The Pope addressed this issue in an address to a group of physicians who were in Rome in March 2004 precisely to discuss it.
I should like particularly to underline how the administration of water and food, even when provided by artificial means, always represents a natural means of preserving life, not a medical act. Its use, furthermore, should be considered, in principle, ordinary and proportionate, and as such morally obligatory, insofar as and until it is seen to have attained its proper finality, which in the present case consists in providing nourishment to the patient and alleviation of his suffering.
The obligation to provide the “normal care due to the sick in such cases” (1) includes, in fact, the use of nutrition and hydration (2). The evaluation of probabilities, founded on waning hopes for recovery when the vegetative state is prolonged beyond a year, cannot ethically justify the cessation or interruption of minimal care for the patient, including nutrition and hydration. Death by starvation or dehydration is, in fact, the only possible outcome as a result of their withdrawal. In this sense it ends up becoming, if done knowingly and willingly, true and proper euthanasia by omission.
In this regard, I recall what I wrote in the Encyclical Evangelium Vitae making it clear that “by euthanasia in the true and proper sense must be understood an action or omission which by its very nature and intention brings about death, with the purpose of eliminating all pain”; such an act is always “a serious violation of the law of God, since it is the deliberate and morally unacceptable killing of a human person” (n. 65). [Pope John Paul II, To the Congress on Life-Sustaining Treatments and Vegetative State, 20 March 2004)
(1) Congregation for the Doctrine of the Faith, Iura et Bona, p. IV
(2) cf. Pontifical Council “Cor Unum”, Dans le Cadre, 2, 4, 4; Pontifical Council for Pastoral Assistance to Health Care Workers, Charter of Health Care Workers, n. 120
In this address the Holy Father draws the following significant conclusions:
- Food and water are natural means of sustaining life, not medical acts, even if delivered artificially.
- Nutrition and hydration are ordinary and proportionate means of care.
- Food and water are morally obligatory unless or until they cannot achieve their finality, which is providing nutrition and hydrating and alleviating suffering.
- The length of time they are, or will be, used is not grounds for withholding or withdrawing artificially delivered nutrition and hydration.
- If the result of withholding or withdrawing nutrition and hydration is death by starvation and dehydration, as opposed to an undying disease or dysfunction, it is gravely immorally.
In summary, nutrition and hydration, like bathing and changing the patient’s position to avoid bedsores, is ordinary care that is owed to the patient. This is true even if it is delivered artificially, as when a baby is bottle-fed or a sick person is tube-fed. Nutrition and hydration may only be discontinued when they cannot achieve their natural purposes, such as when the body can no longer process them, or, when during the death process they would only prolong the person’s suffering. If such a case the patient dies of the underlying disease. On the other hand, if starvation and dehydration is the foreseeable cause of death, to withhold or withdrawn nutrition and hydration is gravely immoral.