As with all moral decisions regarding medical treatment and care, we must begin with the prognosis of the doctor or medical team. What does the doctor assess the condition of the patient to be? Is the illness terminal? Is death imminent? Is the person in a persistent vegetative state from which recovery is considered unlikely? The diagnosis will dictate the procedures to follow. In all cases a person is to be given the proper care and medical treatment appropriate for his or her condition. However, it is the person in a PVS that the question of artificially assisted hydration and nutrition becomes a challenge for medical personnel. Perhaps the uncertainty on how to treat the person in this condition flows from the uncertainty of how to categorize his or her condition. The NCCB Committee on Pro-Life Activities, following the lead of some moral theologians, recommend that we understand this condition as an extreme form of mental and physical disability and not as a fatal pathology or a terminal illness. In this case, the medical condition of the person should not be viewed as one that immediately or inevitably leads to death. Unlike an individual suffering from advanced stages of pancreatic cancer, a person in a PVS can live many years. Therefore, we must view artificially assisted hydration and nutrition not as a medical treatment directed to curing a disease but as normal care due any person.

If the condition of the patient were to be understood as a fatal pathology it is easy to see why individuals would encourage termination of hydration and nutrition. This "treatment" is not going to cure the condition of the patient. The "treatment" becomes useless because it will not achieve its purpose, namely, restoring health to the person. Yet, because we view the condition of the patient as an extreme form of mental and physical disability, supplying hydration and nutrition is not intended to cure the patient. Rather, its purpose is to provide nutrition to a living person. Medically assisted hydration and nutrition is necessary care as long as it provides nutrition to maintain the body and death is not imminent. Those who withdraw this care from the person directly cause the death of the individual. Neither the person himself or herself nor another individual entrusted with their care can make the decision to forego hydration and nutrition in this case. To do so is euthanasia by omission. Remember, we define euthanasia as an "act or omission which of its nature or by intention causes death, in order that all suffering may be eliminated."

Pope John Paul II summarizes this position in his Address:

I should like to underline how the administration of water and food, even when provided by artificial means, always represents a natural means of preserving life, not a medical act. Its use, furthermore, should be considered, in principle, ordinary and proportionate, and as such morally obligatory, insofar as and until it is seen to have attained its proper finality, which in the present case consists in providing nourishment to the patient and alleviation of his suffering. (Address to International Congress on "Life-Sustaining Treatments and Vegetative State: Scientific Advances and Ethical Dilemmas," no. 4).

The Pope first notes that we are dealing with a natural means of preserving life, not a medical act. Furthermore, this treatment should be considered ordinary and proportionate, that is, it reflects the proper treatment and care for a person in this condition. Finally, this treatment should continue as long as it fulfills what it is meant to do, namely, provide nourishment and alleviate suffering. If at some time, the stomach is unable to convert the food into nourishment, the artificially assisted hydration and nutrition may be discontinued.

Some people will argue that providing hydration and nutrition to persons in a PVS places excessive burdens on the patient and on the family. While this terminology is part of the Catholic tradition, it refers to treatments as being burdensome, not life in general. In the case of a person in a PVS, the argument seems to move from the treatment being burdensome to life being burdensome. This we cannot deny. The patience and perseverance of a family to sustain one in such a condition can place extreme stress on those in the family. However, this does not justify the direct termination of that life by removing necessary nourishment. What is needed is a greater sense of responsibility on the part of other local and national communities. All those living in society, not family members only, share the responsibility to care for the sick, especially those whose condition requires greater assistance from others.

People will question the logic of continuing hydration and nutrition for those in a PVS, as has occurred in the Schiavo case in Florida. This questioning reveals a more fundamental issue that needs to be addressed: what is our responsibility to the sick and weak in our society? Is our society willing to make the sacrifices necessary to care for those in this extreme form of mental and physical disability? Perhaps we need a greater sense of responsibility for the weak and ill in our society. Of course, this will demand more from us and affect our quality of life, something we are reluctant to do.