"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'", the Holy Father said on Saturday, 20 March,
to participants in the International Congress on "Life-Sustaining
Treatments and Vegetative State: Scientific Advances and Ethical
Dilemmas". The Pope added that "doctors and health-care personnel, society
and the Church have moral duties toward these persons from which they
cannot exempt themselves without lessening the demands both of
professional ethics and human and Christian solidarity". The following is
a translation of the Holy Father's address, which was given in Italian.
Distinguished Ladies and Gentlemen,
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 Prof. Gian Luigi Gigli, President of the International Federation of Catholic
Medical Associations and selfless champion of the fundamental value of life, who
has kindly expressed your shared feelings.
This important Congress, organized jointly by the Pontifical
Academy for Life and the International Federation of Catholic Medical
Associations, is dealing with a very significant issue: the clinical
condition called the "vegetative state". The complex scientific, ethical,
social and pastoral implications of such a condition require in-depth
reflections and a fruitful interdisciplinary dialogue, as evidenced by the
intense and carefully structured programme of your work sessions.
Careful observation for a correct diagnosis
2. With deep esteem and sincere hope, the Church encourages the
efforts of men and women of science who, sometimes at great sacrifice, daily
dedicate their task of study and research to the improvement of the diagnostic,
therapeutic, prognostic and rehabilitative possibilities confronting those
patients who rely completely on those who care for and assist them. The person
in a vegetative state, in fact, shows no evident sign of self-awareness or of
awareness of the environment, and seems unable to interact with others or to
react to specific stimuli.
Scientists and researchers realize that one must, first of all,
arrive at a correct diagnosis, which usually requires prolonged and careful
observation in specialized centres, given also the high number of diagnostic
errors reported in the literature. Moreover, not a few of these persons, with
appropriate treatment and with specific rehabilitation programmes, have been
able to emerge from a vegetative state. On the contrary, many others
unfortunately remain prisoners of their condition even for long stretches of
time and without needing technological support.
In particular, the term permanent vegetative state has been
coined to indicate the condition of those patients whose "vegetative state"
continues for over a year. Actually, there is no different diagnosis that
corresponds to such a definition, but only a conventional prognostic judgment,
relative to the fact that the recovery of patients, statistically speaking, is
ever more difficult as the condition of vegetative state is prolonged in time.
However, we must neither forget nor underestimate that there are
well-documented cases of at least partial recovery even after many years; we can
thus state that medical science, up until now, is still unable to predict with
certainty who among patients in this condition will recover and who will
3. Faced with patients in similar clinical conditions, there are
some who cast doubt on the persistence of the "human quality" itself, almost as
if the adjective "vegetative" (whose use is now solidly established), which
symbolically describes a clinical state, could or should be instead applied to
the sick as such, actually demeaning their value and personal dignity. In this
sense, it must be noted that this term, even when confined to the clinical
context, is certainly not the most felicitous when applied to human beings.
In opposition to such trends of thought, 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. 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".
Even our brothers and sisters who find themselves in the clinical
condition of a "vegetative state" retain their human dignity in all its
fullness. The loving gaze of God the Father continues to fall upon them,
acknowledging them as his sons and daughters, especially in need of help.
The sick person has the right to basic health care
4. Medical doctors and health-care personnel, society and the
Church have moral duties toward these persons from which they cannot exempt
themselves without lessening the demands both of professional ethics and human
and Christian solidarity.
The sick person in a vegetative state, awaiting recovery or a
natural end, still has the right to basic health care (nutrition, hydration,
cleanliness, warmth, etc.), and to the prevention of complications related to
his confinement to bed. He also has the right to appropriate rehabilitative care
and to be monitored for clinical signs of eventual recovery.
I should like particularly to underline how the administration of
water and food, even when provided by artificial means, always represents a
natural means of preserving life, not a medical act. Its use,
furthermore, should be considered, in principle, ordinary and
proportionate, and as such morally obligatory, insofar as and until it is
seen to have attained its proper finality, which in the present case consists in
providing nourishment to the patient and alleviation of his suffering.
