End of life’s persistent dilemmas

The bishop’s teaching on the medical use of feeding tubes for nutrition and hydration was revised last November to mandate “an obligation to provide patients with food and water, including medically assisted nutrition and hydration for those who cannot take food orally” that “extends to patients in chronic and presumably irreversible conditions.” That revision has drawn the attention of the Chicago Tribune and the Kaiser Health News service, which documents some of the ethical incongruities which emerged at a Catholic hospital when the revised teaching conflicted with the patient’s explicit wishes and local law. The stories suggest that, despite the bishop’s recent attempts to clarify this specific end-of-life question, Catholic families, their doctors and staff at Catholic institutions are going to continue to grapple with practically and lovingly interpreting church teaching when confronted personally by these difficult questions.

From Kaiser’s report:

An elderly woman taken last year to St. John Medical Center in Tulsa, Okla., had suffered a massive stroke and could no longer speak, eat or drink. Although she had an advance directive specifying no artificial hydration or nutrition if she weren’t going to recover, local health officials said, her nephew insisted the local bishop’s directive on use of feeding tubes required the Catholic hospital to install one.

Her doctors and St. John officials debated how to proceed, struggling with ethically charged issues that hundreds of Catholic hospitals and nursing homes could face under new doctrine. In November, the U.S. Conference of Catholic Bishops approved a revised ethical and religious directive similar to the Tulsa bishop’s. It states in part that Catholic health facilities have “an obligation to provide patients with food and water, including medically assisted nutrition and hydration for those who cannot take food orally.” 

“This obligation,” the bishops said, “extends to patients in chronic and presumably irreversible conditions,” such as persistent vegetative state, who might live for many years if given such care. A feeding tube is not required, however, if it wouldn’t prolong life, would be “excessively burdensome for the patient,” or would “cause significant physical discomfort.”

The directive raises fresh questions about the ability of patients to have their end-of-life treatment wishes honored — and whether and how a health care provider should comply with lawful requests not consistent with the provider’s religious views. Hospitals and nursing homes do not have to comply with requests that are “contrary to Catholic moral teaching,” according to longstanding policy that, as in the case of the revised directive, applies to non-Catholic patients as well. 

If a patient or family didn’t want a feeding tube “and the reason they don’t want it is they basically want to die, then the Catholic institution would explain to them they can’t cooperate with that and they would have to go to another institution,” said the Rev. Thomas G. Weinandy, executive director for doctrine at the bishops’ conference, who helped draft the policy.

Experts say no other large health systems in the U.S. have nutrition and hydration policies like those governing Catholic facilities.