“For example, when a patient is approaching inevitable death due to a progressive and fatal underlying disease, certain nutritional and hydration measures may be excessively burdensome and therefore not mandatory given their very limited ability to prolong life or provide relief.”

What does the new document from the Pontifical Academy say?

The July pamphlet reaffirms the Church’s long-standing teaching against euthanasia and assisted suicide in several sections, but it was its section 13 on “Artificial Nutrition and Hydration” that attracted the most attention. (An official English translation of the pamphlet is not yet available, so the excerpts here are from an unofficial translation created by Google.)

Catholic teaching allows for the possibility of ending “burdensome, dangerous, extraordinary or disproportionate” medical treatments – such as disconnecting patients who can no longer breathe on their own from ventilators and allowing them to die naturally – and that is not the same as euthanasia.

In Section 13, the PAFL reiterated that for people in a permanent vegetative state—that is, not actively dying—stopping food and water is different from turning off a ventilator because “death is not caused by the disease itself running its course, but by the actions of those who stop it.”

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“Upon closer inspection, however, this topic falls victim to a reductionist understanding of disease, which is understood as a change in a specific function of the organism and in doing so loses sight of the human being as a whole,” the document continues.

“This reductionist way of interpreting the disease leads to an equally reductionist treatment concept that ultimately focuses on individual functions of the organism rather than on the general well-being of the person. The individual functions of the organism, including nutrition – especially when they are permanently and irreversibly impaired – must be considered in the overall picture of the person(.)”

The PAFL further stated that such interventions are “not simple health care measures” because they require a person in a vegetative state to consume food that is “prepared in the laboratory and administered using technical equipment.”

“The doctor is obliged to respect the will of the patient who rejects it through a conscious and informed decision, also expressed in advance in view of the possible loss of the capacity for self-expression and decision,” wrote the PAFL.

The PAFL pointed out that Pope Francis has stressed the importance of considering the whole person and not just individual bodily functions when making medical decisions.

A departure from previous teachings?

Father Tad Pacholczyk, senior ethicist at the National Catholic Bioethics Center, told CNA that his reading of the PAFL document “does not deviate significantly” from what the church has said in the past on the subject of ANH.

The church traditionally teaches that “medically assisted nutrition and hydration become morally ‘extraordinary’ when they cannot reasonably be expected to prolong life or when the use of the means employed would cause significant physical discomfort or complications,” he said.

Against this background, the text emphasizes the “ongoing need for careful assessment and consideration of the benefits and burdens that may be associated with the administration of artificial nutrition and hydration (ANH) to each individual patient.”

Furthermore, the text seems to imply that such careful assessment and differentiation does not always take place, but that some people rely on problematic generalisations such as ‘ANH is always necessary’ or ‘ANH is always an aggressive therapy’ – both of which are incorrect.

“The circumstances and details will be important so that in some cases ANH may indeed be classified as ‘aggressive therapy’, but in many others it clearly is not. Therapy must be understood as a proportionate and therefore mandatory method of caring for our loved ones,” Pacholczyk said.

Catholic ethicist Charlie Camosy took a different view in an August 13 op-ed at The Pillar, warning that PAFL’s statements could be misunderstood in the context of what Pope Francis calls a “throwaway culture” — a culture in which numerous jurisdictions around the world allow and even encourage euthanasia and assisted suicide and which “seeks to conceal the value of disabled people with disorders of consciousness, making it easier to seek their death.”

“The new text from the Pontifical Academy seems to indicate that the food and fluids given to disabled, so-called ‘vegetative’ patients are prepared in a laboratory and administered using technology. Therefore, offering this food and fluids to these patients is not a ‘simple care measure.’ It could be considered more like a medical treatment that could in principle be discontinued, rather than a kind of basic care that can never be refused,” Camosy wrote.

“From a bioethical perspective, this seems to many ethicists a strange presentation of the problem, to say the least,” he continued.

“The food given to such disabled people is not made in a laboratory any more than protein shake powder. And feeding tubes are extremely simple devices that do not require machines or other special technology. Many Catholic bioethicists would view feeding a disabled person through a tube as little different from feeding them with a spoon.”

An ongoing case

Section 13 of the PAFL document is relevant to an ongoing bioethics case in the United States, that of Margo Naranjo.

Naranjo, 28, suffered severe brain damage in a car accident in 2020. Although she is not technically on life support and can breathe without a ventilator, she is now severely disabled and cannot speak, eat or drink on her own.

Naranjo’s parents, Mike and Cathy, are Catholics and have frequently asked for prayers for Margo’s recovery and her family since the car accident. But in a now-deleted Facebook livestream on July 7, Cathy announced that she and Mike had decided – in accordance with what they believed to be Margo’s wishes before the accident – to let Margo starve to death in hospice.

Court records show that on July 19, a Denton County Probate Court judge appointed a temporary guardian for Margo and issued a restraining order against her parents prohibiting them from withholding food and water from her.

Naranjo’s situation has been compared to that of Terri Schiavo, a Florida woman who suffered severe brain damage from lack of oxygen after a heart attack and lived in a persistent vegetative state for a decade and a half. In 2005, Schiavo starved to death after her husband insisted on honoring her wishes and removing her feeding tube, despite a lengthy and very public court battle and the pleas of her family.