The obligation to provide the "normal care due to the sick in such
cases" (Congregation for the Doctrine of the Faith, Iura et Bona, p. IV)
includes, in fact, the use of nutrition and hydration (cf. Pontifical Council
"Cor Unum", Dans le Cadre, 2, 4, 4; Pontifical Council for Pastoral
Assistance to Health Care Workers, Charter of Health Care Workers, n.
120). The evaluation of probabilities, founded on waning hopes for recovery when
the vegetative state is prolonged beyond a year, cannot ethically justify the
cessation or interruption of minimal care for the patient, including
nutrition and hydration. Death by starvation or dehydration is, in fact, the
only possible outcome as a result of their withdrawal. In this sense it ends up
becoming, if done knowingly and willingly, true and proper euthanasia by
In this regard, I recall what I wrote in the Encyclical
making it clear that "by euthanasia in the true and proper sense must be
understood an action or omission which by its very nature and intention brings
about death, with the purpose of eliminating all pain"; such an act is always "a
serious violation of the law of God, since it is the deliberate and
morally unacceptable killing of a human person" (n. 65).
Besides, the moral principle is well known, according to which
even the simple doubt of being in the presence of a living person already
imposes the obligation of full respect and of abstaining from any act that aims
at anticipating the person's death.
Social pressures cannot prevail over general principles
5. Considerations about the "quality of life", often actually
dictated by psychological, social and economic pressures, cannot take precedence
over general principles.
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. Moreover,
to admit that decisions regarding man's life can be based on the external
acknowledgment of its quality, is the same as acknowledging that increasing and
decreasing levels of quality of life, and therefore of human dignity, can be
attributed from an external perspective to any subject, thus introducing into
social relations a discriminatory and eugenic principle.
Moreover, it is not possible to rule out a priori that the
withdrawal of nutrition and hydration, as reported by authoritative studies, is
the source of considerable suffering for the sick person, even if we can see
only the reactions at the level of the autonomic nervous system or of gestures.
Modern clinical neurophysiology and neuro-imaging techniques, in fact, seem to
point to the lasting quality in these patients of elementary forms of
communication and analysis of stimuli.
Proper care is needed for these patients and their families
6. However, it is not enough to reaffirm the general principle
according to which the value of a man's life cannot be made subordinate to any
judgment of its quality expressed by other men; it is necessary to promote the
taking of positive actions as a stand against pressures to withdraw
hydration and nutrition as a way to put an end to the lives of these patients.
It is necessary, above all, to support those families who
have had one of their loved ones struck down by this terrible clinical
condition. They cannot be left alone with their heavy human, psychological and
financial burden. Although the care for these patients is not, in general,
particularly costly, society must allot sufficient resources for the care of
this sort of frailty, by way of bringing about appropriate, concrete initiatives
such as, for example, the creation of a network of awakening centres with
specialized treatment and rehabilitation programmes; financial support and home
assistance for families when patients are moved back home at the end of
intensive rehabilitation programmes; the establishment of facilities which can
accommodate those cases in which there is no family able to deal with the
problem or to provide "breaks" for those families who are at risk of
psychological and moral burn-out.
Proper care for these patients and their families should,
moreover, include the presence and the witness of a medical doctor and an entire
team, who are asked to help the family understand that they are there as allies
who are in this struggle with them. The participation of volunteers represents a
basic support to enable the family to break out of its isolation and to help it
to realize that it is a precious and not a forsaken part of the social fabric.
In these situations, then, spiritual counselling and pastoral aid
are particularly important as help for recovering the deepest meaning of an
apparently desperate condition.
'To cure if possible, always to care'
7. Distinguished Ladies and Gentlemen, in conclusion I exhort you,
as men and women of science responsible for the dignity of the medical
profession, to guard jealously the principle according to which the true task of
medicine is "to cure if possible, always to care".
As a pledge and support of this, your authentic humanitarian
mission to give comfort and support to your suffering brothers and sisters, I
remind you of the words of Jesus: "Amen, I say to you, whatever you did for one
of these least brothers of mine, you did for me" (Mt 25: 40).
In this light, I invoke upon you the assistance of him, whom a
meaningful saying of the Church Fathers describes as Christus medicus,
and in entrusting your work to the protection of Mary, Consoler of the sick
and Comforter of the dying, I lovingly bestow on all of you a special Apostolic