“Ask a Priest: Are Health-Care Proxy Directives OK?”

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Q: Is it morally permissible for a Catholic to have a health care proxy that directs his next-of-kin and doctors to withhold artificially delivered food/water in the event that he is in a persistent vegetative state? -D.

Answered by Fr. Edward McIlmail, LC

A: Thanks for your question, which is timely and touches on an issue that can be very difficult for families to deal with.

The short answer to your question is: in most cases, no, because it is not morally permissible to withhold what is known as assisted nutrition and hydration. In most cases patients in the so-called persistent vegetative state are normally healthy and not in physical distress, except they do not have awareness or meaningful interaction. In these cases the use of assisted nutrition and hydration is considered basic care and thus cannot be omitted.

Pope John Paul II in a 2004 address said that such food and water “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.” Note that phrase, “morally obligatory.”

The National Catholic Bioethics Center, however, notes, “The pope’s address does not teach anything about when nutrition and hydration cease to nourish the patient and for that reason can be withdrawn, which is a judgment rightly left to medical professionals.”

That means that a moment might arrive when assisted nutrition and hydration no longer serves a positive purpose. This can happen in the last stages of a person’s life, when the body starts to shut down, so to speak. At that point it could be morally permissible to halt the nutrition and hydration, since this kind of care then becomes “extraordinary” and disproportionate and even burdensome to the patient. But these cases might be more the exception than the rule.

A word on “persistent vegetative state” is in order too. Patients in PVS have been known to regain consciousness (see this Q&A), so diagnoses need to be prudent. It is not uncommon nowadays to find a “pull the plug” mentality at the first sign of a prolonged illness or “vegetative state.”

What is required, therefore, is proper discernment by medical officials as well as by next of kin. In practice doctors and healthcare workers have a lot of influence at this point. So one might think twice before signing a statement that could clear the way for a premature withdrawal of assisted nutrition and hydration. The Catechism in No. 2280 reminds us: “Everyone is responsible for his life before God who has given it to him. It is God who remains the sovereign Master of life. We are obliged to accept life gratefully and preserve it for his honor and the salvation of our souls. We are stewards, not owners, of the life God has entrusted to us. It is not ours to dispose of.”

Instead, you might think about giving written consent to a trustworthy person who can make the right decisions if you are incapacitated. This person should understand and be willing to follow the principles taught by the Church — or at least be willing to confer with someone who does know these principles well.

I hope this helps. Count on my prayers for you to make a wise decision. God bless.

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