Posted By: Michael Sullivan "Persistent Vegetative State" - 04/06/04 08:05 PM
Here in its entirety is His Holiness Pope John Paul II's important recent speech regarding the treatment of people who have been diagnosed as being in a "persistent vegetative state:"


Saturday 20 March 2004

Distinguished Ladies and Gentlemen!

1. I cordially greet all of you who took part in the International Congress: "Life-Sustaining Treatments and Vegetative State: Scientific Advances and Ethical Dilemmas." I wish to extend a special greeting to Msgr. Elio Sgreccia, Vice-President of the Pontifical Academy for Life, and to Prof. Gian Luigi Gigli, President of the International Federation of Catholic Medical Associations and selfless champion of the fundamental value of life, who has kindly expressed your shared feelings.

This important Congress, organized jointly by the Pontifical Academy for Life and the International Federation of Catholic Medical Associations, is dealing with a very significant issue: the clinical condition called the "vegetative state." The complex scientific, ethical, social and pastoral implications of such a condition require in-depth reflections and a fruitful interdisciplinary dialogue, as evinced by the intense and carefully structured program of your work sessions.

2. With deep esteem and sincere hope, the Church encourages the efforts of men of science who, sometimes at great sacrifice, daily dedicate their task of study and research to the improvement of the diagnostic, therapeutic, prognostic and rehabilitative possibilities confronting those patients who rely completely on those who care for and assist them. The person in a vegetative state, in fact, shows no evident sign of self-awareness or of awareness of the environment, and seems unable to interact with others or to react to specific stimuli.

Scientists and researchers realize that one must, first of all, arrive at a correct diagnosis, which usually requires prolonged and careful observation in specialized centers, given also the high number of diagnostic errors reported in the literature. Moreover, not a few of these persons, with appropriate treatment and with specific rehabilitation programs, have been able to emerge from vegetative state. On the contrary, many others unfortunately remain prisoners of their condition even for long stretches of time and without needing technological support.

In particular, the term permanent vegetative state has been coined to indicate the condition of those patients whose "vegetative state" continues for over a year. Actually, there is no different diagnosis that corresponds to such a definition, but only a conventional prognostic judgement, relative to the fact that, statistically speaking, the recovery of patients is ever more difficult as the condition of vegetative state is prolonged in time.

However, we must neither forget nor underestimate that there are well documented cases of at least partial recovery even after many years; we can thus state that medical science, up till now, is still unable to predict with certainty who, among patients in this condition, will recover and who will not.

3. Faced with patients in similar clinical conditions, there are some who cast doubt on the persistence of the "human quality" itself, almost as if the adjective "vegetative" (whose use is now solidly established), which symbolically describes a clinical state, could or should be instead applied to the sick as such, actually demeaning their value and personal dignity. In this sense, it must be noted that this term, even when confined to the clinical context, is certainly not the most felicitous when applied to human beings.

In opposition to such trends of thought, I feel the duty to reaffirm strongly that the intrinsic value and personal dignity of every human being do not change, no matter what the concrete circumstances of his or her life. 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."

Even our brothers and sisters who find themselves in the clinical condition of a "vegetative state" retain their human dignity in all its fulness. The loving gaze of God the Father continues to fall upon them, acknowledging them as his sons and daughters, especially in need of help.

4. Medical doctors and health care personnel, society and the Church have toward these persons moral duties from which they cannot exempt themselves without lessening the demands both of professional ethics and human and Christian solidarity.

The sick person in a vegetative state, awaiting recovery or a natural end, still has the right to basic health care (nutrition, hydration, cleanliness, warmth, etc), and to the prevention of complications related to his confinement to bed. He also has the right to appropriate rehabilitative care and to be monitored for clinical signs of eventual recovery.

