catholic teaching on withholding food to hasten death

The moral obligation to provide medically assisted nutrition and hydration, then, is conditioned by medical efficacy.

The use of medically assisted nutrition and hydration, it said, should be presumed “in principle.” Clear medical reasons are to be given in each particular case to demonstrate why such assistance is not morally obligatory. John Paul II’s allocution also underscores that the administration of food and water-even when given by medical means, including feeding tubes-is a natural way of conserving life. In other words, such patients retain their moral claim to basic health care. The papal allocution strongly reaffirms the intrinsic worth and the personal dignity of every person, including those in the PVS, and insists on their right to basic health care, particularly nutrition and hydration, hygiene, a comfortable environment and the prevention of complications resulting from bed confinement. He also acknowledged that recovery is more difficult the longer the condition of the vegetative state remains. He referred to studies showing that up to 43 percent of patients were misdiagnosed and to cases of patient recovery after a period of time with sustained rehabilitative efforts. There Pope John Paul II delivered an allocution that encouraged scientists and researchers to find ways to diagnose PVS more accurately. In March 2004 an International Congress took place in Rome with the title Life-Sustaining Treatments and the Vegetative State: Scientific Progress and Ethical Dilemmas. The pivotal question for them has been: Is tube feeding a medical intervention-not just basic care-that can be morally evaluated using the traditional distinction between ordinary and extraordinary means of care? Other questions further complicate the issue: Can a persistent vegetative state be diagnosed with certitude? How does one determine the quality of life of a patient in this state? What the Church Teaches Given this complex history, it is not surprising that within the Catholic tradition a number of theologians, ethicists and groups of bishops have come to different conclusions regarding the use of tube feeding.

Clinicians agree that withholding or withdrawing a feeding tube is appropriate when 1) it is medically futile-that is, does not provide effective nutritional support or prevent dehydration 2) the patient would experience no real benefit 3) the burdens for the patient outweigh the benefits and 4) the patient is dying. Less unanimity, however, exists in the medical and moral fields. As a result, there is a virtually universal legal consensus that tube feeding is a medical treatment that may, depending on the result of a careful decision-making process, be withheld or withdrawn. In the past several decades, more than 40 courts in the United States have addressed medically assisted nutrition and hydration. A number of relevant questions also should be asked: What medical method is best suited for this person and for how long? What are the benefits and burdens of various methods? What are their side effects? In short, there is no single or simple answer to the questions surrounding tube feeding. To make an informed decision about the use of tube feeding, one must consider several factors, like a patient’s diagnosis, prognosis and current condition, as well as any complicating factors like the presence of renal failure and pneumonia. In such cases, feeding tubes and incisions need consistent monitoring. A tube can be passed through an incision in the abdominal wall and into the stomach, for example, or through the abdomen into a portion of the small intestine. Other tube-feeding methods require surgery. Nutrition and hydration can be provided by medical means, which are sometimes wrongly called “artificial.” A tube, for example, can be inserted through the nose and into the stomach, a method usually employed for short-term use. A diagnosis of PVS means that the doctor sees virtually no prospect for the patient’s recovery. While some brain functions, like wake/sleep cycles and spontaneous/automatic reflex actions of the nervous system may continue, all detectible activity of their neocortex has stopped. Such relatively common legal and moral debates are concerned with persons who are in a persistent vegetative state. The provision of nutrition and hydration through various medical interventions, generally described as “tube feeding,” is one of the most complex and controversial issues in contemporary bioethics. A number of high-profile legal cases since the 1980s have involved persons receiving medically assisted nutrition and hydration (food and water): Claire Conroy, Paul Brophy, Nancy Cruzan, Hugh Finn and Terri Schiavo.

Catholic teaching on withholding food to hasten death