"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 not.
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
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
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 omission.
In this regard, I recall what I wrote in the
Vitae, 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
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
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
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 Blessing.