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Artificial Nutrition and Hydration and the Permanently Unconscious Patient

The Catholic Debate

Publication Year: 2007

During the past few decades, high-profile cases like that of Terry Schiavo have fueled the public debate over forgoing or withdrawing artificial nutrition and hydration from patients in a persistent vegetative state (PVS). These cases, whether involving a

Published by: Georgetown University Press


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pp. vii-ix

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Introduction: The State of the Debate

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pp. 1-5

The debate about forgoing or withdrawing artificial nutrition and hydration, especially regarding patients in a persistent vegetative state, dates back at least to the early 1980s. High-profile cases brought the issue to the fore and to the attention of clinicians, bioethicists, theologians, attorneys, legislators, and the...

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PART ONE: Medical Perspectives

Good ethics, it is often said, begins with good facts. Unless there is a clear and accurate understanding of the issue at hand in its various dimensions, it is quite likely that moral judgments would be misjudgments or would be correct judgments only by chance. When what is at stake is human life and well-being, especially...

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1. Position of the American Academy of Neurology on Certain Aspects of the Care and Management of the Persistent Vegetative State Patient

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pp. 9-13

I. The persistent vegetative state is a form of eyes-open permanent unconsciousness in which the patient has periods of wakefulness and physiological sleep/wake cycles, but at no time is the patient aware of him- or herself or the environment. Neurologically, being awake but unaware is the result of a functioning...

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2. Feeding Tubes: Sorting Out the Issues

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pp. 15-25

The use of feeding tubes, especially in long-term care settings, is a touchy issue in Catholic health care. Decisions about feeding tube use can be difficult for a variety of reasons: complicated clinical situations, strong emotions surrounding these decisions on the part of families and caregivers, and conflicting perceptions...

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PART TWO: The Catholic Tradition and Historical Perspectives

Any discussion of forgoing or withdrawing artificial nutrition and hydration for patients in a persistent vegetative state must ultimately return to the tradition. For almost five hundred years theologians beginning with the Spanish Dominican theologian Francisco de Vitoria (1486–1546) have addressed the...

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3. Catholic Teaching on Prolonging Life: Setting the Record Straight

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pp. 29-51

Recently there has been a lot of confusion among Catholics regarding the Church’s teaching on prolonging life, especially when it comes to prolonging life with medically assisted nutrition and hydration. This was well illustrated in the nationally publicized case of Hugh Finn, a forty-four-year-old former...

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4. A History of Ordinary and Extraordinary Means

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pp. 53-77

The death of Terri Schiavo in Florida on March 31, 2005, brought into high relief many of the central questions concerning the care and treatment of patients in the persistent vegetative state (PVS). At the center of the Catholic discussion of this contentious issue has been whether the provision of food and water...

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5. Must We Preserve Life?

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pp. 79-88

Is the removal of a feeding tube that supplies nutrients and fluids, especially in patients in a persistent vegetative state (PVS), simply a means of killing a vulnerable person—a form of euthanasia? Judging from some of the responses to the much-publicized Terri Schiavo case, it seems there are those who think...

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PART THREE: Ecclesiastical and Pastoral Perspectives

Over the past fifty years, the magisterium and various episcopal bodies have addressed the Catholic moral tradition on the duty to preserve life and forgoing life-sustaining treatment. This section offers a sampling of these statements....

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6. The Prolongation of Life

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pp. 91-97

According to Dr. Haid’s statement, modern anesthesiology deals not only with problems of analgesia and anesthesia properly so-called, but also with those of “resuscitation.” This is the name given in medicine, and especially in anesthesiology, to the technique which makes possible the remedying of certain occurrences...

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7. Declaration on Euthanasia

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pp. 99-106

The rights and values pertaining to the human person occupy an important place among the questions discussed today. In this regard, the Second Vatican Ecumenical Council solemnly reaffirmed the lofty dignity of the human person, and in a special way his or her right to life. The Council therefore condemned...

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8. The Artificial Prolongation of Life

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pp. 107-108

After having noted the recent progress of the techniques of resuscitation and the immediate and long-term effects of brain damage, the study group discussed the objective criteria of death and of the rules of conduct in the face of a persistent state of apparent death. On the one hand, experiments carried...

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9. On Withdrawing Artificial Nutrition and Hydration

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pp. 109-113

Human life is God’s precious gift to each person. We possess and treasure it as a sacred trust. All persons therefore have a moral responsibility, in accord with their own capacities, roles and personal vocation, to make those decisions and take those necessary steps to preserve and promote their own life and health...

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10. Nutrition and Hydration: Moral and Pastoral Reflections

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pp. 115-136

Modern medical technology seems to confront us with many questions not faced even a decade ago. Corresponding changes in medical practice have benefited many but have also prompted fears by some that they will be aggressively treated against their will or denied the kind of care that is their due as human...

