About Medicine &
Morality
Archdiocese
of St. Louis Office of Communications Statement
July 3, 2000
On June 30, 2000 Archbishop Justin Rigali sent the following Statement of Principles for Health Care Decisions Concerning Assisted Nutrition and Hydration and Related Issues to a number of local healthcare providers:
Recently there has been some public discussion regarding the Catholic Church's teaching pertaining to end-of-life issues particularly to the issue of Assisted Nutrition and Hydration. The Archbishop believes now is an important moment to clarify general Catholic principles related to the subject of Assisted Nutrition and Hydration.
The Statement emphasizes that
while there are limited circumstances in which medical personnel
may discontinue providing nutrition and hydration to those who
are ill, there should be a presumption in favor of providing
nutrition and hydration to all patients.
Statement of
Principles for Health Care Decisions The responsibility to provide
or to continue to provide Assisted Nutrition and Hydration (ANH),
referred to by some as artificial nutrition and hydration, to
individuals who are diagnosed to be in a so-called Persistent
Vegetative State (PVS) is one of the most challenging medical-moral
issues confronting individuals and families. As Catholics, we believe that
God is the author of all life. We believe that we have a responsibility
to preserve our life. We believe that euthanasia and/or assisted
suicide is a usurpation of God's authority over all human life
and is, therefore, always morally wrong. Euthanasia is an action
or omission which of itself or by intention causes death, in
order that all suffering in this way may be eliminated (Declaration
on Euthanasia: Congregation for the Doctrine of the Faith, 1980). We also believe that there are
some limited qualifications to the obligation to attempt to preserve
life. "Discontinuing medical procedures that are burdensome,
dangerous, extraordinary, or disproportionate to the expected
outcome can be legitimate; it is the refusal of 'over-zealous'
treatment" (Catechism of the Catholic Church, 2278). Moreover, we believe that Jesus
Christ has defeated death and won the victory of life. Through
our baptism, we share in His victory and receive the gift of
eternal life. Death is not to be feared as the end of our existence,
but it is rather the doorway to our eternal destiny. Our faith
enlightens us that we need not desperately do everything possible
regardless of the futility or the burdens imposed on us or on
others to cling to life in this world as if it is our only hope. As Catholics, we believe "a
person has a moral obligation to use ordinary or proportionate
means of preserving his or her life" (The Ethical
and Religious Directives for Catholic Health Care Services
[ERD], 56). Conversely, "a person may forgo extraordinary
or disproportionate means of preserving life" (ERD,
57). "Proportionate means are those that in the judgment
of the patient offer a reasonable hope of benefit and do not
entail an excessive burden or impose excessive expense on the
family or the community" (ERD, 56). The decision to forgo a medical
treatment cannot be made because a person's life is judged as
not meaningful. We also believe: "There should be a presumption
in favor of providing nutrition and hydration to all patients,
including patients who require medically assisted nutrition and
hydration, as long as this is of sufficient benefit to outweigh
the burdens involved to the patient" (ERD, 58) Pope John Paul II in his October
2, 1998 Ad Limina Address to the Bishops of California,
Nevada, and Hawaii, after commending Catholics in America for
successfully working with other Christian communities to resist
the efforts to legalize assisted suicide, affirmed and further
explained the application of the presumption for the provision
of ANH. The Pope stated: "As ecumenical witness in defense
of life develops, a great teaching effort is needed to clarify
the substantive moral difference between discontinuing medical
procedures that may be burdensome, dangerous, or disproportionate
to the expected outcome what the Catechism of the Catholic Church
calls the refusal of overzealous treatment (no. 2278; cf.
Evangelium Vitae,
no. 65) and taking away the ordinary means of preserving life,
such as feeding, hydration, and normal medical care. The statement
of the U.S. bishops pro-life committee, Nutrition and Hydration:
Moral and Pastoral Considerations, rightly emphasizes that
the omission of nutrition and hydration intended to cause a patient's
death must be rejected and that, while giving careful consideration
to all factors involved, the presumption should be in favor of
providing medically assisted nutrition and hydration to all patients
who need them. To blur this distinction is to introduce a source
of countless injustices and much additional anguish, affecting
both those already suffering from ill health or the deterioration
which comes with age, and their loved ones." The presumption for the provision
of ANH does yield in some very limited circumstances. For instance,
there is a clear consensus that assisted nutrition and hydration
are "not morally obligatory either when they bring no
comfort to a person who is imminently dying or when they cannot
be assimilated by a person's body" (ERD, Part 5). Pope John Paul II in his October
2, 1998 Ad Limina Address referred to Nutrition and
Hydration: Moral and Pastoral Reflections, a 1992 statement
by the National Conference of Catholic Bishops' Committee for
Pro-Life Activities. The statement provides a thoughtful reflection
on the issues, questions, theories and rationales for addressing
this area of moral uncertainty. I recommend study of this statement
by individuals and families that are confronted with questions
regarding the moral appropriateness of continuing or withdrawing
ANH. The conclusion of the Pro-Life Committee's statement still
provides the best moral guidance on this question at this time: We reject any omission of
nutrition and hydration intended to cause a patient's death.
We hold for a presumption in favor of providing medically assisted
nutrition and hydration to patients who need it, which presumption
would yield in cases where such procedures have no medically
reasonable hope of sustaining life or pose excessive risks or
burdens. Recognizing that judgments about the benefits and burdens
of medically assisted nutrition and hydration in individual cases
have a subjective element and are generally best made by the
patient directly involved, we also affirm a legitimate role for
families' love and guidance, health care professionals ethical
concerns, and society's interest in preserving life and protecting
the helpless.
Concerning Assisted Nutrition and Hydration and Related Issues
