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In Italy, Support for Those in a Vegetative State

Bioethicist Comments on Committee's Decision

ROME, OCT. 12, 2005 (Zenit) - The case of a patient who woke up after a two-year coma coincided with a National Bioethics Committee decision to defend the non-suspension of feeding of patients in a persistent "vegetative" state.

Salvatore Crisafulli, 38, of Catania, Sicily, fell into a coma after a traffic accident on Sept. 11, 2003, and was looked after by his brother Pietro. The latter also requested and received help from Francesco Storace, the minister of health.

Salvatore Crisafulli woke up last summer. He is now talking and said that while he was in coma, he saw and heard everything.

Meanwhile, on Oct. 4, the National Bioethics Committee (NBC) approved by a large majority a document in which it expresses "a decisive no to the suspension of artificial feeding and hydration" of patients who maintain normal vital functions and breathe autonomously, even if they are not conscious.

Commenting on the NBC decision, Bishop Elio Sgreccia, president of the Pontifical Academy for Life, stressed on Vatican Radio that the "patient in a persistent vegetative state is not dead."

"He only needs to be fed artificially because otherwise he would die of hunger," said the prelate. "Feeding and hydration are not therapeutic cruelty. ... It is not a question of therapy, it is a vital support that is provided as a duty for any person who is alive."

The NBC decision presumably might exclude in Italy a death similar to that of Terri Schiavo in Florida.

To understand better the implications of these two cases, ZENIT interviewed Dr. Claudia Navarini, professor at the School of Bioethics of the Regina Apostolorum Pontifical University.

Q: What do you think of the document recently approved by the NBC?

Navarini: This document of imminent publication is of utmost importance, because it clarifies a doubt that in Terri Schiavo's case assailed many, namely, that artificial feeding and hydration can be "disproportionate" means which must be suspended in terminal phase or in serious conditions such as the vegetative state.

To give water and food are not medical acts, and do not configure cases of therapeutic cruelty, at least until it doesn't become obvious that they are totally useless, namely, that the organism is not capable of assimilating them.

They are, on the contrary, basic, normal care that must be assured to all patients insofar as a form of maintaining human life which can never be given up. On this the committee's document agrees by a large majority.

Whoever does not want to share this judgment is probably influenced by the concept of "worthy life" or "quality of life," which leads to distinguish the value of some human lives from others with discriminatory conduct that I frankly find unworthy in a society that desires to call itself civil.

The question assumes grave dimensions because, as Francesco D'Agostino, the president of the National Bioethics Committee says, the improvement of biomedical technologies makes the number of these patients progressively greater, who at one time could not be supported.

Urgent therefore are health, welfare and social measures to care for these persons in a way that is in keeping with their intrinsic dignity, eventually also with the promotion of home care, which is a great resource for these patients: cared for by their families, they seem to have greater probabilities of recovery or, in any case, are able to benefit from the closeness of their loved ones.

The minister of health himself, Storace, commenting on Salvatore's happy story, said that "it was his family who cured him."

The NBC's positions, on the other hand, had already been adopted by the Pontifical Academy for Life and the International Federation of Catholic Medical Associations last year, in the joint document published at the end of the March congress on the vegetative state.

Q: Are there similarities between Salvatore Crisafulli's and Terri Schiavo's cases?

Navarini: It is difficult to see similarities, because cases of unconsciousness -- coma, vegetative state, serious mental disability -- can vary much from person to person, to the point of requiring diagnosis and prognosis that are altogether individual; moreover, the information I have at my disposition is essentially journalistic.

Of course, Terri Schiavo was not in a coma; too much time had gone by. It is not known precisely if she was in the "classic" vegetative state or rather in a serious condition of mental disability with discrete moments of cognitive and communicative competence.

In the Italian case, two years represent a time still compatible with a coma, and all the newspapers in fact speak of him as a case, fortunately not so infrequent, of coming out of a coma.

However, some sources -- and, according to some voices, the testimonies of the family some months ago [in Schiavo's case] -- speak of the vegetative state, namely, of chronic condition or "coma with the eyes open."

If this was so, we would be faced with an episode that proves once more how it is a duty to do everything possible to guarantee patients in coma and patients in vegetative state impeccable therapeutic care -- and not just basic care.

And also whenever hope for recovery is really vain, the fundamental and inescapable truth remains that a man's life -- no matter how sick or disabled, or how precarious his state is -- always has immense value, before which man's dominating will must halt.

In the U.S. the whole debate was reduced to the question whether Terri wanted or did not want to die. But here, the NBC stresses, it is a decision for life or for death. Not even if the patient requests it are we authorized to suspend feeding and hydration, because the intrinsic value of human life also exceeds the value attributed to it by the individual. In other words, we are not the owners of our life.

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Keywords

Bioethics, Vegetative, Coma, Health

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