In a blunt and hard-hitting statement on 19 March 2004 to 400 participants at a conference in Rome, Pope John Paul II condemned the removal of feeding tubes from patients in a persistent vegetative state, calling it "genuine euthanasia by omission". Such cases have been publicised around the world, in the wake of the battle over the fate of brain-damaged Florida woman Nancy Schiavo.
As the Pope pointed out during his address, "The sick person, in a vegetative state, awaiting recovery or his natural end, has the right to basic health care, and to the prevention of complications linked to his state."
Providing food and water, he said, should be considered natural, ordinary and proportional care - not artificial medical intervention.
The conference was organised by the World Federation of Catholic Medical Associations and the Pontifical Academy for Life, a Vatican advisory body, and had as its theme, "Life-Sustaining Treatments and Vegetative State: Scientific Advances and Ethical Dilemmas".
On 18 March, Fr Norman Ford of the Caroline Chisholm Centre for Health Ethics in Melbourne sparked debate by arguing in favour of withdrawal of care under some circumstances. "Failure to give due regard to the clinical reality of permanently unconscious patients shows a lack of respect for them," he said.
"The patient should not be subjected to the ontological indignity of being sustained by medically assisted nutrition and hydration for years of unconscious life."
Fr Gerald Gleeson of the Catholic Institute of Sydney said that food and water could be removed, "if it becomes futile, burdensome, not beneficial to patient, and is prolonging death."
These arguments were opposed by other participants.
A French physician who works with persistently unresponsive patients challenged Fr Ford, asking how he knew that these patients didn't feel pain. In any event, she asked, why starve people to death over two weeks? If the aim is to end their life, why not be honest and simply put them to death by lethal injection? In other words, why not admit that what you're really talking about is euthanasia?
Sydney auxiliary Bishop Anthony Fisher issued a similar challenge: If continuing to live is unworthy of human dignity with patients incapable of recovery, he asked, why spoon feed an incapacitated person? Why bother covering them up to avoid colds?
He also rejected "quality of life" arguments as justifications for withdrawing minimal care. "To admit that one can decide on the life of a human being in virtue of a recognition of its quality from outside, is equivalent to recognising that one can attribute to any person from outside increasing or decreasing levels of quality of life and, therefore, of human dignity."
The following day, the Pope gave strong support to Bishop Fisher's argument in his address to the conference.
"A man, even if he is gravely ill or limited in the exercise of his higher functions, is and always will be a man, he will never become a 'vegetable' or an 'animal'," the Holy Father stressed during his lengthy address to the conference participants.
"Our brothers and sisters who are in the clinical condition of 'vegetative state' preserve all their human dignity," he said. "God the Father continues to look upon them lovingly, recognising them as his children, especially in need of assistance.
"Doctors and health agents, society and the Church have moral duties toward these persons, of which they cannot exempt themselves without betraying the demands of professional deontology and of human and Christian solidarity."
The prolongation of the vegetative state "cannot justify ethically the abandonment or interruption of the minimal care of the patient, including food and water," he said. "Death by hunger or thirst, in fact, is the only possible result should these be suspended."
If caused, in a "conscious and deliberate manner," it is "genuine euthanasia by omission," he concluded.
Earlier, Bishop Elio Sgreccia, vice-president of the Pontifical Academy of Life, had asserted that people in a persistent vegetative state can recover after months, in some cases even after years. When people lose the use of reason, he said, the temptation is to see them as no longer human, but this cannot be tolerated.
"We do not have separate human, animal and vegetable souls", Bishop Sgreccia argued. There is only one soul that animates the entire being. And in a point with keen legal significance, he insisted that food and water cannot be considered therapy. They are a form of care that is always obligatory until biological death.
Professor Gianluigi Gigli, from the World Federation of Catholic Medical Associations, argued that permitting the withdrawal of food and water carries enormous risks, such as creating a market for patients' organs. He also said that a softening of traditional ethical strictures could end up as a Trojan horse for euthanasia.
A panel of Australian ethicists pointed out that the debate is between two notions of human dignity, one existential, focusing on a person's capacities and "quality of life," another connatural, focusing on the inherent dignity of all human life. The panel also contended the very term "vegetative" is unworthy of human dignity, arguing that it should be replaced with "persistently unresponsive."