By Gretchen Keiser

In a debated Georgia case involving a paralyzed man on a ventilator, the archdiocese of Atlanta submitted a court brief saying that permitting the man to stop using the machine is not the equivalent of suicide.

Instead, the friend-of-the-court brief said, the use of a ventilator in the case of Larry James McsAfee is an “extraordinary means of preserving life.” Morally this means the Catholic Church believes the patient is free either to continue to use the ventilator or to decide to discontinue using it, “even though such interruption will end in death,” the document said.

McAfee, 33, was paralyzed from the neck down in a May 5, 1985 motorcycle accident and since then has been unable to breathe on his own. Single and without dependents, he asked in Fulton County Superior Court for permission to turn off his ventilator himself and be provided with a sedative for the pain and distress he would experience prior to death.

Judge Edward H. Johnson conducted a bedside hearing with McAfee, along with lawyers for Grady Hospital, and the patient’s statement that he is competent to decide his own treatment and that his relatives do not oppose his request and that his condition is irreversible were not contested.

“The sole question before the Court appears to be whether Mr. McAfee, a competent adult, has the right to refuse extraordinary medical treatment, without interference from third parties, even though such refusal will likely result in his immediate death,” the brief said.

“Recognizing the unsettling nature of this question, the Archdiocese neither opposes nor advocates Mr. McAfee’s Petition, but is of the opinion that granting his request would not be assisting in suicide or undermining the State’s and the Roman Catholic Church’s interest in preserving life,” the brief said.

In its presentation of Catholic Church teaching, the brief draws upon the June 26, 1980 Declaration on Euthanasia issued by the Vatican Congregation for the Doctrine of the Faith with the approval of Pope John Paul II.

One of the principles drawn from the Declaration is that “the obligation to preserve or prolong life ultimately resides with the patient,” the brief said.

The patient must be fully informed and understand the consequences of his decision, the brief said, quoting from the Declaration on Euthanasia that “in numerous cases, the complexity of the situation can be such as to cause doubts about the way ethical principles should be applied. In the final analysis, it pertains to the conscience either of the sick person, or those qualified to speak in the sick person’s name, or the doctor’s to decide, in the light of moral obligations and of the various aspects of the case.”

The distinction between “ordinary” and “extraordinary” means of medical treatment is not spelled out in the Declaration on Euthanasia. The court brief uses definitions of moral theologian Daniel Cronin which say that “ordinary means” are means “commonly used in given circumstances, which this individual in his present physical, psychological and economic condition can reasonably, employ with definite hope of proportionate benefit.”

In the case of Mr. McAfee, the brief says, the use of a ventilator clearly constitutes an extraordinary means of preserving life. The brief cites Mr. McAfee’s testimony that he “receives no enjoyment out of life,” that his continued treatment by ventilator prolongs his emotional pain and suffering, that he is dependent upon public funds and has no economic resources of his own, that his condition is irreversible and that he is “still in a lot of pain.”

Since it is judged to be an “extraordinary means” in Mr. McAfee’s case, the position of the archdiocese is that he has the right under the church law to continue treatment or to interrupt that treatment even though it will end in death, the brief said.

Concerning the request for sedation, the brief said that such a request “is not offensive to the Roman Catholic Church.” Again quoting the Declaration on Euthanasia, the brief said, “it would be imprudent to impose a heroic way of acting as a general rule. On contrary, human and Christian prudence suggest for the majority of sick people the use of medicines capable of alleviating or suppressing pain, even though these may cause as a secondary effect semi-consciousness and reduced lucidity.”

In an interview, Father Edward Dillon, vicar general of the archdiocese and director of the Pro-Life Office, said the Church disagreed with the rationale used by Attorney General Michael Bowers who also submitted a brief on behalf of the state. Bowers said that the state would not oppose McAfee’s request because in Georgia suicide is not against the law. “From an ethical point of view, it is not suicide,” Father Dillon said. “It is an extraordinary means of life support. One is not bound to utilize extraordinary means.”

Father Stephen Churchwell, a canon lawyer who assisted in drafting the section on ecclesiastical law said the 1980 Vatican document outlines principles addressing situations “that could presumably happen to all of us” involving ordinary and extraordinary medical treatment and the use of pain killers at the time of death.

“The decision to no longer use the ventilator, while it might lead to death, is not the equivalent of suicide,” he said. “Nature is taking its course. It is the treatment that is maintaining life. If the treatment is ended, then life will end. What this man is doing is ceasing a certain form of treatment.”