Link (http://news.yahoo.com/s/ap/20070914/ap_on_re_eu/vatican_vegetative_state) VATICAN CITY - The Vatican reiterated Friday that it considers the removal of feeding tubes from people in vegetative states to be an immoral act.

The Vatican issued the statement in response to questions from bishops in the United States in July 2005 — just months after the case of an American woman, Terri Schiavo, made world headlines. Not sure if we already had a quality of life/right to death thread running, but I caught the headline and thought it might be worth discussing.

i quite honestly feel exactly the opposite,i belive it is immoral to be kept alive with machines death is part of life

says that in my will also

I agree with the Vatican.

There's a program on sometime in the next week about a Woman in a vegetable state for 20 years finally coming out of it.

I suppose the real question is whether it counts as heroic efforts to keep someone alive, if they are on feeding tubes.

When I was high school I wanted a tube stuffed anywhere possible to keep me alive. I feared death and believed in miracles.

Now, having seen that there are worst things than death, I am against keeping myself alive by artificial means. However I personal do not consider a feeding tube artificial means. Providing nutrition to someone that is unable to swallow, but whose other vital organs are functioning properly under their own power is not unnatural, I’d actually consider it humane.

I have no problem with the Vatican opposing the removal of feeding tubes. The Catholic Church is just telling the followers of the church their position on this particular issue. The Church giving their position is not the same as legislators, courts or heads of states telling its citizens that removing the tubes is a crime. The Vatican is just stating its opinion to influence and advise it followers. The real choice is still with the individual and his/her family members and not the church. When governments take the choice out of the individual hands that is when it becomes a real issue. That is when I would be up in arms over this issue.

If you really want your wishes adhered to, while keeping your personal decision out of the influence of the church or the rule of the courts and possibly Congress, may I suggest a Living Will.

im sorry but feed me, if i cannot move and am permenently paralyzed let me go. thats what i personally would want

Generalizing much?

Terri Schiavo was beyond all hope. Most of the of her brain was gone (not dormant or damaged, gone, as in irreparable), and she could never be awaken, no matter what advances were made by science. On the other hand, other people on vegetative states eventually recover, and therein lies the problem - the Vatican are generalizing all cases of vegetative states, rather than letting medical staff determine what it's possible to do for individual patients. It's like me saying no wounded legs should be amputated, regardless of severity, or that everyone who suffers from depression should receive medications.

I have no problem with the Vatican opposing the removal of feeding tubes. The Catholic Church is just telling the followers of the church their position on this particular issue.My problems with the decision are spelled out above.

At the time, the Vatican condemned Schiavo's death as "arbitrarily hastened" and called the removal of her feeding tube a violation of the principles of Christianity and civilization.Utter drivel. If a case consisting of five years of court battles is 'arbitrarily hastened', I'd hate to see the Pope's idea of giving the system the time it needs.

"A patient in a 'permanent vegetative state' is a person with fundamental human dignity and must, therefore, receive ordinary and proportionate care which includes, in principle, the administration of water and food even by artificial means," the Vatican said in a statement.Terri Schiavo was an empty shell. To be frank, she was not much more alive than a half-rotted corpse dug out of a grave and put on a ventilator and feeding tube.

For crying out loud, if you want to fight undue euthanasia and utilitarianism, there are real problems to be dealt with out there. It disgusts me to see people 'defend the sanctity of life' by beating the dead horse that is Terri Schiavo. What about the right-to-die people who press for legalized assisted suicide for any reason? What about those who feel press for laws that will make all fetuses with genetic disorders aborted? But oh no, go for the ending of life-prolonging treatment of irrecoverable patients. Geez.

The removal of feeding tubes is entirely dependent on patient (and sometimes family of the patient) wishes. I don't think the government should get involved in what is a very private decision between patients, families, and their physicians.

Having your wishes respected on whether or not you want a feeding tube, respirator, medication support of blood pressure, pain management, etc., if you're in a vegetative state is an important reason for you to have a 'living will'/advance directives that states in writing what kind of treatment you want if you are in a position where you can't tell anyone. Jimbo and I have told each other our wishes (and I think we have it written down in our will, but I need to double check--we did that like 5 or 6 years ago).

Most people in vegetative states don't live terribly long. Terri Schiavo was an exception, actually, living as long as she did. Being bed-ridden makes people at much higher risk for blood clots, bed sores that get infected, general systemic organ failure, strokes, urinary tract infections (since these patients have catheters) and pneumonia, among many other problems (Source (http://content.nejm.org/cgi/content/full/330/22/1572#T3)--older) but useful for the purposes of this discussion for a quick look at numbers). Between a third and half of adults will die within the first year of falling into a vegetative state, and most will die by 5 years. The average life expectancy for adults in a vegetative state at the time of that study was about 3.5 years.

