays is quite good, though there are some inconsistencies. For example, while it is to be expected that in such a highly controverted issue such as this we would find differences in both nuance and conclusions, one normally would not expect to find these in a single essay written by a solitary author. Thus, it is surprising that when Donald Henke gives a very good overview of the history of the development of ordinary and extraordinary means, when he finally turns to his own personal conclusion regarding the application to PVS patients there seems to be a huge logical disconnect, almost as if another person wrote the last few paragraphs of the essay, had not read carefully, if at all, the bulk of chapter. In a related vein it is interesting to note the contribution of Germain Grisez who speaks with his usual authoritative and absolutist tone, but this time taking one to task of his earlier pieces for not being sufficiently tutiorist (though he can’t resist attacking Kevin O’Rourke, O.P. and Richard McCormick, S.J. in the process). A helpful balance to this sort of argumentation are the pieces by medical experts such as Dr. Myles Sheehan, and Daniel Sulmasy, OFM whose scientific pieces remind us of the danger of apriori apodictic assertions that ultimately rest on problematic, if not downright fallacious health care presumptions.

While obviously in a complex and ongoing issue such as this one not everything that might have a bearing on the debate can be reasonably included. However, a couple of omissions are both surprising and unfortunate. While there is a whole section devoted to “Ecclesiastical and Pastoral Perspectives” one looks in vain for a sustained treatment of how one can and should interpret such magisterial teaching either in general, or in reference to this specific issue. Such works are available and so it is perplexing that the editors either overlooked them or chose not to incorporate them into their collection.

In general the selection of essays was well-done, though another editorial perspective might have substituted essays well over twenty years old with more recent offerings, especially if they could have filled in some of the lacunae noted above. Finally, as with most debates whoever has the last word often seems to carry the day, and so it is unfortunate that Paris/Himes/Keenan 2006 rejoinder to the second of the Shannon/Walter articles included (2005 Theological Studies), failed to make the editorial cut. Nevertheless, this is a welcome and valuable collection of essays which should be widely used by experts, graduate students, and anyone wishing to become better informed on the status quaestionis of this particular end-of-life health care debate.

The debate is obviously still ongoing, and though it is a regret (and not a criticism!) that this volume came out before the CDF’s 2007 Responsum on ANH (artificial hydration and nutrition), the essays contained here provide a sound foundation to continue the discussion, and we all stand in their debt for the balanced mode of discussion they have modeled for us.

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