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Catholic Ethical and Religious Directives

The United States Council of Catholic Bishops (USCCB), through a change in its “Ethical and Religious Directives for Catholic Healthcare Services,” has ordered Catholic institutions to institute and maintain artificial feeding in permanently unconscious patients, regardless of their advance directive instructions or family wishes.

Compassion & Choices is alarmed at the impact of this order on Catholics and non-Catholics alike.

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The new USCCB mandate, Directive #58, creates “an obligation to provide patients....medically assisted nutrition and hydration” in all instances except when a patient is actively dying. This instruction replaces the former Directive 58, which merely established a “presumption” in favor of tube feeding, to be overcome when the burden was deemed to outweigh the benefit. But Catholic facilities and providers are now obliged to insert and maintain feeding tubes in all patients who are and will be kept alive by artificial nutrition. Examples include those with severe advanced dementia, permanent unconsciousness and persistent vegetative state.

The revised Directive fails to respect settled law that empowers patients with the right to refuse or direct the withdrawal of life prolonging care, including artificial nutrition and hydration. The United States Supreme Court in the case of Nancy Cruzan recognized that such a choice is a fundamental liberty guaranteed by the US Constitution. State courts have reached the same conclusion based on State constitutional law and common law.

The Bishops have demonstrated no interest in patient choices that conflict with their directives.

In the summer of 2000, Archbishop Justin Rigali of St. Louis forced Steven G. Becker to leave a Catholic hospital in St. Louis and go home to die. Rigali overruled a decision to remove a feeding tube that had been approved by a court decision, advised by the hospital’s ethics committee and requested by Becker’s wife Christie, in keeping with her husband’s wishes. Rigali is now chairman of the Bishops’ Committee on Pro-life Activities and participated in crafting the
newly adopted language in Directive 58.
Rigali intervenes: feeding tube must stay, by Pamela Schaeffer, National Catholic Reporter, Oct 20, 2000

“One solution to the issue was offered by John Haas, president of the National Catholic Bioethics Center and consultant to the U.S. bishop’s Committee on Pro-Life Activities, which helped draft the new directive along with other groups. He said that if attempts to resolve a conflict over a feeding tube by talking through the issue failed, the patient or their legal guardian are free to seek care elsewhere.”
Caught in the middle, End-of-life care at issue with new Catholic directives, by Joe Carlson, Modern Healthcare, November 23, 2009.

“And, if she doesn’t like the way Catholics do health care, go somewhere else. It’s a free country and there are no guards at the hospital doors. And, if there is no other hospital to go to, start one."
Intellectual Idiocy #2, Opinion by Catholic commentator Michael Sean Winters, America, The National Catholic Weekly.

“Father Thomas G. Weinandy, executive director for the Secretariat of Doctrine at the [United States Conference of Catholic Bishops], says the position of the Catholic Church and therefore the imperative for Catholic hospitals, is clearly outlined in the recently updated directive. ‘If a patient or person comes to a Catholic hospital and has and advance directive [stating] that if they are diagnosed with being in a permanent vegetative state, that even if they could live indefinitely with nutrition and hydration that they would want the nutrition and hydration to cease, then that advance directive could not be honored in a Catholic hospital because that would be seen as participating in passive euthanasia,’ says Father Weinandy, ‘A person could live if this were done, and the very fact that they don’t want it done is because they want to die.’… “Whoever was speaking on behalf of the hospital would tell [the patient’s representative] what the Catholic Church’s teaching is and why it holds to that,’ he says. ‘If they want that [patient’s] directive followed, they’d need to move them to another health care facility where the directive would be followed.’”
Catholic clergy, hospitals torn over new church directives,” The Sunday Paper, Dec. 20, 2009

“What specifically then does this revision mean and what conclusions can we draw from it?...This teaching extends beyond the specific case of persons in PVS to include any patient suffering a pathology that makes them unable to assimilate food and water without artificial assistance, such as advanced Alzheimer's disease or acute dementia….Determining if and when ANH can be removed will often require responsible parties, especially those designated as healthcare proxies for their incapacitated loved ones, to consult with care-givers, other family members, the attending physicians and a priest or ethicist trained in the Church’s moral teaching on these matters.” The Westchester Institute for Ethics and the Human Person commentary, Catholic Teaching on Assisted Nutrition and Hydration (Jan. 26, 2010), (emphasis added).

“In essence, the new language makes it morally obligatory, barring medical complications, to provide medically assisted nutrition and hydration to patients in a persistent vegetative state, such as Terri Schiavo. This appears to mean that in many cases advance directives from patients, instructing caregivers in Catholic facilities to discontinue artificial nutrition and hydration when there is no hope of recovery from a catastrophic neurological injury, will no longer be honored.” Commonweal Magazine editorial (11/2009)

“Catholic health care facilities have an obligation to review their protocols concerning the provision of food and water to those who have suffered a serious cognitive diminution….Catholic facilities should be aware that general medical practice is not necessarily following Church teaching in this area, and so they should be prepared to distinguish their own practice from the growing tendency to deprive certain patients, especially the elderly, of the basic necessities to sustain life. Catholic health care facilities will also need to reevaluate patient requests, whether oral or written, that they be deprived of food and water in the event that they fall into an unconscious state from which they may not recover. The return of records and transfer of patients may be necessary in such cases.”
National Catholic Bioethics Center commentary, The Revision of Directive 58 of Ethical and Religious Directive for Catholic Health Services (12/2009), (emphasis added).

“If at any time the wishes of the patient, directly expressed or expressed through and advance directive or a patient’s surrogate decision maker are inconsistent with the Reds, an explanation will be provided by the Agency as to why these wishes cannot be honored (n. 24). In such circumstances, if agreement cannot be reached between this Agency and the decision maker, this Agency reserves the right to transfer the patient to an agency to which the decision maker has arranged transfer, consistent with local laws governing such transfers.”
Model Policy Concerning the Care to Patients at Life’s End for Catholic Health Care Agencies (August 2008)   

“The U.S. Conference of Catholic Bishops issued the directive Nov. 17 to the more than 1,000 church-affiliated hospitals and nursing homes in the United States and to all Catholic doctors and nurses….the bishops’ language appears to
conflict with a hospital’s legal duty to follow a patient’s instructions to withdraw life support, as expressed in an advance written directive or by a close relative or friend who knows the patient’s intentions….a hospital will send a patient elsewhere rather than violate his or her expressed wishes, [Catholic hospital] organizations said….’In some instances, this might include the transfer of the patient to another facility,’ the [Catholic Health Association of the United States] said.”
New Catholic mandate on comatose patients, San Francisco Chronicle, Jan. 3, 2010

“Rigali intervenes: feeding tube must stay: Man leaves Catholic hospital to die
“Archbishop Justin Rigali of St. Louis has barred removing a feeding tube from a man in a persistent vegetative state, forcing a Catholic hospital to alter its usual practice. Rigali's stance handed a victory to anti-euthanasia groups picketing the hospital, but evoked dismay from prominent ethicists who say the intervention violates sound Catholic medical ethics. Specifically, Rigali required that artificially administered food and water be given Steven G. Becker as long as he remained in a Catholic hospital. Becker, 29, removed Oct. 5 from St. John's Mercy Medical Center in St. Louis, died Oct. 10 at home.”
National Catholic Reporter, Oct 20, 2000 by Pamela Schaeffer

Catholic health care systems and facilities provide services in all 50 states. Services encompass acute care, skilled nursing, hospice, home health,assisted living and senior housing. Catholic institutions include: