In the case of a terminal illness, is there any moral obligation to continue with the artificial provision of food and fluids?
The basic ordinary procedure for the artificial provision of nutrition and fluids is either through a nasogastric tube (a tube passed down the nose into the stomach and left permanently in place for those who cannot swallow), or through a gastrostomy tube (inserted through the skin directly into the stomach.
Among the different life-sustaining procedures, the artificial provision of food and fluids poses today one of the most acute ethical problems. As infants, we were given food and drink when we were too helpless to nourish ourselves. For many of us, a day will come before we die when we will be once again too helpless to feed ourselves. Even when the struggle against disease has been lost and there is nothing more than to wait for death, it would seem that the instinctive reaction is to continue providing food and drink for the dying. This assumption is today widely challenged, and many assert that it is morally justifiable to withhold antibiotics and artificial nutrition and hydration, as well as other forms of life-sustaining treatment, allowing the terminally ill patient to die.
The truth is that the provision of food and fluids is not simply—or strictly—“medical care,” but the minimum care that must be provided for the sick, whatever their medical condition. All beings need food and water to live, but such nourishment by itself does not heal or cure disease. In consequence, to stop feeding the permanently unconscious patient is not to withdraw from the battle against illness, but simply to withhold the nourishment that sustains all life.
Moreover, to withdraw the artificial provision of food and fluids is not simply “to allow the patient to die:” what we are doing is not to cease a treatment against disease, but to withdraw what is essential to sustain the life of every human being, either healthy or ill. Death will happen, not because of the illness, but because of our omission to provide adequate nutrition and hydration.
In consequence, the procedure is neither useless nor burdensome: it preserves life, and the material inconveniences that it provokes are certainly and abundantly compensated by the good that it preserves. Consequently, whatever the medical condition of the patient, artificial nutrition and hydration have to be continued.
In some very particular and extraordinary instances (as examples, in the case of a patient in a terminal condition to whom the artificial nutrition imposes a pain excessive in proportion to the very short span of life remaining, or in the case of an irreversibly demented patient who keeps tearing apart the feeding tubes and causing himself serious wounds, and who cannot be continually restrained) the inconveniences may become so burdensome that the artificial nutrition might be considered an extraordinary, non-obligatory means of preserving life. But such cases are, as stated, extraordinary, and the decision should be reached by consultation both with the physician and the priest.
Why is IVF (in vitro fertilization) immoral?
In IVF, a human egg is surgically removed from the mother’s ovary, transferred to a special solution and mixed with the sperm (usually obtained through a sinful act). Once fertilization has occurred, the embryo is implanted in the uterine wall. Although the procedure has become more or less common, it still is painful, expensive and not always successful. To reduce the pain, expense and risk of failure, women are usually given drugs to stimulate ovulation, allowing the retrieval of multiple eggs at one time, which once fertilized will produce many embryos ready for implantation. Usually, the extra embryos are frozen and kept in liquid nitrogen to be used later, if need be, although freezing reduces their capacity to be implanted.
Why is this procedure immoral?
“By comparison with the transmission of other forms of life in the universe, the transmission of human life has a special character of its own, which derives from the special nature of the human person. The transmission of human life is entrusted by nature to a personal and conscious act, and as such is subject to the all-holy laws of God: immutable and inviolable laws that must be recognized and observed. For this reason, one cannot use means and follow methods which could be licit in the transmission of the life of plants and animals” (Congregation for the Doctrine of Faith, Donum Vitae).
The Church has always rejected the attitude “which would pretend to separate, in generation, the biological activity from the personal relation of the married couple. The child is the fruit of the conjugal union, when that union finds full expression by bringing into play the organic functions, the associated sensible emotions, and the spiritual and disinterested love which animates the union. It is in the unity of this human act that we should consider the biological considerations of generation. Never is it permitted to separate these various aspects to the positive exclusion either of the procreative intention or of the conjugal union” (Pius XII).
Thus, the fundamental immorality of in vitro fertilization lies in the fact that it constitutes a perversion of the order of nature—willed by God—in the use of marriage. In effect, the act of procreation is replaced by a technical intervention, which takes place apart from the physical union of the spouses. As procreation is separated from the conjugal act, so in consequence the procreative end of marriage is utterly separated from its unitive end, the mutual love and gift of the spouses.
Moreover, “in the usual practice of in vitro fertilization, not all of the embryos are transferred into the woman’s body; some are destroyed. Just as the Church condemns induced abortion, so she also forbids acts against the life of these human beings[.] By acting in this way, the researcher usurps the place of God; and, even though he may be unaware of this, he sets himself up as the master of the destiny of others inasmuch as he arbitrarily chooses whom he will allow to live and whom he will send to death, and kills defenseless human beings” (Congregation for the Doctrine of Faith, Donum Vitae).
