Address Of John Paul II To The Participants In The International Congress
On
"Life-Sustaining Treatments And Vegetative State: Scientific Advances And
Ethical Dilemmas"
Saturday, 20 March 2004
Distinguished Ladies and Gentlemen,
1. I cordially greet all of you who took part in the International Congress:
"Life-Sustaining Treatments and Vegetative State: Scientific Advances and
Ethical Dilemmas". I wish to extend a special greeting to Bishop Elio
Sgreccia, Vice-President of the Pontifical Academy for Life, and to Prof.
Gian Luigi Gigli, President of the International Federation of Catholic
Medical Associations and selfless champion of the fundamental value of life,
who has kindly expressed your shared feelings.
This important Congress, organized jointly by the Pontifical Academy for
Life and the International Federation of Catholic Medical Associations, is
dealing with a very significant issue: the clinical condition called the
"vegetative state". The complex scientific, ethical, social and pastoral
implications of such a condition require in-depth reflections and a fruitful
interdisciplinary dialogue, as evidenced by the intense and carefully
structured programme of your work sessions.
2. With deep esteem and sincere hope, the Church encourages the efforts of
men and women of science who, sometimes at great sacrifice, daily dedicate
their task of study and research to the improvement of the diagnostic,
therapeutic, prognostic and rehabilitative possibilities confronting those
patients who rely completely on those who care for and assist them. The
person in a vegetative state, in fact, shows no evident sign of
self-awareness or of awareness of the environment, and seems unable to
interact with others or to react to specific stimuli.
Scientists and researchers realize that one must, first of all, arrive at a
correct diagnosis, which usually requires prolonged and careful observation
in specialized centres, given also the high number of diagnostic errors
reported in the literature. Moreover, not a few of these persons, with
appropriate treatment and with specific rehabilitation programmes, have been
able to emerge from a vegetative state. On the contrary, many others
unfortunately remain prisoners of their condition even for long stretches of
time and without needing technological support.
In particular, the term permanent vegetative state has been coined to
indicate the condition of those patients whose "vegetative state" continues
for over a year. Actually, there is no different diagnosis that corresponds
to such a definition, but only a conventional prognostic judgment, relative
to the fact that the recovery of patients, statistically speaking, is ever
more difficult as the condition of vegetative state is prolonged in time.
However, we must neither forget nor underestimate that there are
well-documented cases of at least partial recovery even after many years; we
can thus state that medical science, up until now, is still unable to
predict with certainty who among patients in this condition will recover and
who will not.
3. Faced with patients in similar clinical conditions, there are some who
cast doubt on the persistence of the "human quality" itself, almost as if
the adjective "vegetative" (whose use is now solidly established), which
symbolically describes a clinical state, could or should be instead applied
to the sick as such, actually demeaning their value and personal dignity. In
this sense, it must be noted that this term, even when confined to the
clinical context, is certainly not the most felicitous when applied to human
beings.
In opposition to such trends of thought, I feel the duty to reaffirm
strongly that the intrinsic value and personal dignity of every human being
do not change, no matter what the concrete circumstances of his or her life.
A man, even if seriously ill or disabled in the exercise of his highest
functions, is and always will be a man, and he will never become a
"vegetable" or an "animal".
Even our brothers and sisters who find themselves in the clinical condition
of a "vegetative state" retain their human dignity in all its fullness. The
loving gaze of God the Father continues to fall upon them, acknowledging
them as his sons and daughters, especially in need of help.
4. Medical doctors and health-care personnel, society and the Church have
moral duties toward these persons from which they cannot exempt themselves
without lessening the demands both of professional ethics and human and
Christian solidarity.
The sick person in a vegetative state, awaiting recovery or a natural end,
still has the right to basic health care (nutrition, hydration, cleanliness,
warmth, etc.), and to the prevention of complications related to his
confinement to bed. He also has the right to appropriate rehabilitative care
and to be monitored for clinical signs of eventual recovery.
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"
(Congregation for the Doctrine of the Faith, Iura et Bona, p. IV) includes,
in fact, the use of nutrition and hydration (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). 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).
Besides, the moral principle is well known, according to which even the
simple doubt of being in the presence of a living person already imposes the
obligation of full respect and of abstaining from any act that aims at
anticipating the person's death.
5. Considerations about the "quality of life", often actually dictated by
psychological, social and economic pressures, cannot take precedence over
general principles.
First of all, no evaluation of costs can outweigh the value of the
fundamental good which we are trying to protect, that of human life.
Moreover, to admit that decisions regarding man's life can be based on the
external acknowledgment of its quality, is the same as acknowledging that
increasing and decreasing levels of quality of life, and therefore of human
dignity, can be attributed from an external perspective to any subject, thus
introducing into social relations a discriminatory and eugenic principle.
Moreover, it is not possible to rule out a priori that the withdrawal of
nutrition and hydration, as reported by authoritative studies, is the source
of considerable suffering for the sick person, even if we can see only the
reactions at the level of the autonomic nervous system or of gestures.
Modern clinical neurophysiology and neuro-imaging techniques, in fact, seem
to point to the lasting quality in these patients of elementary forms of
communication and analysis of stimuli.
6. However, it is not enough to reaffirm the general principle according to
which the value of a man's life cannot be made subordinate to any judgment
of its quality expressed by other men; it is necessary to promote the taking
of positive actions as a stand against pressures to withdraw hydration and
nutrition as a way to put an end to the lives of these patients.
It is necessary, above all, to support those families who have had one of
their loved ones struck down by this terrible clinical condition. They
cannot be left alone with their heavy human, psychological and financial
burden. Although the care for these patients is not, in general,
particularly costly, society must allot sufficient resources for the care of
this sort of frailty, by way of bringing about appropriate, concrete
initiatives such as, for example, the creation of a network of awakening
centres with specialized treatment and rehabilitation programmes; financial
support and home assistance for families when patients are moved back home
at the end of intensive rehabilitation programmes; the establishment of
facilities which can accommodate those cases in which there is no family
able to deal with the problem or to provide "breaks" for those families who
are at risk of psychological and moral burn-out.
Proper care for these patients and their families should, moreover, include
the presence and the witness of a medical doctor and an entire team, who are
asked to help the family understand that they are there as allies who are in
this struggle with them. The participation of volunteers represents a basic
support to enable the family to break out of its isolation and to help it to
realize that it is a precious and not a forsaken part of the social fabric.
In these situations, then, spiritual counselling and pastoral aid are
particularly important as help for recovering the deepest meaning of an
apparently desperate condition.
7. Distinguished Ladies and Gentlemen, in conclusion I exhort you, as men
and women of science responsible for the dignity of the medical profession,
to guard jealously the principle according to which the true task of
medicine is "to cure if possible, always to care".
As a pledge and support of this, your authentic humanitarian mission to give
comfort and support to your suffering brothers and sisters, I remind you of
the words of Jesus: "Amen, I say to you, whatever you did for one of these
least brothers of mine, you did for me" (Mt 25: 40).
In this light, I invoke upon you the assistance of him, whom a meaningful
saying of the Church Fathers describes as Christus medicus, and in
entrusting your work to the protection of Mary, Consoler of the sick and
Comforter of the dying, I lovingly bestow on all of you a special Apostolic
Blessing.
Taken from:
L’Osservatore Romano
Weekly Edition in English
31 March 2004, page 5
Permission given to use and taken from "Life Sustaining treatments and the Vegetative State" (www)