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)."
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 ..."
Consumers of Catholic healthcare, don't say you weren't warned.
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" 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."