Address Of John Paul II To The Participants In
The International Congress On
"Life-Sustaining Treatments And Vegetative
State: Scientific Advances And Ethical Dilemmas"
Saturday, 20 March 2004
Distinguished Ladies and Gentlemen,
1. I cordially greet all of you who took part in the International Congress:
"Life-Sustaining Treatments and Vegetative State: Scientific Advances and
Ethical Dilemmas". I wish to extend a special greeting to Bishop Elio Sgreccia,
Vice-President of the Pontifical Academy for Life, and to Prof. Gian Luigi Gigli,
President of the International Federation of Catholic Medical Associations and
selfless champion of the fundamental value of life, who has kindly expressed
your shared feelings.
This important Congress, organized jointly by the Pontifical Academy for Life
and the International Federation of Catholic Medical Associations, is dealing
with a very significant issue: the clinical condition called the "vegetative
state". The complex scientific, ethical, social and pastoral implications of
such a condition require in-depth reflections and a fruitful interdisciplinary
dialogue, as evidenced by the intense and carefully structured programme of your
2. With deep esteem and sincere hope, the Church encourages the efforts of
men and women of science who, sometimes at great sacrifice, daily dedicate their
task of study and research to the improvement of the diagnostic, therapeutic,
prognostic and rehabilitative possibilities confronting those patients who rely
completely on those who care for and assist them. The person in a vegetative
state, in fact, shows no evident sign of self-awareness or of awareness of the
environment, and seems unable to interact with others or to react to specific
Scientists and researchers realize that one must, first of all, arrive at a
correct diagnosis, which usually requires prolonged and careful observation in
specialized centres, given also the high number of diagnostic errors reported in
the literature. Moreover, not a few of these persons, with appropriate treatment
and with specific rehabilitation programmes, have been able to emerge from a
vegetative state. On the contrary, many others unfortunately remain prisoners of
their condition even for long stretches of time and without needing
In particular, the term permanent vegetative state has been coined to
indicate the condition of those patients whose "vegetative state" continues for
over a year. Actually, there is no different diagnosis that corresponds to such
a definition, but only a conventional prognostic judgment, relative to the fact
that the recovery of patients, statistically speaking, is ever more difficult as
the condition of vegetative state is prolonged in time.
However, we must neither forget nor underestimate that there are
well-documented cases of at least partial recovery even after many years; we can
thus state that medical science, up until now, is still unable to predict with
certainty who among patients in this condition will recover and who will not.
3. Faced with patients in similar clinical conditions, there are some who
cast doubt on the persistence of the "human quality" itself, almost as if the
adjective "vegetative" (whose use is now solidly established), which
symbolically describes a clinical state, could or should be instead applied to
the sick as such, actually demeaning their value and personal dignity. In this
sense, it must be noted that this term, even when confined to the clinical
context, is certainly not the most felicitous when applied to human beings.
In opposition to such trends of thought, I feel the duty to reaffirm strongly
that 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 become a "vegetable" or an "animal".
Even our brothers and sisters who find themselves in the clinical condition
of a "vegetative state" retain their human dignity in all its fullness. The
loving gaze of God the Father continues to fall upon them, acknowledging them as
his sons and daughters, especially in need of help.
4. Medical doctors and health-care personnel, society and the Church have
moral duties toward these persons from which they cannot exempt themselves
without lessening the demands both of professional ethics and human and
The sick person in a vegetative state, awaiting recovery or a natural end,
still has the right to basic health care (nutrition, hydration, cleanliness,
warmth, etc.), and to the prevention of complications related to his confinement
to bed. He also has the right to appropriate rehabilitative care and to be
monitored for clinical signs of eventual recovery.
I should like particularly to underline how the administration of water and
food, even when provided by artificial means, always represents a natural means
of preserving life, not a medical act. Its use, furthermore, 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, which in the present case consists in providing nourishment to the
patient and alleviation of his suffering.
