People in vegetative states are entitled to compassion and care

FATHER RAYMOND J. DE SOUZA

Can a human person ever become a vegetable? And be treated as such?

We use the term "vegetative state" to describe patients who are alive but have no apparent awareness of what is going on around them. Lacking intellectual functions or even consciousness, our vocabulary suggests that they have somehow slipped out of the human realm into a lower form of life. The question then arises: Do they still enjoy a right to life as all human beings do? Or has that ceased when their injuries or disease have rendered them a "vegetable"?

The issue is a critical one. High-profile euthanasia cases have skewed popular perception. Jack Kervorkian grabbed headlines with his "suicide machines" and Robert Latimer became a national figure when he killed his disabled daughter with carbon monoxide, but such cases are rare. The more common situation is the one in which allowing someone to die without aggressive treatment instead becomes killing due to withholding basic care. And the latter happens more than we would care to admit.

Those questions were examined last week at a major palliative care conference held in Rome, sponsored by the World Federation of Catholic Medical Associations and the Pontifical Academy for Life. The thorniest question was whether patients in a vegetative state are entitled to nutrition and hydration (usually intravenous or through an abdominal tube).

Pope John Paul II gave a definitive answer when addressing the group, saying that "sick people in a vegetative state, waiting to recover or for a natural end, have a right to nutrition, hydration, hygiene, warmth, etc... [W]ater and food, even when administered artificially, are a natural means of preserving life, not a medical procedure and as such, [are] morally obligatory." (see Pope John Paul II's address To the Congress on Life-Sustaining Treatments and Vegetative State)

The remarks clarified a (minor) debate amongst moral theologians about the necessity of artificially administering food and water. It has always been recognized that heroic measures are not required to preserve life, and that allowing someone to die without aggressive treatment is a legitimate moral option in view of various other factors: the burdens of treatment, physical and emotional condition, suffering, pain, age, side-effects of therapy, limited prognosis for improvement, expense. But food and water? Food and water are not medicines; they are basic care for life.

A good rule of thumb is whether, by withdrawing nutrition and hydration, the cause of death will be starvation or dehydration, rather than the injury or disease afflicting the patient. If so, such withdrawal is no longer allowing the patient to die, but active killing, no matter how well-intentioned. Similarly, if the withdrawal will hasten death without any other benefit to the patient, such as reducing pain or infection, it too becomes active killing.

The importance of this issue will only grow as the population ages. The weakest among us — and the vegetative state is as weak as it gets — challenge us, in their dependency, to see that human dignity and the right to live are not conferred by conformity to an external standard of quality, but are rooted in the inherent being of a human person. The weak among us test the strength of our common humanity.

It is never necessary to take heroic clinical measures, but such cases do call forth from us heroic virtue — the compassion to accompany the weak and the suffering. Care and support — spiritual, emotional and practical — for the families of such patients is necessary to help them avoiding crossing the line from allowing-to-die to active killing.

As a priest, it sometimes falls to me to accompany families to meetings when decisions have to be made about continuing care. Well-meaning and honourable doctors (who have no intention of euthanasia) often say things like "he's not there anymore" or "she's no longer with us". But of course they are. Communication might no longer be possible, and the possibility of recovery remote, but sick people, including those in vegetative states, are still with us, still alive, still persons, still bearers of human dignity, still entitled to compassion and care.

"The intrinsic value and the personal dignity of every human being do not change, no matter what the specific circumstances of his life," John Paul said. Despite grave injuries or the ravages of disease, such patients "are and always will be human beings and will never become 'vegetables' or 'animals'."

Today, somewhere, in a hospital not far away, decisions are being made about persons in a vegetative state. It is critical to remember that "person" is the noun, and "vegetative" is the adjective.

The news this past week from Calgary that two patients died after being inadvertently injected with potassium chloride has raised proper outrage. What could be a more grotesque turn of events than to be accidentally killed in a hospital by medical personnel? Only being killed in a hospital by those who know what they are doing.

ACKNOWLEDGEMENT

Father Raymond J. de Souza, "People in vegetative states are entitled to compassion and care." National Post, (Canada) 27 March, 2004.

Reprinted with permission of the National Post and Fr. De Souza.

THE AUTHOR

Father Raymond J. de Souza is currently assigned to Our Lady of Lourdes parish as a curate, and as a chaplain to Newman House, the Roman Catholic mission at Queen's University, Kingston, Ontario. Father de Souza's web site is here.

Copyright 2004 National Post


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