I should like particularly, to underline how the administration of water and food, even when provided by artificial means, always represents a natural means of preserving life, not a medical act. Its use, furthermore, should be considered, in principle, ordinary and proportionate, and as such morally obligatory, insofar as and until it is seen to have attained its proper finality, which in the present case consists in providing nourishment to the patient and alleviation of his suffering. The obligation to provide the "normal care due to the sick in such cases" (Congregation for the Doctrine of the Faith, Iura et bona, p. IV) includes, in fact, the use of nutrition and hydration (cf. Pontifical Council "Cor Unum", Dans le cadre, 2.4.4; Pontifical Council for Pastoral Assistance to Health Care Workers, Charter of Health Care Workers, no. 120). The evaluation of probabilities, founded on waning hopes for recovery when the vegetative state is prolonged beyond a year, cannot ethically justify the cessation or interruption of minimal care for the patient including nutrition and hydration. Death by starvation or thirst is, in fact, the only possible outcome as a result of their withdrawal. In this sense it ends up becoming, if done knowingly and willingly, true and proper euthanasia by omission.

In this regard, I recall what I wrote in the Encyclical Evangelium vitae, making it clear that "by Euthanasia in the true and proper sense must be understood an action or omission which by its very nature and intention brings about death, with the purpose of eliminating all pain"; such an act is always "a serious violation of the law of God, since it is the deliberate and morally unacceptable killing of a human person" (no. 65).

Besides, the moral principle is well known, according to which even the simple doubt of being in the presence of a living person already imposes the obligation of full respect and of abstaining from any act that aims at anticipating the person's death.

5. Considerations about the "quality of life," often actually dictated by psychological, social and economic pressures, cannot take precedence over general principles. First of all, no evaluation of costs can outweigh the value of the fundamental good which we are trying to protect, that of human life. Moreover, to admit that decisions regarding man's life can be based on the external acknowledgment of its quality, is the same as acknowledging that increasing and decreasing levels of quality of life, and therefore of human dignity, can be attributed, from an external perspective, to any subject, thus introducing into social relations a discriminatory and eugenic principle. Moreover, it is not possible to rule out a priori that the withdrawal of nutrition and hydration, as reported by authoritative studies, is the source of considerable suffering for the sick person, even if we can see only the reactions at the level of the autonomic nervous system or of gestures. Modern clinical neurophysiology and neuro-imaging techniques, in fact, seem to point to the lasting quality in these patients of elementary forms of communication and analysis of stimuli.

6. However, it is not enough to reaffirm the general principle according to which the value of a man's life cannot be made subordinate to any judgement of its quality expressed by other men; it is necessary to promote the taking of positive actions as a stand against pressures to withdraw hydration and nutrition as a way to put an end to the lives of these patients.

It is necessary, above all, to support those families who have had one of their loved ones struck down by this terrible clinical condition. They cannot be left alone with their heavy human, psychological and financial burden. Although the care for these patients is not, in general, particularly costly, society must allot sufficient resources for the care of this sort of frailty, by way of bringing about appropriate, concrete initiatives such as, for example, the creation of a network of awakening centers, with specialized treatment and rehabilitation programs; financial support and home assistance for families, when patients are moved back home at the end of intensive rehabilitation programs; the establishment of facilities which can accommodate those cases in which there is no family able to deal with the problem or to provide "breaks" for those families who are at risk of psychological and moral burn-out.

Proper care for these patients and their families should, moreover, include the presence and the witness of a medical doctor and an entire team, who are asked to help the family understand that they are there as allies who are in this struggle with them. The participation of volunteers represents a basic support to enable the family to break out of its isolation and to help it to realize that it is a precious and not a forsaken part of the social fabric.

In these situations, then, spiritual counseling and pastoral aid are particularly important as they help recover the deepest meaning of an apparently desperate condition.

7. Distinguished Ladies and Gentlemen, in conclusion I exhort you, as men and women of science, responsible for the dignity of the medical profession, to guard jealously the principle according to which the true task of medicine is "to cure if possible, always to care."

As a pledge and support of this, your authentic humanitarian mission to give comfort and support to your suffering brothers and sisters, I remind you of the words of Jesus: "Amen, I say to you, whatever you did for one of these least brothers of mine, you did for me."(Mt 25, 40).

