Current law requires that everyone who is admitted to the hospital, regardless of age or health status, be offered the opportunity to complete an advance directive. Be very wary of the directives provided by most secular health care institutions. They focus on withholding care rather than on the premise of preserving life. While they may be in accord with federal law, they are not in accord with Catholic moral teaching. Health care institutions in Virginia utilize a document produced by the Virginia Department of Health. It is biased towards the patient refusing what it calls "life-prolonging" procedures. It defines "life-prolonging" as:
These are treatments that are not expected to cure a terminal condition or to make you better. They only prolong the dying process. The treatments may include hydration (giving water) and nutrition (giving food) by tube, connection to machines that breathe for you and other kinds of medical and surgical treatment such as kidney dialysis.
Withholding nutrition and hydration from a patient, even when given by artificial means such as intravenously or via a feeding tube, is contrary to Catholic teaching. Nutrition and hydration are considered ordinary care and not medical treatments. Only if the patient has lost the capability to process nutrition or hydration, or the administration itself it too burdensome, can it be discontinued. Pope John Paul II made this clear in an address to anesthesiologists:
I should like particularly to underline how the administration of water and food, even when provided by artificial means, always represents a natural means of preserving life, not a medical act. Its use, furthermore, should be considered, in principle, ordinary and proportionate, and as such morally obligatory, insofar as and until it is seen to have attained its proper finality, which in the present case consists in providing nourishment to the patient and alleviation of his suffering.
The Congregation for the Doctrine of the Faith confirmed this in a letter to the U.S. Conference of Catholic Bishops:
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.
Health care institutions, insurance companies, and government entities that pay for health care seek to cut costs. It is to their financial advantage to push patients to refuse care. Therefore, it is important for Catholics to take action to ensure their health care will be in accordance with Catholic principles. That means studying what the Church teaches about end-of-life care. Two primary principles govern Catholic end-of-life care.
The first is that the worthiness of a life cannot be judged, but treatment can be judged. Decisions about care must be based on an analysis of proportionate vs. disproportionate care. The Ethical Religious Directives for health care from the USCCB states in Directive 56:
“Proportionate means are those that in the judgment of the patient offer a reasonable hope of benefit and do not entail an excessive burden or impose excessive expense on the family or the community”
Directive 57 states:
“Disproportionate means are those that in the patient’s judgment do not offer a reasonable hope of benefit or entail an excessive burden or impose excessive expense on the family or the community”
Note that in each of these cases, the judgment of what is proportionate or what is disproportionate is the judgment from the perspective of the patient or the patient’s surrogate. The health care providers have the duty to provide the patient or the patient’s surrogate with all the information to make an informed decision. They can make recommendations. In the final analysis it is the patient’s decision.
The second principle is that life is preferable to death. Be wary of judgments based on the patient's "quality of life". The patient is never better off dead. Such analysis violates the first principle by judging the life of a patient rather than the treatment. The benefit of a treatment can be judged to be not worth the burden it imposes. The refusal of such a treatment may hasten the patient's death. However, the underlying intent was not to cause death but rather to better experience life.
Archbishop Jose Gomez of San Antonio recently published an excellent booklet, A Will to Live, on Catholic end-of-life care. It is in an easy to understand question and answer format. It is available in both English and Spanish.
Catholics should avoid using secular advanced directive documents. The National Catholic Bioethics Center, the Diocese of Arlington, and the National Right to Life Committee all have documents that provide advanced medical directives that are in accord with Catholic teaching. In order to protect yourself from immoral end of life care, state very clearly in whatever document you use that you are Catholic. You want all of your care to be in accordance with Catholic principles. You do not want any intervention given or withheld with the specific intention of causing death. Because what is proportionate or disproportionate care is so dependent on the immediate circumstances, it is not a good idea to make generalized judgments about specific therapy. For example, do not say that “I never want to be connected to a ventilator”. In reality, the most important thing you can do is to designate a primary health care proxy and an alternate proxy. These should be individuals with whom you have discussed your values and who understand Catholic principles. You should be able to trust them to make decisions in accord with Catholic teaching.
For more info:
National Catholic Bioethics center Guide to End of Life Care
Dioceseof Arlington Advanced Medical Directive
National Right to LIfe Advanced Medical Directive information
A Will to LIve by Archbishop Jose Gomez
Pope John Paul II on nutrition and hydration (PDF)
Implications of current health care reform on end of life care
Comments
When did we start making doctrine by speech and press release? It is clearly a case of conservatives running amok in the Church and is in fact a change from prior and long held doctrine. One may always licitly refuse nutrition if one is a patient. Eating is not a personal requirement when you are dying. Additionally, the treatment of those who have died and been partially resuccitatated should be different from those who are experiencing decline. Hopefully, advances in resuccitation (like the use of hypothermia) make this question moot - but until it is, if someone is all but brain dead, feeding them is an imposition.
Michael, that is not your call to make. The point is that proportionate vs. disproportionate care must be made from the perspective of the patient or the patient's surrogate. If the patient or the patient's surrogate believes that the treatment is too burdensome, it can be refused. Treatment cannot be denied to a patient because someone else thinks that the patient is too burdensome. The presumption is that nutrition and hydration are ordinary care. However, circumstances can arise where a patient artificial nutrition and hydration are too burdensome. No one is advocating that every patient on his death bed have a feeding tube. However, even a profoundly disabled life is a valuable life.
Michael Everything Denise has written is accurate. Why don't you do some fact checking before you attack her? Also if you don't like the church maybe you should just leave. You're spreading misinformation and heresy.
I'm sorry, but I've done the checking at the Library of Congress and other bi-partisan sites and I have to say that the provisions in health care reform about end of life and palliative care say nothing at all about being forced by anyone to accept or reject end of life care. The patient and/or the patient advocate are the only ones who can decide and are and will be given that option with adequate time. I've been through it recently in several cases and I've found nothing in any proposed bills that dispute or change that.
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