Signs of the Times

Pope Says Patients Must Receive Nutrition, Hydration

Patients who are in a persistent vegetative state, even for years, must be given nutrition and hydration as long as their bodies can absorb the nourishment, Pope John Paul II said. The administration of water and food, even when delivered using artificial means, always represents a natural method of preserving life and not a medical act, the pope told an international group of physicians and ethicists. The pope met the group on March 20 at the end of a four-day meeting on ethical decisions surrounding life-sustaining treatments for patients in a persistent vegetative state.

The conference, sponsored by the Pontifical Academy for Life and the World Federation of Catholic Medical Associations, brought together dozens of speakers with differing points of view, especially regarding the moment when providing artificial nutrition and hydration goes beyond an act of protecting human life and becomes a burdensome fight against death and the hope for eternal life.

Cases of patients at the center of high-profile debates over the withdrawal of nutrition and hydration were not examined in depth at the conference. But several were mentioned in order to highlight the emotional, ethical and legal complexity of the debate, including the cases of Terri Schindler Schiavo in the United States. Schiavo remains in a Florida nursing home after 14 years in what her doctors describe as a persistent vegetative state. Her husband wants her feeding tube removed, but her parents object.

Pope John Paul told the group that while the term vegetative state has been accepted as a medical description of the clinical condition of patients who give no sign of consciousness or awareness of their environment, too many people think vegetative also describes the patients themselves, as if they were no longer human. I feel an obligation to reaffirm vigorously that the intrinsic value and the personal dignity of every human being do not change, no matter what the concrete situation of his life, the pope said. A human being never becomes a vegetable’ or an animal,’ he said. Even our brothers and sisters who are in the clinical condition of the vegetative state’ maintain their human dignity in its entirety, he said.

The pope said that as long as the patient is not dying, artificial nutrition and hydration must be considered ordinary and proportionate and, as such, morally obligatory to the degree thatand as long asthey reach their aim, which consists in providing nourishment to the patient and easing suffering.

The pope said an evaluation of the monetary costs of continuing care cannot outweigh the value of protecting human life. He also urged doctors and parishes to do more to help the families of patients in a persistent vegetative state. They cannot be left alone with their heavy human, psychological and economic burden, he said.

Salvino Leone, M.D., a moral theology professor who works with the Hospitaller Order of St. John of God in Rome, said there is a profound ethical and conceptual distinction between causing death and letting someone die. One must never hasten a patient’s death, he told the conference on March 20, and one always must provide pain relief, nutrition and hydration and take precautions so that bedsores and infections do not develop. But a Christian, Leone said, also must recognize that letting die is a service to the gift of God, the humble consciousness of being a creature in the face of divine will and the acknowledgment of his absolute lordship over human destiny. In a single word: It is a true act of faith.

Determining the exact moment when it becomes ethical to let someone die is difficult to determine, speakers at the conference said, and some argued that there even are instances when the artificial provision of nutrition and hydration is so burdensome to the patient and his or her family that it is not obligatory.

Ann Verlinde, president of the International Committee of Catholic Nurses, said that because nurses spend so much time with patients and their families, their opinions should be given greater weight on hospital ethics boards and in discussions with individual families about continuing or withdrawing certain types of care. In many situations, she said, nurses find it easier than doctors to say, It is finished; let them go. We will be with them, caring for them as they die.’

Msgr. Kevin T. McMahon of St. Charles Borromeo Seminary in Philadelphia, Pa., said that when patients are in a persistent vegetative state, artificially delivered nutrition and hydration are simply the medically assisted supply of food and drink. He said people should keep in mind that, while a return to consciousness is highly improbable after one year in a vegetative state, withholding nutrition and hydration always results in death.

No one is arguing to use all means, at all costs, for all persons in all circumstances, particularly those who are imminently dying and unable to benefit from the treatment, said Eugene F. Diamond, M.D., director of The Linacre Institute of the Catholic Medical Association, based in Boston. But with patients who are not dying, Diamond said, our choice is really between caring for such persons or abandoning them.

