Food and water for patients in vegetative state is obligatory, Vatican says

By JOHN L. ALLEN JR.
New York

Responding to an anguished moral debate in the United States and elsewhere, the Vatican's Congregation for the Doctrine of the Faith ruled this morning that providing food and water to patients in a "vegetative state" is obligatory, even through artificial means, except when the food and water can't be assimilated by the patient's body or when providing it causes "significant physical discomfort."

Specifically, the CDF held that even in a situation where there's moral certainty that a patient will never recover, it's not permissible to withdraw food and water, in effect allowing the person to die of dehydration or starvation.

The ruling came in a brief response to two questions that had been submitted by the bishops of the United States, where Catholic opinion has long been divided about precisely where to draw the line between "ordinary" means of care, which Catholic tradition regards as obligatory, and "extraordinary," which the church treats as optional.

Two recent events had exacerbated this debate.

The first came in March 2004, when Pope John Paul II addressed a conference on patients in a persistent vegetative state organized by the Pontifical Academy for Life in Rome. The pope appeared to suggest that the provision of food and water is always an “ordinary” means and therefore morally obligatory, but there has been a lively back-and-forth about exactly how his comments should be interpreted and what level of authority they held.

The second episode lending urgency to the Vatican clarification was the high-profile national debate surrounding Terry Schiavo in 2005, the Florida woman in a persistent vegetative state who died after life support was removed. Her husband argued that she should be allowed to die with dignity, while Schiavo’s family strenuously defended her right to life. Among other things, the parents argued that their daughter was a devout Roman Catholic who would not wish to violate the Church’s teachings on end-of-life care.

The full text of the CDF ruling is as follows:

CONGREGATION FOR THE DOCTRINE OF THE FAITH
RESPONSES TO CERTAIN QUESTIONS OF THE UNITED STATES CONFERENCE OF CATHOLIC BISHOPS CONCERNING ARTIFICIAL NUTRITION AND HYDRATION

First question: Is the administration of food and water (whether by natural or artificial means) to a patient in a "vegetative state" morally obligatory except when they cannot be assimilated by the patient’s body or cannot be administered to the patient without causing significant physical discomfort?

Response: Yes. The administration of food and water even by artificial means is, in principle, an ordinary and proportionate means of preserving life. It is therefore obligatory to the extent to which, and for as long as, it is shown to accomplish its proper finality, which is the hydration and nourishment of the patient. In this way suffering and death by starvation and dehydration are prevented.

Second question: When nutrition and hydration are being supplied by artificial means to a patient in a "permanent vegetative state", may they be discontinued when competent physicians judge with moral certainty that the patient will never recover consciousness?

Response: No. A patient in a "permanent vegetative state" is a person with fundamental human dignity and must, therefore, receive ordinary and proportionate care which includes, in principle, the administration of water and food even by artificial means.

* * *

The Supreme Pontiff Benedict XVI, at the Audience granted to the undersigned Cardinal Prefect of the Congregation for the Doctrine of the Faith, approved these Responses, adopted in the Ordinary Session of the Congregation, and ordered their publication.

Rome, from the Offices of the Congregation for the Doctrine of the Faith, August 1, 2007.
William Cardinal Levada
Prefect
Angelo Amato, S.D.B.
Titular Archbishop of Sila
Secretary