Bishops revise directives on withdrawal of food, water

Give the Bishops another few revisions as they get closer to dying and begin to realize how they are altering natural death, ask a few nurses who have to actually care for the dying, and they may finally get a merciful, reasonable, workable and fully moral directive that fully respects the dying person's decisions.

PS: Lifelong, outstanding Catholics in their 80s, have asked me to be sure they don't go to a Catholic Hospital for their last illness because "the Bishops must never have seen anyone die or they would never write what they do."

PPS: If you'll recall when the great advocate of taking any and all measures possible to extend life, John Paul II, came time to pass over; he decided to remain in his room and not go to the hospital and pretty much let nature take its course.

Clearly food & hydration as well as necessary medication should not be withheld & should be provided if reasonably possible in all medical cases. But what of a feeding tube surgically implanted? Can that ever be required according to Catholic medical ethics? Is that a question that the Magisterium has ruled on? I can see the problem with removing it once it has been implanted like in the TS case but I would think the patient & family should have some discretion on that. I was once told by a doctor that the surgery to implant a feeding tube in a family member would most probably kill the person. He also said that there were other ways to feed the person if it came to that. Luckily, it didn't.

Whatever happened to the old Catholic reliance on "Natural Law"! Since when can we call feeding and hydration tubes natural? When someone is in a permanent vegetative state, they die if not artificially nourished. That's what most people call "Nature". This sort of dysfunctional document is what happens when legalism and tradition overcome rational thinking. God help us all! I am a lifelong Catholic but quickly beginning to believe that the people who write these documents are a bunch of loons!

This will prove an interesting test vote of who is more Catholic than the Vatican.

This debate,which lingers from the Schaivo case, shows the glaring difference between someone getting progressively worse and someone who has already died, was revived, but never regained conciousness. There should be a difference in the guidance. Of course, there have been advances. Forward thinking ER's now chill people who have arrested, shock them back to life and then warm them slowly without loss of brain function. This is bad for transplant patients but good for those who would otherwise end up like Terri Schaivo.

Turning medical technology into a god.

I'm reminded of a theologian's picture of a special facility dedicated to preserving the lives of hundreds of folks in a persistent vegetative state: Don't these folks believe in life after death???

At some point, we need to let nature take its course.

The bishops seem to be equating biological existence with life. Not the same.

I would say that the bishops are writing this from one perspective only. They would be better off to state what they probably think is the obvious. That is, that people are supposed to stay alive until God wills that they die. This would include people who are likely never to regain their ability to communicate with other people or be understood by them and people who lose the ability to get the food and water into themselves.

If the only reason a person would be dying is because they have lost the ability to feed and hydrate themselves, then because we have the technology to overcome this handicap, these people have a right to be provided with this assistance. Furthermore, we are also morally obligated to allow and assist persons who are likely to be mentally and physically handicapped to live despite the fact that the kind of life they would have is not what we would wish for them.

Medical/surgical intervention for food and water is a very expensive procedure, so the bishops of course recognize that this "teaching" is only for the very well insured.

The rest of you without health insurance or access to healthcare can forget about it. If you have access to 'basic healthcare,' e.g., in the form of a visit to the ER or a parish clinic, you can also expect that this "teaching" does not apply to you because no one will want to pay for this intervention for you.

And there is a trend now that even health insurance companies will not see this as basic to your life...in our area, an individual with a debilitating neurological condition was able to get his insurance company to cover the surgery to implant a shunt for parenteral nutrition, but they won't pay for the special, expensive liquid food formula which must be used in conjunction with the shunt. Thus he is starving anyway.

Regarding the Church's reliance on "natural law" and letting nature take its course, especially related to birth/fertility/reproduction, etc., it is odd they support such artificial medical technologies at the end of life.

