End-of-Life Choice, Palliative Care and Counseling

Catholic Bishops Lay Down the Law on Feeding Tubesby Barbara

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On November 17, 2009, with little fanfare, the United States Conference of Catholic Bishops issued a directive for Catholic health care that could bring distress and grief to hundreds of thousands of American families each year. Compassion & Choices wants you to know how this limits your healthcare choices.

“This won’t affect my family,” you may say to yourself. “We aren’t even Catholic.”

That doesn’t matter. Approximately 30% of Americans receive healthcare or reside in Catholic institutions, and this edict could affect any of them.

A little known but far reaching aspect of the Church’s organizational structure requires every hospital, nursing home, assisted living center, etc., with a Catholic charter to abide by a set of rules called “Ethical and Religious Directives for Catholic Health Care Services.” The 72 directives itemize exactly how the services you receive will conform to Catholic doctrine, as promulgated by the Holy See and enforced by its Congregation for the Doctrine of the Faith (formerly known as the Holy Office of the Inquisition.)

The Bishops’ latest change to Directive #58 says everyone who needs a feeding tube to stay alive must have one surgically implanted, and must keep it indefinitely. This will apply to anyone in a permanent coma from stroke or trauma, in persistent vegetative state or with advanced dementia, having lost the ability to eat along with other sentient activity. It will apply irrespective of your religious faith, your stated wishes in an advance directive, or the instructions of your family.

The Catholic Healthcare Association was quick to point out the new Directive does not apply to patients who are actively dying. But those are not the usual recipients of feeding tubes anyway. Rest assured, it applies in all situations where we most cherish our own authority to make healthcare decisions.

Catholic hospitals probably hoped this day would never come. The Bishops put them in a real bind. Ever since Pope Benedict XVI (Formerly Joseph Cardinal Ratzinger, Prefect of the Congregation for the Doctrine of the Faith) articulated this rule during the Terri Schiavo fiasco, hospital spokespeople have held tenaciously to a balancing rationale that allowed them to honor a person’s stated wishes in these matters. Last month the Bishops pointedly dismissed the “untenable positions” of “some Catholic ethicists” and made Benedict’s strict rule official and binding. Now hospitals and nursing homes have no choice but to enforce Catholic doctrine universally over patient wishes.

What had been Directive #58′s “presumption” in favor of feeding tubes is now an “obligation” and the language about balancing is gone. Pity the poor hospital administrators. As much as they may wish to honor the advance directives of patients and the heartfelt decisions of grieving families, the Church just won’t let them do that anymore.

I know a lot of readers are incredulous. “Surely,” you think, “no sane church would force hundreds of hospitals to systematically trump established principles of patient autonomy and force disruption, adversity and grief on families.” It seems unfeeling, unethical, and hardly good for business.

Well, think again, for when it comes to settled dogma, this church does not compromise.

Let me describe a precedent, and a clue to what lies ahead for families: For decades Catholic hospitals have subjected new mothers to unnecessary inconvenience, pain and surgical risk to enforce Directive #53, which forbids sterilization. Every doctor knows the safest, most convenient time to perform an elective tubal ligation is immediately following delivery of a baby. The uterus is high and fallopian tubes readily accessible. Yet women delivering in Catholic centers who request this simple operation must recover from delivery, then submit to a second hospitalization, a second anesthetic and surgical risk and the pain of a second procedure, at a non-Catholic institution. Not to mention the cost of the second operation, routinely borne either by insurers or tax payers — that is to say, all of us.

From the Bishops’ perspective, this is a small price to pay to maintain what they call “the distinctive Catholic identity of the Church’s …health care ministry.” Central to that ministry is imposition of the Church’s “moral teaching” on all its patients.

Many of us view Catholic hierarchy as having long ago squandered any moral authority they might once have had. Church officials cannot engage in conspiracies to hide crimes of sexual molestation and protect child abusers on one hand, and on the other, presume to dictate legitimate healthcare decisions. Certainly they have no authority over decisions as central to personal dignity as whether I will accept or reject medical feeding to keep my comatose body alive. The sanctimonious audacity of these Bishops simply takes my breath away.