The US Conference of Catholic Bishops (USCCB), as I have written, recently mandated tube-feeding for all permanently unconscious patients in Catholic healthcare institutions. This contradicts the desires of the vast majority of Americans. The Bishops are indifferent and have decided to act as agents of the Vatican, even as they exercise enormous control over healthcare choices in America. How did they arrive at this position of arrogance?
The story of how one pope's opinion came to control Catholic healthcare throughout America is both fascinating and scary. It is the story of debate squashed, and profound authoritarianism prevailing. It ends with absolute obedience to the dictates of Rome by Catholic medical providers who vow to impose the pope's dictates on Catholic and non-Catholic patients alike, even though they personally disagree with the edict.
For decades after feeding tubes became commonplace, the ethics of Catholic healthcare institutions maintained a generous and merciful position toward their use. Their position rested on a principle that one must employ ordinary means to prolong life but may forgo extraordinary means in the same circumstance.
Professor of religion and social ethics Thomas Shannon wrote:
..the common Catholic tradition has sought to determine what benefits an intervention would provide and whether the burdens of intervention are proportionate or disproportionate to the expected benefits.
In this view, the use of a feeding tube is evaluated considering a patient's individual views on the quality of life, burdensome medical treatment and what constitutes a faithful and devout relationship with God. Many Catholics were comfortable with the common tradition, and many Catholic ethicists are comfortable allowing families to give weight to their loved ones' aversion to living in a state of suspended animation for years or decades.
Extreme pro-life Catholics, however, argued that food and water, even artificially administered, are ordinary and basic, and sustaining life itself of any quality is fundamentally beneficial. Pope John Paul II fostered the ascendancy of the pro-life movement within the Church.
Prompted by The Terri Schiavo case, the Pope sided with the picketers outside Ms. Schiavo's hospice room, declaring that tube-feeding patients in a permanent vegetative state "always represents a natural means of preserving life, not a medical act" and should "be considered, in principle, ordinary and proportionate."
Did the pope's guidelines allow for the patient's view of benefits and burdens? Some ethicists still thought yes, but a September, 2007 response from the Congregation for the Doctrine of the Faith (CDF, formerly called the Office of the Inquisition), said:
"No. A patient in a 'permanent vegetative state' is a person with fundamental human dignity and must, therefore, receive ordinary and proportionate care which includes, in principle, the administration of water and food even by artificial means."
Even then some Catholic bioethicists like John Hardt looked for personal choice in the CDF's use of the phrase, "in principle." But in November, the Bishops closed the door: feeding tubes are obligatory.
Why did the bishops make a nationwide rule at odds with the beliefs of many devout Catholics, with a tradition of weighing benefits and burdens on an individual basis, and with established medical practice at most Catholic institutions? My own opinion is the Vatican and the Bishops turned to serious enforcement to impose their dogma precisely because Catholic patients and practitioners were not following their extreme pro-life doctrine in private medical decisions.
My friend Dan Maguire, Professor of Moral Theology at Marquette University, has said:
"In Catholicism there are three sources of truth (or magisteria): the hierarchy, the theologians, and the wisdom and experience of the laity (called in Latin sensus fidelium)."
Like a three-legged stool, multiple sources of wisdom have maintained the stability of Catholic wisdom. In the feeding tube decision, I believe the honest observer would see a one-legged stool making all the decisions, and a clear victory for the hardliners.
The moderates have lost the debate, and so have we. The Vatican has cut off the two offending legs of the stool and nullified ethical consideration of individual weighing of burdens and benefits.Cardinal Rigali, chair of the Committee on Pro-Life Activities and Bishop Lori, chair of the USCCB Committee on Doctrine, in stern tones, announced as much:
"Even if one judges that such a condition, when prolonged, makes survival itself a burden, such a judgment does not justify removing food and water ..."
Codification of the Vatican's ruling in the Ethical and Religious Directives ties the hands of Catholic patients and families, faithful physicians, nurses and caregivers and impacts everyone under care in a Catholic healthcare institution. We must increase public awareness of the threats to their rights in Catholic institutions and take steps to stop the Vatican from unilaterally ignoring legally executed advance directives. There can be no further dissent from within the Church. Daniel Sulmasy, a Franciscan Brother, internist and ethicist at St. Vincent's hospital in New York, sympathizes with people of deep faith who do not wish to offend God, but nevertheless are horrified at the prospect of years, or even decades, lingering in a state of mere existence, without the ability to think, feel, pray, or relate to loved ones. Fr. Sulmasy said the restrictive rule would be difficult to follow, though as "an obedient friar and physician" he would do so.
Consumers of Catholic healthcare, don't say you weren't warned.