Bioethicists alarmed by ruling to withdraw food and water from Catholic patient

Bioethicists expressed alarm Tuesday at a U.K. court ruling allowing the withdrawal of food and water from a practicing Catholic patient.

In a statement Jan. 12, the Anscombe Bioethics Centre in Oxford, England, stated its “grave concern” at the court’s judgment, given the “well-attested views” of the patient, “that ‘every life is precious and that you must hold onto life, and also that if anything happened to him, he would want all steps to be taken to save him but that if he was beyond saving, he did not want to be kept alive.’”

In an accompanying briefing paper, also issued Jan. 12, David Albert Jones, the center’s director, said the court case “sets a very worrying precedent.”

“The grave danger of this judgement is that committed Catholics and those who hold a similar view about the human significance of food and drink may be starved and dehydrated to death against their will,” he stated.

When, as in this case, “a Catholic is known to uphold the Church’s teaching on pro-life issues and is not known to dissent from the Church’s teaching on these issues, then this should guide the interpretation of the person’s previous statements,” Jones said in his ethical analysis of the court’s judgment.

He added that “in this context, rejection of being ‘kept alive’ when ‘beyond saving’ most naturally refers to rejection of intensive medical treatment and ventilation where there is no hope of recovery, not to rejection of nutrition and hydration where they are effective in sustaining life.”

Jones called it “regrettable” that “expert opinion on the view of the Catholic Church was not thought appropriate in this case.” He said, “had such evidence been presented it might have helped the interpretation of the remarks made.”

The bioethics center’s statement noted that as of Jan. 12, the patient’s food and water had been restored until an appeal of his case could be made to the European Court of Human Rights.

The director said his analysis, given from a Catholic perspective, “does not interrogate the facts of the case as presented and should not be understood as a comment on the actual moral circumstances of any of the persons involved. The moral reality of the situation may depend on details not presented in the evidence or on details that are presented but are mistaken or misinterpreted.”

The case concerns a Catholic man, known by the initials “RS,” who had a heart attack on Nov. 6, 2020, and who, at the time of the court’s initial judgment in December, was in a coma.

“The Court declared that it was ‘in RS’s best interests not to receive life-sustaining treatment, including artificial ventilation, nutrition and fluids. The result is that RS will die within a few weeks,’” Jones explained.

He noted that “no one can live for ‘a few weeks’ without breathing, so this statement already anticipated that RS might recover the ability to breathe spontaneously after the withdrawal of artificial ventilation.’”

In the January decision by the Court of Protection, there was no reference to ventilation, only to nutrition and hydration, the director said. “In contrast, if clinically assisted nutrition and hydration were provided then RS might live ‘for five years or longer’ though, at best, in a ‘minimally conscious’ state.”

“From a Catholic perspective, to provide food and drink to those who are hungry and thirsty is a corporal work of mercy,” Jones commented, adding that “patients should not be abandoned to die from lack of nutrition or hydration, however that is best provided.”

Jones explained that the reason he is publicly commenting on the case is because the patient RS is described “as a committed practicing Catholic who had ‘expressed his disagreement with a widely reported case in England where the decision was to terminate medical treatment for a very small child born with serious abnormalities.’”

The patient, he said, was also known to be “religiously conservative, opposed to abortion, even for an unborn child likely to be medically compromised, and was opposed to euthanasia.”

Despite the well-attested views of the patient, “the Court declared food and fluids not to be in the best interests of RS because he had previously stated that ‘he never wanted to be a burden if he was seriously ill.’”

According to Jones, to think or say that one does not want to be a burden to others is very common. “Who wishes to be kept alive by extraordinary treatment if they are ‘beyond saving?’” he said. “But it does not follow that, if one unfortunately did end up in a situation of great dependence, one would as a result prefer to discontinue all treatment and even basic care.”

“These statements therefore should not be taken to license the deprivation of food and water from someone in a coma or a minimally conscious state,” he continued. “In particular, someone who is strongly committed to the teaching of the Catholic Church may make these or similar statements and yet regard food and water, however provided, as part of basic care rather than a medical treatment.”

Jones pointed to the thought of St. Pope John Paul II on the topic, as expressed in his 2004 address on “Life-sustaining treatments and the vegetative state.”

Speaking in the context of a patient who is unconscious, John Paul II said: “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 includes, in fact, the use of nutrition and hydration.”

Jones commented: “It seems that all the judges in the case took for granted that statements about sustaining life referred equally and without distinction to medical treatment and to food and fluids.”

“Rejection of life sustaining treatment by a Catholic patient should not be presumed to include clinically assisted nutrition and hydration unless explicitly stated,” he explained.