Undue Burden? the Vatican & Artificial Nutrition & Hydration: Consortium of Jesuit Bioethics Programs

Article excerpt

Most Americans know the case of Terri Schiavo, the Florida woman who suffered cardiac arrest and subsequently lived for years in a persistent vegetative state while moral, legal, and political wrangles over her care divided her family and roiled the nation.

The Schiavo case highlighted the medical practice of providing artificial nutrition and hydration (ANH) to patients who can no longer swallow food or eat sufficiently well to sustain health or life. In the process, it prompted concern among many Catholic bishops, both in the United States and the Vatican, that ANH might be withdrawn from patients with the intention either of euthanasia or of ending a life that some people deem unworthy of further medical care. In July 2007, seven directors of bioethics programs at Jesuit universities came together to form the Consortium of Jesuit Bioethics Programs, dedicated to informing and influencing medical-ethical debates within the Catholic Church and the larger society. As one of our first outreach tasks, our consortium decided to address the subject of ANH.

First, some background on recent and pending church teachings concerning artificial nutrition and hydration. In 2004, John Paul II delivered an allocution on the use of ANH for patients in a persistent vegetative state (PVS). We strongly affirm his stance that all of human life deserves respect, and that health-care workers should not unilaterally deny patients treatments based on their own judgments of quality of life. However, the pope's statement included some assertions that surprised many involved in health care. One was that ANH "always represents a natural means of preserving life, not a medical act," and thus should be considered "morally obligatory." The pope stated furthermore that "no evaluation of costs can outweigh the value of the fundamental good which we are trying to protect, that of human life," and added that "society must allot sufficient resources for the care of this sort of frailty."

Some theologians believe these statements represent a departure from long-standing Roman Catholic bioethical traditions. The current U.S. Conference of Catholic Bishops' Ethical and Religious Directives for Catholic Health Care Services (fourth edition, 2001)--which guide all Catholic-sponsored health care in the United States--state that "a person may forgo extraordinary or disproportionate means of preserving life," and define such means as "those that in the patient's judgment do not offer a reasonable hope of benefit or entail an excessive burden, or impose excessive expense on the family or the community." The bishops' directives would appear not to align with John Paul's 2004 allocution in two important ways. First is their insistence that the decision of whether a "means" or treatment is ordinary (and thus obligatory) or extraordinary (and not obligatory) is based on the patient's judgment of that treatment's benefits and burdens. In contrast, the papal allocution defines ANH as ordinary and obligatory--regardless of the patient's judgment. Second, the Ethical and Religious Directives state that such a judgment may take into consideration a treatment's financial burdens to the patient, the patient's family, or the community; the papal statement, on the other hand, seems to prohibit such considerations.

Subsequent statements by the Congregation for the Doctrine of the Faith (CDF) and the Vatican have seemed to uphold a stringent reading of the pope's statement. A Vatican commentary on the CDF's response listed just three conditions when ANH might not be morally obligatory: (1) when it would be impossible to provide; (2) when a patient may be unable to assimilate food and liquids; and (3) when ANH may be excessively burdensome for the patient or may cause significant physical discomfort, for example resulting from complications in the use of the means employed.

Catholics both within and without the health-care system are left with uncertainty about how to apply John Paul II's allocution. …