Way back in 1995, #120 of the Vatican's Charter Health Care Workers stated that "The administration of food and liquids, even artificially, is part of the normal treatment always due to the patient when this is not burdensome for him: their undue suspension could be real and properly so-called euthanasia." Even so, a confusing sentence appeared in the U.S. Catholic Bishops' Ethical and Religious Directives for Catholic Health Care Services, 4th edition (2001):
- "The USCCB Committee on Pro-Life Activities' report...points out the necessary distinctions between questions already resolved by the magisterium and those requiring further reflection, as, for example, the morality of withdrawing medically assisted hydration and nutrition from a person who is in the condition that is recognized by physicians as the 'persistent vegetative state' (PVS)."
- "The sick person in a vegetative state, awaiting recovery or a natural end, still has the right to basic health care (nutrition, hydration, cleanliness, warmth, etc.), and to the prevention of complications related to his confinement to bed. He also has the right to appropriate rehabilitative care and to be monitored for clinical signs of eventual recovery ....the administration of water and food, even when provided by artificial means, always represents a natural means of preserving life, not a medical act....The evaluation of probabilities, founded on waning hopes for recovery when the vegetative state is prolonged beyond a year, cannot ethically justify the cessation or interruption of minimal care for the patient, including nutrition and hydration. Death by starvation or dehydration is, in fact, the only possible outcome as a result of their withdrawal."
- "The administration of food and water even by artificial means is, in principle, an ordinary and proportionate means of preserving life. It is therefore obligatory to the extent to which, and for as long as, it is shown to accomplish its proper finality, which is the hydration and nourishment of the patient. In this way suffering and death by starvation and dehydration are prevented....A patient in a 'permanent vegetative state' is a person with fundamental human dignity and must, therefore, receive ordinary and proportionate care which includes, in principle, the administration of water and food even by artificial means."
- "The Schiavo case highlighted the medical practice of providing artificial nutrition and hydration (ANH) to patients who can no longer swallow food or eat sufficiently well to sustain health or life. In the process, it prompted concern among many Catholic bishops, both in the United States and the Vatican, that ANH might be withdrawn from patients with the intention either of euthanasia or of ending a life that some people deem unworthy of further medical care. In July 2007, seven directors of bioethics programs at Jesuit universities came together to form the Consortium of Jesuit Bioethics Programs, dedicated to informing and influencing medical-ethical debates within the Catholic Church and the larger society. As one of our first outreach tasks, our consortium decided to address the subject of ANH.... "In 2004, John Paul II delivered an allocution on the use of ANH for patients in a persistent vegetative state (PVS)....the pope’s statement included some assertions that surprised many involved in health care...."Some theologians believe these statements represent a departure from long-standing Roman Catholic bioethical traditions. The current U.S. Conference of Catholic Bishops’ Ethical and Religious Directives for Catholic Health Care Services (fourth edition, 2001)....would appear not to align with John Paul’s 2004 allocution...."Subsequent statements by the Congregation for the Doctrine of the Faith (CDF) and the Vatican have seemed to uphold a stringent reading of the pope’s statement...."Catholics both within and without the health-care system are left with uncertainty about how to apply John Paul II’s allocution....In June 2008, at the annual meeting of the U.S. bishops, Bishop Lori and Cardinal Rigali convinced the bishops to begin a process of amending the Ethical and Religious Directives, potentially extending recent teachings to new patient populations. The bishops may vote on these changes as early as June 2009...."Though John Paul II explicitly maintains that providing ANH is not a medical act, the reality is that within the fields of medicine and law, the practice generally is viewed as a medical treatment...."Health-care costs associated with tube feedings are significant...."From a legal point of view, ...a 2002 review of statutory and case law published in the Journal of the American Geriatrics Society concluded that case law supports a 'consensus that ANH is a medical treatment that can be forgone like any other treatment'...."We urge physicians to practice evidence-based medicine and to start ANH only when data indicate a reasonable hope of benefit."We believe that when ANH is used inappropriately, as might be the case with many advanced dementia patients, such patients are denied the care they deserve....In our view, tube feeding implemented for convenience, or to assuage the sensibilities of family, or for cosmetic reasons, is inappropriate...."patients, families, physicians, and nurses must be reassured by Catholic facilities that health care will not be provided without informed consent...."While ANH may delay death in some cases, in many others the dying process will continue unabated. So while the denial of treatment for patients based on health-care workers’ quality-of-life judgments remains a legitimate concern, so too do overtreatment and the failure to accept that some conditions, such as advanced Alzheimer’s disease, are terminal and will cause death...."We wish to warn against making hasty generalizations from recent Catholic teaching on the use of ANH with patients in a relatively stable persistent vegetative state...."We believe that the current edition of the Ethical and Religious Directives properly acknowledges the importance both of long-standing principles and of individual discernment—and we hope that as the U.S. bishops consider revising specific directives, they will preserve that balance."
- "McCormick has established a moral criterion for treatment decisions regarding handicapped newborns as a 'revised' natural-law ethicist in the Roman Catholic tradition....when a never-competent patient, even with treatment, will have no potential for human relationships, the appropriate decision-makers can decide to withhold treatment and allow the patient to die [emphasis added].... For many contemporary ethicists the traditional terminology of ordinary-extraordinary means has outlived its usefulness and could take us only so far, especially in the case of handicapped newborns....McCormick, along with ethicist John Paris, S.J., proposed the following norms that would further specify the capacity for human relationships and the benefit-burden evaluation: "(1) Life-saving intervention ought not to be omitted for institutional or managerial reasons. Included in this specification is the ability of this particular family to cope with a badly disabled baby.(2) Life-sustaining interventions may not be omitted simply because the baby is retarded. There may be further complications associated with retardation that justify withholding life-sustaining treatment.(3) Life-sustaining intervention may be omitted or withdrawn when there is excessive hardship on the patient, especially when this combines with poor prognosis.(4) Life-sustaining interventions may be omitted or withdrawn at a point when it becomes clear that expected life can be had only for a relatively brief time and only with continued use of artificial feeding...."McCormick’s moral criterion is appropriate for Christian decision-makers because it emphasizes 'the reasonable' from within a Christian context."
Father Peter Clark, S.J.'s co-authorship of Jesuit Bioethics Group Endorses Health Care Reform (September 2009) should also be of grave concern. In a rush to endorse health care reform, he and his co-authors indicated approval to disregard public financing of abortion:
- "We did not seek to address the issues of financing abortion services...because we fear that they will simply be politicized in the effort to again fail to insure the uninsured. This should not be allowed to happen....We believe that it is a morally legitimate approach to remove those issues from the table in an effort to build the consensus necessary to rectify a terrible injustice."
