Center for Ethics and Leadership

Sunday, August 10, 2008

But Is Artificial Nutrition & Hydration Basic Care?

This week's America (August 4-11) carries an article co-authored by Cardinal Justin Rigali, Archbishop of Philadelphia, and Bishop William E. Lori of Bridgeport, Connecticut, on artificial nutrition and hydration and patients in a persistent vegetative state (PVS). Cardinal Rigali chairs the Committee on Pro-Life Activities of the U.S. Conference of Catholic Bishops (USCCB), and Bishop Lori the Committee on Doctrine.

The question of the moral obligation to provide artificial nutrition and hydration to patients in PVS has a longer history than one might think. In the early 90s, local American conferences of Catholic bishops were divided on the question. Eventually John Paul II wrote that such treatment was life-sustaining and basic care and could not routinely be withdrawn. Noted Catholic moralist, Thomas Shannon described his reservations about this in America, and now the cardinal and bishop have responded.

There is much to agree with in their response. Patients in PVS cannot be dismissed, along with their medical treatment, as having a life not worth living, that is, a life without meaning or value. As the cardinal and bishop write convincingly, such reasoning too easily transfers to "anyone with mental illness, retardation or cognitive disabilities who is not able to pursue . . . 'worthwhile' activity." Yet I remain stuck on the starting point. I recognize the moral obligation of basic care --turning the patient to prevent sores, ice chips, and so on, but continue to have difficulty not placing artificial nutrition and hydration in the same category as ventilation and dialysis. Furthermore, something just does not look right about waiting for the need for either of these other two technologies to arise and then choosing not to apply them or waiting for a disease process to begin, such as pneumonia, and not treating it. One might argue that at that point the disease process has taken over. But is that not what raised the need for long-term nutrition and hydration in the first place?

Perhaps the issue is less the technology and more the need to further study the condition that has triggered the controversy. For the moment, this teaching is a difficult one for me.

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