Vatican says no to euthanasia even in the case of “vegetative states”, there is still a person

» 09/14/2007 13:43

VATICAN
Vatican says no to euthanasia even in the case of “vegetative states”, there is still a person
A document from the Congregation for the Doctrine of the Faith: giving water and food is not a therapy, which in some cases can be suspended, but a natural means by which life is preserved. The issue was raised by the US bishops.

Vatican City (AsiaNews) – People in a “permanent vegetative state” have the right to food and drink, even via artificial means: those instruments are in fact “ordinary and proportionate means of preserving life and not a therapeutic treatment”, which can however be interrupted when there is no further possibility of curing the patient whose suffering is being uselessly prolonged. The Vatican today reiterated its no to euthanasia, recalling at the same time not only its refusal of so-called assisted suicide but also underlining the possible existence of some cases – such as when the patient is unable to assimilate either food or drink – which allow for the suspension of the administration.

These are the indications which – with explicit papal approval –the Congregation for the Doctrine of the Faith supply in answer to two questions posed by the United States Bishops Conference on the issue of patients in a “permanent vegetative state”.

Evidently brought to light by the case of Terry Schiavo, the women in a “permanent vegetative state” who died in the USA at the end of March 2005 as a result of the suspension of feeding.

“The administration of food and water – affirms the Vatican’s Doctrinal ministry - 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”.

These “ordinary” means should not be suspended not even when “competent doctors judge with moral certainty that the patient will never regain consciousness”. A patient in a “permanent vegetative state” in fact, “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”.

A long note accompanying the document from the Congregation retraces the indications offered by past popes on the issue – starting with Pius XII – and the self same dicastery. In it, in particular, it reveals how “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 an illness nor the "vegetative state" itself, but solely starvation and dehydration. At the same time, the artificial administration of water and food generally does not impose a heavy burden either on the patient or on his or her relatives. It does not involve excessive expense; it is within the capacity of an average health-care system, does not of itself require hospitalization, and is proportionate to accomplishing its purpose, which is to keep the patient from dying of starvation and dehydration. It is not, nor is it meant to be, a treatment that cures the patient, but is rather ordinary care aimed at the preservation of life.”.

In affirming that the administration of food and water is a moral obligation in line with principal, the Congregation of the Doctrine of the Faith “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”.

Does this mean that the Bishop of Worcester, Most Rev. Robert McManus, will now PUBLICALLY recant the erroneous position which he once held and caused the Bishop whom he advised at the time to publish?

Relevant article from the archives of The New York Times:

January 12, 1988

Bishop Sees No Moral Issue If Feeding Ends in Coma Case

By PETER STEINFELS

LEAD: The Roman Catholic Bishop of Providence, R.I., Louis E. Gelineau, said yesterday that a diocesan official's opinion approving the removal of a feeding tube from a comatose patient ''does not contradict Catholic moral theology.''

The Roman Catholic Bishop of Providence, R.I., Louis E. Gelineau, said yesterday that a diocesan official's opinion approving the removal of a feeding tube from a comatose patient ''does not contradict Catholic moral theology.''

The opinion was written at Bishop Gelineau's request by the Rev. Robert J. McManus, vicar of education, who is a member of the diocesan medical ethics commission.

It has been criticized as ''utterly and unquestionably wrong'' by another Catholic theologian, the Rev. Robert Barry, who teaches religious studies at the University of Illinois. A diocesan press officer said abortion foes in the Providence area had expressed concern that Father McManus's view weakened the church's teaching on the protection of life.

A Kind of Precedent

Although Father McManus's opinion in the case of Marcia Gray, a 48-year-old Catholic who has been in a coma since January 1986, is not unprecedented among moral theologians, it is apparently the first time such a viewpoint has been expressed by someone acting in a diocesan capacity.

A growing number of state courts have ruled that such chemical feeding is a means of artificial life support like mechanical respirators, which can be removed.

Bishop Gelineau, in Providence, had asked Father McManus to study the case after Mrs. Gray's husband, H. Glenn Gray, who is seeking to remove a tube supplying food and water to his wife, sought church advice, The Bishop emphasized yesterday that Father McManus's opinion ''in no way supports or condones the practice of euthanasia.''

Mr. Gray, who is a University of Rhode Island professor, has sued the Rhode Island Department of Mental Health, Retardation and Hospitals, which administers the hospital where Mrs. Gray is a patient, to have the feeding tube removed. The case is scheduled to be heard this month by the Federal District Court in Providence.

According to Bishop Gelineau, the church has made no ''definitive statement regarding the need to provide nutrition and hydration to the permanently unconscious person.''

At a news conference, Bishop Gelineau acknowledged that his position supporting Father McManus might differ from the standpoint of other bishops. But Dr. James J. Walter, associate professor of theology at Loyola University, in Chicago, said that Father McManus's opinion appeared to be one held by a ''growing majority'' of Catholic moral theologians. 'Ordinary' vs. 'Extraordinary'

According to Dr. Walter as well as Dr. Lisa Sowle Cahill, professor of theology at Boston College, the terms Father McManus used to examine the issue were traditional ones. Most Catholic theologians ask whether artifically provided nutrition and hydration constitute ''extraordinary'' medical treatment. Such treatment may be suspended if seen as burdensome. On the other hand, ''ordinary'' medical treatment cannot be morally withdrawn.

Dr. Cahill noted that theological foes of removing feeding tubes for the permanently unconscious stress the ''ordinary'' and basic character of food and drink. ''But food and drink is no more basic than air,'' said Dr. Cahill, noting that Catholic theologians have agreed that artificial respirators qualify as ''extraordinary'' treatment and can sometimes be disconnected.

The differences among theologians, Dr. Walter said, depend on whether they look at the medical treatment alone or in relation to the benefit it may give a particular patient. In the case of Mrs. Gray, Father McManus had concluded that the measures ''supplying nutrition and hydration artificially offer no reasonable hope of benefit'' and were therefore ''disproportionate and unduly burdensome.''

NB: Then-Cardinal Ratzinger was in the United States at the time for the famous presentation on scriptural exegesis in New York, where he was subjected to gay-rights' activitists' protests and insults, and took issue with the McManus opinion. Such an opinion surely must have been formally recanted by the author before his nomination to the episcopacy, but we've not seen that recantation in print.

"What is the Catholic position when someone is on total life support?"

If you're interested in Catholic medical ethics in context, you'll want to look into Ethical and Religious Directives for Catholic Health Care Services --- then scroll down and click on "PART FIVE, Issues in Care for the Dying."

The short answer boils down to these principles, which make a distinction between "ordinary care" and "extraordinary care":

The patient always has the right to refuse "extraordinary" forms of treatment, which would mean treatment which is disproportionately painful, burdensome, futile, experimental, "heroic," etc.
The patient has a right to opt for these measures, too, if he's weighed the costs and benefits and judges that he'd derive some proportionate benefit despite the burdens and costs.
EVERY patient, no matter how old, disabled, poor, terminal, etc. and without exception, has the right to "ordinary care" til natural death. That includes nutrition and hydration (if his body can still assimilate them to prevent hunger and thirst, starvation/dehydration); hygienic care, clothing and bedding, pain medication, comfort care, and "accompaniment" (human presence: not being personally abandoned.)

Plus, no act or omission should ever deliberately and directly intend death.

Does that cover what you wanted to know?

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