US hospitals in dilemma over vegetative patients
Pope John Paul II's insistence that health care providers are morally obliged to continue to give water and food to patients in a persistent vegetative state (PVS) has left the United States' vast Church-run health sector uncertain how to proceed.
The Tablet reports that PVS patients are normally fed by tube into the stomach or through the nose. They are awake but not apparently aware of themselves or their environment. Their brains are badly damaged but their brain stems maintain breathing functions.
The Pope's statement on 20 March to an international meeting of doctors and ethicists at the Vatican made clear that "the administration of water and food, even when provided by artificial means, always represents a natural means of preserving life, not a medical act."
Its use should therefore be considered "in principle, ordinary and proportionate and, as such, morally obligatory." Denying such care to a PVS patient, the Pope concluded, was "euthanasia by omission".
That view contradicts the policy followed by Catholic hospitals in the US, which consider feeding tubes to be medical care that may be withdrawn when the burdens of a particular treatment are deemed to outweigh the benefit to the patient. This is the view upheld by the US Supreme Court.
A spokesman for the US bishops' Secretariat for Pro-Life Activities said the "theological stakes have now been raised" over the question. "To have the Pope speak on this and speak his mind is something people on both sides of the question have been waiting for for years," said Richard Doerflinger, adding that it was not clear how it would affect Catholic hospitals. "It does not remove practical judgements about whether a feeding tube in an individual case is doing more harm than good," he said.
Dr Charles Daschbach, academic director at St Joseph's Hospital in Phoenix, Arizona, said there were about 10,000 PVS patients at any one time in American hospitals. St Joseph's decided how to care for its small number of PVS patients according to the requirements of each one, he told the Arizona Republic.
The Tablet says Catholic health providers will now look for directives from the US Conference of Catholic Bishops (USCCB), which in 1992 favoured continuing to feed PVS patients but left the final decision to patients' families and doctors. Cardinal William Keeler, the Archbishop of Baltimore, last week said it could be some time before the directives were revised. "We are waiting for an analysis from our moral theologians, who will look at every angle," he said.
The Catholic Health Association, which oversees America's 624 Church-run hospitals, said the Pope had reminded people of the responsibility not to abandon the sick and the dying. But the current directives for Catholic hospitals would remain in place until the "significant ethical, legal, clinical and pastoral implications" of the Pope's statement had been carefully considered, the association said last week.
The Pope's comments were made at the end of a four-day conference in Rome organised by the Catholic Medical Association and the Vatican's Academy of Life. Fr Norman Ford, of the Caroline Chisholm Centre for Health Ethics in Melbourne argued at the conference that PVS patients lacked the instinct to eat or drink, and experienced loss of appetite. To administer food and water to PVS patients "shows a lack of respect for them," he argued. But afterwards he told The Tablet: "I accept the teaching given by the Pope in his speech to congress participants."
US hospitals in dilemma over PVS patients (The Tablet 10/4/04)
Experts say pope's speech on feeding tubes settles some key issues (Catholic News Service 7/4/04)
Australian bioethicists debate letting life end (CathNews 30/3/04)
Vegetative State Conference website
Looking to Explain Suffering (Zenit 28/3/04)
Pope calls removing feeding tubes immoral (CathNews 22/3/04)
Pope speaks up for coma patients (Daily Telegraph 21/3/04)
Pope decries care shutdowns (Boston Globe/Associated Press 21/3/04)
Major palliative care conference at the Vatican (CathNews 17/3/04)
International congress on vegetative state (Vatican Information Service 16/3/04)
Pontifical Academy for Life
13 Apr 2004