updated 4/15/2004 3:56:29 PM ET 2004-04-15T19:56:29

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

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In a talk March 20, Pope John Paul II said that feeding and hydrating such patients is “morally obligatory” — and that withdrawing feeding tubes constitutes “euthanasia by omission.” Since then, American 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 Springfield, Mo.-based St. John’s Health System, which includes a half-dozen regional hospitals.

In noting that the health system would continue following the ERDs, Dwyer said “we don’t want to tell a physician not to practice medicine.”

“Our intention is to provide care and comfort, not to put someone to death quicker because they’re suffering,” he said. “If there’s a vague or gray zone, we always favor providing nutrition and hydration. It’s recognized as a very special form of care.”

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

Pope's comments have significant implications
In a statement, the chief of the St. Louis-based Catholic Health Association of the United States said the pope’s “recent allocution affirms the church and the Catholic health ministry’s abiding commitment to the inviolable dignity of human persons no matter their physical or medical condition.”

“It reminds us of our responsibility never to abandon the sick or dying,” said the Rev. Michael Place, the CHA’s president and chief executive.

Still, he said, the pope’s words have “significant ethical, legal, clinical, and pastoral implications that must be carefully considered,” requiring dialogue among bishops and health-care providers. Such guidance or clarification isn’t expected for months; until then, the CHA assumes the ERDs stay in effect.

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

In recent years, the issue had been stoked by the Florida right-to-die legal battle over Terri Schiavo, the severely brain-damaged woman whose husband wants to have her feeding tube removed against her parents’ wishes.

In a so-called vegetative state, patients are awake but not aware of themselves or their environment. The condition is different from a coma, in which the patient is neither awake nor aware. But both are states in which the patient is devoid of consciousness.

Statement 'not a threat to Catholic health care'
A vegetative state is considered persistent if it lasts more than a month. After a year, it is called permanent.

Providing food and water to such patients should be considered natural, ordinary and proportional care — not artificial medical intervention, the pope said.

“As such, it is morally obligatory” to continue such care, he said.

The pope said families of such ill people needed more emotional and economic support, so that they can better care for their loved ones.

Gerard Magill, executive director of Saint Louis University’s Center for Health Care Ethics and Health Sciences, cast the pope’s pronouncement as “a clarification, a helpful nuance, that is not a threat to Catholic health care.”

“There are people reading into the doomsday scenario, and I think they’re wrong,” he said. “Everything as we know it now would remain the same.”

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