The questions about the morality of feeding tubes (artificial nutrition and hydration delivered either through a tube inserted through the nose or directly into the stomach via a surgical procedure) are of frequent concern in the Catholic community here in the United States, where most patients have ready access to technology that can help nourish patients who can no longer eat on their own.

All the media attention given to the tragedy of Terri Schiavo's death last year has caused great discussion, but not always clarity, surrounding the Catholic Church's teaching about when there is a moral obligation to use feeding tubes. It is not uncommon for loving family members to be confused and for parish clergy to be consulted especially when a family member is dying:

Father, my mom is 82 years old and has been fighting cancer for several years. Last week we put her in the hospital again. She seems to be failing every day and doesn't even want to eat much if at all. The doctors now tell us that there is nothing more they can do except try to keep her comfortable. They tell us that the cancer is terminal. They are suggesting that it would be best for us to bring her home and arrange for hospice care. We're confused; my brother says that if we don't insert a feeding tube we are killing her and that is a sin; my sister says that mom always said she did not want to be kept alive by tubes and machines and so we should follow her wishes. We all love our mom and want to do the right thing for her but this is really dividing us as a family. What should we do?

Most simply put, the Church teaches that everyone has the right to a natural death. We defend the sanctity of life, as an innate good to be protected from conception until natural death. In all questions regarding care of the dying, there are two immoral extremes that must be avoided: 1) euthanasia in which there is a deliberate attempt to "kill the patient and end their suffering" and 2) prolonging the dying process when it is clear that God is calling one of his children to their final home.

The Church's teaching tells us that our lives are from God and that while we are stewards of our lives, we do not have moral hegemony over either our beginning or our ending. To end life before its natural conclusion or to prolong it with "therapeutic obstinacy," what the Catechism calls "overzealous treatment" (n. 2278), is equally immoral.

Says the U.S. Bishops' 2001 statement, "Ethical Directives for Catholic Health Care Institutions":

"We are not the owners of our lives and, hence, do not have absolute power over life. We have a duty to preserve our life and to use it for the glory of God, but the duty to preserve life is not absolute, for we may reject life-prolonging procedures that are insufficiently beneficial or excessively burdensome" (Part V).

Pope John Paul II quoted the U.S. bishops' statement on nutrition and hydration in 1998: "Omission of nutrition and hydration intended to cause a patient's death must be rejected." In 2001, the U.S. bishops elaborated on this statement:

"There should be presumption in favor of providing nutrition and hydration to all patients, including patients who require medically assisted nutrition and hydration, as long as this is of sufficient benefit to outweigh the burdens involved to the patient" (ERD, n. 58).

It is clear then, that nutrition and hydration, even when assisted artificially, should normally be provided. However, it is also clear that there are times when it is not morally necessary. "We should not assume," the U.S. bishops remind us, "that all decisions to withhold or withdraw medically assisted nutrition and hydration are attempts to cause death.… The patient may be imminently dying, whether feeding takes place or not.…"

We must be careful to distinguish between two very different contexts regarding the administration of artificial nutrition and hydration. In one situation the patient is dying or terminal; in the other, that is clearly not the case. In the case of a patient who is dying, artificial nutrition and hydration often is extraordinary, or optional, care. However, in situations where the patient is not dying, such as someone who is in a persistent vegetative state (PVS), nutrition and hydration --- as indicated by Pope John Paul II --- is generally ordinary care.

This distinction, is important as seen in the comments made by John Paul in March 2004: "…the administration of water and food, even when provided by artificial means, always represents a natural means of preserving life…and as such (is) morally obligatory insofar as and until it is seen to have attained its proper finality."

It is important to notice that the Holy Father placed his moral concern about artificial nutrition and hydration for the person in a permanent vegetative state in the context of traditional "end of life" morality. Since everyone eventually reaches a state where even nutrition and hydration are helpless to prolong life beyond its natural end, artificial nutrition and hydration can be stopped even in the case of a person who is in a "permanent vegetative state" when "it is seen to have attained its proper finality" --- or, in other words, when its burdens outweighs its benefits.

Again the U.S. bishops point out, "…hydration and nutrition are not morally obligatory either when they bring no comfort to a person who is imminently dying or when they cannot be assimilated by a person's body." By this point, it should be clear that in the case outlined at the beginning of this article, the mother would have no moral obligation to accept artificial nutrition and hydration.

For the Catholic, the moral obligations surrounding death and dying are only legitimately grounded in an authentic spirituality focused beyond physical life:

"Christ's redemption and saving grace embrace the whole person, especially in his or her illness, suffering and death…. In the face of death --- for many, a time when hope seems lost --- the Church witnesses to her belief that God has created each person for eternal life" (ERD, Part V).

To view "Ethical Directives for Catholic Health Care Institutions," visit http://www.usccb.org/bishops/directives.shtml.

Vincentian Father Richard Benson is academic dean and professor of moral theology at St. John's Seminary, Camarillo. His column appears monthly in The Tidings.