| By John Thavis
Catholic News Service
VATICAN CITY (CNS) — In a brief document
approved by Pope Benedict XVI, the Vatican said it was generally a moral
obligation to provide food and water to patients in a vegetative state.
Nutrition and hydration, even by artificial means, cannot simply be terminated
because doctors have determined that a person will never recover consciousness,
the Vatican said Sept. 14.
Exceptions may occur when patients are unable to assimilate food and water
or in the “rare” cases when nutrition and hydration become
excessively burdensome for the patient, it said.
The text was prepared by the Congregation for the Doctrine of the Faith
in the form of a response to questions raised by the U.S. bishops’
conference. It was signed by U.S. Cardinal William J. Levada, prefect
of the doctrinal congregation, and approved by the pope before publication.
The congregation’s document strongly reaffirmed points by Pope John
Paul II in a landmark speech in 2004, when he said nutrition and hydration,
even by “artificial” means such as feeding tubes, should generally
be considered ordinary care and not extraordinary medical treatment.
That was a key point, because the Church teaches that “extraordinary”
means of treatment for unresponsive patients can sometimes be discontinued.
The late pope’s speech prompted questions in the theological and
medical communities, and the U.S. bishops’ Committee on Doctrine
submitted questions to the congregation in 2005 to clarify the issues.
After a lengthy study, the congregation released its responses to two
basic questions.
First, it said, administering food and water to a patient in a vegetative
state is morally obligatory “to the extent to which, and for as
long as, it is shown to accomplish its proper finality, which is the hydration
and nourishment of the patient.”
“In this way suffering and death by starvation and dehydration are
prevented,” it said.
Second, the congregation said it was not morally acceptable to discontinue
such care even when physicians judge that the patient will never regain
consciousness.
“A patient in a ‘permanent vegetative state’ is a person
with fundamental human dignity and must, therefore, receive ordinary and
proportionate care which includes, in principle, the administration of
water and food even by artificial means,” it said.
The congregation’s accompanying commentary explored the reasons
behind the Church’s teaching and explained a few scenarios where
exceptions might apply.
It noted that the very expression “vegetative state,” which
the Church reluctantly uses because it is a common medical term, is unfortunate
and misleading. Patients in this state maintain full human dignity, right
up to natural death, it said.
Moreover, such patients are not necessarily terminally ill and generally
carry on basic metabolic functions. They are simply unable to feed themselves,
it said.
“If they are not provided artificially with food and liquids, they
will die, and the cause of their death will be neither an illness nor
the ‘vegetative state’ itself, but solely starvation and dehydration,”
it said.
The commentary said the artificial administration of food and water usually
does not impose a heavy burden on the patient or the relatives, although
it acknowledged that the burden could become notable when such treatment
continues for months or years.
Nutrition and hydration does not require excessive expense and does not
of itself require hospitalization, it said.
“It is not, nor is it meant to be, a treatment that cures the patient,
but is rather ordinary care aimed at the preservation of life,”
it said.
In that sense, it said, the general ethical principle is that “the
provision of water and food, even by artificial means, always represents
a natural means for preserving life and is not a therapeutic treatment.
Its use should therefore be considered ordinary and proportionate, even
when the ‘vegetative state’ is prolonged.”
That was also the conclusion of Pope John Paul’s 2004 speech and
reflects the development of Church statements over the last 50 years,
the Vatican said.
In a brief discussion of exceptions to this basic moral principle, the
congregation outlined three possible situations:
• In very remote or impoverished places, artificial provision of
food and water may be physically impossible.
• Because of complications, a patient may be unable to assimilate
foods and liquids, so their provision becomes useless.
• In some rare cases, artificial nourishment and hydration may be
excessively burdensome for the patient or may cause significant physical
discomfort.
The U.S. Conference of Catholic Bishops, in a question-and-answer commentary
on the Vatican document, also looked at the potential exceptions.
It said there are medical situations in which it is moral to withhold
nutrition and hydration — for example, a patient in the last stages
of stomach cancer might refuse nutrition and hydration because it causes
pain and produces little benefit. But the vegetative state is not itself
a case of imminent dying and, therefore, it is generally not a burden
to nourish such patients, it said.
The USCCB commentary said providing such nutrition and hydration could
impose significant financial burdens on Catholic health care facilities,
which are sometimes obliged to bear the cost of health care for families
that are poor or have no health insurance.
In an interview with Vatican Radio, U.S. Dominican Father J. Augustine
Di Noia, undersecretary of the doctrinal congregation, said the insistence
on nutrition and hydration as an ordinary means of treatment does not
represent a change in Church teaching.
It should be remembered, he said, that the person in a persistent vegetative
state generally does not face imminent death and so is “not actually
dying, in that sense, any more than any of us.”
“The Church is not here enjoining a kind of excessive prolongation
of life, but simply saying that to withdraw nutrition and hydration is
to end a life that would otherwise continue naturally,” Father Di
Noia said.
What the congregation is also saying is that the “quality of life”
frequently mentioned as a determining factor in medical care is not a
judgment that is “in our hands to make,” he said.
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