By Alex Schadenberg
Executive Director – Euthanasia Prevention Coalition
Participant – International Congress on “Life-Sustaining Treatments and Vegetative State”
As a participant to the International Congress (March 17 – 20, 2004) on “Life-Sustaining Treatments and Vegetative State” I feel the need to make a commentary on Pope John Paul II’s address on to the international congress. Many people who were not present at the congress, have attempted to distort the papal address, by either misinterpreting the address or by attacking the very nature of the papal address.
Pope John Paul II established two very important precedents by making this address on March 20, 2004.
TM First, the Pope effectively reinforced the human nature of all persons, no matter their state in life. He especially reinforced the humanity of people in a vegetative state. TM Second, the Pope states that people in a vegetative state have the right to receive basic health care which include nutrition and hydration. Therefore Pope John Paul II makes it clear that to withhold or withdraw food and fluids from a person in a vegetative state who is not otherwise dying is euthanasia.The Papal address: In section 1 of the address, the Pope greets the leaders, organizers and participants of the congress.In section 2 Pope John Paul II establishes the definitions of vegetative state and makes reference to the condition and prognosis for people in a vegetative state. The Pope clearly recognizes that only a few people will ever emerge from a vegetive state after 12 months and yet he also establishes that: “we must neither forget nor underestimate that there are well-documented cases of at least partial recovery even after many years; we can thus state that medical science, up until now, is still unable to predict with certainty who among patients in this condition will recover and who will not”
This last comment is important because to refer to vegetative state as permanent creates negative attitudes toward attempts at rehabilitating these people.
In section 3 Pope John Paul II makes several clear statements. In the first paragraph he states that the term (vegetative state) actually demeans the value and personal dignity of the person in this condition. The term vegetative state may in fact: “cast doubt on the persistence of the “human quality” itself”In section 3, paragraph 2, Pope John Paul II states: “I feel the duty to reaffirm strongly that the intrinsic value and personal dignity of every human being do not change, no matter what the concrete circumstances of his or her life. A man, even if seriously ill or disabled in the exercise of his highest functions, is and always will be a man, and he will never become a “vegetable” or an “animal”.”
This is an important statement because many medical care-givers question the humanity of the person in a vegetative state and believe that their life is not worth living.
The Pope concludes section 3 by stating: Even our brothers and sisters who find themselves in the clinical condition of a “vegetative state” retain their human dignity in all its fullness. The loving gaze of God the Father continues to fall upon them, acknowledging them as his sons and daughters, especially in need of help.In section 4 Pope John Paul II settles the question of providing food and fluids for people in a vegetative state.
The Pope states in section 4, paragraph 2: “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.”
This is an important statement because everyone has the right to receive basic health care, including people in a vegetative state.
The Pope states in section 4, paragraph 3: “the administration of water and food, even when provided by artificial means, always represents a natural means of preserving life, not a medical act. Its use, furthermore, should be considered, in principle, ordinary and proportionate, and as such morally obligatory, insofar as and until it is seen to have attained its proper finality, which in the present case consists in providing nourishment to the patient and alleviation of his suffering.”
This is an important statement because the Pope is stating that food and fluids are always a natural means of preserving life and not a medical act. For years there has been a debate among moral theologians as to whether artificially provided food and fluids were medical treatment or normal care. Legally, medical treatment is always optionally and morally medical treatment is optional when the treatment is not ordinary (easy to use and access) and disproportionate to its hoped outcome. In other words if the treatment is ordinary and proportionate (good chance of success) then the treatment is considered morally obligatory.
Many theologians have been debating the full meaning of section 4, paragraph 3. It is self-evident that the Pope intends this section to be taken seriously because of his use of the words morally obligatory. Previously the statement concerning nutrition and hydration were that there should be a presumption in favour of life. The medical care-giver is now morally obligated to provide nutrition and hydration to persons in a vegetative state.
