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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
Concerning Assisted Nutrition and Hydration and Related Issues

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.

Related Statement
Taking a stand against causing death, March 2,2005

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