Catholics Lack X-Ray Vision in Cuba Hunger Strike

Catholics like to have things in black and white.

It's fun to think that we can answer any question on faith or morals by reaching for the Bible, the Catechism or the Summa.

That's not always the case, as I found while considering the situation at Camp X-Ray in Cuba, where the U.S. military is holding prisoners from the war on terror. The ethical quandary is this: Was the United States justified in force-feeding hunger-strikers to prevent them from starving themselves to death?

The situation arose after camp authorities banned turbans for fear that they might conceal weapons. On Feb. 26, guards removed a turban from a praying prisoner. Other inmates, seeing this as a violation of religious freedom, began refusing food. Two prisoners continued the fast for 30 days. On March 31, these men were forcibly fed through a tube.

I contacted two experts on Catholic medical ethics. Both pointed out that a Catholic hospital would not forcibly feed an anorexic patient, so long as he could freely choose to refuse nourishment. Once the patient fell unconscious, a Catholic doctor might seek an injunction to force-feed.

I was unsatisfied. Wouldn't this create a never-ending cycle in which the patient would pass out, be revived through the stomach tube, then refuse food and collapse again? More to the point, why should the hospital, or the state, permit someone to commit suicide, which is a grave violation of the natural law?

Then someone at a party pointed out a more exact analogy: The Christian Scientist or Jehovah's Witness who declines life-saving medical treatment. I scurried to my books of medical ethics to see what the Church had to say.

Again, the presumption in Catholic ethics and in law favored the free choice of the patient to refuse treatment for reasons of conscience. The only exceptions were for minor and unborn children.

This has to do with the distinction between ordinary and extraordinary means of preserving life. Catholics are generally obliged to accept ordinary means of prolonging life, including nutrition and low-risk therapies. But they may avoid extraordinary means, such as experimental or painful treatments, if the inconvenience is out of proportion to the expected good result.

The Jesuit ethicist Thomas O'Don-nell, in Medicine and Christian Morality, argues that ordinary means, such as nutrition, become “subjectively extraordinary” if a patient has “a grave subjective abhor-rence” towards them. This would apply to the Jehovah's Witness who rejects a blood transfusion for religious reasons and, according to Catholic medical ethics, to the Muslim who refuses food in a religious protest.

In this case, however, circumstances keep us from seeing the hunger strike as a purely medical issue. O'Donnell affirms that “one must prevent evil insofar as one can reasonably do so.” Surely the action of force-feeding the prisoners not only prevented the evil of their deaths, but also worked against the great social evil of terrorism? Since suicide was the means al-Qaeda used to attack the United States, the prevention of suicide might interfere with the terrorists' strategy.

In my opinion, the unusual circumstances of the Camp X-Ray case downgrade the argument for free choice from a true to a doubtful proposition. In doubtful cases, my books tell me, another set of criteria kick in.

If a person is in doubt as to whether he may perform an action like force-feeding, then he ought not to act. First, he should test his judgment against three “reflex principles,” none of which are decisive here. If he is still doubtful, then he may resort to the fourth reflex principle, “probabilism.”

Here it is: One may take action in a doubtful situation as long as there is a solidly probable opinion in favor of acting. It doesn't matter if the arguments against acting are even more probable. One can act as long as there is a solidly probable way to justify the action.

Here, then, are my arguments in favor of force-feeding the Camp X-Ray hunger strikers.

E In a time of national emergency, the common good outweighs certain natural rights of the individual. Even a citizen may be imprisoned without the writ of habeas corpus in wartime.

E Prisoners forfeit some of the personal liberty that pertains to a patient in a hospital setting.

E Liberty is not license. For the French philosopher Montesquieu, liberty is “the power of doing what we ought to will.” Suicide falls outside the scope of ordered liberty.

Vatican II's “Declaration on Religious Liberty” states that “within due limits,” no man should be “forced to act against his convictions.” This holds true even for those whose consciences are in error, as long as “the just requirements of public order are observed.”

Concern for the common good, the “general welfare” mentioned in our Constitution, sets “due limits” to religious freedom in the case of the Muslim prisoners. After all, a Jehovah's Witness may refuse a blood transfusion for himself, but not necessarily for his minor child. The principle here is that liberty of conscience obtains as long as no one else is unwillingly injured. Many people may become unwilling victims of terrorism if the United States permits prisoners to employ the suicide tactic.

Pro-lifers, having experienced government repression, are understandably reluctant to let the state interfere in matters of conscience. However, we need the state to uphold natural law and the common good when they are attacked. Martin van Creveld argues in The Rise and Decline of the State that, in today's world, national states are losing power to multinational organizations. At times we must uphold governmental power, especially since every law that is in keeping with natural law binds on pain of sin.

The Guantanamo Bay hunger strike, with its maddening complexity, poses a challenge to Catholic moral decision-making. As in many other situations, even Catholics do not have X-ray ethical vision. Sometimes we find ourselves in a gray area. Then we must use our right reason and strive to inform our consciences in truth, while praying — and trusting — that God's will be done.

Scott McDermott writes from Nashville, Tennessee.