End-of-life decisions are not typically as complex as Terri Schiavo's or Karen Ann Quinlan's (for those that remember her) cases. From my experience working for a number of years in ICUs, the vast majority of the time, it's obvious to doctors and family that the end is very near, and the question becomes how to make the patient as comfortable as possible in the last few hours and minutes. In the case of my grandma and Jimbo's mom, it was agreed to leave IVs in to allow the staff to give them morphine. Because of their particular health problems, they would have been in tremendous pain without it. My grandma was able to breathe on her own so we didn't have respirator questions, but there was no attempt to intubate her when she did stop breathing--doing so would have prolonged her suffering. My mother-in-law was not able to breathe on her own and required some medication to keep her blood pressure from falling. My sister-in-law could have stopped the respirator and my mother-in-law would have died within minutes, but she decided to take Nita off the blood pressure medicine instead and just let the blood pressure fall to the point where she fell into a coma and her heart stopped. My sister-in-law was concerned that Nita would become aware and scared as she struggled to breathe her last few minutes without a respirator, and decided discontinuing the dopamine was more humane. I agreed with her. It's actually fairly unusual for anyone to have to make decisions on extended care for those in persistent vegetative states--the event that caused it in the first place is fatal for most people. However, it happens often enough, and medical care is improving survivability of major trauma and illnesses that can contribute to vegetative states, so it's generally wise to have some kind of directive on file. If Terri Schiavo had had an advance directive on file, family and doctors would have known her wishes, and her case would never have become international news.

Edit: @ Dagobahn Eagle--part of the problem in the Schiavo case was that it was not 100% clear whether she was in a persistent vegetative state or had very minimal consciousness. There were doctors who came down on both sides of that question, which muddied the waters greatly.

Dagobahn Eagle--part of the problem in the Schiavo case was that it was not 100% clear whether she was in a persistent vegetative state or had very minimal consciousness. There were doctors who came down on both sides of that question, which muddied the waters greatly.
The other problem with the Schiavo case was the family could not agree on what was best for Terri Schiavo.

Terri Schiavo was beyond all hope. Most of the of her brain was gone (not dormant or damaged, gone, as in irreparable), and she could never be awaken, no matter what advances were made by science.
Something that was not known with absolute certainty until the autopsy was performed. I would fight just as hard as the parents did to keep someone I love alive if there was any hope. If I was in that state I would want my family to pull the plug and I’ve made it clear to all of them.

On the other hand, other people on vegetative states eventually recover, and therein lies the problem - the Vatican are generalizing all cases of vegetative states, rather than letting medical staff determine what it's possible to do for individual patients. It's like me saying no wounded legs should be amputated, regardless of severity, or that everyone who suffers from depression should receive medications.
I agree with you on this, but I still don’t have a problem with the Vatican’s statement as their statement does not make it a felony to pull the plug. It should be up to the individual’s family and not the church or the government. Both can offer their guidance, but when they interfere with the families’ decision then they have gone too far.

To those that say you MUST keep the patient on the feeding tube against their wishes, I ask this question: Who should cover the cost of all these vegetative patients after the family has decided to pull the plug?

I don’t like the idea of money entering into my decision making process when it concerns a loved one, but it must. That is one more important points in my decision to tell my family to pull the plug on me. I don’t want them going bankrupt in order to allow me to spend the rest of my life drooling on myself. I’d also rather my savings be spent on sending my cousins to college instead of wasted on me in that condition.

Personally, I think that stuff like this is just a good reason everyone should make up a living will so that IF this happens to them we have that document to fall back upon.

Personally, I think that stuff like this is just a good reason everyone should make up a living will so that IF this happens to them we have that document to fall back upon.
And how will you be sure that your decision will be the same, when you're starving and dehydrating, and unable to speak? This is the great problem with the whole living will thing....


Who should cover the cost of all these vegetative patients after the family has decided to pull the plug?

Once we reduce morality to money, we might as well give up and go back to living in caves.

I remember reading that PVS people dream.

I mean, there are in a deep, deep sleep, unable to wake up, but they are not dead. Their brain is active though, so that they are able to dream and come up with strange thoughts. We won't know what thoughts, but it would likey be quite werid dreams. Alice in Wonderland-type deals, which they cannot wake up from. Maybe we could easily drop down to "Brain in a Vat"?