In a presentation written with Ronald P. Hamel of the Catholic Health Association of the United States, John Collins Harvey, M.D., of the Georgetown University Center for Clinical Bioethics in Washington, offered concrete examples of cases in which artificial nutrition and hydration were necessary and useful and of cases in which they became overly burdensome.

He told of a woman in a persistent vegetative state for four years whose Catholic husband and six children struggled with decisions regarding her care, particularly because of aspiration pneumonia and lung damage caused by regurgitation. They questioned whether continued biological life was the highest good for the human person and whether maintaining biological life was always morally obligatory, he said. Human life is sacred, he said, but the duty to prolong life is not absolutely binding under all circumstances, because we know that our ultimate end lies in eternal life with God.

Most Americans Do Not Blame All Jews

Less than 2 percent of Americans blame Jews and Jewish institutions of today for the death of Jesus, according to the results of a poll taken within two weeks of the release of the movie The Passion of the Christ, directed by Mel Gibson. The results were very good news that the teachings of Vatican II, and the teachings that have come from the Lutheran Church and other denominations, [are] what American Christians believe, said Gary Tobin, president of the Institute for Jewish & Community Research, which sponsored the poll.

By contrast, 24 percent of Americans familiar with the movie say that Jews alive at the time were most responsible for Jesus’ crucifixion. Among those polled who had seen the film, 5 percent said The Passion made them more likely to hold Jews responsible, while 12 percent said it made them less likely to hold today’s Jews responsible. While the film may have a different impact elsewhere in the world, so far The Passion of the Christ’ is not producing any significant anti-Jewish backlash in the United States, Tobin said.

Mixed Reactions to Passion Film

Church leaders in Eastern and Central Europe voiced mixed reactions to Mel Gibson’s The Passion of the Christ, while in Mexico and the Philippines bishops praised the movie. Cardinal Jozef Glemp of Warsaw described the movie as a great, decisive film and predicted it would assist better knowledge and comprehension of Christ’s mission. This film speaks about overcoming hatred with love for one’s enemiesabout struggling with an evil which is cruel and cynical, which can jeer and then wash its hands, the cardinal said.

Bishops in Germany criticized the film’s excessive violence and warned against its use as an instrument of anti-Semitism. With its drastic portrayal of atrocities, the film reduces the Bible’s message in a problematic way, the bishops’ conference said in a statement on March 4.

In Scotland, Bishop Joseph Devine of Motherwell, president of the Scottish bishops’ communications commission, said The Passion was the most powerful [film] I have ever seen. The secretary-general of the Hungarian bishops’ conference, Bishop Andras Veres of Eger, called the film accurate and infinitely enriching. But Catholic bishops in Austria warned the film could leave non-Christians with a total misunderstanding of the Christian faith’s foundations.

Several prominent Mexican bishops praised The Passion, and one even recommended that his parishioners see it. Philippine bishops who watched advance screenings of the movie recommended the film to Filipinos of all faiths.

The Passion of the Christ was the leading U.S. box-office attraction in each of its first three weekends of release and through March 14 had tallied an estimated $264 million, nearing the record for the largest-grossing R-rated movie of all time.

News Briefs

According to a new report by the National Catholic Educational Association, 123 Catholic schools were closed or consolidated in the past year and 34 new Catholic schools opened in September.

Sixty percent of U.S. dioceses have diocesan pastoral councils, according to a survey done for the bishops’ Committee on the Laity. This is up from 44 percent in 1977. An average of 85 percent of U.S. parishes were reported to have established parish pastoral councils.

The Vatican spoke out against the killing of Ahmed Yassin, founder and spiritual leader of Hamas, who was assassinated in Gaza City on March 22 by Israeli forces. The Holy See joins the international community in expressing its disapproval of this act of violence, which is not justifiable in any state of law, said the head of the Holy See’s press office, Joaquín Navarro-Valls.