Nutrition and Hydration: Should They be Considered Medical Therapy?

Muriel M. Gillick, M.D., “Rethinking the Role of Tube Feeding in Patients with Advanced Dementia,” New England Journal of Medicine (January 20, 2000), pp. 206-210; Finucane T. “Tube Feeding in Patients with Advanced Dementia,” Journal of the American Medical Association (October 13, 1999), pp. 1365–69.

The Multi-Society Task Force on PVS, “Medical Aspects of the Persistent Vegetative State (First of Two Parts),” The New England Journal of Medicine, Vol. 330, No. 21, (June, 1994) pp. 1499–1508.

Diamond Eugene “Medical Issues When Discontinuing AHN,” Ethics and Medics, Vol. 24, No. 9, (September, 1999).

The Multi-Society Task Force on PVS, “Medical Aspects of the Persistent Vegetative State (Second of Two Parts),” p. 1578.

Diamond Eugene “Medical Issues When Discontinuing AHN;” Robert J. White, “A Note on the ‘Vegetative’ State,” Ethics and Medics. Vol. 24, No. 7.

Cf. Council on Ethical and Judicial Affairs of the American Medical Association, “Report on Decisions Near the End of Life,” Journal of the American Medical Association, Vol. 267, No. 16 (April, 1992), p. 2229–2233. Cf. also, The Multi-Society Task Force on PVS, “Medical Aspects of the Persistent Vegetative State (Second of Two Parts),” The New England Journal of Medicine, Vol. 330 (1994), p. 1577.

Council on Ethical and Judicial Affairs of the American Medical Association, “Report on Decisions Near the End of Life,” p. 2229.

The Multi-Society Task Force on PVS, “Medical Aspects of the Persistent Vegetative State (First of Two Parts),” p. 1501.

Cf. The Pontifical Academy of Sciences, “On the Artificial Prolongation of Life,” Origins (December 5, 1985), which states: “If the patient is in permanent coma, irreversible as far as is possible to predict, treatment is not required, but all care should be lavished on him, including feeding.” The Pontifical Council of Health Affairs states: “… there remains the strict obligation to continue by all means those measures which are called ‘minimal,’ which are intended normally and customarily for the maintenance of life (alimentation, blood transfusions, injections, etc.).” This text is quoted in Orville N. Griese, Conserving Human Life, (Boston: Pope John XXIII Center, 1989). p. 172.

Cf., for example, Eugene Diamond, “Medical Issues when Discontinuing AHN,” and Fisher Anthony O.P., “On Not Starving the Unconscious,” New Blackfriars, Vol. 74, No. 869, (March, 1993).

Anthony Fisher O.P. “On Not Starving the Unconscious.” New Blackfriars, Vol. 74, No. 869, (March, 1993).

Cf. Grisez Germain G. “Should Nutrition and Hydration be Provided to Permanently Unconscious and Other Mentally Disabled Persons?” Linacre Quarterly, Vol. 57, (May, 1990) and The Way of the Lord Jesus Christ, Vol. III (Quincy, Ill: Franciscan Press, 1997), Question 47. See also Anthony Fisher, O.P., “On Not Starving the Unconscious.” New Blackfriars, Vol. 74, No. 869, (March, 1993).

McHugh James T. “Artificially Assisted Nutrition and Hydration,” Origins (September 21, 1989), pp. 314–316. The position is best articulated by the Bishops of Pennsylvania, “Nutrition and Hydration; Moral Considerations,” Origins (January 30, 1992), and by the Pro-Life Activities Committee of the United States Conference of Catholic Bishops, “Nutrition and Hydration: Moral and Pastoral Reflections,” Origins (April, 1992). Several State Catholic Conferences including New York, New Jersey, Delaware, Maryland, and Florida all recognize a presumption in favor of the supply of nutrition and hydration, while allowing for its withdrawal if it should become futile or excessively burdensome. This position is stated in a normative form in Directive 58 of the Ethical and Religions Directives far Catholic Health Care Facilities, last issued by the United States Conference of Catholic Bishops in 2001. It should be noted that the Bishops of Texas (save two who dissented) and five or six individual bishops who have commented on specific cases, do not hold a presumption in favor of the supply of ANH to PVS patients.

Cf. O'Rourke Kevin O.P. , and Patrick Norris O.P. “Care of PVS Patients: Catholic Opinion in the United States,” Linacre Quarterly, Vol. 68, No. 3, (August, 2001), pp. 201–217. These authors identify three theological positions, but they dismiss one of them which “seems to prohibit the removal of ANH in all circumstances” as outside the realm of Church teaching. The other two positions which represent opposing views on the withdrawal of ANH from the PVS patient, are viewed by these authors to fall within the realm of Church teaching “insofar as the general principles for removing life support are concerned,” and at the present time when the Magisterium has not yet rendered a judgment on this specific question.

The Pontifical Council for Pastoral Assistance to Health Care Workers, Charter for Health Care Workers, (1995) no. 120.

