ROME: This week, the Vatican Academy for Life issued a new text on a range of bioethical issues, including the provision of food and fluids to patients in a vegetative state. The text represents a slight departure from the Vatican’s previous stance on the issue.
The volume published on Thursday by the Pontifical Academy for Life (PAV) is entitled “Small Dictionary of the End of Life” and deals with various bioethical questions.
According to an introduction by Italian Archbishop Vincenzo Paglia, president of the PAV, the aim of the volume is to “reduce at least that part of the disagreement which is based on an imprecise use of the terms implied in the speech.”
Specifically, Paglia referred to “the statements that are sometimes attributed to believers and which are often based on insufficiently verified clichés.”
The 88-page text reaffirms, among other things, a blanket “no” to euthanasia and assisted suicide, but also indicates a new openness on the part of the Vatican when it comes to so-called “aggressive treatment,” in particular the obligation to give food and fluids to patients in a vegetative state.
Section 13 of the volume, which deals with this issue of nutrition and hydration, refers to the recently published Declaration on the Dignity of the Human Being by the Vatican Dicastery for the Doctrine of the Faith (DDF). Dignitas Infinita.
In Dignitas InfinitaThe DDF reiterated the need to avoid “any aggressive therapy or disproportionate intervention” in the treatment of seriously ill patients.
The new volume of the PAV also referred to the letter of July 2020 Samaritan Bonuswhich, among other things, mentioned “the moral obligation to exclude aggressive treatment plans”.
The volume points out that the nutrition and hydration prepared for vegetative patients is produced in the laboratory and administered using technology and is therefore not “simple nursing care.”
Doctors, the text states, are “obliged to respect the will of the patient who rejects it through a conscious and informed decision, even if this was expressed in advance, in view of the possible loss of the capacity to express an opinion and make decisions.”
They pointed out that in patients in a vegetative state, there are some who argue that when food and fluid intake is withheld, it is not the disease that causes death, but those who cause the withholding.
This argument, according to the PAV, “is a victim of a reductionist understanding of disease, which sees disease as a change in a specific function of the organism and in doing so loses sight of the human being as a whole.”
“This reductionist interpretation of disease leads to an equally reductionist concept of care, which ultimately aims at the individual functions of the organism and not at the general well-being of the human being,” the volume states.
To this end, the magazine quoted a speech given by Pope Francis to members of the PAV in November 2017. In it, he said that technical interventions in the body “can support or even replace biological functions that have become inadequate, but this is not the same as promoting health.”
“This requires an extra dose of wisdom, because today the temptation is more insidious to insist on treatments that have strong effects on the body but sometimes do not benefit the overall well-being of the person,” the text continues, continuing the quote from Pope Francis.
The PAV stressed that this position does not contradict the position previously held by the DDF on the issue of nutrition and hydration. This statement was issued in 2007 in response to the address by the US bishops on the moral obligation to provide nutrition and hydration, even artificially, to patients in a vegetative state.
In its brief response, the then Congregation for the Doctrine of the Faith stated that even in a situation where there is moral certainty that a patient will never recover, it is not permissible to deprive him of food and water because this would de facto cause the person to die of dehydration or starvation.
The position adopted in the new PAV document marks a departure from this position towards a new openness. However, the PAV stresses in its document that its position does not represent a departure from the 2007 decision and, to this end, cites “ethnically legitimate” reasons for the suspension of treatment that were contained in the response of the CDF at the time.
Among other things, the PAV noted that the then CDF considered that treatment could be interrupted when it was ‘no longer effective from a clinical point of view’, i.e. when the body tissue ‘can no longer absorb the administered substances’ and when the treatment causes the patient ‘excessive stress or significant physical discomfort related, for example, to complications in the use of instrumental aids’.
In an effort to clarify the continuity in the Vatican’s position on this issue, the PAV volume states that this last point of the 2007 response relates to the question of proportionality in the administration of treatments, and argues that the new DDF document Dignitas Infinitawhich was published in April, “goes in the same direction.”
The PAV’s new “lexicon” suggested that Dignitas Infinita be interpreted in a “long-term and broad perspective” and notes that the DDF text “does not contain a comprehensive reflection on the relationship between ethics and the legal field.”
On this point, “there remains room for the search for mediation at legislative level, in accordance with the principle of ‘imperfect laws’,” explained the PAV.
Regarding the legal mediation on this issue, the PAV stated: “In dealing with the issues raised by individual words, this lexicon takes into account the pluralist and democratic context of the societies in which the debate takes place, especially when it touches on the legal field.”
“The different moral languages are by no means incompatible and untranslatable, as some claim,” the PAV explained, stressing that dialogue between people with different views on the issue is possible.
By leaving room for research into legislative mediation on this issue, Paglia said in his introduction that “in this way believers fulfill their responsibility to explain to all the universal (ethical) meaning revealed in the Christian faith.”
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