Address correspondence to: Jeffrey P. Bishop, Director, Albert Gnaegi Center for Health Care Ethics, Tenet Chair of Health Care Ethics, Albert Gnaegi Center for Health Care Ethics Salus Center, 3545 Lafayette, 5th floor, St. Louis, MO 63104-1314, USA. E-mail: email@example.com.
With the advent of new technologies in the 1950s, patients with severe head injuries began to survive what would have been mortal injury, creating the need for new diagnostic categories. A whole set of new brain states became possible, where patients would have previously died. One of the brain states that emerged as a new diagnostic category was the persistent vegetative state (a diagnostic category), and the permanent vegetative state emerged as a prognostic category. In Roman Catholicism, Pope Pius XII’s statement on the use of ventilators in patients with severe brain injury seemed also to apply to patients in need of artificial nutrition and hydration (ANH). His statement noted that in moral deliberation around questions of removal of ventilators, families and health care professionals should discern if the means of keeping the patient alive were ordinary—in which continued treatment is required—or extraordinary—in which continued treatment is optional.