This is an important book. Its topic is the status of people with profound learning difficulties and those in a so-called ‘persistent vegetative state’(PVS) understood from the perspective of bioethics and of the theology of disability, and in particular through the writings of Pope John Paul II.

The author shows an extensive knowledge of the works of John Paul II (with more than three quotations on most of the more than three hundred pages, and references to a wide range of material not only the more well-known encyclicals). The book also includes a well-researched account of the current state of bioethics and links the idea of human ‘non-persons’ found in academic bioethics with the more populist idea of people in PVS being ‘better off dead’.

The longest chapter (Chapter 9) engages with what is perhaps the most controversial area in contemporary Catholic moral theology, the treatment and care of people in PVS. This chapter is a robust and well-argued defence of the teaching of John Paul II on the requirement to provide assisted nutrition and hydration to people in this state. The key arguments of Matthews are not new. They were articulated by Anthony Fisher OP in the pages of New Blackfriars two decades ago. What makes this analysis fresh and gives it a depth not found in previous treatments of the subject is the placing of these arguments within an extended theological reflection on the significance of a life with profound disability. It should be required reading for any who mistakenly believe that, in his teaching on the treatment and care of people in PVS, John Paul II diverged from the previous Catholic moral tradition.

The most speculative chapter in the book is Chapter 10 where Matthews draws a parallel between the spiritual lives of those with profound intellectual disabilities and the experience of the “dark night of the soul” described by St John of the Cross. This analogy is summed up in the following quotation:

According to Matthews, one cannot discount the possibility of those with cognitive impairment having an inner spiritual life because, in relation to knowing God ‘all human intellects are inadequate’ (p.239). It might seem that the book is suggesting that there can be faith without intellectual acts, but on closer reading the argument seems to be that through grace and the disposition of faith given by God, the intellect of the person may be active but not through self-conscious acts of deliberate choice. Indeed a reiterated theme of the book is that all living human beings are active in a personal way. All living human beings have a biographical story, a subjective perspective, and an inner life. This is evident in the title of the book, the profoundly disabled are acting, they are only ‘apparently non-acting’.

What is different here from the traditional account of how faith is in the soul of the person without capacity (the young infant or injured adult) is that faith has generally been regarded as present in such persons only as a disposition, not as one that could be in act. What Matthews suggests is that there might be graced active attentiveness to God with inner peace ‘without any acts and exercises of the faculties of memory, intellect and will’ (p.247). This is speculative (as Matthews acknowledges) and some would see it as romanticism but it is not contrary to the teaching of the Church. In practical terms, this implies giving the benefit of the doubt with regard to the spiritual life of persons with profound learning disabilities, as well as having a greater recognition of the personal aspect of their behaviour, in part by being attentive to their language of the body.

A more dangerous form of romanticism is the tendency to regard people with learning disabilities as free from guilt or sin as if by nature. ‘[P]eople with profound disabilities may have of an openness and simplicity towards the world and other human beings. That receptiveness to a spirituality that is not reliant on knowledge or perhaps clouded by the complexity of day to day living… There is a strong temptation for some to see disabled children as angels, as if they do not quite belong in the earthly realm. Undoubtedly this springs from an appreciation that the profoundly disabled child is pure and free from the guile and deceit that affects other human beings’ (p.55, p. 164).

Matthews shows why this temptation is misleading. A theme running through the book is that a false angelism would deprive the apparently non-acting person of the spiritual help he or she needs. ‘…‘each one of us’ [is] separated from the mystery of original innocence by original sin. This of course includes the disabled… Thus it is important to acknowledge that even the most profoundly disabled person has spiritual needs’ (p.84, p.92). In particular, ‘the profoundly disabled are human beings and they live human lives so, as Christians they also are to have the sacraments, take part in the liturgy and pray as far as they are able’ (p.164). Such access to the sacraments is a matter of justice.

This book is a work of theology, but it does not need the claim that ‘for St Thomas, there is no formal separation of theology and philosophy’ (p. 43). There is some equivocation here. Certainly, for Thomas, ‘the human person is most fully understood by reference to God’ (p. 43). Human beings are created by God and can find complete fulfilment only in the vision of God. Yet this conclusion remains at the level of natural reason, that is, of philosophy. It does not require revealed theology. Furthermore, while there are truths about human nature which can be known only by revelation (such as the promise of resurrection) this does not show that natural reason has no understanding of the human person. Thomas appreciates the illumination of human understanding provided by the gospel, but sometimes he confines his arguments to what can be known by the natural light of reason. This is particularly evident in his commentaries on Aristotle and in much of the Summa Contra Gentiles.

The enduring role of philosophy in moral reflection even after the revelation of the Gospel is of political importance, given the contentious status of theological claims in public policy discussion and indeed much of what Matthews says can be said without recourse to theology. Nevertheless, what the book ably demonstrates is that theology can take us further and can take us there more securely.