"The Catholic health ministry is grateful for the clarification provided today," said Sister Carol Keehan, a Daughter of Charity who is president and CEO of the Catholic Health Association, in a Sept. 14 statement.

"Patients in a persistent vegetative state, while making up a very small percent of all patients, pose some of the most challenging and heart-wrenching situations for families and caregivers," she added. "This clarification affirms the church's belief in the value of their lives in spite of the circumstances of their condition."

The Vatican's responses to two questions posed by the U.S. Conference of Catholic Bishops and its commentary on those responses "provide a clear rejection of the claim of certain theologians that the provision of food and water for patients in the persistent vegetative state is not morally obligatory," said the Philadelphia-based National Catholic Bioethics Center in a Sept. 14 statement.

The USCCB questions were prompted by confusion in the U.S. over a 2004 talk by Pope John Paul II in which he said nutrition and hydration, even by artificial means such as feeding tubes, should generally be considered ordinary care and not extraordinary medical treatment.

"The (Vatican) commentary takes pains to note that John Paul II's address stands in conformity with previous tradition, and is not, in any way, an innovation or abandonment of previous teaching," the bioethics center statement said, adding that the commentary's "review of previous (papal and Vatican) statements speaks to the claim of those who have said John Paul II's address was completely unexpected and without precedent."

Sister Carol said the latest Vatican documents make clear that "the provision of artificially administered nutrition and hydration to patients in a vegetative state is morally obligatory except when they cannot be assimilated by the patient's body (and, hence, don't achieve their purpose) or cause significant discomfort."

In addition, she said, "artificially administered nutrition and hydration cannot be discontinued for a patient in a persistent vegetative state even when physicians have determined with reasonable certainty that a patient will never recover consciousness."

Sister Carol told Catholic News Service that she did not see a need for any revisions to the "Ethical and Religious Directives for Catholic Health Care Services," most recently revised by the U.S. bishops in 2001. The directives, also known as the ERDs, guide Catholic health care facilities in addressing a wide range of ethical questions, including nutrition and hydration.

"The Vatican made clear they were clarifying, not issuing new doctrine," she said.

Directives 57 and 58 of the ERDs state: "There should be a 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. The free and informed judgment made by a competent adult patient concerning the use or withdrawal of life-sustaining procedures should always be respected and normally complied with, unless it is contrary to Catholic moral teaching."

In April an opinion piece on Virtual Mentor, the American Medical Association's online ethics journal, by Ron Hamel, CHA's senior director of ethics, said Pope John Paul's 2004 speech "seemed to reflect a change in church teaching about ordinary and extraordinary means of caring for the dying ..., which had remained consistent for over 500 years."

"The logic of the pope's statements could be applied beyond patients in PVS to all patients as, in fact, several bishops and others have proposed since the allocution," Hamel wrote. "Such a development could have a devastating effect on end-of-life care in Catholic health facilities."

As stated on the AMA site, the "learning objective" for Hamel's article was to "understand why most Catholic health care organizations refer to the 'Ethical and Religious Directives for Catholic Health Care Services' rather than to Pope John Paul II's 2004 allocution when making decisions about artificial nutrition and hydration."

Much of the recent discussion of the issue in the United States has focused on Terri Schindler Schiavo, the brain-damaged Florida woman who died in March 2005 after a court ordered her feeding tube removed.

The Terri Schindler Schiavo Foundation, founded by Schiavo's parents and siblings after her death, also thanked the Vatican for issuing the documents.

"It is our fervent hope that the clergy, religious and those who administer Catholic health care, as well as the laity who persistently ignored the basic right to life of our daughter and sister Terri, and who persist to this day to dissent from this basic moral teaching of the church by claiming that Pope John Paul II's March 20th allocution is 'up for discussion,' will begin to open their eyes and hearts to the immutable and incontrovertible truth reaffirmed by the Holy See today," the foundation leaders said in a Sept. 14 statement.