Many of the nation's 600-plus Roman Catholic hospitals may have to rethink their standards for end-of-life care after Pope John Paul II said hospitals are morally obligated to continue artificial feeding and hydration for patients who are in a persistent vegetative state.
Speaking at a Vatican congress on life-sustaining treatments, the pope called removal of feeding tubes "euthanasia by omission." The pope said artificial feeding and hydration should be considered basic care for people in a vegetative state and that hospitals should continue providing the care.
"The guidance contained in his remarks has significant ethical, legal, clinical and pastoral implications," said the Rev. Michael Place, president and chief executive officer of the Catholic Health Association, which represents 624 hospitals. "This will require dialogue among sponsors, bishops and providers, especially with regard to practical implications for those patients who are not in a persistent vegetative state."
Catholic healthcare ethicists consider feeding tubes for vegetative patients to be medical treatment that can be provided or discontinued based on the patient's condition.
At Trinity Health, a Novi, Mich.-based Roman Catholic system that operates 45 hospitals, ethicists follow the Ethical and Religious Directives for Catholic Healthcare Services, which consider the patient's wishes when it comes to artificial feeding, said Gerry Heeley, director of ethics and mission at Trinity. The directives, a set of 72 principles that implement the moral teachings of the Catholic Church in healthcare, also take into account the patient's diagnosis when determining whether to continue feeding.
The English translation of the pope's directive was made public late last week and Heeley said it would take time to determine its impact. "It has got to be studied just to make sure there is proper understanding, especially in more than one culture," Heeley said. "You can't take it for face value without a critical analysis."
While healthcare leaders begin to discuss the pope's statement, Place said he anticipates that the ethical and religious directives will remain in effect.
Catholic Health Initiatives, which operates 68 hospitals, also will review the pope's guidance and discuss the issue among ethicists and its Catholic sponsor, said Joyce Ross, senior vice president of communications at the system.
"It is difficult for us to know what the impact will be on our hospitals and long-term-care facilities," Ross said. "We need to look at what this means."