What is exactly required by the precept of “abstinence from meat”?
The current law for the universal Church requires “abstinence from meat,” to be observed every Friday of the whole year.
What is exactly meant by this?
Diversity in customs, in climate, and even in prices of food have gradually paved the way for modifications of the law of abstinence—things are now permitted (through a more literal understanding of the law) which were previously forbidden. Thus, the precept of abstinence went, historically, through four stages: 1) Prohibition from eating any kind of animals or animal products, including fish. 2) Permission to eat fish. 3) Permission to eat also eggs and milk products. 4) Permission to use any kind of animal fats to condiment meals.
Abstinence laws consider that meat comes only from the flesh and organs of mammals and fowl—animals such as cows, sheep, pigs, chickens and birds in general. Abstinence does not include meat juices and liquid foods made from meat. Thus, such foods as chicken broth, consommé, soups cooked or flavored with meat, meat gravies or sauces, as well as seasonings or condiments made from animal fat are technically not forbidden. However, moral theologians have traditionally taught that, aiming for a greater perfection, on the required days we should abstain from all animal-derived products (except foods such as gelatin, butter, cheese and eggs, which do not have any meat taste).
Fish are a different category of animal. Salt and freshwater species of fish, amphibians, reptiles, (cold-blooded animals) and shellfish are permitted. While these are not considered meat and can be consumed on days of abstinence, indulging in the lavish buffet at your favorite seafood place sort of misses the penitential intent of the precept…
Now, which is the extent of this obligation?
The precept, being negative, obliges semper et pro semper—that is, every time in the day that meat is eaten, the precept is violated and a sin is committed—although it may be slight, on account of the small amount eaten. The age for abstinence is from the seventh birthday onwards.
Those that are excused from observing the laws of fast and abstinence include the physically or mentally ill including individuals suffering from chronic illnesses such as diabetes. Also excluded are pregnant or nursing women. In all cases, common sense should prevail, and ill persons should not further jeopardize their health by fasting, but, in principle, there is no reason not to abstain from meat for one day in the week…
Should a Catholic study the ancient pagan classics?
It is a historical fact that Catholics—laymen, monks, priests, bishops, saints and doctors—have read and studied these works throughout the centuries.
The natural environment for the development of the Christian soul is the family. Thus, in the early Church, the moral training and discipline, the laws of Christian behavior, were first learned at home, in the bosom of the family, for the mainspring of all education is imitation; therefore, the most important thing was the moral example received at home. The doctrinal formation, the instruction in the Faith, although begun at home, was fully given in the Church, by special teachers, in preparation for baptism.
But there was, nonetheless, an absolute minimum of literary culture that the Church could not do without, to persist and spread, to continue her teaching activity, to preserve her form of worship. Early Christians, so adamant in breaking with pagan world, did not however develop their own schools, as something separate from the classical pagan school. At least, not in ancient times.
Christian schools on the pattern of Jewish rabbinical schools were created when the Church was set up in barbarian lands (those that had not assimilated classical culture)—the schools were established together with the churches, to add to the instruction received at home.
Nothing like this existed in the original Greco-Latin cultural area. The Church simply added its own specifically religious kind of training in church and family, on to the classical training received along with non-Christian fellows in the established schools.
But to accept the classical system of education did not mean the acceptance of the culture it subserved. The dangers were acknowledged, but the risk was counterbalanced by the good to be achieved and the protection afforded by the education in the Faith, received from parents and priests. The Church condemned classical culture if it was set up as an independent ideal hostile to Christian revelation.
The medieval monks thought those works worth preserving—appreciated, and used them. The monastic contribution to Western civilization involved the copying of manuscripts, both of sacred and profane works, and of the pagan authors. This task, and those who carried it out, were accorded special honor. Desiderius, the greatest of the abbots of Monte Cassino after Benedict himself, and who became Pope (Blessed) Victor III in 1086, specifically oversaw the transcription of works by Horace, Seneca, Cicero and Ovid. St. Anselm of Canterbury, while abbot of Bec-Hellouin, commended Virgil and other classical writers to his students, though he wished them to put aside morally objectionable passages.
The reason for this study is that these works are an introduction to the natural order. It allows the presentation of a series of truths about human nature and society, capable of being apprehended by man’s natural reason, independent from Revelation, but underlying Catholic teachings. Even among traditional Catholics, the injunctions of the moral law are often accepted simply “because the Church says so”—without perceiving that the moral precepts are universal truths, capable of being known by human reason and thus obligatory for all men.
Nonetheless, we should not expect from these works what they cannot offer us—they are still non-Catholic and they contain errors, as human reason also suffers from the wounds of original sin and, thus, requires the aid of Revelation to see without distortions.