Response of the Holy See to Questions Concerning Artificial Nutrition and Hydration

The Teaching Mission of the Church

Saint Bernard of Clairvaux (1090-1153) wrote very beautifully about God's Revelation. In explaining that God's word is forever, even though it may have been written or spoken once in time, he writes: "once indeed, because for ever. His is a single, uninterrupted utterance, because it is continuous and unending." God's Revelation to us, which culminated in the sending of His Son, is always "speaking to us." In order to maintain the purity of this Revelation, Jesus gave to the Church He founded charisms and guarantees so that those who seek to live by this Revelation may receive it in all its purity, along with the grace to respond to it, despite human weakness. On the day of His Resurrection, Jesus entrusted to His Apostles the mission He had received from His Father (John 20:21) and later, He would give to Saint Peter the primacy He had promised him (John 21:15-17). Jesus sums up this mission in the Gospel of Saint Luke, when He says: "Whoever listens to you, listens to me. Whoever rejects you, rejects me. And whoever rejects me, rejects the one who sent me" (Luke 10:16). The Second Vatican Council reminds us that the Pope is the successor of Peter, and the bishops the successors of the Apostles (Lumen Gentium, 20). The Council goes on to state that: "Bishops who teach in communion with the Roman Pontiff are to be revered by all as witnesses of divine and Catholic truth. This loyal submission of the will and intellect must be given, in a special way, to the authentic teaching authority of the Roman Pontiff, even when he does not teach ex cathedra" (Lumen Gentium, 25). In light of this responsibility to the People of God, the Church always seeks to apply the "eternal word" of God's Revelation in a concrete and practical way as a response to the needs and challenges of the particular moment in history in which she is living. From time to time, the Bishops, who share in the teaching mission of the Church in union with the Pope, seek the guidance of the Holy See in confronting the challenging issues of the time.

One such issue, which many of us have probably read about in the last few years, has been the question of providing food and hydration, even using artificial means, to someone who is said to be in a "persistent vegetative state." That term itself can be misleading but we will make use of it for now because it is commonly used today.

Response of the Holy See to the Bishops of the United States

The United States' Bishops, who have been confronted with this challenge in a special way, approached the Holy See for guidance on this question and a response was received just a week ago. Let me reproduce for you here both the questions of the American Bishops and the response of the Congregation for the Doctrine of the Faith, which was approved specifically by the Holy Father:

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.

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.

Teaching of Pope Pius XII

In previous topics, I have mentioned that Pope Pius XII (1939 -1958) had to confront many of the moral issues that presented themselves as the result of the new technologies and challenges that came with World War II and the scientific advances that were made during and after that war. Many advances had been made in the field of medical science and new moral questions were being asked. In other words, the Church was being asked to apply, once again, lasting principles to new questions and challenges. In an address which he gave in 1957, Pius XII taught a principle which became a guiding force in confronting the medical ethics questions of the next fifty years: he made his famous distinction between ordinary and extraordinary means of prolonging life when confronted with the possibilities of medical science.

He first stated that "natural reason and Christian morality teach that, in the case of a grave illness, the patient and those caring for him have the right and duty to provide the care necessary to preserve health and life." However, he also taught that those means that would be considered extraordinary, causing a severe obligation that would be too burdensome for the patient or others, did not have to be pursued. We might say that this was the Church proclaiming that we do indeed believe in this life and its dignity and we defend that dignity and use the reasonable means given to us to prolong life, but we do not believe only in this life. We do not cling to every moment in any way possible as if we did not believe also in the immortality of the soul and the eternal life promised to the faithful.

"Patients in a ‘vegetative state' breathe spontaneously, digest food naturally, carry on other metabolic functions, and are in a stable situation. But they are not able to feed themselves. If they are not provided artificially with food and liquids, they will die, and the cause of their death will be neither illness nor the ‘vegetative state' itself but solely starvation and dehydration" (Commentary of the Congregation on their decisions). What is important to realize is that the administration of foods and liquids, even artificially, is part of the normal treatment due to this type of patient, provided that this is possible and that it is not burdensome for the patient.

Teaching of Pope John Paul II

In their Commentary on their recent responses, the Congregation references an Address given by Pope John Paul II to a group of Bishops from the United States (October 2, 1998), in which he made clear that "nutrition and hydration are to be considered as normal care and ordinary means for the preservation of life. It is not acceptable to interrupt or withhold them, if from that decision the death of the patient will follow. This would be euthanasia (so called mercy-killing) by omission" (Commentary). The Congregation likewise references another important Address of Pope John Paul II, in which he specifically spoke of the topic we are discussing here. He said: "In response to those who doubt the ‘human quality' of a patient in a ‘permanent vegetative state', it is necessary to reaffirm 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'."

The Holy Father went on to say: "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.). 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" (20 March 2004, Address to International Congress on Life-sustaining Treatments and the Vegetative State).

The Work of the Church, Family Members and Caregivers

At this time, while we examine what may seem to be technical terms and official documents, we recall that this message of Christ and His Church has been lived out and is being lived out in our very midst. Our hospitals and nursing homes, where the sick are cared for with love and dignity proclaim this message each day. I know that throughout our Archdiocese, there are many heroic examples of family members caring for a loved one under very difficult circumstances. Sometimes, their activities are known to God alone and they do not even have the consolation of their loved one, for whom they are caring, being able to thank them or show visible love or affection. Those who are called to be paid care givers also have a special vocation to proclaim the dignity of the human person by carrying out their vocation with gentleness, kindness and understanding.

As I have said when discussing several other topics, we seek to condemn no one but only to show forth in all its clarity the perennial teaching of the Church applied to the "season" in which we have been called to live.

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