Should Nutrition and Hydration be Provided to Permanently Comatose and Other Mentally Disabled Persons?

Flynn Professor of Christian Ethics, Mount Saint Mary's College, Emmitsburg, Maryland; Ph.D., University of Chicago, 1959.

My purpose here is to try to clarify certain philosophical issues underlying the moral norm articulated in a previous collective statement: May William E. , Barry Robert , O.P., Griese Orville Msgr. , Grisez Germain , Johnstone Brian , C. Ss. R., Marzen Thomas J. , J.D., McHugh Bishop James T. , S.J.D., Meilaender Gilbert , Ph.D., Siegler Mark , M.D., and Smith William Msgr. “Feeding and Hydrating the Permanently Unconscious and Other Vulnerable Persons,” 3: 3 Issues in Law & Medicine, pp. 203–211 (1987).

Even within medical circles, the language used in referring to permanently unconscious persons is bewilderingly complex, partly because the subject matter itself is not simple, partly because of the difficulties of diagnosis and prognosis, and partly because the medical community has no established tradition in the matter. On this linguistic-factual problem, see Ronald E. Cranford, “The Persistent Vegetative State: The Medical Reality (Getting the Facts Straight),” 18: 1 Hastings Center Report 27–32 (Feb./March 1988).

Concerning this presupposition, see Grisez Germain , and Boyle Joseph M. Jr. Life and Death with Liberty and Justice. A Contribution to the Euthanasia Debate, pp. 229–38(1979).

See id. at pp. 414-22 in the context of pp. 336-414; cf. John R. , Connery S.J. “The Ethical Standards for Withholding/Withdrawing Nutrition and Hydration,” 2: 2 Issues in Law & Medicine, pp. 87–97 (1986).

See Major David “The Medical Procedures for Providing Food and Water: Indications and Effects,” in By No Extraordinary Means: The Choice to Forego Life-Sustaining Food and Water, pp. 24–25 ( Lynn Joanne ed. 1986).

Grisez Germain “A Christian Ethics of Limiting Medical Treatment” in 2 Pope John Paul II Lecture Series in Bioethics 49–50 ( Lescoe Francis J. , and Liptak David Qu. eds. 1986).

See id., pp. 43–44.

O'Rourke O.P. , Kevin “The A.M.A. Statement on Tube Feeding: An Ethical Analysis,” America, Nov. 22, 1986, at 322.

McCormick S.J. , Richard A. “The Defective Infant (2): Practical Considerations,” The Tablet (London), July 21, 1984, at 691.

For a fuller philosophical and Catholic theological development of this line of argument: Finnis John , Boyle Joseph M. Jr. , and Grisez Germain Nuclear Deterrence, Morality and Realism, pp. 305–9 (1987); Germain Grisez, “Dualism and the New Morality,” in 5 Atti del Congresso Internazionale Tomasso D'Aquino nel suo Settimo Centenario 323-30 (1977); Linacre Centre Working Party, Euthanasia and Clinical Practice: Trends, Priorities and Alternatives 37-43 (1982).

Some other articulations of the argument against dualism: Gabriel Marcel, I The Mystery of Being: Reflection and Mystery, 127-53 (1960); Williams B. A. O. “Are Persons Bodies?” in The Philosophy of the Body: Rejections of Cartesian Dualism 137–56 (Stuart F. Spicker ed. 1970); J. M. Cameron, Bodily Existence, 53 Proceedings of the American Catholic Philosophical Association 59-70(1979).

For an argument for free choice: Grisez Germain , Boyle Joseph M. Jr. , and Tollefsen Olaf Free Choice: A Self Referential Argument, (1976). For a philosophical articulation of an ethics in accord with the Judeo-Christian tradition: Germain Grisez and Russell Shaw, Beyond the New Morality: The Responsibilities of Freedom (3rd ed. 1988).

For fuller formulations (in some ways overstated) of these lines of argument; Meilaender Gilbert “On Removing Food and Water: Against the Stream,” 14: 6 Hastings Center Report, pp. 11–13 (Dec. 1984); Patrick G. Derr, “Nutrition and Hydration as Elective Therapy: “ Brophy and Jobes from “An Ethical and Historical Perspective,” 2: 1 Issues in Law & Medicine, pp. 33-36(1986).

Pius XII, “Allocution to the International Congress of Anesthesiologists” (Nov. 24, 1957), 4 The Pope Speaks 396 (1958).