Nutrition, hydration and the ‘vegetative state’


Bishop William Leo Higi


Published on the Diocese of Lafayette-in-Indiana website


(Now and Forever)

An old-time favorite movie is “The Song of Bernadette.” My mother and I would roll it out (remember VHS tapes) a couple of times a year. It’s a story of the young French girl, Bernadette Soubirous, and the apparitions she experienced of the Blessed Virgin Mary at Lourdes in 1858. The movie has a death scene. Jennifer Jones, who played the part of Bernadette, was never so beautiful. Bernadette closed her eyes in the grand Hollywood tradition and serenely slipped away.

My mother fantasized that was the way she would like to die, immediately after receiving holy Communion from her priest-son as he celebrated Mass at her bedside. Ravaged by cancer, that isn’t quite the way it happened.

Death rarely is as serene as Hollywood pictures it. Often it is a time that tests families and demands decisions we find easy to ponder only from the distance of good health. Among those sometimes tortuous decisions is when to pull the plug.

The Church consistently and persistently defends the intrinsic dignity of all human life from conception to natural death. That insistence has become especially important in these days when human life is threatened in a variety of ways and with increasing acceptance by our culture. All human life, not only a particular kind of life we might consider “normal” or “productive,” is precious and is to be preserved. But, what is one to do when a loved one is diagnosed as being in a persistent “vegetative state”?

People in a “vegetative state” breathe spontaneously, digest food naturally, carry on other metabolic functions and are in a stable condition. But, they are not able to feed themselves. If they are not provided food and liquids artificially, they will die. The cause of their death will be neither an illness nor the “vegetative state” itself. It will be starvation and dehydration. Medically assisted nutrition and hydration are considered normal care. Its use should be considered, in principle, ordinary and proportionate.

Those in a “vegetative state” suffer from a very severe disability, but they do not lose their human dignity. They deserve the same basic care as other patients, and nutrition and hydration is generally part of that normal care owed to patients, along with other necessities such as provision of warmth and cleanliness.

Are there medical situations in which it is moral to withhold nutrition and hydration? Yes, for example, a patient in the last stages of stomach cancer is already dying from that condition. Such a dying patient or others who can speak for the patient may decide to withhold feeding because it causes pain and gives little benefit. The administration of nutrition and hydration in this case would pose a burden on the stomach cancer patient that is disproportionate to its benefit.

Are there possible cases when it would be moral to withhold or withdraw nutrition and hydration from the patient in a “vegetative state”? Yes, they could be withheld if the available means of administering nutrition and hydration were not effective in providing the patient with nourishment (for example, because the patient can no longer assimilate these) or if the means itself constituted a burden (for example, because the feeding tube is for some reason causing persistent infections).

May nutrition and hydration be withheld from patients in a persistent “vegetative state” because prolonged care would involve significant costs? No. The “vegetative state” is not in itself a case of imminent dying. To be sure, the costs and other burdens placed on families by the patient’s need for prolonged care can become very significant. However, this problem must not be resolved by removing basic care.

While one may act to reduce or remove a burden caused directly by the administration of nutrition and hydration if the benefit is not proportionate to the burden, life itself must not be dismissed as a burden even when its helpless state may call on us for other forms of care. To act to end life because life itself is seen as a burden, or imposes an obligation of care on others, would be euthanasia.

This can be extremely challenging in our culture, which finds it difficult to accept the fact that all human life, from the moment of conception to natural death, is sacred and its value is not to be judged on the basis of age or productivity.

Who then should bear the burdens associated with providing proper care for those in a persistent “vegetative state”? Pope John Paul II insisted that families cannot be left alone with their heavy human, psychological and financial burden. He maintained that society must allot sufficient resources for the care of this sort of frailty. Among many other reasons, this is why the bishops of the United States call for universal health care. “Society must allot sufficient resources for the cure of this sort of frailty” (Pope John Paul II).

Here is how the ethical and religious directives for Catholic health care services state the issue (no. 53): “In principle, there is an obligation to provide patients with food and water, including medically assisted nutrition and hydration for those who cannot take food orally. This obligation extends to patients in chronic and presumably irreversible conditions (e.g., the ‘persistent vegetative state’) who can reasonably be expected to live indefinitely if given such care. Medically assisted nutrition and hydration become morally optional when they cannot reasonably be expected to prolong life or when they would be ‘excessively burdensome for the patients or (would) cause significant physical discomfort, for example, resulting from complications in the use of the means employed.’ For instance, as a patient draws close to inevitable death from an underlying progressive and fatal condition, certain measures to provide nutrition and hydration may become excessively burdensome and therefore not obligatory in light of their very limited ability to prolong life or provide comfort.”

I have executed a last will and testament, a living will, authorization to release medical information, and appointed a health care representative to make decisions I may no longer be able to make. General durable power of attorney has been assigned. These documents, prepared by legal counsel, make it clear that in my case, I want the plug pulled if there is no hope of recovery, but hydration and nutrition are not to be denied unless I fall into one of those rare exceptions listed in the ethical and religious directives.

It’s something to discuss with those who likely will be called upon to accept and/or make end-of-life decisions for you. Also important is to share your mindset with your doctor, family and confidants.