By JOHN L. ALLEN JR.
A high-profile Italian nun has run afoul of church authorities for expressing her desire not to be kept alive in a vegetative state, at a moment in which the ultra-Catholic nation is gripped by bitter debate over its equivalent of the Terry Schiavo “right-to-die” case in the United States.
Among other things, the Italian fracas illustrates that bioethical debate today, inside the Catholic church and out, is becoming just as polarized over the end of life as it is at the beginning.
The Italian case pivots on Eluana Englaro, a 37-year-old woman who entered a persistent vegetative state in January 1992 after a car accident. In the 16 years since, she’s been kept alive by a feeding tube, which her father wants to remove on the grounds that Englaro did not wish to be maintained in such a state. Recently, Italy’s highest court sided with the father.
Supporters see the father’s request as an act of compassion, while critics say it amounts to euthanasia – the deliberate killing of a living human being, in this case by starvation and dehydration.
Those critics include leaders of the Italian Catholic church and senior Vatican officials, such as Cardinal Ennio Antonelli, President of the Pontifical Council for the Family, who said recently: “Eluana is in a vegetative state, but she is not a vegetable. She is a person who is sleeping … [who] retains all of her dignity.”
There’s a range of views among Catholic theologians and ethicists about artificial nutrition and hydration, but the clear drift of recent teaching has been in favor of the position that it cannot be removed when someone is a chronic, but not terminal, state. In a March 2004 address, Pope John Paul II said that food and water is not “medical care,” which can be withdrawn, but a basic requirement of human dignity. In 2007, the Congregation for the Doctrine of the Faith affirmed that position in response to an inquiry from the American bishops.
This “tightening” has alarmed some health care professionals, both on the grounds that it may consign patients and their families to long-term burdens without realistic hope of recovery, and because it may drive some patients away from Catholic hospitals out of fear that their wishes about such cases, often expressed in “living wills,” may not be honored.
That’s where Sr. Ildefonsa, a 74-year-old member of the Don Orione community, enters the picture.
She’s well known across Italy for her charitable efforts on behalf of abandoned children, especially young girls who’ve wound up on the street and are vulnerable to abuse. Recently she was given an award in Genoa by a civic organization, part of a program honoring “women outside the chorus.”
In the context of receiving the honor, Sr. Ildefonsa made some remarks which quickly became a cause célèbre.
“I’ve asked my superiors to be able to leave a living will,” Sr. Ildefonsa said. “It was a verbal request, I didn’t put it in writing, and I’m waiting for a response.”
“I don’t want to be reduced to a vegetable. If this were my fate, I’d like them to let me go in peace. I read that Pope John Paul said when his moment came, ‘Let me go.’ I feel the same way.”
Sr. Ildefonsa, known popularly as “suor Ilda,” said that she’s not the only one in her religious community to feel this way.
“There are four of us sisters who’ve asked if we can leave a living will to avoid ‘therapeutic fury,’” she said, employing an Italian phrase referring to over-zealous or uselessly prolonged medical treatment.
The request from the sisters, Ildefonsa said, came on the heels of direct experience with end-of-life issues in their community.
“One of the sisters was sick and collapsed in the courtyard after a heart attack,” she said. “The ambulance came and inserted a feeding tube on the spot, and then took her to the hospital. She was hooked up to machines for almost three months, and I suffered a lot seeing her in that condition,” Ildefonsa said.
“One night they called me. She had a fever, and then she was gone. I thought: ‘I don’t want to hooked up to machines, I don’t want to end up like that. Why prolong the suffering for yourself and for others?’”
Ildefonsa also described a similar experience in her own family.
“Recently I lost my only brother,” she said. “I was in the hospital, where we prayed many rosaries together. He suffered, and he confided in me: ‘I’m tired, it’s enough.’ I prayed that the Lord would open his arms and welcome my brother. They say that the final days of suffering can bring us closer to God and be a blessing, but I truly don’t know if they bring salvation or damnation. I think that science, medicine, can make mistakes too. Sometimes it’s better that providence take its course.”
Asked about the church’s resistance to a “living will,” Ildefonsa said: “It will take time. I was among the first sisters to carry a card for organ donation, so now I’ll wait for the living will.”
Though Sr. Ildefonsa repeatedly stressed that she will follow the orders of her religious superiors, her comments – especially in the context of the Englaro case – brought a mild rebuke from Cardinal Angelo Bagnasco of Genoa, who is also president of the Italian bishops’ conference.
Among other things, Bagnasco indicated that permission to leave a “living will,” if it would deviate from church teaching, would likely not be forthcoming.
A spokesperson for the Don Orione community issued a statement today saying that Sr. Ildefonsa had not meant to challenge the church’s opposition to euthanasia, but rather had simply expressed a common-sense desire, long accepted by Catholic tradition, to avoid “extraordinary means” of prolonging life when one is suffering from a terminal illness.
The statement accused the Italian press of creating a “tempest in a teacup,” hinting at frustration that the award for Sr. Ildefonsa’s lifetime of charitable work has been overshadowed by an ideologically-driven manipulation of a few off-the-cuff comments.
If nothing else, however, the reaction illustrates that end-of-life debates these days are an increasingly global Catholic dilemma.