Last week I talked about withdrawing nutrition and hydration from sick and disabled people using a passage from Pope Benedict’s encyclical Caritas in Veritate (Charity in Truth) on every human beings basic right to receive food and water. I forgot that in 2004 John Paul II discussed this issue specifically in an address to participants in the International Congress on Life-Sustaining Treatments and the Vegetative State. This is an extremely difficult teaching for most people, even most Catholics, to understand or come to terms with. Let’s face it, no one wants to see their loved ones in pain and sometimes it can seem that death is much more preferable to life when that life is full of pain and suffering or, worse yet, does not appear to be very “alive” at all. But, the Church has always maintained that nutrition and hydration are not extraordinary means of sustaining life and it is not acceptable to withdraw basic health care from patients, regardless of how cognitively disabled they may be. John Paul II, referencing some key Church documents on the subject, spelled it out perfectly in his address:

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.

…[T]he 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 obligation to provide the “normal care due to the sick in such cases” (Congregation for the Doctrine of the Faith, Iura et Bona, p. IV) includes, in fact, the use of nutrition and hydration (cf. Pontifical Council “Cor Unum”, Dans le Cadre, 2, 4, 4; Pontifical Council for Pastoral Assistance to Health Care Workers, Charter of Health Care Workers, n. 120). 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.

In this regard, I recall what I wrote in the Encyclical Evangelium Vitae (n. 65), 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” (n. 4).

There is a difference between a dying person who can no longer contain nutrition or hydration and a severely brain damaged/disabled person who cannot feed himself. There is a difference between allowing nature to take its course and actively starving a person to death. Again, food and hydration are NOT extraordinary means of sustaining life. Not only does denying patients of these basic human needs ultimately amount to euthanasia, as the pope says, but can really only add to their suffering and discomfort – not to mention be an even harder sight for loved ones to bear.

Of course it’s hard to see a loved one lose their cognitive capabilities, to be barely living by our standards. But considerations about “quality of life,” says JP II, cannot take precedence over general principles.

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. (n. 3)

Having little to no cognitive brain function with no hope for any kind of “recovery” does not change the fact that the severely sick and disabled are still human beings who should be loved and cared for, not killed.

You can read JP II’s entire address online – not too long, very readable. Other helpful resources: Ethics and Human Life and A Will to Live: Clear Answers on End of Life Issues

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