Distinguished Ladies and Gentlemen!
. . .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. . .
1. I cordially greet all of you
who took part in the International Congress:
"Life-Sustaining Treatments and Vegetative State:
Scientific Advances and Ethical Dilemmas." I wish to
extend a special greeting to Bishop Elio Sgreccia,
Vice-President of the Pontifical Academy for Life,
and to Prof. Gian Luigi Gigli, President of the
International Federation of Catholic Medical
Associations and selfless champion of the
fundamental value of life, who has kindly expressed
your shared feelings.
This important Congress, organized jointly by the
Pontifical Academy for Life and the International
Federation of Catholic Medical Associations, is
dealing with a very significant issue: the
clinical condition called the "vegetative state".
The complex scientific, ethical, social and pastoral
implications of such a condition require in-depth
reflections and a fruitful interdisciplinary
dialogue, as evidenced by the intense and carefully
structured program of your work sessions.
2. With deep esteem and sincere
hope, the Church encourages the efforts of men and
women of science who, sometimes at great sacrifice,
daily dedicate their task of study and research to
the improvement of the diagnostic, therapeutic,
prognostic and rehabilitative possibilities
confronting those patients who rely completely on
those who care for and assist them. The person in a
vegetative state, in fact, shows no evident sign of
self-awareness or of awareness of the environment,
and seems unable to interact with others or to react
to specific stimuli.
Scientists and researchers realize that one must,
first of all, arrive at a correct diagnosis, which
usually requires prolonged and careful observation
in specialized centers, given also the high number
of diagnostic errors reported in the literature.
Moreover, not a few of these persons, with
appropriate treatment and with specific
rehabilitation programmes, have been able to emerge
from vegetative state. On the contrary, many others
unfortunately remain prisoners of their condition
even for long stretches of time and without needing
technological support.
In particular, the term permanent vegetative
state has been coined to indicate the condition
of those patients whose "vegetative state" continues
for over a year. Actually, there is no different
diagnosis that corresponds to such a definition, but
only a conventional prognostic judgment, relative to
the fact that the recovery of patients,
statistically speaking, is ever more difficult as
the condition of vegetative state is prolonged in
time.
However, 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.
3. Faced with patients in
similar clinical conditions, there are some who cast
doubt on the persistence of the "human quality"
itself, almost as if the adjective "vegetative"
(whose use is now solidly established), which
symbolically describes a clinical state, could or
should be instead applied to the sick as such,
actually demeaning their value and personal dignity.
In this sense, it must be noted that this term, even
when confined to the clinical context, is certainly
not the most felicitous when applied to human
beings.
In opposition to such trends of thought, 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."
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.
4. Medical doctors and health
care personnel, society and the Church have moral
duties toward these persons from which they cannot
exempt themselves without lessening the demands both
of professional ethics and human and Christian
solidarity.
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.
I should like particularly, to underline how 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.
The obligation to provide the "normal care due to
the sick in such cases" (Congregation for the
Doctrine of the Faith, Iura et bona, p. IV)
includes, in fact, the use of nutrition and
hydration (cf. Pontifical Council "Cor Unum", Dans le cadre, 2.4.4; Pontifical Council for
Pastoral Assistance to Health Care Workers, Charter of Health Care Workers,
no. 120). 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.
In this regard, I recall what I wrote in the
Encyclical Evangelium vitae, making it clear
that "by Euthanasia in the true and proper sense
must be understood an action or omission which by
its very nature and intention brings about death,
with the purpose of eliminating all pain"; such an
act is always "a serious violation of the law of
God, since it is the deliberate and morally
unacceptable killing of a human person" (no. 65).
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.
5. Considerations about the
"quality of life," often actually dictated by
psychological, social and economic pressures, cannot
take precedence over general principles.
First of all, 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.
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.
6. However, it is not enough to
reaffirm the general principle according to which
the value of a man's life cannot be made subordinate
to any judgment of its quality expressed by other
men; it is necessary to promote the taking of
positive actions as a stand against pressures to
withdraw hydration and nutrition as a way to put an
end to the lives of these patients.
It is necessary, above all, to support those
families who have had one of their loved ones
struck down by this terrible clinical condition.
They cannot be left alone with their heavy human,
psychological and financial burden. Although the
care for these patients is not, in general,
particularly costly, society must allot sufficient
resources for the care of this sort of frailty, by
way of bringing about appropriate, concrete
initiatives such as, for example, the creation of a
network of awakening centers, with specialized
treatment and rehabilitation programmes; financial
support and home assistance for families, when
patients are moved back home at the end of intensive
rehabilitation programmes; the establishment of
facilities which can accommodate those cases in
which there is no family able to deal with the
problem or to provide "breaks" for those families
who are at risk of psychological and moral burn-out.
Proper care for these patients and their families
should, moreover, include the presence and the
witness of a medical doctor and an entire team, who
are asked to help the family understand that they
are there as allies who are in this struggle with
them. The participation of volunteers represents a
basic support to enable the family to break out of
its isolation and to help it to realize that it is a
precious and not a forsaken part of the social
fabric.
In these situations, then, spiritual counseling
and pastoral aid are particularly important as help
for recovering the deepest meaning of an apparently
desperate condition.
7. Distinguished Ladies and
Gentlemen, in conclusion I exhort you, as men and
women of science, responsible for the dignity of the
medical profession, to guard jealously the principle
according to which the true task of medicine is "to
cure if possible, always to care."
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).
In this light, I invoke upon you the assistance
of Him, whom a meaningful saying of the Church
Fathers describes as Christus medicus, and in
entrusting your work to the protection of Mary,
Consoler of the sick and Comforter of the dying, I
lovingly bestow on all of you a special Apostolic
Blessing.
(published in "L'Osservatore Romano" (English
edition), 31 March 2004, p. 5)