Nutrition

May 14, 2004

 

My Dear Brother Priests,

 

The teaching of the Holy Father in his allocutio of March 20, this year, will touch our lives significantly.  It will affect, perhaps, the decisions we need to make about our own parents and other family members and, also, the manner in which we counsel those who need to decide the matter of nutrition and hydration for those in a "permanent vegetative state."  It will also bring into question directives already in place for those in a coma or vegetative state.

 

The Holy Father is saying that to provide nutrition and hydration, even through artificial means, for a person in a vegetative state should be considered ordinary and natural.  It is the minimal care demanded for a patient.  I have enclosed the address of the Holy Father in this mailing.

 

This is a significant change in our approach to the question of nutrition/hydration, which, until now, we have labeled extraordinary.  We have said that removing nutrition/hydration is justified when there is no apparent hope for the reversal of the patient's condition.  This is often a painful dilemma for the decision-maker.

 

The following brief reflections are intended to help you in your role as counselors, and in the important pastoral task of being present to your parishioners who are living through these crucial situations.

 

1.         This document must first be examined and studied to understand its nuances.  There are issues not addressed in this allocutio which could have an effect on its interpretation, e.g., the modes of delivery of hydration and nutrition, different types of coma, and a number of other concerns.  In the meantime, the Ethical and Religious Directives for Catholic Health Care Services remain in effect.

 

2.         There are issues not fully addressed in this allocutio, such as the role of intention in removing nutrition and hydration, in what the Holy Father calls "euthanasia by omission."

 

3.         This is an allocutio at an International Congress and is not, at this point, considered a part of the Ordinary Magisterium.  The Holy Father has given a basis and some principles for dialogue among moral theologians and ethicists for reflecting more deeply on this question.

 

4.         Pope John Paul II emphasizes the responsibility that is ours for having a correct diagnosis of the vegetative state.  Medical science is still not able at all times to predict with certainty who, among patients in this condition, will or will not recover.

 

5.         The Holy Father is speaking out against those who deny the intrinsic value of life by emphasizing "quality of life" over the dignity and personhood of every human being at every stage of life.  "Even our brothers and sisters who find themselves in the clinical condition of a vegetative state retain their human dignity in all its fullness."

 

6.         The principal message is found in Paragraph Four:  "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."  And "the administration of water and food, even when provided by artificial means, always represents a natural means of preserving life, not a medical act."

 

7.         Two particular phrases used by the Holy Father need study and dialogue for the proper interpretation of this instruction:  "in principle" and "proper finality."  These phrases are used in the following sentence:  "Its use (artificial means for hydration and nutrition), 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."

 

8.         The Holy Father states that removing nutrition and hydration is euthanasia by omission.  He also quotes his own statement from 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."  Theologians will be discussing the meaning of "intention" as applied to this statement and to this act.

 

9.         The Holy Father speaks of positive actions needed to support the individual and family, who will be pressured to withdraw hydration and nutrition; need for support of the family; society's allotting sufficient resources; creation of a network of awakening centers; financial support and home assistance for families; establishment of facilities to accommodate those cases in which there is no family, and to provide rest for those families at risk of burn‑out; and spiritual and pastoral aid.

 

10.       The Pope quotes a basic principle according to which the true task of medicine is "to cure, if possible, always to care.”

 

For now, until there is further clarification of the teaching in this allocutio from Rome and the USCCB, one should abide by the Ethical and Religious Directives for Catholic Health Care Services.  The basic points of these Directives are:  Care is always required; nutrition and hydration are not.

 

 In Christ, our Lord

Most Rev. John T. Steinbock

Bishop, Diocese of Fresno