In this light, I invoke upon you the assistance of Him, whom a meaningful saying of the Church Fathers describes as Christus medicus and, in entrusting your work to the protection of Mary, Consoler of the sick and Comforter of the dying, I lovingly bestow on all of you a special Apostolic Blessing.
Posted By: Administrator Re: "Persistent Vegetative State" - 04/06/04 08:16 PM
See the article in USA Today. [usatoday.com]

Excerpt: Pope John Paul II has stunned Catholic health care providers, ethicists and theologians by announcing emphatically that it is "morally obligatory" to continue artificial feeding and hydration for people in a persistent vegetative state, even if they remain so for years.

I had thought this was already Catholic teaching.
Posted By: theophan Re: "Persistent Vegetative State" - 04/07/04 12:18 AM
Brother Administrator:

So did I.

Do you think that the great surprise registered came about because so many have thought they are so far ahead of Church teaching that it is for them to lead and the Church merely to "catch up"?

I recently faced this question with the great-uncle I have charge of. He had a stroke and cannot swallow without choking to death since the flap over his esophagus will not cover his brachial tube. Anyway, I insisted that he receive hydration and a feeding tube. The doctors were afraid because of his advance directive that stated there should be no extraordinary treatments--no surgery, no antibiotics, etc. I told them no one would starve to death on my watch, I'd take complete responsibility, etc. Needless to say that was last November, he's had his 90th birthday, and is better and more alert every day. So even if the Church would not have taken that stance, no one starves when he/she is in my charge--period. In addition, I've signed for units of blood and continuing antibiotics that have brought him back to a state almost as alert and alive as before the stroke. My attitude is that the Lord will decide when it is my uncle's time, not me and certainly not the doctors. So far the measures taken are not extraordinary. In short, if I'm caring for you, that's what I intend to do--care.

I have to go with His Holiness--life is precious no matter at what stage it is. And I believe that the measure of our own humanity and Christianity is how we treat the weakest, sickest, and most vulnerable among us.

In Christ, Who has come for our salvation at this most sacred time of the year,

Posted By: Deacon John Petrus Re: "Persistent Vegetative State" - 04/07/04 01:58 AM
Dear Brothers and Sisters in Christ,

I am a hospice physician, with board certifications in, among other things, internal medicine, pain medicine, and hospice and palliative medicine.

I am also a Professor of Medicine and teach medical ethics.

I am one of those stunned by the Pope's speech and especially upon this requisite that the use of artificial nutrition is "ALWAYS A NATURAL MEANS OF PRESERVING LIFE." While I can see an internal consistency with Humanae Vitae in that personhood exists even in its potentiality, I personally have great trouble with this exhortation.

I have always approached this with the questions: When is man, this man(woman)/patient in the image and likeness of God. When was Jesus in the image and likeness of God and simultaneously the fullness of the image of being human. Did Jesus do everything to deny his own death? Surely he could have lived longer if he so desired. Why did he refuse the drink of sour wine offered him? Should he have? Why did he not save Lazarus BEFORE his death? Or the centurion's daughter? Or his father Joseph for that matter! Surely he was capable of doing this!

When do we image Christ? Do we image Him in our comprehensive caring for this gravely injured one? Or are we causing him to suffer, washing our hands of the situation, saying it is really not up to us like Pontius Pilate?

What about this unfortunate patient? Are we not denying his right to image Christ by showing so great a love for his family, church, community, that he is willing to die for them so as not to burden them?

Are we Christian in our anxious denial of death?

And, in our Trinitarian understanding, do we not image the Trinity when we are in relation to each other and to God? While I can relate to someone in persistent vegetative state, they cannot relate to me. They cannot relate to God. The relationship is one-sided, us to them, God to them, but with nothing in return. Thus are they capable of sharing in that Trinitarian image? If so, how, if not, are they still persons? (Is this not different from a fetus who very actively participates and relates with her mother?)

