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Artificial Nutrition and Hydration in Catholic Healthcare: Balancing Tradition, Recent Teaching, and Law

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Abstract

Roman Catholics have a long tradition of evaluating medical treatment at the end of life to determine if proposed interventions are proportionate and morally obligatory or disproportionate and morally optional. There has been significant debate within the Catholic community about whether artificially delivered nutrition and hydration can be appreciated as a medical intervention that may be optional in some situations, or if it should be treated as essentially obligatory in all circumstances. Recent statements from the teaching authority of the church have attempted to clarify this issue, especially for those with a condition known as the persistent vegetative state. I argue that these recent teachings constitute a “general norm” whereby artificial nutrition and hydration are considered obligatory for most patients, but that these documents allow for exception in cases of complication from the means used to deliver nutrition and hydration, progressive illness, or clear refusal of such treatment by patients. While the recent clarifications do not constitute a major deviation from traditional understanding and will rarely conflict with advance directives or legal statutes, there may be rare instances in which remaining faithful to church teaching may conflict with legally enshrined patient prerogatives. Using the Texas Advance Directives Act as an example, I propose ways in which ethics committees can remain faithful to their Roman Catholic identity while respecting patient autonomy and state law pertaining to end of life health care.

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Notes

  1. Catechism of the Catholic Church p. 424 states: “The dignity of the human person is rooted in his creation in the image and likeness of God…”.

  2. Again the Catechism of the Catholic Church p. 69 remarks: “The ultimate end of the whole divine economy is the entry of God’s creatures in the perfect unity of the Blessed Trinity.” See also p. 45: “Faith makes us taste in advance the light of the beatific vision, the goal of our journey here below. Then we shall see God ‘face to face,’ ‘as he is.’”

  3. Ethical and Religious Directives for Catholic Health Care Services, part 5.

  4. The authors reviewed the medical literature from 1966 to 1999 finding no evidence that tube feeding in patients with advanced dementia prolonged survival or prevented aspiration pneumonia. In addition there were some studies suggesting worse survival with tube feeding along with significant mortality from the procedures required to place a feeding tube.

  5. The term “persistent vegetative state” was first used in 1972 to describe patients who, following severe brain injury, evolved into a state with apparent sleep–wake cycles, but no evidence of cerebral cortical function. The multi-society task force was formed in 1991 to create a summary of clinical and prognostic factors. According to the task force “The distinguishing feature of the vegetative state is an irregular but cyclic state of circadian sleeping and waking unaccompanied by any behaviorally detectable expression of self-awareness, specific recognition of external stimuli, or consistent evidence of attention or intention or learned responses.”

  6. The task force found that the average life expectancy was 2–5 years with only rare patients surviving beyond 10 years.

  7. The task force reported on one study of 434 patients with traumatic brain injury in which only 7 of the 434 patients recovered consciousness after 12 months, and one recovered consciousness 30 months after the injury but was severely disabled.

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Zientek, D.M. Artificial Nutrition and Hydration in Catholic Healthcare: Balancing Tradition, Recent Teaching, and Law. HEC Forum 25, 145–159 (2013). https://doi.org/10.1007/s10730-013-9214-4

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