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11. Ethical and Religious Directives: Introduction to Part V and Directives 57–58

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pp. 137-139

Christ’s redemption and saving grace embrace the whole person, especially in his or her illness, suffering, and death.35 The Catholic health care ministry faces the reality of death with the confidence of faith. In the face of death—for many, a time when hope seems lost—the Church witnesses to her belief that God has...

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PART FOUR: Ethical and Theological Perspectives

While the preceding sections have discussed the key components of the debate about forgoing or withdrawing artificial nutrition and hydration for persons in a persistent vegetative state and the differing views about them, the present section offers more in-depth theological and ethical analyses of many of...

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12. The PVS Patient and the Forgoing/Withdrawing of Medical Nutrition and Hydration

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pp. 143-170

Over the last several decades modern medicine has progressed at a rate that has astonished even its practitioners. Developments in drugs, vaccines, and various technologies have given physicians an incredible amount of success over disease and morbidity as well as allowing them to make dramatic interventions into the...

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13. Should Nutrition and Hydration Be Provided to Permanently Unconscious and Other Mentally Disabled Persons?

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pp. 171-186

The title of this article can be understood either as a legal or as an ethical question. I treat it here only insofar as it is an ethical question—that is, a moral issue.1 But I hope my treatment will contribute to the current debate about what law ought to require in this matter. For, of course, questions about what law...

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14. End-of-Life Care Revisited

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pp. 187-199

A number of claims made in recent discussions about Catholic teaching and the use of life-sustaining treatments raise important and very serious theological, philosophical, and medical questions that have received almost no direct attention or examination....

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PART FIVE: John Paul II’s Papal Allocution and Responses

On March 20, 2004, Pope John Paul II addressed participants in an international congress at the Vatican on “Life-Sustaining Treatments and Vegetative State: Scientific Advances and Ethical Dilemmas.” The pope’s speech, “Care for Patients in a ‘Permanent’ Vegetative State,” set off a vigorous debate, especially...

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15. Care for Patients in a “Permanent” Vegetative State

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pp. 203-207

1. 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 Professor Gian Luigi Gigli,...

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16. John Paul II on the “Vegetative State”

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pp. 209-213

In a March 20 address, Pope John Paul II made a very significant contribution to an ethical debate that has troubled Catholic ethicists in the United States and elsewhere for many years: The feeding of patients diagnosed as being in a “vegetative” state....

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17. Medically Assisted Nutrition and Hydration: A Contribution to the Dialogue

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pp. 215-222

The Address to Participants in the International Congress on “Life-Sustaining Treatments and the Vegetative State: Scientific Advances and Ethical Dilemmas,” promulgated in March of this year by Pope John Paul II, has become a source of considerable controversy, partly due to the theological and clinical complexity of this issue, and partly...

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18. Assisted Nutrition and Hydration and the Catholic Tradition

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pp. 223-235

The Terri Schiavo case in Florida focused attention on a variety of issues related to the end of life: who is the decision maker, the status of advanced directives, the role of family members with respect to married adult children, and issues related to the removal of life support systems, particularly assisted nutrition and...

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19. Reflections on the Papal Allocution Concerning Care for Persistent Vegetative State Patients

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pp. 237-253

Recently, Pope John Paul II issued a statement in regard to the care of persons in the persistent vegetative state (PVS) (2004). The statement was received with dismay by many people inside and outside the Catholic healthcare ministry (see O’Brien, 2004; Shannon and Walter, 2004). In sum, the Holy Father stated that...

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PART SIX: Legal and Public Policy Perspectives

The debate about forgoing or withdrawing artificial nutrition and hydration is not only theological in nature, it also has public policy dimensions, and the debate has taken place in numerous courts and legislatures across the country. Among the more important legal cases are those concerning Clarence Herbert...

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20. The Clarence Herbert Case: Was Withdrawal of Treatment Justified?

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pp. 257-264

Clarence Herbert, age fifty-five, was admitted to the Kaiser Permanente Hospital in Harbor City, California, on Aug. 25, 1981, for routine closure of an ileostomy. In the recovery room after the surgery on August 26 he suffered respiratory collapse, which one doctor believed was caused by cardiac arrest. It...

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21. Caring or Starving? The Case of Claire Conroy

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pp. 265-274

Claire Conroy was an eighty-four-year-old nursing home resident. She suffered from irreversible physical and mental impairments including arteriosclerotic heart disease, diabetes, and hypertension. She could neither speak nor swallow and was fed by a nasogastric tube. Her movements were very limited though she...


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pp. 275-276


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pp. 277-278


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pp. 279-294

E-ISBN-13: 9781589012424
E-ISBN-10: 1589012429
Print-ISBN-13: 9781589011786
Print-ISBN-10: 1589011783

Page Count: 304
Publication Year: 2007

Research Areas


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Subject Headings

  • Fluid therapy -- Moral and ethical aspects.
  • Loss of consciousness.
  • Medical ethics.
  • Persistent vegetative state -- Religious aspects -- Catholic Church.
  • Artificial feeding.
  • Euthanasia -- Moral and ethical aspects.
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