End-of-Life Choice, Palliative Care and Counseling

Council of Catholic Bishops Veto Millions of Advance Directivesby Blaine

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Catholic Health Care Facilities to Ignore Advance Directives,
Patients will be Force-Fed Against their Will

The United States Council of Catholic Bishops has ordered Catholic healthcare institutions to veto the Advance Directive wishes of millions of Americans on the refusal of tube feeding if they were to become permanently unconscious. Compassion & Choices, the nation’s oldest and largest nonprofit working for end-of-life care and choice, sharply criticized the action as an imposition of dogma over the desires and dignity of patients and families. Polls show that at least three-quarters of Americans report they would not want to be kept alive artificially if they were in a persistent vegetative state. Most people who fill out advance directives indicate they do not want artificial feeding if they become permanently unconscious.

But the revised “Ethical and Religious Directives for Catholic Health Care Services” (ERD) decrees those wishes will not be honored at the 565 Catholic hospitals across the nation, by Catholic HMO’s and health care plans and by millions of nurses, doctors and hospital workers who must follow the bishops’ lead.

“The impact is enormous, for Catholics and non-Catholics alike,” said Barbara Coombs Lee, president of Compassion & Choices. “The USCCB order runs counter to written instructions in hundreds of thousands of Advance Directives and the clear wishes of many individuals with no written document. The primary consideration in healthcare decisions should always be the individual’s values, beliefs and desires, not fixed doctrine of any one religion. We respect the beliefs of all Catholics, but we do not respect an attempt by Catholic Bishops to override the health care decisions of a majority of Americans. This Directive could bring an equivalent of Terri Schiavo’s tragedy to 300,000 families each year.”

Catholic healthcare institutions must abide by a set of rules called “Ethical and Religious Directives, written by the US Bishops. Meeting in Baltimore, the bishops yesterday overwhelmingly approved a revision to the directives with a specific reference to the “persistent vegetative state” that afflicted Terri Schiavo. Removing all flexibility to respect the wishes of a patient or family, the revised directive creates “an obligation to provide patients . . . medically assisted nutrition and hydration” in all instances except when a patient is actively dying. Thus, Catholic hospitals and nursing homes are now obliged to insert and maintain feeding tubes in all patients with severe advanced dementia, permanent unconsciousness and persistent vegetative state.

An estimated 10,000 to 25,000 U.S. adults are in persistent vegetative states (PVS), according to the Multi-society Task Force on the Persistent Vegetative State. Every year, 300,000 feeding tubes are inserted, usually in patients with PVS, advanced Alzheimer’s disease, and permanent unconsciousness from other causes, such as strokes. Decisions must be made to withhold them, withdraw them, or retain them indefinitely. The prior version of the ERD suggested a “presumption in favor” of feeding tubes, balanced against the burdens to the patient. That balancing allowed doctors to give weight to a patient’s previously stated wishes and reports from family of what the patient would want. The new guidelines allow no consideration of the burden to the patient or the testimony of the family.

“When a healthcare institution adopts a conscience provision that effectively invalidates the advance directives of millions of Americans, it calls into question whether federal dollars are funding religious discrimination against Americans who do not share the Catholic view of end-of-life decisions,” said Barbara Coombs Lee, President of Compassion & Choices.

The revision to the ERD reads, “As a general rule, 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 conditions (e.g., the ‘persistent vegetative state’) who can reasonably be expected to live indefinitely if given such care.”

Compassion & Choices is a nonprofit organization working to improve care and expand choice at the end of life. We support, educate and advocate.