While much of the current discussion regarding the disconnecting of Terri Schiavo’s feeding tube and her death on Thursday focuses on interesting legal and political aspects of the issue, it is the ethical debate that still remains as the fundamental one.

Lacking, however, is a broader framework for conducting the ethical debate. The ethical discussion at the popular level generally limits itself to feelings regarding Schiavo’s quality of life and to speculation about her undocumented wishes about long-term dependency upon a feeding tube.

There are other questions, which, while they may seem a bit heady, nonetheless need to be raised.

I am proposing an expansion of the ethical debate to an assessment of the burdens and benefits assisted tube feeding provides. This framework would allow different conclusions on the disconnecting of a feeding tube, depending largely on the circumstances.

For example, at times there have been cases where the body, particularly of a dying patient, has rejected further nourishment. Tube feeding at this point is at best burdensome, forcing food on a system that only rejects it, but worse than that, it is futile. No one is morally obliged to engage in futile acts or to impose unnecessary burdens on others.

On the other hand, when assisted tube feeding provides nourishment to a patient, it is beneficial to the patient because of its life-sustaining effect. In this situation, it would be morally obligatory to keep the feeding tube connected. If someone, not duly authorized, were to make a decision whether another’s quality of life merited the discontinuing of assisted feeding it would be considered a crime. Does society want to sanction that kind of power over others?

Only a little imagination is needed to see the potential for abuse. Isn’t the threshold for discontinuing assisted feeding only reached when it no longer benefits the person, not when another decides that a person’s quality of life calls for a cessation of life-sustaining measures?

Some have argued that disconnecting the feeding tube does not cause the patient to die from starvation; rather, the underlying pathology suffered by the patient is the cause of death, for example, the inability to swallow food. There are two problems with that position. First, the whole reason for disconnecting a feeding tube is precisely so the patient will no longer remain alive. The suggestion that the underlying pathology causes death runs the risk of being disingenuous.

To say it another way, if the tube remained connected, the patient most likely would continue to live until a life-threatening episode occurred.

Second, as already noted, dying by starvation is not always unethical, so starvation is not the cornerstone of the debate.

A further benefit-burden question needs to be explored when deciding whether one may disconnect a feeding tube: What is it that is burdensome? The use of a feeding tube as a treatment or the life itself of the patient?

If it’s the life of the patient that is burdensome, and that burdensomeness provides ethical justification for its termination, then the issue quickly moves into the ethics of suicide and assisted suicide, a related debate also in need of careful analysis.

The Rev. John Gouldrick lives in Lewiston.

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