Artificial Nutrition and Hydration and the Permanently Unconscious Patient: The Catholic Debate

Artificial Nutrition and Hydration and the Permanently Unconscious Patient: The Catholic Debate

Artificial Nutrition and Hydration and the Permanently Unconscious Patient: The Catholic Debate

Artificial Nutrition and Hydration and the Permanently Unconscious Patient: The Catholic Debate

Synopsis

During the past few decades, high-profile cases like that of Terry Schiavo have fueled the public debate over forgoing or withdrawing artificial nutrition and hydration from patients in a persistent vegetative state (PVS). These cases, whether involving adults or young children, have forced many to begin thinking in a measured and careful way about the moral legitimacy of allowing patients to die. Can families forgo or withdraw artificial hydration and nutrition from their loved ones when no hope of recovery seems possible?

Many Catholics know that Catholic moral theology has formulated a well-developed and well-reasoned position on this and other end-of-life issues, one that distinguishes between "ordinary" and "extraordinary" treatment. But recent events have caused uncertainty and confusion and even acrimony among the faithful. In his 2004 allocution, Pope John Paul II proposed that artificial nutrition and hydration is a form of basic care, thus suggesting that the provision of such care to patients neurologically incapable of feeding themselves should be considered a moral obligation. The pope's address, which seemed to have offered a new development to decades of Catholic health care ethics, sparked a contentious debate among the faithful over how best to treat permanently unconscious patients within the tenets of Catholic morality.

In this comprehensive and balanced volume, Ronald Hamel and James Walter present twenty-one essays and articles, contributed by physicians, clergy, theologians, and ethicists, to reflect the spectrum of perspectives on the issues that define the Catholic debate. Organized into six parts, each with its own introduction, the essays offer clinical information on PVS and feeding tubes; discussions on the Catholic moral tradition and how it might be changing; ecclesiastical and pastoral statements on forgoing or withdrawing nutrition and hydration; theological and ethical analyses on the issue; commentary on Pope John Paul II's 2004 allocution; and the theological commentary, court decisions, and public policy resulting from the Clarence Herbert and Claire Conroy legal cases.

A valuable resource for students and scholars, this teachable volume invites theological dialogue and ethical discussion on one of the most contested issues in the church today.

Excerpt

The debate about forgoing or withdrawing artificial nutrition and hydration, especially regarding patients in a persistent vegetative state, dates back at least to the early 1980s. High-profile cases brought the issue to the fore and to the attention of clinicians, bioethicists, theologians, attorneys, legislators, and the general public: In the 1982 Baby Doe case, an infant with Down syndrome and esophageal atresia was denied artificial nutrition and hydration; in the 1983 Clarence Herbert case, two physicians were charged with murder for discontinuing nutrition and hydration for a patient who had suffered a profound anoxic brain injury; and in the 1983 Claire Conroy case, a nephew requested discontinuation of artificial nutrition and hydration on his elderly, demented aunt who resided in a nursing home.

Subsequent high-profile cases continued to fuel the debate while clinicians frequently struggled with decisions about withdrawing feeding tubes for the many patients who did not make the evening news or the front page of the newspaper. A good deal of literature, both secular and religious, was generated in response to the cases themselves and in response to the situations they represented. Whereas some people considered feeding tubes as another form of life-sustaining treatment subject to a burden–benefit analysis, others viewed them as a basic form of care and generally morally obligatory. Still others might permit the withdrawal of feeding tubes in patients who are imminently dying but not in patients in a persistent vegetative state (PVS). It is the latter that has become the flash point in the debate about forgoing or withdrawing artificial nutrition and hydration, as was evidenced in the recent Terri Schiavo case and in reactions to the 2004 address of John Paul II on “Care for Patients in a ‘Permanent’ Vegetative State.” It is the papal speech that is especially the focus of this volume.

What accounts for the enormous differences in perspective between those who believe that forgoing or withdrawing artificial nutrition and hydration for patients in a persistent vegetative state is morally permissible and those who do . . .

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