ARTICLES

Part II: Vatican stand on artificial nutrition and hydration

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

There may indeed be legitimate indications when nutrition and hydration may be morally withheld or withdrawn from a person in PVS (permanent vegetative state).

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. The Vatican is essentially saying that the diagnosis of PVS in and of itself cannot be the reason why to withdraw care from a person suffering from such a condition.

The claim has been made that this statement contradicts other authoritative Church teachings. Specifically, paragraph 2278 from the Catechism of the Catholic Church states, “Discontinuing medical procedures that are burdensome, dangerous, extraordinary, or disproportionate to the expected outcome can be legitimate; it is the refusal of ‘over-zealous’ treatment. Here one does not will to cause death; one’s inability to impede it is merely accepted.”

Rather than contradicting the Catechism, the Vatican’s recent statement echoes the same discipline of weighing the benefits vs. the burdens of any particular medical intervention. The Vatican now extends this instruction from the Catechism by unambiguously declaring that a person in PVS not be summarily denied nutrition and hydration simply because of being in PVS.

At the same time however, the Vatican stipulates that circumstances and/or the person’s health status may later change thus permitting the re-evaluation of the benefit/burden ratio of continuing artificial nutrition and hydration, or any other form of medical treatment for that matter.

This balancing between what treatments or procedures are proportionate vs. disproportionate, ordinary (meaning necessary) vs. extraordinary (meaning optional) are further developed in the Ethical and Religious Directives for Catholic Health Care Services, an official position statement issued by the United States Conference of Catholic Bishops (USCCB).

This document states the following regarding the care for the sick and dying:

• 55. A person has a moral obligation to use ordinary or proportionate means of preserving his or her life. Proportionate means are those that in the judgment of the patient offer a reasonable hope of benefit and do not entail an excessive burden or impose excessive expense on the family or the community.

• 56. A person may forgo extraordinary or disproportionate means of preserving life. Disproportionate means are those that in the patient’s judgment do not offer a reasonable hope of benefit or entail an excessive burden, or impose excessive expense on the family or the community.

• 57. There should be a presumption in favor of providing nutrition and hydration to all patients, including patients who require medically assisted nutrition and hydration, as long as this is of sufficient benefit to outweigh the burdens involved to the patient.

The Directives add, “These statements agree that hydration and nutrition are not morally obligatory either when they bring no comfort to a person who is imminently dying or when they cannot be assimilated by a person’s body.”

Again, the Vatican more clearly defines the morality of providing artificial nutrition and hydration to a person in PVS; and again, the Vatican’s statement read in context with the Directives articulated by the USCCB shows that there is no contradiction.

If any contradiction is to be found, it is not within the Magisterium of the Church, but possibly within the systems of secular government.

For example, the Code of Virginia defines PVS as a “terminal condition” (§ 54.1–2982 ) while at the same time defines a terminal condition as a condition where the “medical prognosis is death within six months…” (§ 38.2–3418.11).

What the saga of Teri Schiavo illustrates is that though competent physicians diagnosed her to be in a state of PVS, the fact that she lived eight years in this state indicates that she obviously was not terminal.

At one time the medical community considered PVS to be invariably terminal, but from the example of Teri Schiavo as well as from other unfortunate victims trapped in this state, medical science no longer holds such a consensus.

Point of fact, doctors no longer define PVS as being a “permanent” state, but instead describe it as being “persistent” to reflect the clinical observation that, though exceedingly rare, a patient may in some way partially recover from the condition.

The moral code and/or the Church’s teachings have not changed. Rather, changes in medical science are challenging our understanding of what PVS is, changes that have necessitated the Church to respond.

The Vatican is turning nothing back, but what we are seeing is the development of doctrine in response to advances in medicine and science.

Lastly, the broader context in which the Church speaks must be understood — noting that in the exercise of its teaching authority the Church tends to speak to much larger audiences than those singularly interested in the Teri Schiavo ordeal.

The threat to dignity of the human person and the sanctity of life is a worldwide phenomenon. Where the State of Oregon has legalized physician-assisted suicide, the nation of Holland has sanctioned involuntary euthanasia.

Truly, the Church is not turning back the clock but boldly entering into the 21st Century.

Though I suspect some are using this recent clarification issued by the Vatican to support their perception that an elderly pope is trying to revert the Church back to the pre-Vatican II days, I contend that the Church unfailingly is recognizing and responding to the challenges presented by modern medical science and contemporary society. There is no contradiction.

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