In lieu of an abstract, here is a brief excerpt of the content:

  • Making Sense of the Roman Catholic Directive to Extend Life Indefinitely
  • Lydia S. Dugdale (bio) and Autumn Alcott Ridenour (bio)

In November 2009, the U.S. Conference of Catholic Bishops issued "Ethical and Religious Directives for Catholic Health Care Services," requiring that all patients—including those in the so-called persistent vegetative state—be provided with artificial hydration and nutrition if such care could extend life indefinitely.1

The directives—particularly directive 58—prompted outcry from death-with-dignity movements and confusion within hospital ethics committees. Barbara Coombs Lee, president of Compassion and Choices, was quoted as saying that the new directive could potentially create "300,000 Terri Schiavo cases," equal to the number of feeding tubes inserted in the United States each year.2 Some hospital ethics committees debated whether their hospitals would be obliged to accept patients who refused such treatment as transfers from local Catholic hospitals. These discussions raise several questions with direct bearing on patient care: Do the bishops have authority over Roman Catholic health care institutions? Do the bishops' directives represent a departure from—or even a radicalization of—traditional Catholic teaching? How might these directives change clinical practice?

The answer to the first question is straightforward. U.S. bishops exercise spiritual and structural authority over Catholic institutions in their respective dioceses, but the extent to which their authority affects the institutions varies by bishop. Depending on the influence of other interest groups, some bishops take a proactive role; others allow health care leadership to function autonomously.

Next, a brief consideration of the evolution of the Catholic position on end-of-life care is warranted. In his 1957 "Address to an International Congress of Anesthesiologists," Pope Pius XII spoke of the obligation to provide ventilator support to unconscious patients without hope for recovery. He emphasized that physicians have a duty to provide ordinary (not extraordinary) treatments as necessary to preserve health and life. In contrast to ordinary care, a stricter obligation (defined as extraordinary) would be too burdensome for the majority of patients and would impede what he described as a higher, spiritual good.

In 1980, the Congregation for the Doctrine of the Faith (the papal office overseeing Catholic doctrine) adopted a "Declaration on Euthanasia" that noted that due to technological advancement, the delineation between ordinary and extraordinary means of sustaining life had grown muddled. However, the declaration permitted physicians (with patient consent) to discontinue treatment if harm would outweigh benefit. The declaration was clear: patients who refused care in such circumstances were not suicidal; rather, they were accepting of the human condition.

Between 1980 and 2001, various groups within the Church—including the Pontifical Council on Health Affairs (1981), the Pontifical Academy of Sciences (1985), and the U.S. Conference of Catholic Bishops (1992)—continued to reflect on these issues, reinforcing the notion that "minimal" care, including feeding, is obligatory. However, as the 1992 U.S. Conference of Catholic Bishops stated, "the teaching of the Church has not resolved the question whether medically assisted nutrition and hydration should always be seen as a form of normal care."3

In 2001, the U.S. Conference of Catholic Bishops issued directives for Catholic health care services that would be the forerunner for the directives of 2009. Directive 58 called for a "presumption in favor" of providing nutrition and hydration to all patients, including patients who require artificial means, as long as the burdens do not outweigh the benefits.4

It was not until a 2004 address by Pope John Paul II on "Life-Sustaining Treatments and Vegetative State" that the Catholic Church specifically addressed the issue of medically assisted alimentation for irreversibly ill patients. The Pope declared that food and water—even when provided artificially—is a natural way to preserve life, an ordinary means, and morally obligatory. Accordingly, the facilitation of death by starvation or dehydration is a form of euthanasia. The Congregation for the Doctrine of the Faith reinforced this position in its 2007 "Responses to Certain Questions of the United States Conference of Catholic Bishops Concerning Artificial Nutrition and Hydration" by stating that food and fluids may not be withdrawn from a patient in a vegetative state, even if such a patient is...

pdf

Share