Nourishment and hydration of patients in persistent vegetative state

30 September 2005


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After defining the PVS – distinguishing it from a coma and the terminal stage of an incurable illness - the ICB points out how people in this condition do not normally require sophisticated and expensive technologies that are difficult to access, but the treatment that they need is principally care.

The ICB confirms that a pathological condition, even of extreme gravity, can not alter the dignity of those affected and their full entitlement to rights, including the right to treatment. Human life should be regarded as a right that can not be waived, regardless of the level of health, the perception of the quality of life, autonomy or capacity. Consequently, any distinction between lives that are worth and not worth living is to be deemed arbitrary.

The ICB states that hydration and nutrition of patients in PVS are customarily considered basic life support as they are indispensible to guaranteeing the basic physiological conditions for survival. Therefore ethically, they are proper acts (even on deontological and juridical grounds).The means of administration of these acts to the sick person should be irrelevant.

Even in the case of these acts representing a form of medical treatment, the assessment of their appropriateness and suitability should only depend on the objective condition of the patient (that is, from an appraisal of the actual clinical needs of the patient in relation to the risks and benefits) and not on a judgement of the patient’s present and/or future quality of life.

The discontinuation of these practices is not to be seen as the rightful cessation of therapeutic persistence, but rather as a form of “abandonment” of the sick person. The only objectively recognisable limit to the ethical duty to nourish the person in PVS is the body’s ability to assimilate or a clinically detectable intolerance linked to the nourishment.

In addition, the opinion includes several observations regarding the possibility that an individual on drawing up the so-called “Advance treatment statement” may include a request to withhold nourishment and hydration, in anticipation of a future state of PVS. The ICB deems licit the formulation of such a request, despite emphasising that it is extremely difficult to predict the specific conditions of such special future circumstances. As regards the fundamental ethical criteria for reference in such cases, the ICB reiterates what was previously stated in the document on “Advance treatment statements” (2003).

The document is accompanied by a supplementary note, in which other members of the ICB are in favour of withholding hydration and nutrition for patients in PVS, in particular circumstances and with appropriate guarantees. Two personal remarks which integrate the text with additional arguments have also been published.

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