Reflection on Nutrition and Hydration

All of the notoriety given to Mrs. Terri Schiavo, the Florida woman with serious brain damage, and the feeding tube that provides her nutrition and hydration highlights for us once again the need for moral reflection when we deal with human life and particularly the termination of any human life.

Our Holy Father, Pope John Paul II, in his encyclical letter Evangelium Vitae, The Gospel of Life, provides an up-to-date frame of reference for these moral reflections. In 1991 the bishops of Pennsylvania provided guidance on this important issue in their statement, Nutrition and Hydration: Moral Considerations.

The media reports, both electronic and print, on the condition of Terri Schiavo indicate that she is seriously impaired but aware of her surroundings and capable of responding to some stimuli particularly pain. On the one hand are those who would like to see her feeding tube removed thus terminating her nutrition and hydration and bringing about, since she is still aware, an excruciatingly painful death. On the other hand are those who argue that she must be allowed to continue to receive basic human care – a care that is obligatory to every human being.

At the core of this discussion is the distinction between medical treatment and basic human care. No one is obliged to extraordinary medical treatment but every one is entitled to ordinary human care. It is important to note in the Terri Schiavo case we are not dealing with extraordinary treatment such as a ventilator or dialysis but rather with a feeding tube that supplies basic nutrition and hydration – food and water.

The provision of nutrition and hydration is a normal part of human care. The United States Bishops’ pro-life committee provides us direction in this area when it writes: “We reject any omission of nutrition and hydration intended to cause a patient’s death. We hold for a presumption in favor of providing medically assisted nutrition and hydration to patients who need it, which presumption would yield in cases where such procedures have no medically reasonable hope of sustaining life or pose excessive risks or burdens” (NCCB, Pro Life Committee, Nutrition and Hydration: Moral and Pastoral Reflections, 1992).

The Catholic Church teaches that when medical treatment becomes futile and it is no longer possible to prevent a patient’s death, or when the only result of intensive medical treatment would be to add suffering or prolong dying, we must accept the inevitability of death. At this point, respect for the dying indicates that it is no longer necessary to offer medical treatment. Yet normal comfort care must be provided.

While it is true that the means of supplying nutrition and hydration can in themselves become morally extraordinary in some circumstances, the presumption should always be in favor of sustaining human life through the provision of nutrition and hydration (see proceedings of Pontifical Academy for Life, February 1999).

The call for uninterrupted respect for all human life requires that people of faith act responsibly in end-of-life situations. When we deal with the last stages of human life, we need to be particularly sensitive to both our capabilities and our limitations. Eventually all physical remedies fail. All life begins, grows, matures, declines, and ends in death. As responsible Christians, we are called to provide medical treatment for the body while there is still hope of healing and restoration of health. But even when healing is no longer possible, treatment is futile, and death is inevitable, we are still obliged to care for the dying.

As he concludes his encyclical on human life, Pope John Paul II calls us to reflect on the Gospel of Life in our actions, culturally, socially and politically. “Walk as children of light . . and try to learn what is pleasing to the Lord. Take no part in the unfruitful works of darkness’ (Eph. 5.8, 10-11). In our present social context, marked by a dramatic struggle between the ‘culture of life’ and the ‘culture of death,’ there is need to develop a deep critical sense capable of discerning true values and authentic needs.

“What is urgently called for is a general mobilization of consciences and a united ethical effort to activate a great campaign in support of life. All together, we must build a new culture of life; new because it will be able to confront and solve today’s unprecedented problems affecting human life” (95).

The Catholic Church brings a living ethical tradition to this and so many current issues. It does so with confidence because the Church’s moral reflection is guided by a wisdom rooted in God’s word and directed by God’s Spirit.

May God continue to enlighten and strengthen all of us as we face the critical issues of our day with an attitude and perspective rooted in the Gospel and the Church’s teaching. May we be guided by the Holy Spirit so that we truly pass on to our children and their children a civilization of love.

Holy Week, 2005