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Msgr. David Q. Liptak
Q. Could you summarize the most recent Vatican statement on providing food and water to dying patients?
A. The latest Magisterial statement on the so-called “vegetative state,” made public on 14 Sept. 2007, by the Congregation for the Doctrine of the Faith, and approved by Pope Benedict XVI, strongly reaffirms the principle that nutrition (e.g., food) and hydration (water), whether by natural or artificial means, should be provided to patients perceived to be in a “vegetative state,” except when their administration cannot be assimilated by a patient’s body or cannot be given without causing “significant physical discomfort.”
The reason is the Biblical datum, also sourced in reason as illumined by Revelation, that each person is unique, precious, and unrepeatable, and that only God, who gives life, may withdraw it.
Again, this principle is valid whether the means used for nutrition and hydration is natural or artificial.
This latest statement was in response to formal inquiries by the United States Conference of Catholic Bishops, specifically directed to the context of persons viewed as in a persistent “vegetative state.”
Pope John Paul II, back in the Spring of 2004, affirmed this position in a talk to members of the International Congress in Rome on “Life-Sustaining Treatments and Vegetative State: Scientific Advances and Ethical Dilemmas.” (Cf. lead editorial, The Catholic Transcript, May 2004; p. 28)
In that earlier 2004 Papal statement, John Paul II, the Ethician of Lublin, remarked that the phrase “vegetative state,” whose use is widely accepted, cannot (indeed, should not) be employed with respect to a person, even though it is predicated of a clinical state. In words that echo thoughts he had expressed at the University of Lublin (KUL), where he taught ethics for two decades: “A man, even if seriously ill or disabled in the exercise of his highest functions, is and always will be a man, and he will never become a ‘vegetable’ or an ‘animal.’” (ibid; italics added)
Moreover, John Paul II declared that although “permanent” is used of the “vegetative state,” the person who experiences this condition does not thereby lose his or her right to basic health care, which includes nutrition, comfortable climate, as well as protection from side-effects of confinement in bed. Nor does he or she lose the right to rehabilitative help.
Furthermore, he added, not a few of persons described as “vegetative” have been able, with proper treatment, to recover, at least partially – even after lengthy intervals (e.g., years).
The new statement (14 Sept.) reaffirms the traditional teaching. For one thing, it states that providing the food and water is morally obligatory, even by artificial means. Such means should be viewed as ordinary and proportionate for preserving life, as long as the provision of such means can be shown to fulfil its proper finality (the hydration and nourishment of the patient). In this manner, suffering and death by starvation or dehydration are prevented.
The latest Vatican statement also takes up the question as to whether nutrition and hydration, under the same circumstances cited above, may morally be terminated when physicians determine with moral certainty that a patient will not recover. The answer is, of course, in the negative; ordinary and proportionate care are necessary.
Furthermore, the statement raises the real possibility that providing food and water may be useless, or, in a rare case, excessively burdensome, thereby causing, for example, significant physical discomfort. Here one can refer back to the basic principle defining “extraordinary means”; i.e., those means which are not ethically obligatory. This principle, simply put, is that “extraordinary means” constitute whatever is overly burdensome, overly risky, or else useless.
The conclusion is evident: hydration and nutrition, even by artificial means, are “natural,” and
not a therapeutic “treatment.” Such means cannot ethically be denied.