Recently, the debate on end of life issues got a little murkier.
On March 20, Pope John Paul II came out with a statement called "Life-Sustaining Treatments and Vegetative State: Scientific Advances and Ethical Dilemmas." The statement was read at a conference of the Pontifical Academy for Life and the International Federation of Catholic Medical Associations in the Vatican, but did not have a full English translation until April 1.
The statement said the pope believed it was immoral for a person in a persistent vegetative state to be removed from artificial hydration or nutrition and considered it euthanasia by omission. In many health circles artificial hydration and nutrition are considered to be extraneous actions to preserve life if enough time had gone by and the person did not recover consciousness.
According to National Institute of Neurological Disorders and Strokes, individuals in a persistent vegetative state have lost their thinking abilities and awareness of their surroundings, but retain non-cognitive function and normal sleep patterns. Patients lose their higher brain functions but basic functions of life remain. Spontaneous movements may occur, and the eyes may open in response to external stimuli. The state is considered persistent when it lasts for over three months or more.
The "administration of water and food, even when provided by artificial means, always represents a natural means of preserving life, not a medical act," the pope said in the statement.
The Rev. Germaine Kopaczynski, director of education for the National Catholic Bioethics Center said the statement is less of a new stance on the issue, as it is a clarification.
"There have been a lot of statements on end of life issues from various theologians and Catholic health professionals and the pope wanted to narrow this down into something that is in line with the principle of human dignity," Kopaczynski said.
"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," the pope said in the statement. "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.'"
Kopaczynski also said the statement was meant to clarify that the decision to remove artificial nutrition was a philosophical one.
"The pope is trying to tell doctors to stick to medicine and not to make philosophical decisions," Kopaczynski said. "The Church is trying to reiterate that the Decartes philosophy of 'cogito erg sum' (I think therefore I am), is not a good philosophy to live by or base your ethic of value of life on."
However, the statement has aroused concern in others.
"This departs from the best sense of Catholic medical ethics," said Dan Maguire, a professor in theology at Marquette who has specialized in medical ethics. "Catholic medical ethics recognizes that biological life is not our absolute reality — it sees that there is more beyond that."
Maguire said the pope's recent statement seems to contradict previous statements made by Pope Pius XII who said that a respirator could be turned off if a person was in a coma and showed no sign of recovery.
"It is not as though doctors and families are arbitrarily removing feeding tubes," Maguire said. "In the past the tube was only removed if there was no reasonable hope for a return to good health."
The pope's statement claimed the often slim chance of recovery legitimized the need to keep a person on artificial nourishment and hydration.
"Moreover, not a few of these persons, with appropriate treatment and with specific rehabilitation programs, have been able to emerge from a vegetative state," the pope said in the statement. "On the contrary, many others unfortunately remain prisoners of their condition even for long stretches of time and without needing technological support."
The reaction from Catholic health care workers has ranged from supportive to cautious.
A statement from Rev. Michael D. Place, president and chief executive officer of the Catholic Health Association seemed reserved in its opinion.
Place reaffirmed that the statement challenged Catholic doctors and nurses to always put the welfare of their patients first, but showed desire to discuss more what the statement would mean.
"That being said, the guidance contained in his remarks has significant ethical, legal, clinical and pastoral implications that must be carefully considered," Place's statement said. "This will require dialogue among sponsors, bishops and providers, especially with regard to practical implications for those patients who are not in a persistent vegetative state."
An employee of a Catholic hospital in Milwaukee who did not want to be named for fear of losing her job said the decision was thought to be unrealistic for patients, care workers and families.
"This shows a total lack of understanding for the families or the patients," the source said. "The Vatican is so obsessed with showing life is sacred they aren't giving people the freedom to die."
Kopaczynski said quality of life was not being properly considered by those who used the argument against the pope's statement.
"Quality of life is not a trump card to hold over someone's head," Kopaczynski said.
Maguire disagreed somewhat with the sentiment and pointed to the concern for the cost of artificial nutrition and hydration.
"What is the real need for preserving our unconscious remains?" Maguire said. "We have to consider the social cost that is born by the state or the individuals if people are kept on feeding tubes."
In the pope's statement, he clarified that no cost was too large to preserve a life.
"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," the pope's statement said.
On a local level, Archbishop Timothy Dolan is apparently pleased with the statement made by the pope.
"The archbishop is very supportive of this as he is with anything that supports the sanctity of life issue," said Kathleen Hohl, spokeswoman for the archdiocese of Milwaukee.
Maguire emphasized that removing artificial hydration and nutrition could be an action that respects life because it allows a person to die, rather than keeping them alive against their and God's will. He also pointed to the argument as coming from an anxiety about death that was unnecessary for Christians.
"Death is as natural as life," Maguire said. "If we have a strong belief in the afterlife we should not be afraid of death."