The Pope states in section 4, paragraph 4: “The evaluation of probabilities, founded on waning hopes for recovery when the vegetative state is prolonged beyond a year, cannot ethically justify the cessation or interruption of minimal care for the patient, including nutrition and hydration. Death by starvation or dehydration is, in fact, the only possible outcome as a result of their withdrawal. In this sense it ends up becoming, if done knowingly and willingly, true and proper euthanasia by omission.”Section 4, paragraph 5 states from Evangelium Vitae (no. 65) the definition of Euthanasia. Therefore the Pope is re-inforcing that to dehydrate a person to death is euthanasia and bears the full weight of the Church’s teaching.
Pope John Paul II is not only saying that providing food and fluids to people in a vegetative state is morally obligatory, but that the withholding or withdrawing of food and fluids from people in a vegetative state is euthanasia by omission. This ends the debate within the Catholic Church concerning the moral nature of this act.
The Pope concludes section 4 by stating: “Besides, the moral principle is well known, according to which even the simple doubt of being in the presence of a living person already imposes the obligation of full respect and of abstaining from any act that aims at anticipating the person’s death.” In other words, you must always respect the lives of every living person and you may never intentionally cause another person’s death.Section 5 of the papal address further elaborate on the moral considerations for providing food and fluids.Section 5, paragraph 1 states: “Considerations about the “quality of life”, often actually dictated by psychological, social and economic pressures, cannot take precedence over general principles.”Section 5 paragraph 2 states: “no evaluation of costs can outweigh the value of the fundamental good which we are trying to protect, that of human life. Moreover, to admit that decisions regarding man’s life can be based on the external acknowledgment of its quality, is the same as acknowledging that increasing and decreasing levels of quality of life, and therefore of human dignity, can be attributed from an external perspective to any subject, thus introducing into social relations a discriminatory and eugenic principle.”
Paragraphs 1 and 2 essentially state that quality of life arguments, and evaluations of cost do not make the dehydration of persons in a vegetative state acceptable. The Pope recognizes the reality of the utilitarian arguments that are proposed today when he states that questions of quality of life and human dignity are based on discriminatory and eugenic principles. All people of good will should re-evaluate societal attitudes toward the weak and defenseless in order to prune out eugenic principles that society to discriminate against others.
To conclude section 5 the Pope states: “Moreover, it is not possible to rule out a priori that the withdrawal of nutrition and hydration, as reported by authoritative studies, is the source of considerable suffering for the sick person, even if we can see only the reactions at the level of the autonomic nervous system or of gestures. Modern clinical neurophysiology and neuro-imaging techniques, in fact, seem to point to the lasting quality in these patients of elementary forms of communication and analysis of stimuli.” In other words, we do not know if people in a vegetative state suffer from dehydrating to death, and we should not assume that they don’t.In section 6 of the address the Pope is calling on all men and women of good will to take positive actions as a way to stand up against the pressures to withdraw food and fluids. The Pope recognizes the support that is needed for the families and the people in a vegetative state. This support should include for the patients, special rehabilitation centres while the families should receive respite, hope care, financial, psychological and spiritual support.
Pope John Paul II concluded his address by stating : “As a pledge and support of this, your authentic humanitarian mission to give comfort and support to your suffering brothers and sisters, I remind you of the words of Jesus: “Amen, I say to you, whatever you did for one of these least brothers of mine, you did for me” (Mt 25: 40).
On March 20, 2004, Pope John Paul II may have made one of his most important addresses of his pontificate. Within this address the Pope ended the long debate over the ethical nature of dehydrating to death people in a vegetative state. Even though he does not extend his statement beyond the vegetative state I think it is clear that it is also morally obligatory to provide food and fluids to other cognitively disabled people, such as: people born anecephalic (only a brain stem).
For more information call the Euthanasia Prevention Coalition toll free at: 1-877-439-3348 or send to Box 25033 London ON N6C 6A8