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A question of last rights
What if a Catholic hospital doesn't respect your wishes?
By Robert McClory
October 21, 2007
For severely ill patients, particularly Catholic ones, the choice
of hospital has suddenly become more complicated.
Following a declaration from the Vatican, Catholic medical
facilities will be required to use feeding tubes and other means to
keep alive patients in a persistent vegetative state. This holds
even if the insertion of a feeding tube goes against a patient's
living will or the family's wishes.
Catholic hospital officials are downplaying the declaration's
effect. But some theologians are predicting that patients may feel
compelled to leave or avoid Catholic hospitals and nursing homes.
That goes especially for elderly people who might normally use a
Catholic medical facility but do not want their end-of-life wishes
contradicted.
The issue is complicated. This, after all, is the Vatican.
Last month, the Congregation for the Doctrine of the Faith, with
the approval of Pope Benedict XVI, issued what it called a
"clarification." It said "the administration of food and water,"
usually by feeding tube, "is in principle an ordinary and
proportionate means of preserving life."
"Therefore," the statement went on, the measure was "morally
obligatory ... for as long as it is shown to accomplish" its
goal.
Some theologians see the declaration not as a "clarification" of a
moral tradition but as a step backward on a basic question: how
best to respect human dignity in the last days of life. If the
document was intended to bring Catholic unanimity on the subject,
it clearly has not done so.
"I've talked to more than seven medical ethicists around the
country, and we're all aware of a degree of consternation in the
Catholic community," said Rev. Kenneth Himes, chairman of theology
at Boston College. He deemed the Vatican statement a "bizarre turn
of events."
But Rev. Michael Place, senior vice president for social ministry
for Resurrection Health Care, which oversees many Chicago health
facilities, said the Vatican statement "should not be a source of
concern."
A persistent vegetative state is extremely rare, Place said. It is
in a medical category that is not easily or readily defined. And,
Place said, each case must be weighed individually, and there is a
wide range of possible exceptions to the general principle.
Nonetheless, Place acknowledged that if a definite diagnosis of
persistent vegetative state has been made and all the possible
disqualifying conditions are absent, a patient must be kept on a
feeding tube indefinitely regardless of the patient's stated wishes
and those of the family.
"Yes, that is the current Catholic position," Place said.
Himes and Place are in basic disagreement about the declaration's
legitimacy.
For some 400 years, Himes said, "Catholic tradition did not demand
that everything that can be done must be done to keep persons
alive."
"The church distinguished between 'ordinary' and 'extraordinary'
means of preserving life, and the distinction was not between the
various medical techniques to be used, such as artificial hydration
and nutrition," Himes said.
Rather, Himes said, the basis was the subjective benefit to the
patient, versus the burden of the treatment to the patient or
family.
Thus, if a feeding tube or other intervention could conceivably
help restore health or improve quality of life, it should be used,
he said; if it did not achieve such ends, merely keeping the
patient technically alive, the tube was considered extraordinary
and could be rejected by the patient or by another with authority
to act in the patient's name.
Pope John Paul II gave mixed signals on the issue. In his 1995
encyclical, "Evangelium Vitae," he seemed to endorse the position
that a feeding tube was extraordinary, saying, "Certainly the life
of the body in its earthly state is not an absolute good for the
believer." Yet in 2004 he indicated otherwise.
The lack of clarity, and lobbying by the National Right to Life
Committee and others over the Terri Schiavo case in 2005, brought
calls from the U.S. Bishops Conference for a ruling. That came last
month. And it left little wiggle room.
Coming from perhaps the most powerful Vatican congregation, the
declaration carries more weight than a passing statement in a papal
speech.
Himes said theologians, not to mention many loyal Catholics, are
mystified.
But Place said the declaration is part of the 400-year-old
tradition in Catholic moral teaching. One can see changes as far
back as the pontificate of Pius XII more than 50 years ago, he
said.
Place also argued that the number of cases for which the ruling is
relevant will be "potentially minimal."
It is "extremely unlikely that one in the vegetative state would be
kept in a Catholic hospital or nursing home" because of the level
of intensive care required for a person in that condition, Place
said.
But even if the person were in a non-Catholic facility or at home,
he noted, those Catholics responsible for his care would be morally
obligated to abide by the ruling. "The dignity of a human person
remains constant no matter their state," he said. "So there is a
positive obligation to preserve and protect human life."
How all this is interpreted in Catholic health facilities and, more
important, how it is accepted by grass-roots Catholic consumers of
health services deserves to be carefully watched.
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Robert McClory is an associate professor emeritus at Northwestern
University, a former Catholic priest and author of "As It Was in
the Beginning: The Coming Democratization of the Catholic
Church."
Copyright © 2007, Chicago Tribune