Could that be a legit reason to keep someone alive? Because of the possiblity that they might have a good dream and we may be taking that away from them? For me, that may be the only good reason to keep someone alive. And caring about your own personal self rather than caring about a drooling idiot...well, that's just too revealing a statement about the human condition that it's better not to reveal.

I think the government has no right whatsoever to interfere with something like this. The catholic church, on the other hand happens to be the de facto moral compass for many, many people around the globe. I'll spare you the (rather terrible) details of my own experience with a loved one in a persistant vegetative state(which was brief because my family decided to pull the plug early), but I think the right to die is just as important as the right to live.

Once we reduce morality to money, we might as well give up and go back to living in caves.
So are you saying that it is morally right to completely devastate a family’s finance in order to keep someone that is brain dead plugged in?

I wasn’t saying that money should be the main factor. The medical personals advice and the “living will” and/or the known wishes of the person in a vegetative should be primary, at least IMO should be the most important considerations. However, money will HAVE to enter the discussion, because the insurance company (if any) will not pay forever.
How much does it cost to maintain someone in persistent vegetative state? Eighty thousand dollars a year. http://www.ulsterpublishing.com/index.cfm?fuseaction=article&articleID=340523)
I’m unsure how accurate this figure, but unless it is off by more than half the average American family is going to have to factor in money because according to US Census report in 2006 the real median income in the US was $48,201.
http://www.census.gov/hhes/www/income/income06.html)
So I’m not saying money should be a part of the decision. I am saying unfortunately money MUST be a factor, no matter if we consider it morally wrong or not.

It just may be the accountant in me. :)

@ Below Jae, sorry but I can name a least two family members that have gone through bankruptcy over this. They are by the way Catholic, they did get money from a lawsuit which ran out. They are also the reason I believe in living wills. It is their daughter and if it was my daughter and not my cousin I would have done the exact same thing as them.

In the US, the person in a persistent vegetative state ends up on disability, which means they receive Medicare and in many situations Medicaid as well. The family doesn't pay the vast majority of those costs. In countries with socialized medicine, the families don't have these costs, it's paid by the gov't.

It means all of us share a bit of the burden via taxes, but no one family is sent into bankruptcy.

I think Medicaid comes in after all other family/patient money has been exhausted.

Normally Medicaid does, but Medicare is given to anyone who's on SSI disability, and since people in vegetative states can't earn an income (barring unusual circumstances), they usually end up on Medicaid as well. The state always makes Medicare pay first--they just pick up the portion Medicare doesn't.

Bingo. My biggest problem with the whole darned thing, and why no one should be legalizing or moralizing on the subject - I DO NOT WANT TO PAY FOR IT.

Yes, I am extremely selfish. I am also extremely broke, yet the government still taxes me. Taxes me for things like keeping an empty shell alive to placate a sad family. My pity for these families stops when the doctors throw their hands up.... when it is time, it is time.

There will always be exceptional cases - I saw a show on a man who returned to consciousness after many years in a coma... his capacity and ability was greatly diminished, but he was still a human being. So, judge on a case by case basis... maybe.

I still don't want to pay for it. The Catholic church should stay out of my pocketbook.

Actually, qui-gon, the Catholic Church doesn't have the power to get into your pocketbook, unless you let it. But, the views of that church do influence something like 20% or so of the population to varying degrees in the US. This being a "democracy", you have to deal with it wanting to to try to push its agendas vis-a-vis legislation, just like any other group that represents a small(er) minority. Frankly, I'm much more concerned about the money hemhoraging from the system due to illegal immigration. I shouldn't have to pay for illegals to access medical care here b/c they can't get it at home, nor for their education. It's a shame things are f'ed up in other countries, but their problems shouldn't have to be my fiscal responsibilty either.

So are you saying that it is morally right to completely devastate a family’s finance in order to keep someone that is brain dead plugged in?
I am saying that once we reduce morality to a matter of pecunial quantity, we are no better than animals. There are no loopholes to it.

@Totenkopf: I believe that 40% of the USA are Catholic, at least according to the last statistic I heard quoted. How many of those would recognise transubstantiation if it got up and punched them, is, of course, another matter entirely, post-Vatican II....

And how will you be sure that your decision will be the same, when you're starving and dehydrating, and unable to speak? This is the great problem with the whole living will thing....

Once we reduce morality to money, we might as well give up and go back to living in caves.

Does it matter? I'd have spelled out in the living will that if I'm in such a case only what I say in the will matters.

But simply lacking the ability to speak is NOT what we're talking about here.