And what about other considerations? If one ALWAYS has the right to artifical nutrition, why does he/she not always have a right to artificial respiration and cardiac function? Are these not even more basic to existence than even food and water?

How can any therapy ever be denied to any patient no matter how futile its use may seem?

My brothers and sisters,

I am stunned

John, deacon
Posted By: Administrator Re: "Persistent Vegetative State" - 04/07/04 02:16 AM

I don�t think that this is an issue of people being far ahead or behind Church teaching. Maybe it is for some. It is probably more of an issue of many in the Church honestly believing that a feeding tube is an advanced medical treatment. I�m glad for this teaching. It always bothered me whenever I heard someone make reference to �they removed his tube� so he could die.

God bless you for caring for your uncle! I will remember both you and your uncle in prayer this week.

Posted By: Administrator Re: "Persistent Vegetative State" - 04/07/04 02:42 AM
Father Deacon John,

It seems to me that nutrition and hydration, together with cleanliness and warmth, are basic elements of health care, even if delivered by artificial means. Artificial respiration and cardiac function require more than basic health technology.

It also seems to me that if we withdraw nutrition and hydration we are telling God that we are no longer open to God�s will for the patient, that we have decided it is time for the patient to die, that our desire to be freed from the burden of caring for him outweighs even his right to nutrition and hydration.

I think that the Holy Father is drawing a line between basic health care and advanced health care. I applaud him for it.

Posted By: Vesty Re: "Persistent Vegetative State" - 04/07/04 04:55 AM
Deacon John,

I too am a brother deacon and physician. We cannot conform our minds to the world, and its misguided compassion which seeks to eliminate suffering by eliminating those who suffer. The Mystery of Suffering---The Mystery of the Cross---can only be explained by love. As deacons and Catholic physicians we must put on the mind of Christ and His Church--which means following the teachings of our Holy Father---who in matters of faith and morals---is guided by the Holy Spirit! I recommend those with questions read Pope John Paul's---prophetic text Donum Vitae, The Christian Meaning of Human Suffering and The Gospel of Life. ALL human life is sacred from the moment of conception to natural death! Another great resource is the International Anti-Euthanasia Task Force in Steubenville, Ohio run by Rita Marker.

In Christ,

Deacon Michael
Posted By: Deacon John Petrus Re: "Persistent Vegetative State" - 04/07/04 09:16 PM
Dear Deacon Michael;

What specialty of medicine do you practice?

To all,

Do not misunderstand me. I am not promoting the discontinuation of feeding and hydration so that someone may starve to death or die of dehydration if they are otherwise stable. I would, for example, be against the discontinuation of tube feedings in Terry Schiavo's case at this time.

However, there does come a time when food and hydration no longer provide comfort or ease suffering. In fact, there comes a time when they may actually contribute to a patient's suffering or hasten their demise. And so, I am uncomfortable with the Pope's speech in its tone and unintended consequences, not in its targeted message.

Feeding tubes are not for everyone nor can they be considered "ordinary care." Their placement must be considered in the wider concept of the greater good for the individual patient. While, for example, to provide a meal to a patient is ordinary and expected, to feed them via a feeding tube can be demoralizing, dehumanizing, and done for no reason other than to make the feeding less time consuming for the care-giver. (This is but one example of how such an intervention may not be "ordinary.)

There is great misconception regarding the benefits of tube feedings as well as the reasons for their withdrawl. With the active hospice movement in this hemisphere as well as in Europe, I really don't believe people are dying from hunger or as a result of dehydration. But I do see the tube feedings discontinued because they are contraindicated!

In hospice, our goal is not to expedite the death of patients, but to return dignity to the dying process. Our goal is the alleviation of suffering at all times and in all ways. This is the first and fundamental goal. The preservation of life is the secondary goal. For what have we accomplished if we preserve one's life by prolonging his/her suffering? This too is contrary to Catholic teaching.

John, deacon
Posted By: Deacon John Petrus Re: "Persistent Vegetative State" - 04/07/04 09:18 PM
Essay question:

"Cogito ergo sum" (I think, therefore I am.) Renes Descartes.

