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Story of the day:
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FEEDING-DEBATE Apr-7-2004 (990 words) xxxi
Experts say pope's speech on feeding tubes settles some key issues
By John Thavis
Catholic News Service
VATICAN CITY (CNS) -- Pope John Paul II's forceful defense of nutrition and hydration for patients in a persistent vegetative state has narrowed the margin of Catholic debate on the issue, according to church experts at the Vatican and in Rome.
At the same time, the pope's speech left some key aspects of the question open to further reflection and interpretation, the experts said. One crucial point the pope himself acknowledged was that tube-feeding loses its purpose when the patient is no longer nourished by the process.
Interviewed by Catholic News Service in Rome April 6-7, the experts agreed that the pope's comments marked a significant step in consolidation of the Catholic position on the nutrition and hydration issue.
"I have no doubt that the implications of this statement will be considered extremely important, particularly in the more than 600 Catholic hospitals in the United States," said Redemptorist Father Brian Johnstone, a theologian in Rome who deals with bioethical issues.
The pope's comments are authoritative, church officials said, although less so than if they had been expressed in an encyclical or other document.
"This is a speech that has a clarifying function. It is authoritative without being definitive," said Franciscan Father Maurizio Faggioni, a theological expert on life issues and a consultor to the Vatican's doctrinal congregation.
The main clarification to emerge from the pope's speech was that, in the church's view, nutrition and hydration by "artificial" means such as feeding tubes are generally to be considered ordinary care and not extraordinary medical treatment.
That's important because the church teaches that "extraordinary" means of treatment for unresponsive patients can sometimes be discontinued. Some Catholic experts have argued that feeding tubes fall into the category of extraordinary treatment; the pope said otherwise, and that will alter future discussion.
On this particular point, "it's something that closes the debate, in my view," Father Johnstone said.
"I would not consider it appropriate for a Catholic theologian, one who is committed to the tradition, to deny the (pope's) basic proposition and say that we can stop food and hydration" on the grounds that it is an extraordinary means of treatment, Father Johnstone said.
The pope made his speech March 20 to participants in a Vatican-sponsored conference on life-sustaining treatments for patients in a persistent vegetative state.
In the key section of his talk, the pope said, "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," he said.
Father Faggioni said the pope cut through some false distinctions in arriving at his conclusion.
"The issue is not whether it is natural or artificial treatment. Medicine is all artificial, in a certain sense. That distinction makes even less sense today -- 'artificial' means are quite ordinary," Father Faggioni said.
So rather than dwell on whether a tube or other instrument is involved, the pope's speech focused on the function of the treatment and its effect on the patient, he said.
Bishop Elio Sgreccia, vice president of the Pontifical Academy for Life, which co-sponsored the conference, said April 7 that the pope's remarks have been wrongly interpreted by some to mean that the feeding tube is obligatory in every circumstance.
When the pope spoke of the "proper finality" of nutrition and hydration, he was making an important qualification, Bishop Sgreccia said.
"As long as nutrition and hydration are a support, as long as it is food and thirst-quenching drink that helps avoid suffering, it is obligatory," he said.
"If the patient no longer assimilates food and if the patient no longer has thirst quenched by fluids but is only tormented, there's no longer an obligation to administer it," he said.
Bishop Sgreccia, the pope's top bioethics adviser, said the pope's words were weighed very carefully. In the end, he said, they leave a "margin of judgment" to doctors and other health care professionals, who must decide whether the patient is truly being nourished and having his suffering alleviated.
Father Johnstone, who teaches at Rome's Alphonsianum University and works in a hospice for the terminally ill, said some experts have made the argument that tube-feeding can itself cause or increase suffering in a patient, especially when it requires constant adjustment or when the flesh around the tube degenerates.
Much depends on individual circumstances and a doctor's informed judgment, he said.
Bishop Sgreccia and others emphasized that the pope's speech did not appear out of nowhere. They said the basic position in favor of nutrition and hydration has been expressed before -- for example, in documents of the Pontifical Academy of Sciences and the Pontifical Council "Cor Unum," and in the 1994 "Charter for Health Care Workers" published by the Pontifical Council for Health Care Workers.
"The pope's speech is very much in line with previous church positions going back to Pope Pius XII. In this case, the Holy Father applies it to the particular case of patients in the so-called vegetative state, and discusses the issue with a breadth and depth that is new," said Father Faggioni.
"It's a speech, so clearly this is not an 'ex cathedra' pronouncement. It's not infallible, and it's not an encyclical. But it is not a casual teaching, either. The pope is confirming an important teaching in the light of new medical practices," Father Faggioni said.
The experts said they would not be surprised if the pope writes a new document on this and related issues. Father Johnstone said he believes such a document is already in the works, as an expansion of the pope's 1995 encyclical, "Evangelium Vitae" ("The Gospel of Life").
END
Copyright (c) 2004 Catholic News Service/U.S. Conference of Catholic Bishops. The CNS news report may not be published, broadcast, rewritten or otherwise distributed, including but not limited to such means as framing or any other digital copying or distribution method, in whole or in part without the prior written authority of Catholic News Service.
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