Care of PVS Patients: Catholic Opinion in the United States

Masters Brooke , “Family's Life and Death Battle Plays Out in Court,” Washington Post, 9 September 1998, AI.

Congregation for the Doctrine of the Faith (CDF), “Vatican Declaration on Euthanasia,” Origins 10 (1980): 154–57.

Kobersteiner T. , “Developing Directive 58,” Health Progress, May-June, 2000: 20–27.

Cranford Ronald , “The Persistent Vegetative State: The Medical Reality,” Hastings Center Report 18 (Feb./Mar., 1988): 27–32; American Academy of Neurology, “Position Statement on the Management and Care of the Persistent Vegetative State Patient,” Neurology 39 (1989): 125-26; and The Multi-Society Task Force on PVS, “Medical Aspects of the Persistent Vegetative State,” New England Journal of Medicine 330 (1994): 1499-1508, 1572-79.

The Multi-Society Task Force on PVS, “Medical Aspects of the Persistent Vegetative State,” 1576. Finucane Thomas , Christmas Colleen , and Travis Kathy “Tube Feeding in Patients with Advance Dementia,” The Journal of the American Medical Associations (1999): 1365–70.

The Multi-Society Task Force on PVS, “Medical Aspects of the Persistent Vegetative State,” 1499-1504, 1572-75. Cf., Associated Press, Chicago Tribune (22 March 1983).

Celesia Gastone , “Persistent Vegetative State: Clinical and Ethical Issues,” Theoretical Medicine 18 (1997): 222. See also Fred Plum and Jerome Posner, The Diagnosis of Stupor and Coma (Philadelphia, PA: Davis Company, 1980).

Celesia Gastone , “Persistent Vegetative State: Clinical and Ethical Issues,” 22136; Fred Plum and Jerome Posner, The Diagnosis of Stupor and Coma, passim.

In stating only three opinions, we are excluding the position that would claim legitimacy for the intentional killing of patients through the deliberate omission of AHN. This opinion has never been compatible with Catholic teaching (see John Paul II, Evangelium Vitae, no. 65). For the full text, see Origins 24 (1995): 689727.

Richard Edward , “Bioethical Magisterium on Normal Treatment and Ordinary Care: Medically Assisted Feeding and Hydration,” unpublished paper, copyright 1999, distributed by Archbishop of Saint Louis to diocesan clergy, 1,5.

Grisez Germain , Living a Christian Life, vol. 2 of The Way of the Lord Jesus -(Quincy, IL: Franciscan Press, 1993), 284–86, 524-32. Cf., Robert Barry, “Feeding the Comatose and the Common Good in the Catholic Tradition,” The Thomist 53 (1989): l-30.

Paul John II , Evangelium Vitae, no. 65

CDF, “Vatican Declaration on Euthanasia,” 156.

Boyle Joseph , “A Case for Sometimes Tube-feeding Patients in Persistent Vegetative State,” in Euthanasia Examined, ed. Keown John (Cambridge: Cambridge University Press, 1995), 189-99; and Eugene Diamond Ethics and Medics 24 (Sept., 1999)

McCann Robert , Hall William , and Groth-Juncker Annmarie , “Comfort Care for Terminally 111 Patients,” Journal of the American Medical Association 272 (1994): 1263–66; Ronald Cranford, “The Case of Mr. Stevens,” Issues in Law and Medicine 7 (Fall, 1991): 199-211; Stephen Cox, “Is Dehydration Painful?”

Pious Pope XII , “The Prolongation of Life,” The Pope Speaks 4 (1958): 39398.

Prummer Dominicus , Manuale Theologiae Moralis, vol. 1 (Rome: Herder, 1958), N. 54.

Graham George , “Artificial Nutrition and Hydration: It is Time to Take a Stand,” Homiletic and Pastoral Review 99 (May, 1999): 17.

Cf., “Court Rules Against Christine Busalacchi,” National Right to Life News (6 February 1993).

Wildes Kevin , “Ordinary and Extraordinary Means and the Quality of Life,” Theological Studies 57 (1996): 500–13.

