FEEDING the SICK: NUTRITION and HYDRATION in HEALTH CARE

Preservation of bodily life is among the most basic goals of health care. The means that are used to accomplish this goal can include a wide scope of medical acts, depending on the illness or injury that the patient presents. In addition to various medical means, however, preserving bodily life always includes acts that are not properly medical: such as the provision of food and water.

“Health care” is a broader term than “medicine.” “Medicine” refers to the healing or curing of the sick, to the restoration of health to the previously unhealthy. “Health care” can be applied more broadly to the promotion of health, and is therefore applicable to the healthy as well as the sick. Feeding people is among the most basic ways of caring for their health. Providing nutrition and hydration is a natural act, because it is required for the preservation of natural bodily life. It is an example of normal care that is required for the preservation of every human life.

This point was made by Pope John Paul II in his 2004 allocution on “Life-Sustaining Treatments and Vegetative State: Scientific Advances and Ethical Dilemmas.” There he states,

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. 

The pope calls the administration of water and food “a natural means” as opposed to “a medical act.” This remains the case, he says, even when water and food “are provided by artificial means.” The pope goes on to draw from this distinction a moral conclusion about the administration, artificial or not, of water and food:

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.

Why does the pope draw this conclusion? What does he mean when he says that the administration of water and food should be considered “in principle” morally obligatory? And how are “natural means” morally different from “medical acts”?

We can begin answering these questions by identifying what the pope is not saying. He is not saying that artificial nutrition and hydration are always morally obligatory. If that were his meaning, he would not have added the qualification about water and food “attaining its proper finality.” He is also not saying that administering water and food, as a natural means of preserving life, is exempt from the kind or moral analysis that would be used to evaluate medical acts. In both cases, the morality of the act is judged according to the proportion between the benefits it provides and the burdens it imposes.

What the pope’s statement does mean is that the preservation of life is always to be included in the notion of “benefit.” This notion cannot, in this case, be limited to the medical goals of recovery or restoration of health. The pope’s statement also implies that, in the benefit/burden analysis, life cannot be considered a burden. The purpose of nutrition and hydration is the benefit of preserving life. When nutrition and hydration are withdrawn or withheld because their benefit – namely, the preservation of life – is considered a burden, what we have (whether or not the agents are fully aware of it) is, at worst, suicide and, at best, passive euthanasia.

The preservation of life is always a benefit. It is the primary benefit to which eating and drinking are naturally ordered. The Pope calls eating and drinking “a natural means” of attaining this benefit. In normal circumstances, the fact that preserving human life is beneficial is obvious and undisputed. It is only when a person’s “quality of life” is seriously diminished that it is challenged. Here we are faced with the basic question of the value of human life. Is human life always a good to be valued and respected? Is it ever permissible to intentionally hasten the death of an innocent human being? Does the value of human life depend on its degree of productivity or cognitive functionality? And, specific to our present case: Can we ever intentionally starve to death an innocent human being? Affirming the value of human life does not lead us to conclude that nutrition and hydration are never to be withheld or withdrawn. Rather, we affirm with Pope John Paul II that, insofar as they accomplish their purpose of preserving life, nutrition and hydration are a benefit and should only be withheld or withdrawn when the benefit they provide is outweighed by a burden they simultaneously impose.

There are cases when providing nutrition and hydration imposes burdens. It can be ineffective, cause pain or discomfort, or require excessive expenditure of effort or resources. Moreover, the burdens imposed by administering artificial nutrition and hydration can outweigh the benefits and so justify its rejection or discontinuation. But we should never count the preservation of the patient’s life as a burden. Life is always a benefit and the purpose of health care is to preserve it, not to destroy it.

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