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down to two basic treatment options. Some view it as a disability and suggest we offer
the same kind of help we would give to a disabled person. This view is based on the
evidence that PVS patients can survive for many years with artificial nutrition and
hydration, therefore the condition should not be considered terminal. Others contend that
since such patients cannot chew or swallow without assistance, PVS can be viewed as a
fatal pathology where death is imminent. Idziak notes the importance of patient
autonomy, including a substituted judgment by a surrogate in deciding which direction to
take and that such a decision should be guided by a careful analysis of the burdens and
benefits of prolonged treatment.
Drane's discussion of the "totality principle," a long-standing theological concept,
has a direct bearing on this issue:
The totality principle gave expression to the fact that human life is a
complex whole, and that the whole is more important than the separate
parts.... By analogy, the whole person in our schema includes not
different parts but different activities, functions, and levels of being: some
higher, like cognition and spiritual capacities; some lower, like vegetative
life and physiological functioning.... The whole patient is considered to
take priority, especially over lower biological levels of life. If the total
person, including psychological and social functions cannot be benefited
or sustained, then biological dimensions of life do not demand continued
support. The classical theological principle of totality protects neither
parts nor single levels of life. The whole or total person is what is sacred
and has rights (1997, 223).
Further, in the religious roots of medical ethics there is a distinction between acts
of killing and that of withholding or withdrawing treatment. "Medical codes, from the
time of Hippocrates, forbid acts of killing but endorse, indeed require, not continuing to
treat dying patients...if a patient is beyond help" (Drane 1997, 10). So we may safely say
that although there is no "right to die," there is a "right to let die" if the circumstances
warrant. The court in the Fiori case recognized that Daniel's PVS condition, not the