In a statement issued on 31st July, Bishop John Wilson responds to the Supreme Court ruling to back end of life decisions.
On 30th July 2018 the United Kingdom Supreme Court ruled it is no longer necessary to seek legal permission from the Court of Protection to remove artificial feeding and hydration from patients in a persistent vegetative state. This means that clinicians and families can decide among themselves to bring about a patient’s death by discontinuing the provision of food and water by artificial means.
A person in a persistent vegetative state exists in an altered state of consciousness following some kind of trauma. The person breathes without assistance and follows patterns of sleeping and waking, although without any detectable external response. They are not dying as such, but remain dependent on medical and nursing care.
The Catholic Bishops’ Conference of England and Wales addressed the question of artificial feeding and hydration in cases of patients in a persistent vegetative state in their 2004 teaching document Cherishing Life. In considering the ethics of suicide and euthanasia, the Bishops stated: ‘There is a basic level of nursing care that is demanded by human solidarity. We all recognise that leaving a patient cold, unclean, in pain or without human contact for significant periods of time would fall below a decent standard of care. Within the health service, great efforts are made to maintain high standards in this area, despite the pressure of resources and limited staff. In general, providing food and fluids should also be considered basic care.’ (185)
The Bishops continued: ‘when patients are in the final phase of dying they should not be troubled by intrusive treatment and efforts to place or replace a feeding tube may well be excessive or burdensome.’ However, they clarified: ‘What is not morally acceptable is to withdraw tube-feeding, or other life sustaining treatment, precisely in order to end a patient’s life. This would cross the line from reasonable withdrawal of inappropriate treatment into the realm of passive euthanasia.’ (185)
No one should underestimate the challenges placed on families and carers when a loved one enters a persistent vegetative state. Sustained pastoral support for them is essential. Artificial nutrition and hydration, however, are not treatment. They do not cure anything. In whatever way they are delivered, food and water for a person in a persistent vegetative state fulfil the same purpose as for any other person. They keep them alive as part of their basic care. They prevent death by malnutrition and dehydration.
Patients in persistent vegetative states are some of the most vulnerable in our society. It is not an act of compassion to remove their food and drink in order to cause their death. Equally, it cannot be in a patient’s best interests, whatever their level of consciousness, to have their life intentionally ended. Our care for those in such situations is the test of our common humanity and our solidarity with some of the most fragile of our brothers and sisters.