You may have read press accounts a few weeks ago of a recent address given by the pope on the subject on the necessity of administering nutrition and hydration (i.e., food and water) to individuals in persistent vegetative states. I read these accounts, too, and since then I’ve been trying to locate a copy of the full text of the address. (The press accounts are too sketchy for serious analysis.)
Well, I finally located it! Unfortunately, as usual, the Holy See has given it a absurdly long title that nobody will ever refer to it by (Address of John Paul II to the Participants in the International Congress on "Life-Sustaining Treatments and Vegetative State: Scientific Advances and Ethical Dilemmas"–Man! What is it with Italians and the titles they feel compelled to give ecclesiastical documents?). To get around this unweildy tongue-twister, people have to make up their own names for it, so I’m going to call it the Address on the Vegetative State (AVS).
You can read the whole thing at the address above, but here is some analysis:
The address is encouraging for the pro-life movement. It contains three particular points of encouragement. The first is a section in which the pope takes on the term "vegetative state" and notes its dehumanizing sound. He forcefully states:
I feel the duty to reaffirm strongly 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".
Even our brothers and sisters who find themselves in the clinical condition of a "vegetative state" retain their human dignity in all its fullness. The loving gaze of God the Father continues to fall upon them, acknowledging them as his sons and daughters, especially in need of help `(§3, emphasis in original).
The second is the section that attracted the most notice from the press, in which the holy father stated:
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. Its use, 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. . . .
The evaluation of probabilities, founded on waning hopes for recovery when the vegetative state is prolonged beyond a year, cannot ethically justify the cessation or interruption of minimal care for the patient, including nutrition and hydration. Death by starvation or dehydration is, in fact, the only possible outcome as a result of their withdrawal. In this sense it ends up becoming, if done knowingly and willingly, true and proper euthanasia by omission (§4, emphasis in original).
The same section also provides papal endorsement of a point that pro-lifers have sought to apply in other areas:
[T]he moral principle is well known, according to which even the simple doubt of being in the presence of a living person already imposes the obligation of full respect and of abstaining from any act that aims at anticipating the person’s death.
All of this is great, and I hope that the pro-life movement, Catholic physicians, and Cathoic medical-ethicists fully assimilate what the holy father has said. At the same time, there are some limitations to the document that need bearing in mind.
The first is that as an address, as an address, does not have that high an intrinsic level of authority in the spectrum of papal pronouncements. The points named above would have much more weight if they were included in an encyclical, and it would have been great if they were included in Evangelium Vitae. Perhaps soon they will be worked into an encyclical, depriving opponents of a point that they might try to argue.
The second limitation is that the address does not answer all the questions that can be posed in this area. For example:
- What about situations in which a person’s body has lost its ability to assimilate food and water, so that they do not "providing nourishment to the patient and alleviation of his suffering" but are actually harmful?
- What about situations in which a person is not in a persistent vegetative status but finds the administration of food and water burdensome?
- What about situations in which a person refuses the administration of food and water? What obligations do his caretakers have?
The answer to the first question is the best worked out. If a person cannot assimilate food and water and is being harmed by them (e.g., the fluids he is fed intravenously go out and collect in his tissues, causing them to swell and eventually burst open and weep) then it is licit to discontinue them. However, it would be very helpful to have guidance from the pope regarding the conditions that must be met for this to be legitimate, particularly regarding the nature and degree of harm that a person must experience.
The answer to the second question is less worked out, but the address helps. If the burden is of a physical nature then the conditions pertaining to the first question would seem to apply. If the burden is non-physical (i.e., psychological) then the person would seem called to offer up the suffering and accept nutrition and hydration. If the burden is a combination of the two then the solution would seem to be to factor it into its physical and psychological components and apply the above results.
The answer to the third question is something that the address does not deal with. While it would seem that a person is obliged to accept nutrition and hydration as long as the conditions pertaining to the first question are not met, the address does not tell us whether caretakers have a right or an obligation to force nutrition and hydration on a person who has expressly refused it.
While one can’t hope to have all possible questions answered at once, further guidance from the holy father on these questions would be very helpful. As long as they are not expressly addressed, anti-life forces will continue to use them as loopholes though which to pursue their agenda.