Meisel Alan , “The Legal Consensus About Foregoing Life Sustaining Treatments: Its Status and Its Prospects,” Kennedy Institute of Ethics Journal 2 (1992): 309–45. Court cases: Brophy v. New England Sinai Hospital, Inc., 398 Mass 417, 497 N.E. 2nd 626 (1986); Cruzan v. Director, Missouri Dept. of Health, 497 U.S. 261, 110 S. Ct. 2841 (1990); John Paris, “Hugh Finn's ‘Right to Die’,” America 179 (Oct. 31, 1998): 13-15. Professional Societies: American Academy of Neurology (see note 3); Committee on Ethics, American Nurses Association, Guidelines on Withdrawing or Withholding Food and Fluid (Kansas City, MO: 1987); and American Medical Association Council on Ethical and Judicial Affairs, “Decisions Near the End of Life,” Journal of the American Medical Association 267 (1992): 2229-33.

Goldstein Amy , “Pro-Life Activists Take on Death,” Washington Post 10 November 1998) Al.

Paul John II , Veritatis Splendor, no. 78. For the full text, see Origins 21 (1992): 707.

U.S. Bishops Pro-Life Committee (PLC), “Nutrition and Hydration: Moral and Pastoral Reflections,” Origins 21 (1992): 707.

Saunders William , “Euthanasia and Extraordinary Care, Parts I and II,” Arlington Catholic Herald (15 and 22 October 1998). See also George Graham, “Artificial Nutrician and Hydration,” 11.

Celesia Gastone , “Persistent Vegetative State: Clinical and Ethical Issues,” 22136; Jacquelyn Slomka, “What Do Apple Pie and Motherhood Have to Do with Feeding Tubes and Caring for the Patient?” Archives of Internal Medicine 155 (1995): 1258–63; and Thomas Finucane, Colleen Christmas, and Kathy Travis, “Tube Feeding in Patients with Advanced Dementia,” 1365-70.

PLC, “Nutrition and Hydration,” 705–12; Joseph Boyle, “A Case for Sometimes Tube-Feeding Patient,” 189-99; William May “Tube Feeding and the ‘Vegetative State’ (Part I),” Ethics and Medics 23 (December, 1998): 1-2 and “Tube Feeding and the ‘Vegetative Sate’ (Part II),” Ethics and Medics 24 (January, 1999): 3-4.

CDF, “Instructions on the Ecclesial Vocation of the Theologian,” n. 17. For full text, see Origins 20 (1990): 117–26.

PLC, “Nutrition and Hydration,” 710.

National Conference of Catholic Bishops (NCCB), Ethical and Religious Directives for Catholic Health Services (ERD), fifth printing, (Washington DC: United States Catholic Conference, 1995), 21-22 and Directive nos. 55-58.

National Conference of Catholic Bishops (NCCB), Ethical and Religious Directives for Catholic Health Services (ERD)., Directive nos. 56 and 57.

May William “Tube Feeding and the ‘Vegetative State’ (Part I),” Germain Grisez, Living a Christian Life, 284–86, 524-26; and Bishop McHugh, “Artificially Assisted Nutrition and Hydration,” Origins 19 (1989): 314-16.

Barry Robert , Medical Ethics: Essays on Abortion and Euthanasia (New York, NY: Peter Lang, 1989), 179–200.

Grisez Germain , Christian Moral Principles, Vol. 1 of The Way of the Lord Jesus (Chicago, IL: Franciscan Herald Press, 1983), 115–40; and “Should Nutrition and Hydration be Provided to Permanently Unconscious Persons?” Issues in Law and Medicine 5 (Fall, 1989): 173.

Mclnerny Ralph , “The Principles of Natural Law,” American Journal of Jurisprudence 25 (1980): 1–15; and Benedict Ashley, “What is the End of the Human Person?” in Moral Truth and Moral Tradition, ed. Luke Gormally (Blackrock, Ireland: Four Court Press, 1994), 73. For further discussion of this debate, see Germain Grisez and John Finnis, “The Basic Principles of Natural Law: A Reply to Ralph Mclnerny,” American Journal of Jurisprudence 26 (1981): 2131; and William May, “Recent Moral Theology: Servais Pinckaers and Benedict Ashley,” The Thomist 62 (1998): 130-31.

PLC, “Nutrition and Hydration,” 707–08.

A representative sample would include: Texas Catholic Conference (16 of 18 bishops assenting), “On Withdrawing Artificial Nutrition and Hydration,” Origins 20 (1990): 53–55; Bishop Gelineau, “On Removing Nutrition and Water from Comatose Woman,” Origins 17 (1997): 545-47; Bishop Liebrecht, “The Nancy Beth Cruzan Case,” Origins 90 (1990): 525-26; Bishop Kelly, “Hugh Finn Case,” Associated Press (11 September 1998); and Oregon and Washington Bishops, “Living and Dying Well,” Origins 21 (1991): 345ff.