I am saying that once we reduce morality to a matter of pecunial quantity, we are no better than animals. There are no loopholes to it.

@Totenkopf: I believe that 40% of the USA are Catholic, at least according to the last statistic I heard quoted. How many of those would recognise transubstantiation if it got up and punched them, is, of course, another matter entirely, post-Vatican II....


Always was under the impression that Catholics in the US #ed about 55-62 million out of a population of 270-300 million (~1/4-5). Maybe all those illegals from Mexico bring it up closser to 1/3. ;) You're probably right about the last part, though. I've often heard the distinction "Roman" vs "American" (sort of neo-protestant)/smorgasboard Catholics.

Does it matter? I'd have spelled out in the living will that if I'm in such a case only what I say in the will matters.

But simply lacking the ability to speak is NOT what we're talking about here.
This may not be much of an issue with vegetative states, but for people with degenerative diseases, once they lose the ability to definitely express their desires, and they decide that they'd rather live? It's too little, too late, die now, is that what you're saying?

This may not be much of an issue with vegetative states, but for people with degenerative diseases, once they lose the ability to definitely express their desires, and they decide that they'd rather live? It's too little, too late, die now, is that what you're saying?

so the person in question would be unable to speak, write, type, or heck, cut and paste, or even nod at the right words. And a person would want to live in this state?

And a person would want to live in this state?
I wouldn't, but yes some might. Though extremely sad and disturbing, watching someone die is amazing as they struggle and fight to hang on till their last breathe. I’ve only watched three people (my father, an uncle and ironically a priest invoiced in a car-train accident) and no matter how bad their condition they all struggled for life.

Anyone with medical knowledge know if the organs suffer in someone in vegetative state? I’m wondering if it would affect the viability of organ donation in the future.

I personally wouldn't want to be kept alive with a machine breathing for me. While I am a pro life type person, I do draw the line at some point. In my mind if there little to no hope of recovery from a vegetative state, then I would pull the plug. Then again it is easy for me to say that now since I have never gone through the anguish of that. I just think that there are more important things to worry about than splitting hairs over this.

so the person in question would be unable to speak, write, type, or heck, cut and paste, or even nod at the right words. And a person would want to live in this state?

Yes. I think I would choose to be in a PVS state forever rather than die.

Don't ask why. I just feel that I may choose that way rather than let myself die.

Yes. I think I would choose to be in a PVS state forever rather than die.

Don't ask why. I just feel that I may choose that way rather than let myself die.

I wouldn't, but yes some might. Though extremely sad and disturbing, watching someone die is amazing as they struggle and fight to hang on till their last breathe. I’ve only watched three people (my father, an uncle and ironically a priest invoiced in a car-train accident) and no matter how bad their condition they all struggled for life.

Anyone with medical knowledge know if the organs suffer in someone in vegetative state? I’m wondering if it would affect the viability of organ donation in the future.


exactly, and that's where we differ. I simply proposed people make living wills saying what they wish to be done to them, update them if you are able and you're mind changes. I personally simply wouldn't want to live like that, since IMO, it's not really living.

I'm completely pro-choice, as long as the choice is made by someone actually affected by the situation. Now, I'm no fan of the Catholic Church, and every time they announce that they have "decided" that something is wrong or immoral, I dislike them even more. I wonder how many members of the Vatican have had a loved one in a vegetative state, but even that doesn't matter, since they are trying to tell other people, mostly people they have never met, seen, heard from, or knew of, what they should do. Subjects such as feeding tubes or abortions (another thing the Catholics say is wrong) are highly personal, and I would never accept the word of a stranger who I have never met who is telling me that I shouldn't do something because THEY say it is immoral, I don't care if it's Pope Benedict himself. Only a person's loved ones has the right to be a part of the debate, because these things are not only personal, they are highly circumstantial, and every case is exceptional. There is no "run-of-the-mill" case in the situation of someone being hooked up to a machine that keeps them alive, and everything the family and/or loved ones say or do is a factor, but to close my statement, the Vatican should never be one of those factors.

Anyone with medical knowledge know if the organs suffer in someone in vegetative state? I’m wondering if it would affect the viability of organ donation in the future.

It would depend on what was causing the vegetative state and what causes death. If there's a degenerative disease, it often affects multiple organs and renders them unusable. If the PVS is cause by a cancerous tumor, there would be a risk of metastases, so you wouldn't want to give someone an organ that might harbor cancer. Someone who's suffered a traumatic brain injury, say from an accident, would be more likely to be an eligible donor.

