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EOL group "alarmed" at revised Catholic directive
Compassion & Choices, an end-of-life rights group, says that it is "alarmed" by a newly revised Ethical and Religious Directive approved in November by the United States Conference of Catholic Bishops.
In a Nov. 5 news release announcing the vote that would take place later that month, the USCCB quoted Bishop William Lori, chairman of the U.S. Bishops' Committee on Doctrine, as saying that the directive, prior to revision, stated, "There should be a presumption in favor of providing nutrition and hydration to all patients, including patients who require medically assisted nutrition and hydration, as long as this is of sufficient benefit to outweigh the burdens involved to the patient."
The approved directive #58 states, "In principle, there is an obligation to provide patients with food and water, including medically assisted nutrition and hydration for those who cannot take food orally. This obligation extends to patients in chronic and irreversible conditions (e.g., the "persistent vegetative state"), who can reasonably be expected to live indefinitely if given such care.
"Medically assisted nutrition and hydration become morally optional when they cannot reasonably be expected to prolong life or when they would be 'excessively burdensome for the patient, or [would] cause significant physical discomfort, for example resulting from complications in the use of the means employed.'
"For instance, as a patient draws close to inevitable death from an underlying progressive and fatal condition, certain measures to provide nutrition and hydration may become excessively burdensome and therefore not obligatory in light of their very limited ability to prolong life or provide comfort."
Father Thomas Weinandy, who oversees the Bishops Committee on Doctrine in Washington, DC, told Medical Ethics Advisor that the committee "consulted widely with various health care groups and ethicists [on this matter]. And it took us about three months to come up with the wording that everybody could agree on."
The genesis of the revision in the Ethical and Religious Directives for Catholic Health Services, according to Weinandy and to the news release, was based on Pope John Paul II's March 2004 Address to the Participants in the International Congress on Life-Sustaining Treatments and Vegetative State: Scientific Advances and Ethical Dilemmas.
The revised language was also based on the Congregation for the Doctrine of the Faith's August 2007 Responses to Certain Questions of the United State Conference of Catholic Bishops Concerning Artificial Nutrition and Hydration.
"Within the Catholic Church, it's the bishops who are the formal teachers, when it comes to issues of faith and morals," Weinandy says. "So, what the Pope and the bishops have to say on the issues are ultimately authoritative."
The news release also quotes Bishop Lori as saying prior to the revisions that "It would be useful to update the Ethical and Religious Directive by inclusion of references to these authoritative documents as well as by incorporation of some of their language and distinctions.
"It is particularly appropriate to do so since the recent clarification by the Holy See has rendered untenable certain positions that have been defended by some Catholic ethicists," Lori says in the statement.
The USCCB said the revision was undertaken with the collaboration of the Committee on Pro-Life Activities and in consultation with the Task Force on Health Care Issues, the Catholic Health Association, the Catholic Medical Association, the National Catholic Bioethics Center, and the National Catholic Partnership on Disability.
Power to ignore advance directives cited
Compassion & Choices suggests that the revised ethical directive's language will essentially allow any Catholic health provider to override individual advance directives.
But Wainandy disagrees that it gives Catholic Health Services greater authority to overrule advance directives.
"Not any more really than before," Weinandy tells MEA. "If somebody comes to a Catholic health care institution and has advance directives that would be contrary to what the Catholic Church teaches, the health care institution would have to say, 'Well, if you want your directives to be carried out, you're going to have to go somewhere else for this to take place.'"
But Compassion & Choices spokesman Steve Hopcraft tells MEA that this is part of the problem — that some individuals in the U.S. are in communities where the only available health care is provided by CHS — thereby limiting those individuals' ability to choose the type of health care they prefer.
According to data provided in a news release by Compassion & Choices, Catholic institutions provide more than 30% of patients' health care in Washington, South Dakota, Iowa, and Alaska, for example.
Charles Camosy, PhD, assistant professor of Christian Ethics at Fordham University in Bronx, NY, notes that "The Catholic Church has a 500-year-plus history of making a distinction between euthanasia and removal of . . . extraordinary treatment. If it's ordinary [treatment], the Catholic Church is going to say it's required, and if you forego it, that's the equivalent of euthanasia. But it could be extraordinary. If treatment is extraordinary, that means that even if you foresee, but don't intend that it will result in death, it's not necessarily euthanasia, because you don't have to preserve life at all costs," Camosy says.
Directive #59, the USCCB approved the following language: "The free and informed judgment made by a competent adult patient concerning the use or withdrawal of life-sustaining procedures should always be respected and normally complied with, unless it is contrary to Catholic moral teaching."