Edward Richard, “Bioethical Magisterium on Normal Treatment,” 5; May William , Barry Robert , Griese Orville , “Feeding and Hydrating the Permanently Unconscious and Other Vulnerable Persons,” Issues in Law and Ethics 3 (Winter, 1987): 207–17; amd Robert Barry, “Feeding the Comatose and the Common Good,” 1-30.

American Academy of Neurology, see note 3; and American Medical Association Council on Ethical and Judicial Affairs, see note 20. Also, new laws in Florida recognize explicitly that AHN is a medical device. “Seniority Section,” St. Petersburg Times (27 July 1999).

Finucane T. , Christmas C. , Travis K. , “Tube Feeding in Patients with Advanced Dementia,” JAMA October 13. 1999; 282: 14: 1365–69; M. Gillick, “Rethinking the Role of Tube Feeding in Patients with Advanced Dementia,” NEJM, January 20, 2000;342: 3: 206-10.

The pertinent text reads: “a great teaching is needed to clarify the substantive moral difference between discontinuing medical procedures that may be burdensome, dangerous or disproportionate to the expected outcome… 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 (emphases added),” Paul John II “Building a Culture of Life,” Origins 28 (1998): 316. One notes the careful distinction between normal care versus feeding and hydration as well as the distinction between medically assisted nutrition and hydration versus feeding and hydration.

Cf., Edward Richard, “Bioethical Magisterium on Normal Treatment,” 5; see also unsigned editorial, “Feeding and Hydration of Patients,” St. Louis Review (16 October 1998).

Cf., note 36.

The Pope could have easily confirmed the Pro-Life Committee's conclusion by quoting it verbatim. His failure to do so as well as his failure to mention the condition of PVS suggests that the issue remains unresolved because of the pastoral caution generally used by the Magisterium when offering advice on specific applications of agreed upon norms and principles. Cf., McCormick Richard , “‘Moral Considerations’ 111 Considered,” America 166 (March 14, 1992): 210–14, esp. 211.

Most states permit individuals to refuse artificial nutrition and hydration through Living Wills or Durable Power of Attorney. Cf., Artificial Nutrition and Hydration in Medical Durable Power of Attorney Statutes (New York, NY: Choice in Dying, 1993).

John Paris, “Hugh Finn's ‘Right to Die’,” 13-15; Richard McCormick, “‘Moral Considerations’,” 210-14; Brodeur Dennis , “The Ethics of Cruzan,” Health Progress 71 (October 1990): 42–47; and Kevin O'Rourke, “Should Nutrition and Hydration be Provided to Permanently Unconscious and Other Mentally Disabled Persons,” Issues in Law and Medicine 5 (1989): 181-96. Cf., note 20 for medical societies that approve this practice.

cf., note 36.

Cronin Daniel , “Moral Law in Regard to the Ordinary and Extraordinary Means of Conserving Life,” in Conserving Human Life, ed. Smith Russell (Braintree, MA: Pope John XXIII Center, 1989), 33ff.

Archdiocese of Chicago, “Chicago Commission Speaks Out on Nutrition and Hydration,” Health Progress 68 (December, 1987): 35–36, 68.

Pellegrino Edmund , and Thomasma David , For the Patient's Good: The Restoration of Beneficence in Health Care (New York, NY: Oxford University Press, 1988), 80.

Catechism of the Catholic Church (English Translation), 2nd ed. Liberia Edictrice Vaticana, 1997, n.l.

NCCB Doctrine Committee, “Moral Principles Concerning Infants with Anencephaly,” 26 Origins (1996): 276; and Kevin O'Rourke, “Ethical Opinions in Regard to the Question of Early Delivery of Anencephalic Infants,” Linacre Quarterly 63 (Aug., 1996): 55-59.

Aquinas Thomas , Summa Theologiae, HI, q. 1, a. 1.

Aquinas Thomas , Summa Theologiae., I-H, q. 5, a. 1.

PLC, “Nutrition and Hydration,” 707.

Cf., Ashley Benedict , and O'Rourke Kevin Health Care Ethics: A Theological Analysis, 4th Edition (Washington, DC: Georgetown University Press, 1997), 19192.

NCCB, ERD, Introduction to Part Five, 22.