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A long debate

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One of the ongoing debates in Catholic health care and bioethics has been the question of "artificial nutrition and hydration" for seriously ill patients, particularly those in what has come to be called a "persistent vegetative state."

In the 1990s, the first case to gain national notoriety in the United States was that of Nancy Cruzan in Missouri. Others followed, most famously Terri Schiavo in Florida. In general, the courts allowed close relatives to make the decision to withdraw food and water if doctors did not believe recovery was possible.

As a result, in many hospitals, including Catholic ones, families are confronted with terrible choices regarding the ongoing feeding and hydration of their loved ones. If the families were Catholic, the help they received from their church in making this life-and-death decision was mixed.

Several state bishops' conferences issued statements on this ethical problem. Unfortunately, they took differing stands on the issue. So did moral theologians. Many pastors did not know what to provide to their people.

Those who said that it was more merciful to withhold food and water had popular culture on their side. As the Schiavo case illustrated most graphically, the emphasis was placed on "quality of life" issues, a subjective standard that often reflected what relatives, doctors or the courts judged to be an acceptable quality of life.

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Meanwhile, the church has been moving in the opposite direction. Since the early 1980s, a variety of Vatican documents have been increasingly emphatic about the importance of nutrition and hydration as "ordinary" means of sustaining life -- even when administered through a tube.

The Vatican kept returning to two key points: First, to conclude that food and water were "extraordinary means" for sustaining life would remove virtually any moral protection from the grievously ill. Indeed, it noted that removing food and water could easily become "euthanasia by omission," since death would come by starvation, not disease.

The second point is that it undercut the importance of safeguarding the human dignity and rights of that human being, regardless of his or her mental state or the likelihood of making a recovery. Respect for human dignity and the right to life of every individual binds together in a consistent moral ecology all the church's teachings on life. To approve of an exception in the case of those in a vegetative state would undermine this teaching.

On Sept. 14, in response to questions presented by the head of the U.S. bishops' conference, the Congregation for the Doctrine of the Faith issued a concise and definitive instruction on the topic of artificial nutrition and hydration for those in a vegetative state (see www.usccb.org/comm/archives/2007/07-143.shtml). It made clear that administering food and water, even artificially, is "an ordinary and proportionate means of preserving life," and that "a patient in a 'permanent vegetative state' is a person with fundamental human dignity" and deserving of ordinary care.

Now that this question has been answered, the next one must be faced: How will the church communicate this teaching, and will Catholic theologians and health-care professionals provide this guidance to patients and their families? The answer to this question is a matter of life and death.