Do you agree or disagree?

Posted By: theophan Re: "Persistent Vegetative State" - 04/07/04 10:29 PM
Deacon John:

Do you think that this development of Church teaching by Pope John Paul comes because of the blurring of these categories that we have thought were separate?

I have been told that in certain surgeries the patient is rendered clinically dead so as to reduce certain side effects, especially in surgeries involving the brain. Then they are brought back completely.

I have been told that sometimes patients are aware of all that is being done to them but are just unable to respond.

I have also been told that patients who have been labeled persistent vegetative have been known to come back, despite the fact that our measuring machinery could not detect signs of life.

Forgive me for not being more educated in this area, but I wonder if this argument is not parallel to the abortion argument. There are those who would argue that there are times when a child in the womb is not "ensouled" and therefore that the abortion procedure is not the sin that the Catholic Church says that it is. So if we cannot get a response that we can detect or the person cannot exist without help, the person must be a non-person.

As I wrestled with your questions about imaging Christ, I thought I would have to say that we image Christ from the moment of conception to the point where the body shuts down. I know that this is fraught with all sorts of problems in actual practice--so is almost everything else we do in life. Perhaps that is the reason we have advanced directives. We also have, as Catholic Christians, guidelines that the Church has in all these areas. And, I believe, that is why the Lord has given us His Church, inspired by the Holy Spirit, to help us decide these issues.

I have no easy answers for the questions you pose, just as the questions you pose are not easy. However, in the work that I do I have had many occasions when people have related stories of loved ones coming out of what had been termed a "persistent vegetative state" before dying. And in that brief period were able to fully communicate and relate that they could hear what was being said in the room but not being able to respond. That has, perhaps, clouded my own once-so-certain attitude in this area.

Burden? Whenever I hear this word added to the discussion, I have to wonder where our Christianity and our humanity are. It seems to me that we are all a burden to someone at some point. Babies, children, and teenagers all fit that category. So do the physically and mentally challenged. The old, the sick, and the weak all come in for a portion of that category. But it seems to me that our Christian commandment to love radically makes that word irrelevant. To serve Christ in all of these people is to serve Him: when we serve the least of His brethren, we serve Him. In the Christian context there is no such thing as a burden. But then the Gospel doesn't mention a smooth road. It talks about a narrow door, a difficult road, and a cross to bear.

I appreciate the insights you have added to this discussion. Your wrestling with this complex and difficult situation enriches all of us and forces us to think and wrestle ourselves. Faith that is not tested and wrestled with grows up like plants in a terrarium: weak and unable to withstand real tests. Again, thank you.

In Christ,

Posted By: Pseudo-Athanasius Re: "Persistent Vegetative State" - 04/08/04 03:03 AM

When you connect human dignity to the ability to think, then what has dignity is not the human, but the thinking.

Descartes is not the philosopher you should be turning to for answers in this. His separation of mind and body is a bugbear that still haunts modern thought. We are not souls using a body, but embodied souls, incarnated beings. Aristotle is much better than Descartes on this. You don't have a body, you are a body, in a very real sense.

As long as there is breath, there is a human being there.
Posted By: Deacon El Re: "Persistent Vegetative State" - 04/08/04 12:14 PM
Deacon Dr. John,

Glory to Jesus Christ!

I hope I understand your recent post. Are you saying:

1. For those patients who are able to take food and water through normal means, it is morally wrong for medical personnel to use tubes for feeding and hydration. The principal benefit would be for the convenience of the care givers, and the detriment would be the demoralizing and dehumanization of the patient.

2. For those patients who are unable to take food and water through normal means, it is a moral responsibility of the care givers to provide feeding tubes for feeding and hydration.

So far, no problem. I agree with both points.

Are there circumstances under point 2 in which you would support the removal of feeding tubes? If there are circumstances under which patients unable to take food and water through normal means would still be denied feeding tubes because they were not considered ordinary care? This is the point that troubles me. Any patient here would be starved to death.

