Suffering With Joy

Finally, a Tighter Directive from Catholic Bishops on End-of-Life Care

January 4, 2010

The San Francisco Chronicle wrote its usual one-sided whine in covering a November 17th mandate from the United States Conference of Catholic Bishops to provide nutrition, hydration, and medication to patients who are in a “presumably irreversible conditions … who can reasonably be expected to live indefinitely if given such care.”

The bishops voted to revise the guide,  Ethical and Religious Directives for Catholic Health Care Services, at their November general assembly in Baltimore.  The bishops’ previous guide predated Pope John Paul II’s 2004 address to the International Congress on “Life- Sustaining Treatments and Vegetative State: Scientific Advances and Ethical Dilemmas” and the August 2007 Responses to Certain Questions of the United States Conference of Catholic Bishops Concerning Artificial Nutrition and Hydration issued by the Congregation of the Doctrine of the Faith.

All Catholic health care institutions and workers have been notified of the new mandate.  Whether any will attempt to get around it remains to be seen, but predictably, Barbara Coombs Lee, president of Compassion & Choices, which advocates for the right of terminally ill patients to make life-or-death decisions is making false accusations about the mandate without, apparently, having read it.  She claims that these directives are in conflict with legal instructions from patients or their families and will apply to everyone.  The answer to the first is “Maybe”, to the second, “No.” The work-around stated as hospital policy, that someone or their surrogate who insists on starving and dehydrating the patient to death will be moved to another institution is not acceptable. Not surprising from someone who is in the business of killing.

However, Lori Dangberg, spokeswoman for the Alliance of Catholic Health Care, which represents California’s 55 Catholic hospitals made a disturbing statement.  She is quoted in the article as saying that if a situation was unresolvable, the hospitals would find some other way to accommodate the person.  How do you find a moral way of accommodating a person who wants to commit suicide or a family that wants to murder a member?  What about the fifth commandment do people not understand?

The bishops wrote:

The moral teachings that we profess here flow principally from the natural law, understood in the light of the revelation Christ has entrusted to his Church. From this source the Church has derived its understanding of the nature of the human person, of human acts, and of the goals that shape human activity…

28. Each person or the person’s surrogate should have access to medical and moral information and counseling so as to be able to form his or her conscience. The free and informed health care decision of the person or the person’s surrogate is to be followed so long as it does not contradict Catholic principles…

The Church’s teaching authority has addressed the moral issues concerning medically assisted nutrition and hydration. We are guided on this issue by Catholic teaching against euthanasia, which is “an action or an omission which of itself or by intention causes death, in order that all suffering may in this way be eliminated.”[38] While medically assisted nutrition and hydration are not morally obligatory in certain cases, these forms of basic care should in principle be provided to all patients who need them, including patients diagnosed as being in a “persistent vegetative state” (PVS), because even the most severely debilitated and helpless patient retains the full dignity of a human person and must receive ordinary and proportionate care…

58. In principle, 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 and presumably irreversible conditions (e.g., the “persistent vegetative state”) who can reasonably be expected to live indefinitely if given such care.40 Medically assisted nutrition and hydration become morally optional when they cannot reasonably be expected to prolong life or when they would be “excessively burdensome for the patient or [would] cause significant physical discomfort, for example resulting from complications in the use of the means employed.”[41] For instance, as a patient draws close to inevitable death from an underlying progressive and fatal condition, certain measures to provide nutrition and hydration may become excessively burdensome and therefore not obligatory in light of their very limited ability to prolong life or provide comfort.

59. The free and informed judgment made by a competent adult patient concerning the use or withdrawal of life-sustaining procedures should always be respected and normally complied with, unless it is contrary to Catholic moral teaching.

37. See Declaration on Euthanasia.
38. Ibid., Part II.

40. See Pope John Paul II, Address to the Participants in the International Congress on “Life-Sustaining Treatments and Vegetative State: Scientific Advances and Ethical Dilemmas” (March 20, 2004), no. 4, where he emphasized that “the administration of water and food, even when provided by artificial means, always represents a natural means of preserving life, not a medical act.” See also Congregation for the Doctrine of the Faith, “Responses to Certain Questions of the United States Conference of Catholic Bishops Concerning Artificial Nutrition and Hydration” (August 1, 2007).

41. Congregation for the Doctrine of the Faith, Commentary on “Responses to Certain Questions of the United States Conference of Catholic Bishops Concerning Artificial Nutrition and Hydration.”

The new mandate is a much better document, emphasizing the importance of a properly formed conscience, compassionate about families faced with tough decisions, and clear on Catholic moral teaching. However, a key piece to the puzzle concerning implementation is the elephant in the living room: lack of catechesis on end-of-life issues at the parish and diocesan level.  Some Catholics are very fortunate to have bishops who are vocal about pro-life issues and publish steady, authentic teaching in their diocesan media.  But the priest has to stand up in the pulpit and tell the entire congregation what the Church teaches and why on these issues and do it often because of the pro-death atmosphere we breathe every day.

Support at the parish level for families in troubling circumstances is also a necessity.  Everywhere we must have a loving and caring approach to help people realize that what seems to be the greatest calamity is instead a gift from God and murder has no place in the heart of the Christian.

The Chronicle’s so-called journalism contained no quotes from Catholic medical personnel nor Catholic institutions who view this mandate as a boon and why.  Nor did they present any quotes from pastors who support the mandate and how the mandate helps people deal more peacefully with end-of-life decisions. Clearly, from the article, it appears that this is another “bash the big, bad bishops” slant.

Click on the links provided above to read the article and to read the bishops’ document.  You can order the document from the USCCB publications page on line.

Please join me in my nine month rosary novena for our country and conversion of those who are pro-death.

Tags: Catholic bishops, conversion, end-of-life, pro-life, rosary

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