I am a hospital chaplain who sees cases like the ones mentioned in this article on a regular basis. This is going to cause pain and suffering all around...to patients in persistent vegatative states, and to their families who struggle to make the best decisions under very difficult circumstances. I have helped hundreds of patients complete Advanced Directives and Durable Power of Attorney for Health Care documents. In every case, even with Catholic patients, I have NEVER encountered a person who desired artificial nutrition or hydration if they are ever determined to be in a persistent vegetative state. The faithful are, as usual, way ahead of the bishops on this issue. This will be "obeyed" much like the teaching regarding artificial contraception. My advice is to have a durable power of attorney for health care, also called advanced directive, drawn up and make sure you state your wishes for end of life health care in explicit language. Be sure your agent (the person you designate to act for you if you are incapacitated), knows what you want and is willing to follow your instructions if you are unable to communicate. Your agent has the right to transfer you to another health care facility if the one you are in will not honor your wishes. This, of course, goes both ways. If you want to be kept alive with artificial nutrition and hydration, make sure you specify that.

This is very disturbing to me. Of course we should never do anything deliberately to end the life of a person. But most of the elderly people I have known who died came to a point a few weeks before death where they really didn't want food anymore, a little water or juice perhaps, but no, or only a few bites, of some soft food. If I come to that state some day, does this mean that, regardless of whether I want to eat or not, I will be forced to by an implanted tube? This sounds like torture to me and a deliberate attempt to keep the dying from going to meet their God when they are ready. Am I the only one who feels this way?

It is interesting that the Bishops now wish to be the source of authority on this issue without the recognition of the neurologist. I would imagine that most people will still want to use the expertise of what medical knowledge tells us for their own families. I have not recently seen a Bishop publish in any medical or scientific journal. At least my very rare disease is best treated in a Jewish Hospital that has superior expertise for this disease. Thank God for small favors!

R. Dennis Porch, MD

It is absolutely amazing that the USCCB even exists. That they think ANYONE who is faced with these terrible choices cares what their current interpretation of Church law is defies belief. We have a conscience to listen to so that we don't have to listen to fools, Praise God.

No one - including any Bishop - will ever make the final decisions regarding my life. I have a specifc and "pour-over" power of attorney for medical affairs and a Living Will that both state my wishes to not have my life prolonged by artificail means, other than what is required to keep me comfortable. All of this noise from the USCCB is again it's hardening line with "pro-life" issues to the exclusion of reasonable thought and discussion. If only they had been this driven in their responses to the sex abuse crisis in the US Church, we would have an enforceable, consistent, and 100% implemented policy that would have protected the lives of our children and parishoners. So, once again, the US Catholic Church is coming up with rules and precedures that the vast majority of the faithful will simply ignore. This is a real pattern now. No wonder the heirarchy is so desperate and defensive!

I might not understand the finer details, but it seems that this revision is not much different than what has been said before by the US bishops. The language is different to be sure, but the effect seems very much like it was. The change in language seems more to please the Vatican than it is intended to make any real change in the ERDs. The bishops have left a lot of wiggle room for removing food and water at the end of life, even for PVS patients. Look carefully at what the revision states. What was always true was that food and water was obligatory in principle, even for PVS patients. Now, there may be some who will argue that the bishops are saying that you can never remove food and water from a PVS patient until death is imminent (how imminent does it have to be, by the way), but I don't see it that way. The bishops just never say never. Because they say something less than "never" they leave wiggle room. It is no more complicated than that. Besides, it does not matter what the bishops say. The law in most states says that if a patient or the patient's proxy refuses treatment of any kind, including food and water, it cannot be given, even if it had been give up to that point. And both the law and the medical profession make no distinction between artificial nutrition and hydration and other kinds of health care. It is all the same--healthcare, particularly when it is given in the medical setting. So, if the Catholic hospital refuses to go along with a patient or proxy refusal of ANH, then it will have to move the patient to another facility. Now, how many of those hospitals do you think are going to do that? Why put themselves at financial risk should the patient be harmed in the transfer or have his or her health made worse by the transfer and die sooner than expected. Lawyers will love it should those facilities stand on principle instead of the law and harm the patient in the process. Think of the money to be made on that kind of decision. No, I think your wishes will be honored at all Catholic hospitals. Don't worry about what the bishops say. Worry instead about what the Catholic hospital is likely to do.