ROME, FEB. 28, 2005 (Zenit.org).- The vegetative state is a “pejorative term” which implies lack of humanity, warns Dr. Gian Luigi Gigli, president of the International Federation of Catholic Medical Associations.
Gigli is co-author with Dr. Nathan Zasler of the book “Life-Sustaining Treatments in Vegetative State: Scientific Advances and Ethical Dilemmas,” reprinted in a special issue of the Neurorehabilitation review, published by Iospress. The book is the result of a congress on this topic.
Q: What does it mean to be in a vegetative state and what is the Church’s position?
Gigli: A vegetative state is verified in some patients when they come out of a coma, and it is characterized by a prolonged condition of wakefulness without apparent awareness on the part of the patient either of himself or of his surroundings.
The physiotherapy for this disorder is not yet clear, and the cerebral lesions that can cause it are of different types and in many areas.
The patient, alternating sleep with wakefulness, does not give answers that seem to make sense. It is not a terminal illness and does not require machines to guarantee vital functions.
However, the patient needs care, in particular, to be hydrated and fed, sometimes with patience through the mouth, more often with a probe or a tube in the abdominal wall, the PEG [percutaneous endoscopic gastrostomy].
For the Church, the patient in a vegetative state is a human person, in need of affectionate care. The discussion that has taken place between moralists and Catholic health institutions in past years has focused on indefinite continuation of hydration and nutrition, even if hopes for a resumption, though partial, of consciousness seem to be diminishing.
Some have seen in the prolongation of hydration and nutrition aggressive therapy; others have interpreted it as euthanasia by omission of the suspension of care, considering the mortal consequences that inevitably derive.
From outside the Church, the pressures of scientific societies, magistrates and some family members are very strong, as is occurring in the Terri Schiavo case in the United States, in favor of the suspension of hydration and nutrition. They are pressures based on the attribution of the little value of life, when its “quality” is greatly reduced.
However, resistances are also very strong by those who see in such procedures a surreptitious method to authorize, in fact, euthanasia in countries where it is prohibited, extending it later, as is already occurring, to other conditions such as dementia, mental retardation or acute ictus.
Q: Up to what point is the vegetative state “vegetative”?
Gigli: Beyond the term, which should be reformed because of its pejorative character — referring to a condition of the patient’s lack of humanity — it must be acknowledged that a rudimentary perception of pain cannot be excluded, as there are studies that prove the persistence of rudimentary processes of recognition and discrimination of stimuli.
An indirect proof that there are doubts of a neuroanatomic and neurophysiological order on the total lack of perception of pain in these patients is the common practice of subjecting them to pharmacological sedation during the 15 days in which the death of the patient is effected after the suspension of hydration and nutrition.
The vegetative state is diagnosed too often with excessive speed, with a high percentage of mistaken diagnoses, including within qualified health institutions. In particular, it must not be confused with other neurological conditions in which there is a state of prolonged reduction of the levels of consciousness.
Q: What did John Paul II say that was new in the treatment of patients in vegetative state in his historic address last March 20?
Gigli: The Holy Father, in as you say his “historic” address, pronounced words that serve to clarify misunderstandings among Catholics, avoiding — for example — suspension of hydration and nutrition in cases in which it should not be done, as unfortunately has occurred in some North American Catholic hospitals.
Despite the fact that there are many attempts by moralists and Catholic health institutions to reduce the scope of the Pope’s words, his message was very clear. For the Pope, judgment on the quality of life and on the costs of care cannot prevail over the respect due to the patient’s life.
Hydration and nutrition must be considered as ordinary and proportionate means for the objective that they intend, i.e. to nourish the patient. As such, they are morally obligatory, even if they are administered through a tube.
For the Pope, the fact that there is a high probability that the patient will not recover consciousness cannot justify the interruption of basic care, including hydration and nutrition. Otherwise, there is euthanasia by omission.
Moreover, the Pope called for the raising of our societies’ level of civilization, supporting with attentive solidarity the families of patients in vegetative state.
After the Pope’s words, I believe that for a doctor, a nurse or a Catholic health institution nutrition and hydration may only be interrupted if they no longer achieve their effect, or impose grave burdens on the patient — who on the other hand appears to tolerate them in an admirable way over many years — or family members, something which should not occur in civilized countries, in which basic care should not be a luxury.
Q: You wrote the book with Dr. Nathan Zasler, a Jewish doctor. Is there a meeting point between Catholics and Jews on the topic of nutrition and hydration in the vegetative state?
Gigli: The Jewish world is very diversified. Rabbi E.N. Dorff’s article, which forms part of the work, clarifies adequately that for the majority of Orthodox rabbis and for many Conservative rabbis the doctor has the obligation to do everything possible to maintain the life of the patient in vegetative state.
Other rabbis allow treatments not to be established, but prohibit their suspension once begun.
Instead, the Reformed and secularized Jews tend to decide according to their conscience.
In general lines, however, it seems that we could say that the Jewish tradition is hesitant when it comes to suspending treatments such as hydration and nutrition, on which the life of a patient in vegetative sate depends.
The congress and the volume that derived from it certainly demonstrate great respect for the Catholic position on the part of famous Jewish scholars.