Persistent
Vegetative State
and
Artificial Nutrition and Hydration
Comparative
Analysis
Below
is a chart that compares the current understanding of many in
Catholic health care of church teaching with what an initial and
tentative reading of the papal allocution delivered at the
Vatican March 20, 2004, contains. As with any papal allocution,
the Holy Father's presentation requires careful study that could
result in slight or substantive revision of this preliminary
analysis. This summary is presented in order to encourage study
and dialogue, and is presented in response to many requests for
assistance in understanding the allocution.
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Church
Teaching Until Now
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Papal
Allocution
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While care is
always required, nutrition and hydration are not.
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Nutrition and
hydration, even medically administered, are defined as
basic care (in contrast to medical treatment) and
ordinary, and, therefore, morally obligatory.
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Means basic to
preserving life, including nutrition and hydration, can be
either ordinary or extraordinary and, hence, either
morally obligatory or not morally obligatory.
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Means basic to
preserving life are ordinary and, therefore, morally
obligatory.
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Food and water
are ordinary to the extent that they provide reasonable
hope of benefit and do not entail excessive burden.
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Food and water
are ordinary in that they provide nourishment and relieve
suffering.
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"Benefit"
is understood in a broad sense.
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"Benefit"
is understood in a more narrow sense.
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Appropriateness
of particular means, including nutrition and hydration,
are judged primarily by the patient in relationship to
his/her overall condition (i.e., physical, psychological,
spiritual, and social).
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Appropriateness
of nutrition and hydration appears less dependent on the
overall condition/situation of the patient and the
patient's judgment.
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Financial
costs can and do factor into treatment decisions.
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Cost should
not determine the moral equation.
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There is no
declaration of a treatment being "a priori"
ordinary.
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Usually,
artificial nutrition and hydration (ANH) are "a
priori" ordinary.
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Withdrawal of
ANH is intended to avoid prolonging the dying process, to
forgo disproportionate means, and/or to alleviate
excessive burdens.
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Withdrawal of
ANH results in death by starvation or thirst and, if done
knowingly and willingly, is euthanasia by omission.
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The
"object of the act" can be ceasing what no
longer offers reasonable hope of benefit, or what imposes
excessive burden.
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Ordinarily,
the "object of the act" can only be euthanasia
by omission.
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Other
Assumptions Until Now
|
Papal
Allocution
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Persistent
vegetative state (PVS) is a relevant factor in determining
whether a means is proportionate or disproportionate.
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Ordinarily,
PVS is not relevant in determining whether a means is
proportionate or disproportionate.
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The person
dies of the underlying pathology, i.e., brain injury and
the inability to swallow.
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The person
dies of starvation and thirst.
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Forgoing ANH
could be a recognition of the finiteness of human life.
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Ordinarily,
forgoing ANH constitutes suicide or euthanasia.
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