Regarding “Penitential Plea” in the June 27-July 3 letters to the editor:

The writer's wise father confessor gave great advice, and it is clear the penitent is truly concerned about her dilemma. However, I think the writer should divide the issue into two parts: one dealing with the vegetative and uncommunicative patient and one part with a merely ill patient who is able and cognitive. These are quite different situations and whole treatises have been written on each.

Regarding the vegetative state: If feeding tubes are not yet installed, then a request not to use them would not pose an ethical problem for me. If the tubes are in place when decisions are asked for, then I suspect, an ethical question can arise: If the tubes are removed and the patient dies shortly; is it killing? I don't know. Technology has created this proposition. A hundred years ago, there were no tubes and the patient expired in the normal course of events.

Concerning the cognitive state, we have a rather complicated set of issues. Let's take the case used by the writer where she states that, if she were diagnosed with cancer, she would “do nothing about it.” She expresses concern for her children and for offering up her sufferings to God for good as an explanation for her choice. Again, I suspect it is not nearly so uncomplicated.

Bluntly put, you don't just lay down and die because you're ill. Not so long ago, any number of afflictions would have killed us. Today, thanks to medical advances, our useful lives can be extended many years no matter what we come down with. Each of us is obligated to take advantage of these modern miracles made possible by the grace of God.

In the very beginning, the Father Almighty gave us an admonition: “Be fruitful.” When you contract cancer and your doctor tells you he can cure you or, in most cases, says he can extend your life for five or eight or 10 years, can you, the patient, rightly decline treatment without risking the possibility that you could be committing suicide? And when you do meet our Lord Jesus face to face and he asks why you didn't take the gift of life he offered through your doctor, tell me what you will say.

BILL QUINN

Montague, New Jersey

Editor's note: Pope John Paul II has clarified the question of whether feeding tubes are “extraordinary care” or mandatory “ordinary care.” On March 20, he said providing food and water to patients in a persistent “vegetative” state is “morally obligatory” and withdrawing feeding tubes constitutes “euthanasia by omission.” Nutrition and hydration are required ordinary care and may not be withheld or refused, unless the body can no longer assimilate them.