To the Congress on Life-Sustaining Treatments and Vegetative StatePOPE JOHN PAUL II
"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'", the Holy Father said on Saturday, 20 March, to participants in the International Congress on Life-Sustaining Treatments and Vegetative State: Scientific Advances and Ethical Dilemmas.
Ladies and Gentlemen,
- 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.
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.
Careful observation for a correct diagnosis
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.
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
- 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.
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".
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.
The sick person has
the right to basic health care
- 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.
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
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.
pressures cannot prevail over general principles
about the "quality of life", often actually dictated by psychological, social
and economic pressures, cannot take precedence over general principles.
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
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.
Proper care is needed
for these patients and their families
- 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.
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.
cure if possible, always to care'
- 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".
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.
Pope Johna Paul II. "To the Congress on Life-Sustaining Treatments
and Vegetative State." L'Osservatore Romano (March 31, 2004), 5.
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