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Hello father Angelo,

a warm greeting , wishing you also a  good Lent, which is now near..

In the face of news like this of…, a patient with ALS who had mechanical ventilation removed, and died under sedation, I wonder: was that persistent mechanical ventilation a therapy or not? Was that a case of euthanasia or  of simply allowing things to go their way? Is artificial ventilation a proportionate or disproportionate intervention? What criteria can help us to discern in these cases?

Thanks for your attention!

Father Paolo

The priest’s answer

Dear Father Paolo,

1. The Magisterium of the Church teaches that everyone is required to keep himself healthy by making use of proportionate means.

John Paul II in the Encyclical Evangelium Vitae affirms that «there is certainly a moral obligation to take care of oneself and to be treated, but this obligation must be measured against concrete situations; that is, it is necessary to assess whether the therapeutic means available are objectively proportionate with respect to the prospects for improvement».

The refusal of extraordinary or disproportionate means is not the same as suicide or euthanasia; rather, it shows acceptance of the human condition in the face of death “(EV 65).

2. Mechanical ventilation, total parenteral nutrition, hemodialysis, mechanical care of the circulation, organ transplants should not be considered as therapeutic persistence.

The need to use it depends above all on the conditions of the patient.

3. The Congregation for the Doctrine of the Faith in the Declaration on Euthanasia (5.5.1980) in par. IV provides some practical criteria:

– “It is always legitimate to be satisfied with the normal means that medicine can offer”. Indeed, the use of normal or proportionate means is a must.

– “It is legitimate to stop the application of these means when the results disappoint the hopes placed in them”.

In fact, the axiom “nemo ad inutile tenetur” is always valid (no one is bound to what is useless).

– “In the imminence of an inevitable death despite the means used, it is legitimate in conscience to take the decision to renounce treatments that would only procure a precarious and painful prolongation of life, without interrupting the normal care due to the patient in such cases”.

This means that there is no duty to use means which would prolong life so briefly that they can be considered morally as nothing.

Here we can apply the principle “parum pro nihilo reputatur” (the little is like the nothing).

– “No one can be imposed the obligation to resort to a type of treatment, even though it is already in use, which, however, is not yet free from dangers or is too burdensome. Refusal is not the same as suicide. Rather, it means simple acceptance of the human condition, or the desire to avoid the implementation of a medical device that is disproportionate to the results that could be hoped for, or the desire not to impose too serious burdens on the family and the community”.

4. In light of these criteria, and taking into account the specific case of mechanical ventilation, the patient – given his living conditions – could have renounced the application of mechanical ventilation as a starting point. It was enough that he considered it too burdensome for him, especially in the prospect of surviving in painful conditions.

The same goes for tracheotomy and similar interventions.

Giving up is not the same as euthanasia or suicide.

5. Things change instead once the intervention is accepted.

What was initially optional, is no longer so – as it’s not of someone who underwent a heart or liver transplant saying: take my heart or liver away.

He is obliged to persevere in this new life condition, as long as this means is not useless or harmful.

In the latter case the suspension of artificial feeding could be permitted, in the same way as is lawful if that “causes significant physical discomfort” (Congregation for the Doctrine of the Faith, 1.8.2007).

6. The bishops of Pennsylvania made this statement with regard to stopping feeding patients with brain death in progress.They said that “the omission of artificial nutrition and hydration can be morally justified”.

What helps to grasp the objectively different moral species between this behavior and passive euthanasia is that in the former case we do not want to end the patient’s life, but rather we abstain from useless or too painful practices. The judgment of “uselessness” or “excessive painfulness” concerns the means applied, not the patient’s life” (12.12.1991).

I thank you for the question, I wish you a fruitful ministry and I remember you in my prayer.

Father Angelo