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If she was a living human being, albeit a severely disabled one, then our responsibility was to ask what we can do to benefit the life she had. It's not within the scope of our authority to ask whether it's a benefit to have her life.

Some people are saying that the burden on the family should be a factor.

Well, that's a tricky question—though in this case her parents were eager to accept the burden.

More generally, surely we should not eliminate you simply because you're burdening me. There are circumstances in which there may be things that I just can't do to keep you alive because it's not within my power. I'm not obligated to do what I'm not able to do. But I don't think that's what we're talking about here.

Are there any cases where a feeding/hydration tube could be ethically removed?

If a patient is in the very last stages of dying, it might be right to do so. There might be a cancer patient brought into the hospital for what everyone knows is the last 72 hours of this person's life.

I don't know that you're under some obligation to keep pumping nutrients into a person under those circumstances, because it is of no benefit to that patient.

A different sort of case would be when the feeding tube presents a burden to the patient. A patient in a severely demented state who is unable to be fed by mouth might regularly pull at the tube and dislodge it. He would have to be physically restrained regularly in order to be fed. I wouldn't restrain him in order to keep the tube in.

Assuming Schiavo indisputably expressed her wish to die under these circumstances, would she have had that authority theologically?

The medical ethics language is often of autonomy—that if she can exercise her autonomy, she should. And if she can't, then the appropriate person to exercise it on her behalf should do it.

That language is not entirely satisfactory, however, for we don't, in fact, give completely free rein to autonomous choices. Except in the state of Oregon, if I say to my physician, "I don't want to live this life any longer; please give me the means to take my life," we will not honor that choice. Autonomous choice doesn't count for everything.

We don't give unlimited free rein to autonomy, but we do give substantial scope to it. I don't want to deny that it would be difficult to spell out in law the various kinds of moral distinctions that are important in different cases. But, morally, there are certainly limits on what we may rightly choose.

There's been some debate about whether a person suffers when the feeding tube is removed.

If a person is really in a persistent vegetative state, and if a persistent vegetative state is what it's claimed to be—that the person is entirely unable to have any self-awareness—then it couldn't make sense to say the person suffered. They just would be entirely beyond any such experience.

But how we'd ever know for sure that patients in a persistent vegetative state have no awareness is a hard question to answer. I'd be reluctant to be too confident about that.

People in a persistent vegetative state lose the brain matter that provides (so far as we know) the physiological basis needed to have certain kinds of experience. We need, then, some kind of distinction between a pain reflex and suffering. Pain is a purely physical phenomenon, but suffering is not. If I don't have any self-awareness left at all, I can't suffer. There might still be nerve endings that would react to a hot stove, but I couldn't suffer.

What I want to emphasize, however, is that I don't think the moral argument turns on whether we can answer this question about what kind of experience, if any, these patients have.

They are living human beings, even if severely disabled human beings, and, whatever we say about their capacity for experiencing pain or suffering, we should not deliberately aim to end their lives.

My general view is that, rather than asking whether it's a benefit to have your life, we ought to ask what, if anything, we can do to benefit the life you have.

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May 2005, Vol. 49, No. 5