The obligation to provide the "normal care due to the sick in such cases"
(Congregation for the Doctrine of the Faith, Iura et Bona, p. IV) includes, in
fact, the use of nutrition and hydration (cf. Pontifical Council "Cor Unum",
Dans le Cadre, 2, 4, 4; Pontifical Council for Pastoral Assistance to Health
Care Workers, Charter of Health Care Workers, n. 120). The evaluation of
probabilities, founded on waning hopes for recovery when the vegetative state is
prolonged beyond a year, cannot ethically justify the cessation or interruption
of minimal care for the patient, including nutrition and hydration. Death by
starvation or dehydration is, in fact, the only possible outcome as a result of
their withdrawal. In this sense it ends up becoming, if done knowingly and
willingly, true and proper euthanasia by omission.
In this regard, I recall what I wrote in the Encyclical Evangelium Vitae,
making it clear that "by euthanasia in the true and proper sense must be
understood an action or omission which by its very nature and intention brings
about death, with the purpose of eliminating all pain"; such an act is always "a
serious violation of the law of God, since it is the deliberate and morally
unacceptable killing of a human person" (n. 65).
Besides, the moral principle is well known, according to which even the
simple doubt of being in the presence of a living person already imposes the
obligation of full respect and of abstaining from any act that aims at
anticipating the person's death.
5. Considerations about the "quality of life", often actually dictated by
psychological, social and economic pressures, cannot take precedence over
First of all, no evaluation of costs can outweigh the value of the
fundamental good which we are trying to protect, that of human life. Moreover,
to admit that decisions regarding man's life can be based on the external
acknowledgment of its quality, is the same as acknowledging that increasing and
decreasing levels of quality of life, and therefore of human dignity, can be
attributed from an external perspective to any subject, thus introducing into
social relations a discriminatory and eugenic principle.
Moreover, it is not possible to rule out a priori that the withdrawal of
nutrition and hydration, as reported by authoritative studies, is the source of
considerable suffering for the sick person, even if we can see only the
reactions at the level of the autonomic nervous system or of gestures. Modern
clinical neurophysiology and neuro-imaging techniques, in fact, seem to point to
the lasting quality in these patients of elementary forms of communication and
analysis of stimuli.
6. However, it is not enough to reaffirm the general principle according to
which the value of a man's life cannot be made subordinate to any judgment of
its quality expressed by other men; it is necessary to promote the taking of
positive actions as a stand against pressures to withdraw hydration and
nutrition as a way to put an end to the lives of these patients.
It is necessary, above all, to support those families who have had one of
their loved ones struck down by this terrible clinical condition. They cannot be
left alone with their heavy human, psychological and financial burden. Although
the care for these patients is not, in general, particularly costly, society
must allot sufficient resources for the care of this sort of frailty, by way of
bringing about appropriate, concrete initiatives such as, for example, the
creation of a network of awakening centres with specialized treatment and
rehabilitation programmes; financial support and home assistance for families
when patients are moved back home at the end of intensive rehabilitation
programmes; the establishment of facilities which can accommodate those cases in
which there is no family able to deal with the problem or to provide "breaks"
for those families who are at risk of psychological and moral burn-out.
Proper care for these patients and their families should, moreover, include
the presence and the witness of a medical doctor and an entire team, who are
asked to help the family understand that they are there as allies who are in
this struggle with them. The participation of volunteers represents a basic
support to enable the family to break out of its isolation and to help it to
realize that it is a precious and not a forsaken part of the social fabric.
In these situations, then, spiritual counselling and pastoral aid are
particularly important as help for recovering the deepest meaning of an
apparently desperate condition.
7. Distinguished Ladies and Gentlemen, in conclusion I exhort you, as men and
women of science responsible for the dignity of the medical profession, to guard
jealously the principle according to which the true task of medicine is "to cure
if possible, always to care".
As a pledge and support of this, your authentic humanitarian mission to give
comfort and support to your suffering brothers and sisters, I remind you of the
words of Jesus: "Amen, I say to you, whatever you did for one of these least
brothers of mine, you did for me" (Mt 25: 40).
In this light, I invoke upon you the assistance of him, whom a meaningful
saying of the Church Fathers describes as Christus medicus, and in entrusting
your work to the protection of Mary, Consoler of the sick and Comforter of the
dying, I lovingly bestow on all of you a special Apostolic Blessing.