Providing nutrition and hydration to patients in a permanent vegetative state, or pvs, is a duty, not an option.
That's Rome's final answer to the question of whether or not it's morally licit to withhold food and water from persons who show no signs of recovering from a prolonged period of unconsciousness.
According to the document released by the Vatican's Congregation for the Doctrine of the Faith on Sept. 14, "Responses to Certain Questions Regarding Artificial Nutrition and Hydration," food and water, even when administered by artificial means, are ordinary forms of care, not extraordinary forms of treatment.
That means except for in cases where either the body can't assimilate the nutrition and hydration or where administering it causes the patient significant discomfort -- for example, repeated infections in the intravenous line -- families and health care workers are morally obliged to provide food and water to pvs patients.
The statement, which was issued in response to questions from the U.S. Conference of Catholic Bishops, says nothing that has not been said before. It merely echoes the words of Pope John Paul II's 2004 address to the International Congress on "Life Sustaining Treatments and the Vegetative State," words, which, in turn, echoed a series of Vatican documents from the 1980s and 1990s.
Edward Furton, an ethicist with the National Catholic Bioethics Center, said the bishops asked for the clarification in the hopes of rooting out the deep-seated misconceptions on the question still held by many Catholic theologians, health care workers and laypeople.
"Part of the trouble," he said, "was that Pope John Paul's statement went against what is becoming an increasingly common practice. So what you have is the law of inertia. Once a practice is in place it becomes very difficult to change it."
That "increasingly common practice" is not only withholding food and water from pvs patients, but also from other patients who have become severely disabled mentally and seem unlikely to recover, such as stroke victims.
Although the CDF document only addressed the pvs condition, its content serves as a guidepost for all families and health care workers faced with the decision to begin or withdraw artificial nutrition or hydration in a patient.
"What it essentially comes down to is the question, 'Is this procedure care or treatment?' Care means things like turning the patient in bed so they don't get bedsores, maintaining proper temperature in the room, keeping clean bedclothes," Furton said.
"This document clarifies that food and water are care. They don't even rise to the level of treatment."
Because providing patients with care is morally obligatory, while providing extraordinary forms of treatment is not, in the vast majority of cases involving patients in need of artificial nutrition and hydration, the CDF's classification of the two as care should resolve any dilemmas families or doctors might face.
In other cases, where death appears to be imminent, Furton said the Church allows for another question to be asked: What is the patient going to die from?
"If they're going to die from lack of water, you're taking it away too soon," he said. "If they're going to die from the underlying condition before they become dehydrated, there's no need to provide food or water."
The reasoning behind the Church's position, explained William May, author of "Catholic Bioethics and the Gift of Human Life" (OSV, $17.95), stems from her constant belief in the dignity of the human person.
"Even when people's mental capacities are disabled, they're still living human beings," he said. "They're still persons. The value of their life isn't any less. It's still a good."
Hastening the end of that life through the withdrawal of nutrition and hydration, he continued, is euthanasia by omission. It willfully deprives the person of the good of their bodily life.
It also can cause the patient an undue amount of suffering. According to Furton and May, people who think removing a hydration tube from a loved one allows them to die a quiet, natural death are wrong; death by dehydration is prolonged and painful, causing the muscles to become spastic and the skin to shrivel.
For those reasons, May stressed that pastors must "tell the truth" about the Church's teaching on this subject to their parishioners, urge them to read the documents and look for ways the parish can support those who find themselves bearing what can be a very long and very heavy burden of care.
"Families need support in these situations," May concluded. "They can't do it alone. Theirs is a burden we have to help them accept."
Patient Self-Determination Act: A 1990 federal law requiring health care facilities to inform patients of their right to accept or refuse medical treatment and to formulate advance directives.
Physician-assisted Suicide: A form of euthanasia in which a physician provides the lethal substance or otherwise assists a patient in self-destruction.
Source:"A Catholic Guide to End-of-Life Decisions," published by the National Catholic Bioethics Center ($2.50 per guide). Visit www.ncbcenter.org for more information or to order copies.
According to Edward Furton, staff ethicist for the National Catholic Bioethics Center, a proxy is typically a better way to ensure the most appropriate means are taken to save your life or help you die comfortably should you become unable to make medical decisions for yourself.
The reason for that, he explained, is because a proxy is a person who can make context-specific decisions, while a living will is a document drawn up for circumstances that can't always be foreseen.
"It's difficult to imagine your demise and predict what you're going to need and not need," Furton said. "It's much better to have a person who knows you and can make decisions based on the situation you're in."
A typical example of the limits of living wills is their frequent inclusion of "Do Not Resuscitate" orders.
"A living will might say do not resuscitate," Furton said. "But sometimes it's clear a patient could benefit from that, that they would probably revive immediately and with minimal efforts."
Documents naming a proxy can be obtained from the National Catholic Bioethics Center (www.ncbcenter.org or 215-877-2660), as well as from many dioceses' chancery offices. Typically, these need to be signed and notarized.
Different states have different regulations governing the naming of a proxy, however, so Furton advised that people consult an attorney first to make sure the proxy conforms to their state's regulations.
Emily Stimpson is a contributing editor to Our Sunday Visitor.