Please you could clarify your statement.

Perhaps a story might help this complex question.

There is so much we do not know. One of my close deacon brothers has a college-age daughter who was involved in a serious auto accident. She was comatose for many months, and did not respond to any conversation from anyone.

Her dad decided to conduct his business from her hospital room. He stayed with her constantly, always talking to her and encouraging her to hang on. She had feeding tubes and a variety of monitors for heart rate, etc. This went on for many months with absolutely no improvement.

Her dad became angry when the hospital staff came into the room and began talking about her as if she were not there. He insisted that she was still a person, deserved respect and thoughtful consideration. Then he decided to prove it to them.

One teenage �friend� the daughter could not stand was named �Susie�. Susie never failed to put her down among other friends, and was a great source of irritation. With the nurses watching, her dad went over to her bed and whispered in her ear: �Honey, Susie is here now to visit you. She wants to say hi�.

The needles on the monitoring equipment immediately went crazy. Although she was comatose and seemed unresponsive to anything, this demonstration proved to all present that they were dealing with a very special person.

As it turned out, the story has a happy ending. She came out of the coma, began therapy, and resumed her college studies, although confined to a wheel chair, probably for the rest of her life.

I have always felt that despite our great advances in medical science, there is still so much that remains a mystery. Until we are better in determining the absolutes, our moral responsibility should be to weigh heavily on life itself and to reduce our expectations on issues of quality. Fortunately, the Gospel gives us many examples to help us conduct our lives.

Thank you and have a most blessed Pascha.

Deacon El
Posted By: Michael Sullivan Re: "Persistent Vegetative State" - 04/19/04 08:38 PM
Catholic Hospitals Reassure Living-Will Patients
Associated Press
April 16, 2004

ST. LOUIS - Roman Catholic hospitals are reassuring patients that they'll honor living wills in the wake of a papal pronouncement that hospitals should never remove feeding tubes from patients in persistent vegetative states.

In a talk March 20, Pope John Paul II said that feeding and hydrating such patients is "morally obligatory" and that withdrawing feeding tubes constitutes "euthanasia by omission." Since then, American bishops, theologians and ethicists have been studying the issue closely to see what the pope's words will mean for hospital operations in the United States.

For now, many hospitals are deferring to the "Ethical and Religious Directives for Catholic Health Care Services," commonly called ERDs, outlined by the U.S. Conference on Catholic Bishops.

According to those guidelines, feeding tubes for people in chronically vegetative states are "medical treatment" that can be continued or halted based on the benefits and burdens for patient and family.

Such guidelines call for following directives set out in advance by people who do not want life-prolonging medical treatments, as long as the person's wishes don't conflict with Catholic moral teachings, including the church's ban on euthanasia. The pope's remarks came during a Vatican symposium on caring for people who are incapacitated. They are significant but do not carry the weight of an encyclical.
Posted By: Michael Sullivan Re: "Persistent Vegetative State" - 07/12/04 10:30 PM
Jesus Caritas

I Was Thirsty and You Gave Me Drink: Caring for Persons in a Persistent Vegetative State
Bishop Thomas J. Omsted
The Catholic Sun
June 17, 2004
Page 8

One of my vivid memories of childhood was when my father showed me a secret spring that bubbled out of the Kansas soil, not far from the little creek that crossed our family farm. On a hot July day after cutting weeds out of the cornfield, nothing tasted better than cool fresh water from that secret spring. It was one more of those signs that my dad loved me.

To give drink to the thirsty is a corporal work of mercy and a simple act of love. It is also a basic human duty that we owe to one another. Already in the womb, our mother�s body does this for us, giving us life-sustaining drink and nourishment.

