Nutrition and hydration in the vegetative state – –
Question: I recently heard of a person who regained the ability to communicate after being in a persistent vegetative state for many years. I give thanks to God for that but my question is: what is the Church’s teaching on keeping such patients alive with nutrition and hydration for such a long time? Is it necessary or can it be considered extraordinary and be discontinued?
Ethicists have discussed this question for a long time, with some arguing that artificial nutrition and hydration constitute the ordinary care that must always be given, and others arguing that the provision of these means for a long time becomes extraordinary and burdensome on the health system or the family, and may therefore be discontinued.
Over the years the Holy See has gradually made its position more clear. The most recent statement came from the Congregation for the Doctrine of the Faith in 2007 in the form of Responses to two questions posed by the US Conference of Catholic Bishops.
Firstly though, as regards terminology, it should be understood that in the so-called “vegetative state” the person breathes spontaneously, digests food naturally, may open and close their eyes spontaneously, may be able to follow objects with their eyes, etc., but they cannot move their limbs or feed themselves.
They are often said to be in a “persistent, or permanent, vegetative state” when that condition has lasted for a year or more.
The Responses of the CDF, dated 1 August 2007, were approved by Pope Benedict.
The first question was: “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 Response was: “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.”
The second question was: “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?”
The Response was: “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.”
Pope John Paul II, in an address on 20 March 2004 to participants in an International Congress on “Life-sustaining Treatments and the Vegetative State”, explained that persons in the vegetative state retain their fundamental human dignity. He said 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’” (n 3).
Naturally, there can be exceptional circumstances such as very remote places or situations of extreme poverty in which the artificial provision of food and water may be physically impossible, and then of course it is not morally required.
Likewise, as the first question and its Response mention, if because of the patient’s condition, for example cancer of the stomach, the body cannot assimilate food or liquids or these cause significant physical discomfort, they are not morally obligatory.
The example you give in your question – and there have been several around the world in recent years – shows clearly that we can never know for certain whether a person may not recover from the vegetative state, even after many years. This highlights all the more the need to show these persons every respect and to continue artificial nutrition and hydration.
Got a question for Fr Flader? Email him at: director@caec.com.au.