End-of-Life Choice, Palliative Care and Counseling

Posts Taggedartificial nutrition

Media Shine Light on New Mandate from Bishops

We have been spreading the word since the US Council of Catholic Bishops (USCCB) adopted new rules in November, obligating feeding tubes for permanently unconscious patients in Catholic healthcare facilities. David Dayen at firedoglake and Ann Neumann at otherspoon have reported the story. Now traditional media sources are picking up the story.

On December 20th, Charles Stanley of Atlanta’s Sunday Paper reported on the new directive, its potential conflict with patients’ stated wishes, and the potential legal conflicts.

In yesterday’s San Francisco Chronicle, Bob Egelko reports on the new mandate’s impact on Bay Area Catholic care facilities and the families who could face unexpected challenges in making decisions about care for a loved one.

The directive plunges the bishops into another health care controversy, on the heels of their lobbying for tight restrictions on abortion coverage in health legislation pending in Congress.

Catholic hospital officials say the November decree isn’t rigid and leaves room for accommodating patients’ wishes. But 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.

Courts have ordered hospitals to disconnect feeding tubes when an unconscious patient’s wishes were clearly established. The best-known case involved Terri Schiavo, the Florida woman who died in 2005 after 15 years in a coma and unsuccessful attempts by her parents and Republicans in Congress to keep her alive.

The bishops’ order “fails to respect settled law that empowers patients with the right to refuse or direct the withdrawal of life-prolonging care,” said Barbara Coombs Lee, president of Compassion & Choices, which advocates for the right of terminally ill patients to make life-or-death decisions.

“It will apply irrespective of your religious faith, your stated wishes in an advance directive, or the instructions of your family.”

That’s not how the bishops’ decree will be carried out, Catholic hospital organizations insist.

The decree itself does not require life-sustaining care that would be “excessively burdensome for the patient” or would cause “significant physical discomfort.” If those exemptions don’t apply, a hospital will send a patient elsewhere rather than violate his or her expressed wishes, the organizations said.

“If it was unresolvable … we would transfer them or find some other means to accommodate them,” said Lori Dangberg, spokeswoman for the Alliance of Catholic Health Care, which represents California’s 55 Catholic hospitals.

There you go. “the November decree isn’t rigid and leaves room for accommodating patients’ wishes.” Because you can do what the Bishops tell you to do, or go somewhere else.

You can read the full San Francisco Chronicle article here.

The Long Shadow of the Bishops

Do you remember where you were on November 17th when you heard about the vote to change healthcare delivery throughout America?

Chances are, you don’t remember because you didn’t hear the news – that day or any day since. It has been little reported in the media. But Compassion & Choices understands what this will mean for your healthcare choices. And the impact of the decision is greater than you can imagine.

I’m not talking about anything that happened in Washington, D.C., but in nearby Baltimore, where 500 Bishops voted to order Catholic institutions to require feeding tubes for all permanently unconscious patients, regardless of their advance directive instructions or family wishes.

The vote by the United States Council of Catholic Bishops (USCCB), directed a change in its “Ethical and Religious Directives for Catholic Healthcare Services,”  and I have written about the authoritarian nature of these Directives – on Catholics and non-Catholics alike.

The new language in Directive #58, creates “an obligation to provide patients . . . medically assisted nutrition and hydration” in all instances except when a patient is actively dying.

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 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. But 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.

Modern Healthcare reports,

“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.”

And Catholic commentator Michael Sean Winters writes in America, The National Catholic Weekly,

“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.”

This is the scope of the bishops’ order:
•    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:

•    624 Roman Catholic-affiliated hospitals.
•    499 nursing homes.
•    48 Catholic Health Maintenance Organizations (HMOs).

•    Catholic hospitals employ 525,193 full-time employees and 233,934 part-time workers.
•    More than 5.5 million patients were admitted to Catholic hospitals during a one-year period.
•    8 of the top 13 non-profit hospital systems in the country are Catholic health systems.
•    The Directive conflicts with all advance directives that decline artificial nutrition and hydration in the setting of permanent unconsciousness or advanced dementia.
•    Catholic health care is especially concentrated in some states and communities. In certain areas, including many of the nation’s poorest, it’s the only option.

•    Over 30% of patients in Washington, South Dakota, Iowa and Alaska are in Catholic hospitals, which are now unable to honor advance directives that decline tube feeding.
•    Catholic institutions provide more than 20% of care in Oregon, Montana, Connecticut, Colorado, Wisconsin, Michigan, Minnesota, Kansas, Oklahoma, Missouri, Arkansas, Illinois, Indiana, Ohio, Nebraska, Idaho, and, North Dakota.

and the population the Bishops’ Directive will impact:

• About 300,000 people receive feeding tubes each year. Roughly 75% are 65 years or older.
74% of Americans believe close family members should be the ones to decide medical treatment for a family member who cannot communicate his or her own wishes.

Apologists for the Bishops like to talk of the charitable nature of Catholic institutions, but taxpayers pay for health care to conform with USCCB Directives:

• Religiously sponsored hospitals in the United States bill the government more than $40 billion a year, while using religious doctrine to restrict medical care.
• In order to obtain public funding and still place its religious beliefs above the medical needs and individual conscience rights of its patients, Catholic and other sectarian health care providers have sought and obtained special government accommodations that have permitted these institutions to refuse to provide services they deem morally objectionable, while remaining eligible for public funding.
• Combined Medicare and Medicaid payments accounted for half the gross patient revenues of religiously sponsored hospitals in 1998. The other half came almost entirely from insurance companies and third party payers, not from churches or other religious sources.
500 Bishops voted November 17th to overrule the advance directives of millions of Americans and almost no one reported it. Compassion & Choices is spreading the word, and will keep you up to date as the Bishops move to implement their latest Directive.