Editorial from the St. Louis Review

April 23, 2004

The right to nutrition and hydration

A tremendous amount of confusion continues to threaten the safety and rights of vulnerable human lives affected by the serious disability which has come to be known as the "vegetative" state. To combat this, the Holy Father has made a new statement further clarifying the moral duty of providing nutrition and hydration to patients in a vegetative state. "The administration of water and food, even when provided by artificial means, always represents a natural means of preserving life, not a medical act." Normal care of the sick person includes providing nutrition and hydration. Death is the only possible outcome of the withdrawal of nutrition and hydration. "In this sense it ends up becoming, if done knowingly and willingly, true and proper euthanasia."

The facts: Most scientists who work with patients in the vegetative state acknowledge that a correct diagnosis requires prolonged and careful observation. A high number of diagnostic errors are reported in medical literature and more than a few of these persons have been able to emerge from the state even without any specific forms of treatment given. Still, an overwhelming number of organizations and individuals have promoted the interruption of minimal care, including nutrition and hydration, resulting in the patient’s death without ever providing any form of rehabilitative therapy. However, up till now, medical science is not able to tell anyone with certainty who will recover from the vegetative state and who will not.

The moral analysis: The Holy Father’s statement on the matter was carefully worded and clear. Administering food and water to this type patient is required when it serves its purpose by "providing nourishment to the patient and alleviation of his suffering." An external acknowledgment of the quality of a person’s life cannot be the basis for discrimination against the person resulting in a lack of care to the point of causing his or her death by starvation or thirst. Even the term "vegetative" is misleading and undignified. A human person, even in the clinical condition of "vegetative state," retains his or her human dignity "in all its fullness."

The spin: Since the publication of the Holy Father’s statement March 20, three positions, mostly contrary and contradictory, about the meaning of the statement have been voiced. These positions are that: 1) This teaching is a change in the Church’s teaching and Catholic health care will have to change its practice; 2) This is not a change in the Church’s teaching and Catholic health care can keep removing patients in this clinical condition from food and water; and, finally, 3) We will have to wait and see what the U.S. bishops conclude after consultation with the health care ethicists.

A matter of right: These positions may be of interest to the ethicists but, insofar as they confuse or delay the following of the teaching, are not helpful. Moreover, any further delay and confusion in Catholic health care institutions, which do not currently follow this teaching, will prevent the protection of the human rights of these patients within the same institutions.

The Holy Father clearly articulated the nature of the rights involved. "Medical doctors and health care personnel, society and the Church have toward these persons moral duties from which they cannot exempt themselves without lessening the demands of both professional ethics and human and Christian solidarity. 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." One need not wait for ethicists to settle their disputes to begin to uphold and protect the rights of these patients.

Witness to hope: The Holy Father calls for the taking of "positive actions as a stand against pressures to withdraw hydration and nutrition as a way to put an end to the lives of these patients." Support of the patients’ families is a critical undertaking. Among other things, specialized treatment and rehabilitation programs such as "awakening centers" also are needed, along with financial support and home assistance. Medical consultants, providers of spiritual and pastoral aid, and volunteers also should be part of the struggle to secure these patients’ rights and support their families.

Catholic health care should be at the forefront of this battle to protect the rights and dignity of these patients. Further delay in upholding and following the teaching will result in more rights violations. An unambiguous policy of protecting these patients will present the clear manifestation of the love of Christ in the furtherance of the mission of Catholic health care.