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Feedings Tubes For All --- The Bishops Know What's Best for You

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The enforcement arm of the Catholic Church has ordered feeding tubes to be inserted in all comatose and vegetative patients in Catholic institutions and maintained indefinitely. Compassion & Choices has warned of the impact this will have on your healthcare choices. I want to make clear the sources of the outrage I expressed in my last blog.

For years I have been well-acquainted with the Ethical and Religious Directives for Catholic Health Care Services (ERD's). But the Bishops' recent action prompted me to review the document again, and its arrogant presumption of moral superiority struck me anew.

I understand the history and spirit of sectarian health care, and I feel open and accepting of its role in America. In the 1970's I practiced as a physician assistant in a Seventh Day Adventist healthcare system and I delivered both my children in its hospital. I truly appreciated the staff's attitude of spiritual calling and the prayers they offered for my safety and my babies'. True, those awful soy patties from cans almost turned me away from vegetarianism for life. But it seemed to me the Adventists ranked service and humility ahead of doctrine and I never saw their religion dominate a conversation or a medical decision.

The ERD's are different. They are all about dominance. Four aspects are especially chilling in their authoritarian pronouncement.

First, the Bishops explicitly target everyone, of every faith, with the "revealed truth" reflected in their ERD's. The document specifically directs its mandates beyond hospital employees and Catholics, to every patient, resident or recipient of Catholic services. Everyone --- Buddhist, Muslim, Jewish, Protestant or Unitarian --- must obey.

Second, the Bishops may acknowledge a pluralistic society where various spiritual disciplines lead to different moral conclusions, but they do not hesitate to over-ride them. Your conscience and religious beliefs just don't count because, according to the ERD's, "...Catholic health care does not offend the rights of individual conscience by refusing to provide or permit medical procedures that are judged morally wrong by the teaching authority of the [Catholic] Church." Well, those who believe artificial maintenance of an insensate body degrades God's gift of life might disagree. They might well think insertion of a feeding tube against their will does offend their right of conscience.

Third, doctrine always trumps individual decision-making. Dealing with advance directives, ERD's specify that hospitals "will not honor an advance directive that is contrary to Catholic teaching." So, too, "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." They'll honor your decision --- but only if they agree with it.

Fourth, many find shocking the exaltation of suffering as "participation in the redemptive power of Christ's passion." And few non-Catholics find comfort in Directive #61. There we find that dying patients "experiencing suffering that cannot be alleviated should be helped to appreciate the Christian understanding of redemptive suffering." Apparently the nurses are to deliver a theology lesson to patients dying in agony.

The ERD's demonstrate that one purpose of Catholic health care is to coerce people of all faiths into following Catholic moral teachings. Employers facilitate the coercion when the only health plan they offer is Catholic. States facilitate the coercion when they approve hospital mergers rendering large geographic areas devoid of any but Catholic health care. Insurers facilitate the coercion when they fail to offer a broad choice of providers within their coverage.

My sense is the feeding tube mandate finally crossed a line, where states, employers, and insurers will no longer be willing to participate in the coercion. Personal dignity, individual right of conscience and autonomy in healthcare decisions are too important to continue to pretend Catholic healthcare is not prejudicial and discriminatory against non-Catholics.