In August 2024, the Pontifical Academy for Life (PAV) released a book, titled “Piccolo Lessico del Fine-Vita” (“Small Lexicon on the End of Life”). This publication aims to clarify terms and reduce misunderstandings in discussions on end-of-life care.
The book covers topics such as intensive care, palliative care, euthanasia, organ transplantation, and cremation. However, its section on artificial nutrition and hydration (ANH) garnered the most media attention.
Some outlets claimed the PAV was endorsing practices akin to assisted suicide, while others suggested the Vatican was showing a “new openness” regarding its stance on providing food and hydration to patients in a vegetative state.
The book states:
“In diseases in which there is a prolonged state of unconsciousness, with almost null chance of recovery – as the case of permanent vegetative state – it could be argued that, in cases of suspension of ANH, the death is not caused by the course of the disease, but by the actions of those who suspend them (…) On closer inspection, however, this argument falls victim to a reductive conception of disease (…) leading to an equally reductive conception of care, which ends up focusing in the singular functions of the organism instead of the overall good of the person”
This position appears to contrast with a 2007 response to a couple of dubia from the Congregation for the Doctrine of the Faith (CDF), which asserted that: “administration of food and water even by artificial means is, in principle, an ordinary and proportionate means of preserving life.”
However, the PAV emphasizes that its views “do not necessarily conflict with what was affirmed by the CDF.”
The CDF’s 2007 response was nuanced, noting that the obligation to administer ANH applies only “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.”
Also, the dubium to which the CDF was answering to was qualified: “Is the administration of food and water (whether by natural or artificial means) to a patient in a ‘vegetative state’ morally obligatory except when they cannot be assimilated by the patient’s body or cannot be administered to the patient without causing significant physical discomfort?”
In other words, the CDF’s answer is only applicable if the ANH can be assimilated by the patient and without causing significant physical discomfort.
The PAV book specifically mentions, as legitimately ethic motivations to withdraw ANH, the “loss of efficacy from a clinical point of view” and “a grave and significant physical discomfort” for the patient.
To these circumstances, the PAV book adds the lack of availability of ANH in the healthcare setting under consideration.
The 2007 CDF response came in the context of the highly publicized Terri Schiavo case. Schiavo was a Florida woman in a “persistent vegetative state”, whose life could have continued for years, and whose condition only became “end-of-life” when hydration and nutrition were removed.
This article was originally published at “The City and the World.” Click here to subscribe to this Catholic journalism project by Pedro Gabriel and Claire Domingues.
Pedro Gabriel, MD, is a Catholic layman and physician, born and residing in Portugal. He is a medical oncologist, currently employed in a Portuguese public hospital. A published writer of Catholic novels with a Tolkienite flavor, he is also a parish reader and a former catechist. He seeks to better understand the relationship of God and Man by putting the lens on the frailty of the human condition, be it physical and spiritual. He also wishes to provide a fresh perspective of current Church and World affairs from the point of view of a small western European country, highly secularized but also highly Catholic by tradition.
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