"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." (1)
Those are the words of Pope John Paul II, speaking in March 2004 to an international congress held in Rome. The conference was on "Life-sustaining Treatments and Vegetative State: Scientific Advances and Ethical Dilemmas," and it was organized by the World Federation of Catholic Medical Associations and the Pontifical Academy for Life. The pope was able to cut through all the ethical dilemmas. Although he acknowledged that a patient in a persistent vegetative state, or PVS, "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," he said that they should be kept alive indefinitely. Such patients, he insisted, "retain their human dignity in all its fullness" and "the loving gaze of God the Father continues to fall upon them." For this reason, he said, it is obligatory to continue to provide them with food and water, even if this can only be done through a tube. The pope added that to withdraw the tube, knowing that it will lead to the death of the patient, is "euthanasia by omission."
The pope supported his conclusion by arguing that some patients with PVS make at least a partial recovery, and, in the current state of medical science, we are still unable to predict with certainty which patients will recover and which will not. But here he seems to have been poorly advised. While it is true that in most PVS cases, we cannot definitively exclude the possibility of recovery, modern brain-imaging techniques do now enable us to know that in some PVS cases, the entire cortex has been destroyed. Then, no recovery is possible, for the cortex cannot reconstitute itself. Hence the argument for preserving the lives of these patients cannot be based on medical uncertainty.
No dilemmas for the pope, then, but plenty for Catholic hospitals around the world. In the United States, there are about ten thousand patients in a persistent vegetative state. Many of them are in one of the approximately six hundred hospitals run by the Catholic Health Association. Consistently with the views of some Catholic bioethicists, these hospitals have regarded artificial feeding as an "extraordinary means of life-support" and therefore as something that they are not obligated to provide.
Dr. Charles Daschbach, academic director at St. Joseph's Hospital in Phoenix, Arizona, told the Arizona Republic that at St. Joseph's decisions about whether to continue tube feeding were based on "balancing sufficient benefits to the patients against any burdens to patients and their families." He added that the pope's speech "was not sent as a part of the official church teachings." (2) Laurence O'Connell, director of the nonsectarian Park Ridge Center for Health, Faith, and Ethics in Chicago, put it more bluntly, describing the pope's statement as "a …