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US Catholic hospitals to uphold living wills

Catholic hospitals are reassuring patients they'll honour living wills in the wake of a papal pronouncement that hospitals should never remove feeding tubes from patients in persistent vegetative states.

Pope John Paul II said last month that feeding and hydrating such patients is "morally obligatory" - and that withdrawing feeding tubes constitutes "euthanasia by omission". Since then, US bishops, theologians and ethicists have been studying the issue closely to see what the pope's words will mean for hospital operations in the United States.

For now, many hospitals are deferring to the "Ethical and Religious Directives for Catholic Health Care Services" - commonly called ERDs - outlined by the U.S. Conference on Catholic Bishops.

According to those guidelines, feeding tubes for people in chronically vegetative states are "medical treatment" that can be continued or halted based on the benefits and burdens for patient and family.

Such guidelines call for following directives set out in advance by people who do not want life-prolonging medical treatments - as long as the person's wishes don't conflict with Catholic moral teachings, including the church's ban on euthanasia.

The pope's remarks came during a Vatican symposium on caring for people who are incapacitated. They are significant but do not carry the weight of an encyclical - the Vatican's most authoritative level of teaching, reserved for matters of extreme importance to the church.

"We have to figure out more specifically what he meant and the implications. I think it's too soon to tell; there are a lot of filters to go through," said Dan Dwyer, director of ethics for the St. John's Health System in Springfield, Missouri.

The pope has consistently opposed euthanasia, defined by the Vatican as "an action or omission that by its nature and intention" causes death to end pain.

Many public and private hospitals have honoured living wills - written declarations by people who say in advance they don't want life-prolonging treatments - since the US Supreme Court ruled in 1990 that vegetative patients could be allowed to die if there was "clear and convincing" evidence that was their wish.

Catholic Hospitals to Uphold Living Wills (The Guardian/Associated Press 15/4/04)

Calls for euthanasia ignore real needs of dying and caregivers (NZ Catholic 18/4/04)
Ethical and Religious Directives for Catholic Health Care Services, (US Conference of Catholic Bishops)
Catholic Health Australia
US hospitals in dilemma over vegetative patients (CathNews 13/4/04)
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)
Pontifical Academy for Life

19 Apr 2004