What Directive 58 means: What did the bishops actually say?

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What Directive 58 means: What did the bishops actually say?

Feb 15, 2010 (Chicago Tribune - McClatchy-Tribune News Service via COMTEX) --

Questions and answers about part of the "Ethical and Religious Directives for Catholic Health Care
Services."

Q: What did the bishops actually say?

A: This quote from Directive 58 gives the gist: "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.' "

Q: Is this an entirely new position?

A: An earlier version of the directive, published in 2001, spoke of a "presumption" in favor of giving food and water to patients in a vegetative state; the new version speaks of an "obligation" to do so and appears to extend to patients with other chronic conditions. Precedent for the position comes from a 2004 statement from Pope John Paul II and a 2007 statement from an important advisory group at the Vatican.

Q: What inspired the change?

A: Church leaders oppose assisted suicide and euthanasia and wanted to affirm strongly that the lives of severely disabled people
have value.

Q. Does it apply to Catholics only?

A: The guideline affects all patients who seek care at Catholic medical centers, regardless of their religion, said Stan Kedzior, director of mission integration at Alexian Brothers Health System.

Q: Who decides if a feeding tube is "excessively burdensome" and therefore not warranted?

A: That's up to the patient, but it isn't as simple as, "I don't like it and I don't want it." There have to be discernible physical, emotional or financial hardships for the patient, according to Joseph Piccione of OSF Health Care. Those hardships must outweigh the potential benefits.

Q: Does this mean Catholics must pursue all medical interventions at the end of life?

A: "No. We mustn't all die with tubes," said John Haas of the National Catholic Bioethics Center. "The Catholic Church has never taken that position." Church members may refuse interventions they deem excessively burdensome.

For instance, someone with advanced kidney failure is not obligated to pursue dialysis, said the Rev. William Grogan, a health care adviser to Cardinal Francis George. Someone who has lost the ability to breathe is not required to use a ventilator.

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