If the person in PVS dies from something like a stroke or blood clot, then the organs might be usable. A lot of time, however, they die from major infections that cause multiple organ failure. Not only are the organs irreparably damaged, but they're usually infected as well, and you wouldn't want to put an infected organ into someone else (since the recipient is put on immune-suppressing drugs besides the obvious 'yukk').

The exception might be corneas. Since there's no blood supply to the cornea (it gets its nutrients and oxygen from the tears), it's possible to harvest those when other organs might not be usable.

I thought about the possibility of donating my grandma's corneas, but she lost her ability to blink when she went into a coma, and the staff never thought to put some rewetting gel in her eyes, so her eyes got damaged. I was really ticked off because I know just how bad that must have hurt, too.

@SykoRevan--since priests oftentimes give Last Rites, I suspect they see death on a very regular basis. They usually have family, too. The Catholic church has been (at least in the last 50 years, if not more) consistently pro-life on issues like abortion and capital punishment. I suspect they're just clarifying the church position so people know where they stand and to use it as part of their guidance in making end-of-life decisions.

Thanks for the information Jae. You killed to birds with one stone. You gave me the information I was seeking and in doing that you’ve explained why as an organ donor myself I can only give corneas and skin. Something I never understood till now. I had a blood transfusion as a child and was told by my doctor when I became a donor that I could not give anything beyond skin and eyes. Now I know that is because the corneas are not affected by blood.

Under traumatic brain injury, if I understand correctly, the organs may still be viable in the future? Keeping people on feeding tubes will not affect the use of donor organs just the timing.

@SykoRevan--since priests oftentimes give Last Rites, I suspect they see death on a very regular basis. They usually have family, too. The Catholic church has been (at least in the last 50 years, if not more) consistently pro-life on issues like abortion and capital punishment. I suspect they're just clarifying the church position so people know where they stand and to use it as part of their guidance in making end-of-life decisions.

I'm not saying they're not entitled to their opinion, but some people seem to think that once the Vatican condemns something, then it should become illegal, and the Vatican doesn't really do anything to change that certain perception. As long as they don't do things like picket abortion clinics or hospitals where someone in a vegetative state is being treated. However, some Catholics have been known to do that. I'm not saying that the Vatican is responsible for the picketers, but most of them are only following the word of the Vatican because... well, it's the Vatican. Like I said, some people think the Vatican can think no wrong, and that they know best in all situation, regardless of circumstance. They sometimes fail to sit and think about how the family and loved ones are feeling.

One example is a local case in my hometown that thankfully didn't receive public attention like Terri Schiavo. The man had a stroke, and his brain damage was high enough so that he was pronounced to be in a vegetative state. After about a month, they declared it persistent, and the family didn't go one day without visiting the hospital where their father was being treated on a gastric feeding tube. Incidentally, I met one guy who was being fed through one because he had esophageal atresia, and he said having it in was a mix between a tingle and an open wound, so I personally would never want a feeding tube in me. Anyway, soon the local Catholics started to get involved, and after talking to the wife of the victim (I was in the same hospital), I found out they had followed her home and tried to convince her to keep the tube in. However, after going to their house one day to help them fend off the Catholics, I found a document the man wrote before his stroke while helping them clear out his home office that stated that if he were ever to be in a situation where he was only kept alive through machines, that he did not want to live that way. After hearing that the feeding tube was coming out, the Catholics actually started mailing harsh letters to the family. Of course, my general dislike of those certain Catholics prompted me to go to their church with a bag full of ashes labeled "Catholic Hate Mail" as well as a letter the family wrote with my help, stating our opinion that they were not only sticking their noses in someone else's business (A point I made in my last post) but were also disrespecting the very wishes of the man they were trying to keep alive, someone they had never met, and they never even went to his bedside the entire time he was in the hospital, unlike his family. After that, they didn't go anywhere near the man or his family, although since they already knew me very well, I was now considered by some of that congregation to be "the biggest Anti-Catholic in the city," which I was slightly proud of. However, after meeting the priest that ran the church, I asked him why his congregation had so fervently tried to keep a stranger on life support. He told me it was because of the Vatican's pro-life stance on the subject after the Terri Schiavo case. When I asked him if that was the only reason why he believed in it, he actually didn't have an answer, but he thanked me for supposedly "enlightening him."

I guess my point is, some people will look to the beliefs of the Vatican as Divine Mandate, and ignore the personal aspects of the situation, which says to me that maybe the members of the Vatican Council would do better to keep out of such subjects in the future, and focus on things that affect the Catholic Church as a whole.