In most hospitals in North America, families of patients in permanent vegetative state are asked if they wish their family member to have their artificial feeding tube removed. According to a definitive ruling by the Vatican made public, the withdrawal of artificial nutrition and hydration from such patients is immoral.
The ruling from the Vatican's Congregation for the Doctrine of the Faith was made in response to certain questions raised by the United States Conference of Catholic Bishops concerning artificial nutrition and hydration. The replies were approved by Pope Benedict XVI during an audience granted to Cardinal William Joseph Levada, prefect of the congregation.
First question: 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?
Response: 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. In this way suffering and death by starvation and dehydration are prevented.
Second question: 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?
Response: 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.
An English-language note accompanying the responses indicates that:
When stating that the administration of food and water is morally obligatory "in principle," the Congregation for the Doctrine of the Faith does not exclude the possibility that, in very remote places or in situations of extreme poverty, the artificial provision of food and water may be physically impossible, and then ad impossibilia nemo tenetur. However, the obligation to offer the minimal treatments that are available remains in place, as well as that of obtaining, if possible, the means necessary for an adequate support of life.
Nor is the possibility excluded that, due to emerging complications, a patient may be unable to assimilate food and liquids, so that their provision becomes altogether useless. Finally, the possibility is not absolutely excluded that, in some rare cases, artificial nourishment and hydration may be excessively burdensome for the patient or may cause significant physical discomfort, for example resulting from complications in the use of the means employed.
These exceptional cases, however, take nothing away from the general ethical criterion, according to which 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.