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Examining the Bishops' Ethical and Religious Directives

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November 23, 2011

In November 2009, the U.S. bishops issued the fifth edition of their Ethical and Religious Directives for Catholic Health Care Services (ERDs).

The directives—first released in the 1980s—cover all aspects of Catholic health care: the social, pastoral and spiritual responsibility of Catholic health care providers; the professional-patient relationship; issues in care for the beginning of life and care for the seriously ill and dying; and the forming of partnerships with non-Catholic health care providers.

Although the traditional media gave the ERD revision little attention, Internet blogs began buzzing about the change in Directive 58, which incorporated the recent papal clarifications on providing patients with adequate nutrition and hydration—even if they were in a persistent vegetative state.     (After the jump...Related Articles & Resources)

In February 2010, the Kaiser Family Foundation issued an article entitled: “Catholic directive may thwart end-of-life wishes” and the ever-vigilant Compassion &Choices (pro-assisted suicide advocacy group) spokeswoman Barbara Combs Lee claimed that the bishops are trying to “guilt and shame” people.

Combs Lee also placed an advance care directive “addendum” on the Compassion & Choices website.  Entitled “My Directive Regarding Health care Institutions Refusing to Honor my Healthcare

Choices.”  The form contains a request to be transferred to a facility that will honor the wishes of the signatory—a facility which does have restrictions like the ERDs.

Responding to the misinformation circulating about the ERDs, Capuchin Father Thomas Weinandy, executive director of the U.S. bishops’ Committee on Doctrine, said in an interview with Our Sunday Visitor (April 11, 2010):  “What caused the change in the ERDs is the advance in medical technology.  Providing nutrition and hydration is much more readily available

and acceptable and easier to do than in the past; and so what changed was the medical technology, not the teaching of the Church.” (The article is here, but available only to OSV subscribers.)

Recognizing the general public’s confusion about the revised ERDs—and the false claims that doctors in Catholic hospitals would not honor advance directives or that doctors were mandated to always insert feeding tubes, the Alliance for Catholic Health Care, has prepared a comprehensive Q&A.   The Alliance, an association representing California’s Catholic Health Systems and Hospitals, said: “The advance directive of any patient in a Catholic hospital will be honored.  The obvious exception would be if a patient is requesting...treatment intended to kill the patient as opposed to relieve the patient’s suffering.  Furthermore, no patient...can be forced against his or will to have a feeding tube.”

The three page document explicating the revised ERDs can be found here:

The Catholic bishops of California host a website, Embracing Our Dying which has a uniquely Catholic perspective, offering a better way for individuals, families, and friends to approach end-of-life issues.  Available on the site are Church documents, articles by experts, and downloadable forms for advance directives and durable power of attorney.

Directive 58

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. 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.” 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.