The Congregation for the Doctrine of the Faith, Declaration on Euthanasia (May, 1980), Section II.

The Congregation for the Doctrine of the Faith, Declaration on Euthanasia.

Thomas Aquinas St. Summa Theologica, Part I of the II Part, Questions 6-19. For an analysis of the application of St. Thomas’ thought on the role of the will in human action see: William E. May, “Aquinas and Janssens on the Moral Meaning of Human Acts,” The Thomist, Vol. 48, No. 4 (October 1984). Pope John Paul II emphasized that human intentionality is present in the object of the act and not just in the motive for which the act is performed (see Veritatis Splendor, August, 1993), numbers 78-82.

The Catholic Bishops of Pennsylvania, Nutrition and Hydration: Moral Considerations (December 12, 1991), printed in Origins (January 30, 1992).

For a recent summary of this position which has been presented in numerous articles in various journals over the past twenty years see: May William E. “Tube Feeding and the ‘Vegetative’ State,” Ethics and Medics, Vol. 23, No. 12 and Vol, 24, No. 1 (December, 1998 and January, 1999). Cf. also May, Catholic Bioethics and the Gift of Human Life (Huntington, IN: Our Sunday Visitor, 2000), pp. 268-270.

For a recent summary of this position which has been presented in numerous articles in various journals over the past twenty years see: Kevin O'Rourke O.P. “On the Care of ‘Vegetative’ Patients: A Response to William E. May…” Ethics and Medics, Vol. 24, Nos. 4 and 5 (April and May, 1999). Cf. also Benedict Ashley, O.P. and Kevin O'Rourke, O.P., Health Care Ethics (4th ed. Washington, D.C.: Georgetown University Press, 1997), pp. 421-426.

Kevin O'Rourke O.P. “Should Nutrition and Hydration be Provided?” Issues in Law and Medicine, Vol. 5, No. 2 (1989), p. 188. Here O'Rourke refers to Pope Pius XII, “On the Prolongation of Life,” The Pope Speaks 393 (1958).

In support of this position, O'Rourke cites Pope Pius XII's description of ordinary means as those “that do not involve any grave burden for oneself or another. A more strict obligation would he too burdensome for most men and would render the attainment of the higher, more important good too difficult” (Pius XII, “On the Prolongation of Life”) William E. May considers O'Rourke's representation of the papal teaching as a misinterpretation, noting that “It is surely true that a means imposes a grave burden on a person (and is hence extraordinary or disproportionate] if it prevents him from pursuing the spiritual goal of life. But one cannot declare a means burdensome if it is ineffective in helping a person pursue this goal.” Cf. William E. May, “Tube Feeding and the ‘Vegetative’ State,” Ethics and Medics, Vol. 23, No. 12, p. 2. In his response to May's article, O'Rourke does not address this objection. Cf. Kevin O'Rourke O.P. “On the Care of ‘Vegetative’ Patients: A Response to William E. May…” Ethics and Medics, Vol. 24, Nos. 4 and 5. (April and May 1999).

Kevin O'Rourke O.P. “Applying the Directives,” in Ethical and Religious Directives for Catholic Health Care Services: Seeking Understanding (St. Louis, MO: The Catholic Health Association of the United States, 2003) p. 43.

Kevin O'Rourke O.P. , and Patrick Norris O.P. “Care of PVS Patients: Catholic Opinion in the United Stales,” 204.

Richard A. , McCormick S.J. “Moral Considerations, Ill Considered,” America, Vol. 166, No. 9, (March 14, 1992), Cf. also Kevin T. McMahon, “What the Pennsylvania Bishops Really Said: A Reply to Richard A, McCormick, S.J.”, Linacre Quarterly, (August, 1992).

Kevin O'Rourke O.P. , and Patrick Norris O.P. “Care of PVS Patients: Catholic Opinion in the United States.”

The Pro-Life Activities Committee of the United States Conference of Catholic Bishops, “Nutrition and Hydration: Moral and Pastoral Reflections,” Conclusion (emphasis added).

John Paul Pope II Address to the Bishops of California, Nevada and Hawaii, October 2, 1998.

Kevin O'Rourke O.P. , and Patrick Norris O.P. “Care of PVS Patients: Catholic Opinion in the United States,” p, 208, footnote 43 in which he identifies Edward Richard as reaching this conclusion.

The Pro-Life Activities Committee of the USCCB, “Nutrition and Hydration: Moral and Pastoral Reflections,” Origins, April 1992, section 6 (emphasis added).

Richard MeCormick S.J. “Moral Considerations, Ill Considered,” America, Vol. 166, No. 9, (March 14, 1992), p. 214. Citing this scenario, other authors have made the same argument. Cf. Kevin O'Rourke, “On the Care of ‘Vegetative’ Patients,” (second of two pans), Ethics and Medics, Vol. 24, No. 5 (May, 1999), p. 4; Michael R. Panicola, “Withdrawing Nutrition and Hydration,” Health Progress (November-December, 2001), p. 31.