Reflections on Artificial Nutrition and hydration Colloquium of the Canadian Catholic Bioethics Institute
| Páginas | 117-122 |
Page 117
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The Canadian Catholic Bioethics Institute sponsored a colloquium in Toronto, June 14-17, 2004. The purpose of this colloquium was to discuss the speech made by Pope John Paul II on March 20, 2004 to participants in the International Congress on 'Life- Sustaining Treatments and Vegetative State' and to assist health care professionals, patients, their families and the community in making decisions about artificial nutrition and hydration (ANH) for elderly patients who have medical conditions other than a 'vegetative state'. Participants in the Toronto colloquium, who work in various fields related to bioethics and had different starting points and perspectives, agreed that the following reflections summarize generally the outcome of their discussions.
Those participants who consented to be listed at the end of these reflections do so in their own name and not on behalf of their institutions. Although all the signatories agreed to the three points of interpretation of the papal speech in paragraph 5, they do not necessarily concur with everything in the reflections.
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In keeping with the Catholic moral tradition:
* Life is a gift from God for which we have stewardship. Illness, suffering and death are part of the human condition.
* Humans are relational beings who summon a response from others. All human beings, regardless of their state of health or function, are persons endowed with a spiritual soul and created in the image of God. As such, they possess an intrinsic dignity and value, and have moral status. It follows from this understanding that patients in the state known as 'persistent vegetative state' (PVS) are persons. It also follows that, even when patients with advanced dementia, such as Alzheimer disease, have personalities that are diminished, they remain persons throughout the course of their disease leading to death. Individuals with a developmental or physical disability, even in extreme degrees, also are persons with the same dignity and rights as other persons. Page 118
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The term 'vegetative state' was developed in reference to certain functions of the autonomic or 'vegetative' nervous system. These functions, such as the regulation of breathing and the heart rate, are retained despite a patient's unawareness of self and environment. Patients in a 'vegetative state' have sleep-wake cycles in which they periodically open their eyes, but they show no evidence of response to the environment, purposeful responses to stimuli and language comprehension or expression. Unfortunately some have misunderstood and misused the term 'vegetative state' to suggest that persons in this state are less than fully human. To avoid this, it is preferable to designate the condition as a state of 'post-coma unresponsiveness'.
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If post-coma unresponsiveness lasts longer than 6 months following a brain injury from lack of oxygen, or 12 months following a traumatic brain injury, it is conventionally considered to be 'permanent'. This means that the statistical probability of any recovery is minimal but not unprecedented.
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In the responses to the papal speech of March 20, 2004, there have been uncertainty and speculation in regard to the statement that ANH «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». The colloquium in Toronto reached the following interpretation of this sentence in the papal speech:
* The papal speech needs to be understood in the context of the Catholic tradition.
The words «in principle» (n.4) do not mean 'absolute' in the sense of 'exceptionless' but allow consideration of other duties that might apply.
* Persons in a state of lost cognitive and affective capacity retain a spiritual soul; their life has intrinsic...
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