[Question]{.underline}: Is it not excessive to maintain that the providing of fluids and nourishment is always obligatory, regardless of the state of a sick person?
[Answer]{.underline}: On the surface of it, it may appear that it would be going to extraordinary lengths, unduly continuing a person’s agony, to insist on the duty of providing him with fluids and nourishment, even when he is known to be suffering from a terminal disease or is in an irreversible coma. However, such an opinion fails to consider the wonderful gift of life, of which Almighty God, the Creator, is the alone the source. It replaces the God-centered view of human life, as a manifestation of God’s goodness, with a man-centered conception, that focuses on the value of life rather than life itself.
The whole question of the distinction between ordinary and extraordinary means in the maintaining of life was treated very thoroughly by Father Iscara in the July 1997 issue of the Angelus, in which he establishes that feeding and hydration are always ordinary means and consequently obligatory in conscience, regardless of the condition of the person. He there describes the liberal evolution of these concepts. It is certainly true that there is no absolute distinction between ordinary and extraordinary means, and that a means might be extraordinary for some people but ordinary for others, due to subjective considerations such as excessive cost, pain and discomfort, location and difficulty in using the means, danger of complications, high chance of failure. However, traditionally, and rightly so, the essential consideration is an objective one. An ordinary means is one that can be procured by ordinary effort and diligence, whereas an extraordinary means requires that effort which is out of the common. The distinction is often clear, as is the case with artificial respirators, which are manifestly extraordinary means.
Confusion concerning this distinction has arisen on account of a new emphasis, namely on the quality of life, which gives undue emphasis to the subjective elements, and which is ultimately a form of humanism. It is considered that if a person is healthy enough to walk around, or has the use of his mind, or has the motive to live, that his life is somehow of more value than that of the person who is in a permanent vegetative state, or attained by senility, or suffering pain from terminal cancer, and that consequently the most basic elements of care are no longer ordinary means, since life is just not worth living. This might seem somewhat of a caricature, but it does correspond to the carelessness with which such persons lives are treated in many nursing facilities.
A balanced response will not consider the subjective condition of the person as irrelevant to the decision as to what is extraordinary means, and what is consequently not obligatory in conscience. It will not, however, allow this to be the major determining factor. There are certain basic needs that are not really even medical treatment properly speaking, but corporal acts of mercy inseparable from the love of our neighbor. They include nursing care, and the providing of nourishment and fluids. It was of those who refuse such necessities to their neighbor that Our Lord had this to say: “Lord, when did we see thee hungry, or thirsty, or a stranger, or naked, or sick, or in prison, and did not minister to thee? Then he shall answer them, saying: Amen I say to you, as long as you did it not to one of these least, neither did you do it to me” (Mt 25:44,45). Did Our Lord place any conditions on the providing of these necessities of life? Did he say that it was not necessary for the insane, the senile, the comatose or the dying? Far from it. These are precisely those that He instructs us to practice charity towards, for they are the least among us.
One might well object that sometimes the provision for these physical needs is expensive and difficult. It can sometimes be very difficult and time consuming to feed very sick persons. There is certainly some expense involved in alimentation via a naso-gastric tube or a gastrostomy tube directly into the stomach. But what is that compared to a human life that God has created? In fact by far the most difficult and expensive aspect of caring for the dying, the senile and the comatose is good nursing care. Yet who would maintain that this is an optional extra, that can be withdrawn? Food and fluids fall into exactly the same category. To withdraw such means on account of expense, or inconvenience, or pain or because a person is dying, is to be indirectly responsible for the death of a person, but in a very real and entirely predictable manner. It is euthanasia. It is immoral, except in the very rare cases that it is impossible to provide food and fluids by such means. The fact that sometimes people died in the past of dehydration or starvation, when these means did not exist, is no excuse at all for refusing to use them when they are possible and available.
Let us put aside, then, all considerations of quality of life, when it comes to the consideration of those necessities of human life that common effort and diligence will provide for the sick and dying. Let us fight for the right, in the natural law, of all human persons to the Creator’s gift of life, until such time as He calls them, and of our corresponding duty to protect, defend and nourish that life.
Answered by Father Peter Scott, SSPX.