A few years ago I was appointed the temporary guardian in a case involving a man who was a patient in one of the major non-profit hospitals in town. He had lived many years on the streets, and was a chronic alcoholic, with a long criminal record of petty theft and public drunkenness. He was in the hospital with a closed head injury received when he walked onto a busy freeway in a drunken stupor, and was hit by a car. The man had recovered from his broken bones and lacerations, but he was in a coma with permanent brain damage and paralyzed from the waist down, although when he was not sleeping his eyes were wide open and he could visually follow someone walking around his bed. But his ability to think and process thoughts appeared to be lost. His food and hydration were given to him by a gastric tube surgically inserted directly into his stomach. He clearly could feel pain, but could not talk, although he occasionally laughed inappropriately and without reason as sometimes happens with patients with brain damage.
End of life issues quickly came up. Would I agree, the hospital ethicist asked, to discontinue nutrition and hydration, and to forego all surgery and antibiotics since the patient was comatose, with severe and irreparable brain damage. The man no longer had any quality of life in his current condition, said the ethicist, and it would be ethically proper to free him from his terrible circumstances. I insisted on nutrition and hydration and medications as needed, and indicated that I would review the question of surgery as the need might arise.
I am not sure what the ethicist was actually thinking. However, it did seem to me that he had concluded that since my ward was without full consciousness and the capacity for rational thought, he was no longer a living human person. Apparently for the ethicist, the man’s body was not an integral part of his human person.
The incident reminded me that some people, probably including this ethicist, are afflicted today with a dualism in their understanding of human beings, a separation of the body and bodily acts from the mind or whatever is conceived as the organizing force of the material body. The human person is not considered by the dualists to be one entity composed of a unity of body and soul or mind. Rather, the body is sub-personal, and can be used (abused) in any manner that one wills to act. The body is not integral to the person, only a useful instrument with which it carries out the will formulated in the mind. The human person is identical with the mind or consciousness, and without a rational mind there is no human person, even if the body is biologically very much alive.
Therefore, to the dualist the unborn pre-conscious human and the comatose post-conscious human are not real human persons. They are without inherent worth or dignity, and may licitly be considered to be properly subject to the will of another for their continued existence.
And isn’t that what happened in the Teri Schiavo case? The husband argued that she was no longer really alive as a human being, and that her treatment and care was without purpose. He 
argued also that his wife would not want the treatment and care to continue. The argument was accepted by the probate judge, and accordingly he found no conflict of interest or violation of Teri’s rights for the husband to terminate all nutrition and hydration.
From a legal point of view the action of the probate judge was especially reprehensible since it is fundamental in guardianship cases to ensure that the proposed guardian will have no substantial conflicts of interest in his service to the ward of the guardianship. Living with a mistress with whom he had two children while his legal spouse and ward was in a coma in a nursing home, as the husband was doing in that case, was clearly a conflict of interest. Virtually no probate code in any state would permit the appointment of a guardian with such a pronounced conflict. So why did the judge appoint the husband as guardian?
The judge later said in a talk at a national meeting of probate judges that his decision was required by Florida law. That is clearly debatable since Florida law, while providing a preference for spouses as most states do, nevertheless rests on the fundamental principal of protection of the ward. That principal is a fundamental notion in fiduciary law, and trumps any spousal or other preferences for appointment of family members.
Officially, the judge ruled that the evidence of Teri Schiavo’s wishes supported the claim that she would not want treatment and care to continue if she was in such a condition. But Teri Schiavo was not dying, and given his decision to authorize her killing, it is hard to believe that he truly considered her to be fully human. Would the court actually have authorized her death by starvation and dehydration (a death that would be ruled unconstitutional as cruel and unusual if it were used for capital punishment) if he really thought that she was still fully human?
In reviewing the arguments and the decisions in the case, it is patently clear that underlying the entire proceeding, even if unspoken, was a belief that Teri Schiavo was no longer a human being. In the mind of the trial judge her damaged brain was proof of that. So taking away her nutrition and hydration was not really killing a human being. It was just taking care of the final details before the funeral and burial. Thus, there was no conflict in appointing the philandering husband as guardian to make sign the consents for those details relating to his already dead wife.
As all of this shows, dualism is not just a pointy headed, abstract concept. It is dangerous stuff. The idea that only a conscious person with the power of rational thought equals a real human person who is inherently entitled to human rights, independent of the will of another, is an expressway that leads directly to euthanasia and to abortion as well. When the body becomes mere instrument or biological debris, and not a vital component of human life, then we are all at risk. Some of this is pure utilitarianism, usually for economic reasons. In other cases it is allowed to happen because of sentimentality about possible suffering, but sentimentality is just as dangerous as utilitarianism. As the author Walker Percy said on several occasions, sentimentality leads to the gas chamber!
Mainly dualism is dangerous because it is false. Human persons are sensate human organisms with the natural capacity to reason and to make free choices, and not some consciousness which only inhabits the body. When we fail to recognize this we will have disastrous consequences.
Not surprisingly, Catholic teaching is just the opposite of dualism. The human person is both body and soul, and the body is so integral to the human person that body and soul are unified during one’s entire life. There is no consciousness or rational soul without the body, and human life does not have earthly existence separated from the body. The body-soul unity exists from the beginning of one’s life until death, and ultimately even after death. We may not understand precisely why Jesus chose to rise bodily from the dead and why we are promised that our bodies too will rise on that last day, but it is safe to say that the body is not unessential in the grand scheme of things.
Thus, contrary to the tenets of dualism, a human person is a physical organism that is an individual creation with the natural capacity to reason and exercise free will, and the human body is not merely an instrument or some appendage of the mind. The unity of body and soul is of the essence of the human person, without which there is no earthly human being.
So be on guard if you have a loved one in the hospital or a nursing home, not dying but without his or her full rational capacity. If the doctor or the ethicist recommends that all nutrition and hydration be terminated because, don’t you know, the lights are on but no one his home, just say no. Somebody is home, and, as Yogi Berra said, it ain’t over till it’s over. And it will be over in God’s due time.
