There is an article in the January 21 issue of the America magazine that deals with the questions arising on the PVS (permanently vegetative state) and the moral obligation of providing hydration and nutrition (and ventilation) to these patients: “Church Teaching and My Father’s Choice. 'Medically ordinary' does not always mean morally ordinary” By John J. Hardt (http://www.americamagazine.org/content/article.cfm?article_id=10552 ).

The author while distinguishing between “medically normal” and “morally normal” procedures tries to understand the exceptions to the absolute necessity to provide artificial nutrition and hydration in all circumstances in the CDF (Congregation for the Doctrine of Faith) document entitled “Responses to Certain Questions of the U.S. Conference of Catholic Bishops Concerning Artificial Nutrition and Hydration” (Sep 15, 2007).

'The doctrinal congregation then identifies four such exceptions: first, when remote geography and/or extreme poverty make the administration of artificial nutrition and hydration impossible; second, when “emerging complications” prohibit the assimilation of artificial nutrition and hydration; third, when, “in some rare cases,” it “may be excessively burdensome;” and fourth, when, “in some rare cases,” it “may cause significant physical discomfort.”’

The author intends to find the justification of those Catholics who give advance directions asking to not to keep them alive artificially in PVS, but “let them go” – as his father whom he referred to in the title did. He find the explanation for such decision in the case of “excessive burden”: “In other words, my father has judged that the burden of persisting in a vegetative state far outweighs the benefit of being sustained that way. This is, in my view, a very Catholic way of thinking, shared by other faithful Catholics, and consistent with Catholic tradition.”

The issue seems in any case rather complicated. Besides the distinction between “medically normal” and “morally normal” I wonder about the meaning of “normal living” and “normal or natural dying”. I think that one has right to not to be denied the normal or natural dying experience – that is part of our normal life. On the other side I see that the diagnosis of PVS is not without doubts, which raises more questions. What it means that it is really “permanent” state without return to “normal” living and if it is really “vegetative” in which one does not have experiences, desires and will? It is sure is that there is no communication with such patients, and they need artificial means to be fed for the moment and for the medically foreseeable future.

For me it is also curious that the Congregation established an exception of geography and extreme poverty. It seems to me that this exception is rather the fate of the majority of humanity, based on the “geography” where they live, in Africa, Asia, South America and also in the developed world if they are homeless or otherwise lacking “normal” healthcare. There is no “danger” that they will keep us alive too long if we don’t have good insurance and cannot pay for it. So it seems we are right to deny these people the food and water if they are not able to fetch it for themselves anymore?

I think that one can justify a decision of not wanting to be kept alive in PVS by a motive of solidarity with the poor for whom it is not even an option. It might be in the same time an “excessive burden” morally, to think that all the resources given to me just to keep me as a sort of living mass of tissues could be used for saving real lives.

If it is only a minority for whom the question of living or not in PVS is feasible and also among those who could in theory enter this stage there is only a little fraction that actually will be affected by it, then why the great importance given to the questions regarding it?  The author’s opinion is that the question of euthanasia is the underlying cause: “In exploring the significance of these exceptions, we must recognize that the document is restricted to a discussion of patients in a persistent vegetative state, a diagnosis that affects only a miniscule number of patients. We must also recognize that a growing popular acceptance of outright euthanasia influenced the congregation’s thinking.”

When can discontinuing the nutrition and hydration be bordering with euthanasia? How can we assure that if we desire that at the end of life we want to be let go, it will be done without euthanasia, without ending our life for practical considerations? All we need is allowing us to encounter our “normal and natural” death - even all the suffering involved in this last experience of our earthly life - and letting us to enter in the next life we believe in.

What is your opinion on these questions?