At the end of last year, thousands of Italians crowded in a piazza in Rome to bid farewell to poet and activist Piergiorgio Welby. The Italian bishops had refused to allow his funeral to take place in church. Welby had suffered for years from muscular dystrophy. He made the attending physician turn off his respirator and, in effect, ended his life. Thus, his death became a powerful statement for an individual’s choice to decide whether he lives or dies.

Who has the right to decide the moment of death? This is the question that dramatically divided America in the Terri Schiavo case. For fifteen years, this Florida woman was in an unconscious state. Her family cared for her. She was made comfortable, kept clean, surrounded by love and given food and drink. But after losing a five-year legal battle with her husband, her parents stood by helplessly for thirteen days, unable to provide food and water. The court ordered the removal of her feeding tube. In effect, the court decreed her death.

These cases made the news, provoked discussion and left many people confused. Is it ever moral to end someone’s life by removing the artificial means keeping a person alive? If a person is brain dead, the use of a ventilator is no longer supporting life and can be removed. Furthermore, once it is clear that a respirator provides little benefit and the burden to the patient is greater than the benefit, the respirator can be removed. In such a case, the underlying pathology takes its natural course. The person is allowed to die.

What about the case of removing artificial nutrition and hydration? Is it moral to withhold food and drink from a terminally ill or seriously disabled person? What is the purpose of prolonging the life of someone terminally ill or someone who is in an unconscious state with no foreseeable hope of recovery?

These are not questions found just in academic journals. With the many technological advances in health care, ordinary people who cherish their family members are often confronted with this situation and have to make a decision. There are a number of principles consistently taught by the Church that need to be clear before any decision is made whether to withdraw food and water from a patient.

First, a person remains a person even when terminally ill or seriously disabled. All human life is sacred, not just a productive or useful life. On March 20, 2004, Pope John Paul II made the point of addressing those who argue that the continuation and care of human life depends on the quality of life. He said, “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 come a ‘vegetable’ or ‘animal’” (Address to the participants of an International Congress on “Life-sustaining Treatments and the Vegetative State: Scientific progress and ethical dilemmas”).

Thus, a person who is in a condition that is infelicitously called a “permanent vegetative state” still retains his or her fundamental human dignity. He or she is to receive ordinary care which, in principle, includes the administration of food and water, even by artificial means.

Second, euthanasia, that is, the direct putting an end to the life of the terminally ill, the sick, the disabled or handicapped, is morally unacceptable ( Catechism of the Catholic Church, 2277). Even when the intention is to relieve the suffering of another, assisted suicide and mercy-killing are grave sins. God himself is the giver of life. It does not belong to us to determine who lives and who dies. Such arrogance is a grievous offense against the Creator.

Third, an act of omission that causes the death of another person is murder. Thus, it is morally unacceptable not to provide warmth and shelter, food and water to a patient in normal circumstances. The denial of these basic necessities is the equivalent of willfully taking another person’s life. However, this is different than not providing nutrition and hydration to a terminally ill patient who is actually dying and will die with or without nutrition and hydration.

These principles are clear and consistent with the dignity of the human person as created in the image and likeness of God. However, the application of these principles to particular cases is never easy. What about a patient whose illness makes them unable to feed themselves? What about a patient in an unconscious state for more than a year with less and less hope of recovery? Do family members have to provide artificial nutrition and hydration?

To be continued