Providing food and drink are so fundamental to human life that Jesus told us it will be part of the last judgment: �For I was hungry and you gave me food, I was thirsty and you gave me drink� whatever you did for one of these least brothers of mine, you did for me.� (Matt 25:35ff) But providing food and drink can be done in ever-new ways with the advance of medicine and science. And these new ways bring with them challenging ethical questions, such as one that the Holy Father talked about earlier this spring

On March 20 Pope John Paul II delivered a speech to the participants of the �International Congress on Life-Sustaining Treatments and the Vegetative State: Scientific Advances and Ethical Dilemmas.� In his speech the Holy Father addressed the important and controversial issue of how we ought to care for people who are in the �persistent vegetative state.�

There has been a healthy amount of debate among bishops and moral theologians about this issue in recent years. This is not uncommon for the Church as she seeks clarity about certain complex moral issues. Once a sufficient amount of information has been gathered from science and other sources, and after moral theologians and ethicists have advanced understanding through their observations, insights and argumentation, the Successor of St. Peter is in a position to speak definitively about some of those issues.

The issue that John Paul II addressed on March 20 is whether it is morally obligatory to give food and water to those who are in the persistent vegetative state. These are persons who can survive an indefinite period of time provided that they are given food and water artificially. In most cases if the food and water are withdrawn the person will die as a direct result of that action.

Let us look at what the Holy Father said:

I should like particularly to underline how the administration of water and food, even when provided by artificial means, always represents a natural means of preserving life, not a medical act. Its use, furthermore, should be considered, in principle, ordinary and proportionate, and as such morally obligatory, insofar as and until it is seen to have attained its proper finality, which in the present case consists in providing nourishment to the patient and alleviation of his suffering. (# 4)

What the Holy Father is clarifying here is that water and food are to be considered ordinary care even if they are administered artificially. It is, therefore, obligatory to provide food and water as long as the person�s body is still nourished by them and they alleviate suffering. Once water and food can no longer be accepted by the body as nourishment, it is no longer obligatory to provide it.

Why is it obligatory? Because we can do nothing to directly cause the death of a human person either through action or omission. The Holy Father underlined this point in his encyclical Evangelium Vitae (in 1995):

�Euthanasia in the true and proper sense must be understood [as] an action or omission which by its very nature and intention brings about death, with the purpose of eliminating all pain. [Such an act is always] a serious violation of the law of God, since it is the deliberate and morally unacceptable killing of a human person. (# 65)

To remove or to deny artificial nutrition and hydration to a person in the persistent vegetative state is equivalent to deliberately killing the person because food and water are ordinary, not extraordinary, means of help. In his March 20 talk, the Holy Father continues:

Death by starvation or dehydration is, in fact, the only possible outcome as a result of their [food and water] withdrawal. In this sense it ends up becoming, if done knowingly and willingly, true and proper euthanasia by omission. (# 4)

The reason that food and water should always be provided is because of the inherent dignity of every human person. The Holy Father states:

I feel the duty to reaffirm strongly that the intrinsic value and personal dignity of every human being do not change, no matter what the concrete circumstances of his or her life. 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.� (# 3)

A human person always retains his or her dignity and must be respected as a gift from God. Each one must always be afforded basic health care. This includes the right to food and water, even if it must be provided artificially.

With this speech, the Holy Father is clarifying an issue in medical ethics that has been the focus of much debate.

While this teaching has not yet reached a completely definitive stage, it is an important step in that direction.

And it is not unlikely that a document of a more authoritative nature on this topic will be issued in the not too distant future. Once that occurs, the �Ethical and Religious Directives for Catholic Health Care Services� of the U.S. Conference of Catholic Bishops will need to be updated accordingly. Until that time, the existing directives should continue to guide us in our moral decisions concerning this issue. They are as follows:

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. (# 58)

As you can see, the existing directives already presume the provision of nutrition and hydration. What the Holy Father has done is to offer further clarification to the last phrase �as long as this is of sufficient benefit to outweigh the burdens involved to the patient.�

Difficult decisions like these concerning the care of loved ones must be made by husbands and wives, daughters and sons, and even parents. They are tough decisions and emotionally taxing. But the Holy Spirit, through the ethical directives of the Church, assists family members in making decisions that are good for their loved ones and faithful to the Lord.
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