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VATICAN-NUTRITION Sep-14-2007 (1,100 words) xxxi

Vatican says food, water must be provided to vegetative patients

By John Thavis
Catholic News Service

VATICAN CITY (CNS) -- In a brief document approved by Pope Benedict XVI, the Vatican said it was generally a moral obligation to provide food and water to patients in a vegetative state.

Nutrition and hydration, even by artificial means, cannot simply be terminated because doctors have determined that a person will never recover consciousness, the Vatican said Sept. 14.

Exceptions may occur when patients are unable to assimilate food and water or in the "rare" cases when nutrition and hydration become excessively burdensome for the patient, it said.

The text was prepared by the Congregation for the Doctrine of the Faith in the form of a response to questions raised by the U.S. bishops' conference. It was signed by U.S. Cardinal William J. Levada, prefect of the doctrinal congregation, and approved by the pope before publication.

The congregation's document strongly reaffirmed points made by Pope John Paul II in a landmark speech in 2004, when he said nutrition and hydration, even by "artificial" means such as feeding tubes, should generally be considered ordinary care and not extraordinary medical treatment.

That was a key point, because the church teaches that "extraordinary" means of treatment for unresponsive patients can sometimes be discontinued.

The late pope's speech prompted questions in the theological and medical communities, and the U.S. bishops' Committee on Doctrine submitted questions to the congregation in 2005 to clarify the issues.

After a lengthy study, the congregation released its responses to two basic questions.

First, it said, administering food and water to a patient in a vegetative state is morally 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," it said.

Second, the congregation said it was not morally acceptable to discontinue such care even when physicians judge that the patient will never regain consciousness.

"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," it said.

The congregation's accompanying commentary explored the reasons behind the church's teaching and explained a few scenarios where exceptions might apply.

It noted that the very expression "vegetative state," which the church reluctantly uses because it is a common medical term, is unfortunate and misleading. Patients in this state maintain full human dignity, right up to natural death, it said.

Moreover, such patients are not necessarily terminally ill and generally carry on basic metabolic functions. They are simply unable to feed themselves, it said.

"If they are not provided artificially with food and liquids, they will die, and the cause of their death will be neither an illness nor the 'vegetative state' itself, but solely starvation and dehydration," it said.

The commentary said the artificial administration of food and water usually does not impose a heavy burden on the patient or the relatives, although it acknowledged that the burden could become notable when such treatment continues for months or years.

Nutrition and hydration does not require excessive expense and does not of itself require hospitalization, it said.

"It is not, nor is it meant to be, a treatment that cures the patient, but is rather ordinary care aimed at the preservation of life," it said.

In that sense, it said, the general ethical principle is that "the provision of water and food, even by artificial means, always represents a natural means for preserving life and is not a therapeutic treatment. Its use should therefore be considered ordinary and proportionate, even when the 'vegetative state' is prolonged."

That was also the conclusion of Pope John Paul's 2004 speech and reflects the development of church statements over the last 50 years, the Vatican said.

In a brief discussion of exceptions to this basic moral principle, the congregation outlined three possible situations:

-- In very remote or impoverished places, artificial provision of food and water may be physically impossible.

-- Because of complications, a patient may be unable to assimilate foods and liquids, so their provision becomes useless.

-- In some rare cases, artificial nourishment and hydration may be excessively burdensome for the patient or may cause significant physical discomfort.

The U.S. Conference of Catholic Bishops, in a question-and-answer commentary on the Vatican document, also looked at the potential exceptions.

It said there are medical situations in which it is moral to withhold nutrition and hydration -- for example, a patient in the last stages of stomach cancer might refuse nutrition and hydration because it causes pain and produces little benefit. But the vegetative state is not itself a case of imminent dying and, therefore, it is generally not a burden to nourish such patients, it said.

The USCCB commentary said providing such nutrition and hydration could impose significant financial burdens on Catholic health care facilities, which are sometimes obliged to bear the cost of health care for families that are poor or have no health insurance.

"In the loving care that they provide to such persons, with the assistance of the entire Catholic community, they can provide concrete examples of the church's commitment to human life," it said.

In an interview with Vatican Radio, U.S. Dominican Father J. Augustine Di Noia, undersecretary of the doctrinal congregation, said the insistence on nutrition and hydration as an ordinary means of treatment does not represent a change in church teaching.

It should be remembered, he said, that the person in a persistent vegetative state generally does not face imminent death and so is "not actually dying, in that sense, any more than any of us."

"The church is not here enjoining a kind of excessive prolongation of life, but simply saying that to withdraw nutrition and hydration is to end a life that would otherwise continue naturally," Father Di Noia said.

What the congregation is also saying is that the "quality of life" frequently mentioned as a determining factor in medical care is not a judgment that is "in our hands to make," he said.

He said the church teaches that life is a gift from God and that human dignity endures through a person's entire physical development -- from the mother's womb to the moment of natural death.

- - -

The text of the Vatican document can be found at

The text of the doctrinal congregation's commentary can be found at


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