ARTICLES

Part 1: Vatican stand on artificial nutrition and hydration

By Dr. Michael A. Valente
Special to The Catholic Virginian

On August 1, 2007 the Congregation for the Doctrine of the Faith, with the approval of Pope Benedict XVI, issued a response to a series of questions regarding when it may be morally appropriate to remove a feeding tube from a person diagnosed to be in a persistent vegetative state (PVS).

Since then, there has been a fair degree of confusion and open criticism over the Vatican’s position regarding the application of artificial nutrition and hydration. Indeed, the Vatican has been accused of “turning back the clock” or reversing centuries’ old teachings.

For example, in an article entitled “A question of last rights” published by the Chicago Tribune in October 2007, Robert McClory, an associate professor emeritus from Northwestern University and former Catholic priest, writes “Some theologians see the declaration not as a ‘clarification’ of moral tradition but as a step backward on a basic question: how to best respect human dignity in the last days of life.”

This reaction of seeming consternation is similarly reflected in a release from the Catholic News Service, (reprinted in the September 24, 2007 issue of the Catholic Virginian), where one expert questions if the Vatican is seeking to change the Church’s teaching on ordinary and proportionate care “which has remained consistent for over 500 years.”

Responding to these accusations if not open dissent, I contend that proper analysis of the Vatican’s recent statement, especially in context with prior official Church statements, shows that the Vatican has not changed any of the Church’s teachings regarding the care for the sick and dying.

Everything recently released is consistent with everything previously articulated. Though I cannot speculate as to the motives, it appears that many “experts” are reacting to their perceptions rather than to what actually was said.

The story starts, when in the wake of the Teri Schiavo ordeal, the United States Conference of Catholic Bishops sought clarification from the Vatican about when it might be morally permissible to discontinue artificial nutrition and hydration (commonly speaking, removing a “feeding tube” and intravenous fluids), from a patient trapped in PVS.

The first question asked, “Is the administration of food and water (whether by natural or artificial means) to a patient in a ‘vegetative state’ morally obligatory except when they cannot be assimilated by the patient’s body or cannot be administered to the patient without causing significant physical discomfort?”

The Congregation responded in the affirmative: “Yes. The administration of food and water even by artificial means is, in principle, an ordinary and proportionate means of preserving life. It is therefore 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.”

The second question similarly inquired, “When nutrition and hydration are being supplied by artificial means to a patient in a ‘permanent vegetative state,’ may they be discontinued when competent physicians judge with moral certainty that the patient will never recover consciousness?”

This time the Congregation responded in the negative: “No. 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.”

In scrutinizing this dialogue, it must first be noted that the questions being entertained are only and solely probing the care due to a patient in a persistent vegetative state (PVS).

PVS is a specific medical condition that is narrowly defined as the state, usually due to severe brain trauma, where a person has completely lost the ability to think and reason, but retains basic bodily functions such as circulation, respiration and digestion.

In this condition, though the person’s eyes may spontaneously open and some movements may occur, the person nevertheless has completely lost the ability to speak or obey commands, and clinically exhibits no self-awareness or awareness of the environment.

Neither the questions asked nor the answers given address any other serious illness like Alzheimers Disease, Parkinsons Disease, cancer, etc.

The second thing to note is that the Congregation is clearly stating, whether supplied by artificial means or not, that nutrition and hydration are necessarily due to a person in PVS – unless or until such nutrition and hydration are no longer helpful to the patient, or to use the Vatican’s terminology, when this manner of care has reached its “finality.”

When is this finality reached? It is reached, for example, when the person’s stomach has ceased to function and can no longer absorb the nourishment. It may also be reached when the person’s death is imminent or any time when providing nutrition and hydration would do nothing to forestall the person’s ultimate demise. Employing the Church’s language, it would be at this juncture that these means of support may be considered to be “disproportionate” or “extraordinary” or stated differently, optional.

In other words, there may indeed be legitimate indications when nutrition and hydration may be morally withheld or withdrawn from a person in PVS. However, because a person in PVS “is a person with fundamental human dignity,” none of these reasons can be based on the fact that the person just happens to have been diagnosed as being trapped in PVS.

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