the Congress on Life-Sustaining Treatments and Vegetative State
POPE JOHN PAUL II
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.
Distinguished 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.
This important 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
With 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.
Scientists 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 will not.
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.
In 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".
Even 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.
The 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 by omission.
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.
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.
Social pressures cannot prevail over
Considerations about the "quality of life", often actually
dictated by psychological, social and economic pressures, cannot
take precedence over general principles.
First 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 principle.
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
Proper 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.
'To 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
As 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
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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