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Euthanasia by omission: food and water must not be withheld

By Nicholas Tonti-Filippini - posted Wednesday, 21 April 2004

Pope John Paul II has issued a statement that water and food, even when administered artificially, are "a natural means of preserving life, not a medical procedure. Therefore, their use must be considered ordinary and appropriate and as such, morally obligatory."

The statement is directly relevant to the situation of a Melbourne woman, known as BWV, who died as a result of the withdrawal of food and water following a Victorian Supreme Court decision. Intervening in the case last year, the Melbourne Catholic archdiocese opposed the decision.

His Holiness was speaking to an international medical congress promoted by the World Federation of Catholic Medical Associations (FIAMC) and by the Pontifical Academy for Life entitled "Life Sustaining Treatment and the Vegetative State". The Pope read the statement to a special session of the congress held in the beautiful Clementine Hall on March 20. While we were waiting for the Pope to speak to us, Archbishop Hart and the other bishops of the Victorian province walked past after having met the Pope on their Ad Limina visit.


The Pope arrived seated on a wheeled throne. While receiving a presentation from the congress, his eyes followed the passage of a small child who managed to escape from her Mexican mother and Swiss father. He waved to the audience and read the statement slowly but clearly. The impression was of a strong intellect in a failing body. The following day he spent long hours in the square celebrating mass and canonisation ceremonies. He was strong enough to distribute communion.

After recalling that conference members focused on the theme of the clinical condition known as the "vegetative state", the Pope affirmed that "the intrinsic value and the personal dignity of every human being do not change, no matter what the specific circumstances of their life. Human beings, even if they are seriously ill and impaired in the exercise of their highest functions, are and always will be human beings and will never become 'vegetables' or 'animals'. Our sisters and brothers who are in a 'vegetative state' fully preserve their dignity."

It is worth noting in this respect that the Australian National Health and Medical Research Council has recently published a document in which it maintains that the phrase "vegetative state" is prejudicial to the interests of patients who are in a state of unresponsiveness through illness or brain injury.

The Pope maintained that physicians and health workers, society and the Church have a moral duty toward these persons that they cannot shirk without neglecting the requirements of professional deontology as well as Christian and human solidarity. Sick people in a vegetative state, waiting to recover or for a natural end, have the right to basic health care (nutrition, hydration, hygiene, warmth, etc).

The probability that there is little hope for recovery "when the vegetative state lasts longer than a year, cannot ethically justify abandoning or interrupting basic care, including food and hydration, of a patient". Death by starvation or dehydration carried out "consciously or deliberately is truly euthanasia by omission".

The Pope recalled the "moral principle according to which even the slightest doubt of being in the presence of a person who is alive requires full respect and prohibits any action that would anticipate his or her death. The value of the life of a man cannot be subjected to the judgement of quality expressed by other men; it is necessary to promote positive activities to counteract pressure for the suspension of food and hydration, as a means to putting an end to the life of these patients."


"Above all," he added, "we must support the families" who have a patient in the vegetative state. "We cannot leave them alone with the heavy human, economic and psychological weight." Society must promote "specific programs of assistance and rehabilitation; economic support and help at home for the family; and support structures when there are no family members able to address the problem". In addition, he said, volunteers provide "fundamental support to help the family to escape isolation and to help them to feel a valuable part of society and not abandoned by social institutions".

John Paul II ended by emphasising that "in these situations spiritual and pastoral help is especially important in order to understand the deeper meaning of a seemingly desperate situation".

A feature of the Rome congress was the witness given by so many doctors and nurses engaged in the care of those who through illness or injury are no longer responsive. European doctors expressed surprise that, in Australia, doctors and nurses consider it permissible to withdraw basic care such as nutrition and hydration. We were told that in France, where it is not permissible to allow religion to influence medical practice, it is a criminal offence to withdraw food and water from a person who is in an unresponsive state, even if they have previously requested the withdrawal.

It is a sad reflection on Australia that the NHMRC document refers to the lack of doctors with experience in the long-term care of people in an unresponsive state. Yet on the corresponding European data, there should be at least 400 Australian patients in that condition. Missing in Australia would seem to be clinics that specialise in caring for people in an unresponsive state with activities designed to maintain them physically and to stimulate mental capacity.

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Article edited by Eliza Brown.
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This article was first published in Kairos Catholic Journal.

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About the Author

Dr. Nicholas Tonti-Filippini is an Independent Consultant Ethicist. He is a chairman of the Research Committee for Matercare International and a founding member of the Board of Directors for Matercare Australia

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