Back in 2004, Pope John Paul II gave a speech clearly intended to present the following as the teaching of the ordinary and universal magisterium:
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.
I recall that, in response, the usual suspects expressed first surprise, then dissent. The reaction of Jesuit ethicist John Paris was rather typical; the gist was that the Pope was using the occasion of a minor speech to a small group to contradict centuries of established Church teaching. But the responsum's appearance makes clear that the Pope was speaking with at least ordinary magisterial authority. Here's the CDF text:
First question: Is the administration of food and water (whether by natural or artificial means) to a patient in a “vegetative state” morally obligatory except when they cannot be assimilated by the patient’s body or cannot be administered to the patient without causing significant physical discomfort?
Response: Yes. The administration of food and water even by artificial means is, in principle, an ordinary and proportionate means of preserving life. It is therefore obligatory to the extent to which, and for as long as, it is shown to accomplish its proper finality, which is the hydration and nourishment of the patient. In this way suffering and death by starvation and dehydration are prevented.
Second question: When nutrition and hydration are being supplied by artificial means to a patient in a “permanent vegetative state”, may they be discontinued when competent physicians judge with moral certainty that the patient will never recover consciousness?
Response: No. A patient in a “permanent vegetative state” is a person with fundamental human dignity and must, therefore, receive ordinary and proportionate care which includes, in principle, the administration of water and food even by artificial means.
The Supreme Pontiff Benedict XVI, at the Audience granted to the undersigned Cardinal Prefect of the Congregation for the Doctrine of the Faith, approved these Responses, adopted in the Ordinary Session of the Congregation, and ordered their publication.
Rome, from the Offices of the Congregation for the Doctrine of the Faith, August 1, 2007.
William Cardinal Levada
Prefect
Very well: it's now been made clear by the present pope, through the usual mechanism for doing so, that the teaching of JP2 in that speech is the established teaching of the Church. That of course will not squelch the dissenters, be they clerics or health-care professionals. For that matter, it will make little practical difference for the foreseeable future. The Terri Schiavos of the world will continue to be dehydrated and starved to death, if that is what those responsible for their care desire. Civil law reflects the culture, and the culture right now is a culture of death. But this statement matters. It matters objectively, and it matters to me.
It matters objectively because, as in the case of limbo, we are witnessing the development of doctrine in action. Prior to the papacy of JP2, Church teaching had not been all that explicit about this particular matter; during that papacy, the teaching became steadily more explicit, as the CDF's nota accompanying the present responsum documents. As in most such cases of development, the hue and cry will be raised that the Church is negating centuries of past teaching. Fr. Paris already so cried three years ago; worse, a Dominican has argued that the new teaching is flat-out wrong. (I expect better from Dominicans; Jesuits are another matter.) In this case, it is clear the Church is not negating anything taught authoritatively; but the development itself is quite an adjustment for some people, and presents quite a dilemma for Catholic health-care professionals who operate in environments where doctors follow, for example, the protocol of the American Neurological Association in such cases. The Church's clear, developed teaching on this matter is, as the Gospel is and the Church ought to be, a sign of contradiction to the world.
Some years ago, I confronted that sign of contradiction in my personal life. I had to become the decision-maker for somebody in a coma whose medical prognosis was so poor that her neurologist urged me, quietly and privately, to withdraw her feeding tube. Sensitive to pertinent Vatican statements issued soon after Karol Wojtyla became pope, I refused; in conscience, I believed it would have been homicide. Of course I got no credit for that decision: those who agreed with it took for granted that I was just doing my duty; those who disagreed, including the attending physician, thought I was nuts. It later turned out that the prognosis had been wrong, and my decision would end up costing me, spiritually and emotionally, even more than I had feared. When I acclaim the present doctrinal development, I do so knowing full well what believing the Church about this matter can cost.
Too bad. The teaching is the truth. And when I say it's the truth, I'm not giving my opinion. I wish the matter were otherwise, and until JP2's papacy I believed the matter was otherwise. I still wish it were a matter of opinion. But the Church, through the previous and present papacies, has not only spoken authoritatively on the question; she could not speak otherwise and remain consistent with what was shown, in Evangelium Vitae §57, to have been infallibly set forth by the ordinary and universal magisterium.
