When is it okay to withhold food and water?

Making decisions about assisted nutrition and hydration can be challenging. We are blessed with the gift of the Catholic Church’s clear moral teachings to guide us. While assisted suicide and euthanasia – seeking to eliminate the sufferer as a means of removing suffering – are always immoral, there are nonetheless times when there is no moral obligation for a patient to receive food and water. Here’s a quick primer on when and why.

John A. Di Camillo, Ph.D., Be.L

Food and water may be withheld when the facts of the situation prove ineffective or harmful, not when someone simply decides “it’s Grandma’s time to go.” There are several critical distinctions at play.

Most importantly, nutrition and hydration are distinct from medical treatment. This establishes a general obligation to provide food and water, even by medically assisted means, when the patient cannot take food orally. They are basic human care that every person deserves, regardless of health condition or life expectancy, and so the default action should always be to provide, with medical assistance if necessary. That said, there are three exceptions to this norm based on three additional distinctions.

First, food and water may at times be distinct from nutrition and hydration. That is, they sometimes fail to achieve their finality of nourishment and hydration. There is no duty to provide food and water by oral or by medically assisted means when the body cannot assimilate them.

Second, serious burdens associated with the effects of food and water on the body, or with the assisted means of delivering them, are morally distinct from the minor inconveniences typical of simple and safe administration. Food and water may therefore be withheld when there is moral certitude of serious harms, complications, or discomfort connected with their use, even if they are still able to nourish and hydrate.

Third, imminence of death based on a specific, identifiable cause is distinct from generally declining health or vague expectations about death. Food and water may be withheld if death is imminent, but imminent must not be confused with inevitable. For example, assisted nourishment and hydration may be withdrawn if death is expected within hours or a day due to an advancing cancer, but should not be stopped based solely on a doctor’s prognosis that the person will inevitably die “any day now.”

In sum, food and water must be provided when they actually nourish and hydrate, unless they entail a serious burden or death is imminent. It would be euthanasia to “let Dad die naturally” by withdrawing food and water when he is able to absorb them without significant harm or discomfort. It might be legitimate, however, to withdraw medically assisted nutrition and hydration if Mom is bloating from hydration her body cannot absorb, if Grandpa is experiencing serious issues with recurring infection at the surgical insertion site of a tube, or if Dad is in his final hours with a metastasized cancer.

There are various pitfalls to watch out for in applying these teachings. First, life itself, no matter the person’s health condition, can never be invoked as a “burden” to justify withholding food and water. Similarly, the fact that food and water will not enable a patient to recover from illness or regain lost function is not evidence for “futility.” Food and water can only be assessed as effective or ineffective with reference to their proper finality: nourishing and hydrating. Finally, death is inevitable for us all, but imminence is very narrowly defined and difficult to establish.

In today’s technological and bureaucratic health care context, families are bombarded with all sorts of pressures and confusion. So let us carefully reflect on these key distinctions in the Church’s moral tradition, which can equip us to defend human dignity and advance the culture of life in concrete decision-making.

JOHN A. DI CAMILLO, PH.D., BE.L., is a staff ethicist at The National Catholic Bioethics Center in Philadelphia. He earned his bioethics doctorate and licentiate degrees at the Pontifical Athenaeum Regina Apostolorum in Rome. He lives in Narvon, PA with his lovely wife Serena and their four children.