Catholic bishops mandate treatment to keep comatose patients alive

Catholic hospitals across the country face a new mandate this year to provide life-sustaining treatment to comatose patients regardless of the wishes of those patients and/or their families, and even when there is no hope of recovery.

The U.S. Conference of Catholic Bishops issued the directive Nov. 17 to the more than 1,000 church-affiliated hospitals and nursing homes in the United States and to all Catholic doctors and nurses. Invoking a 2004 speech by Pope John Paul II, the bishops said Catholics must provide nutritional assistance to patients with “presumably irreversible conditions … who can reasonably be expected to live indefinitely if given such care.”

A previous directive let Catholic hospitals and doctors decide whether the burdens on the patient outweighed the benefits of prolonging life. The bishops said the new policy was guided by “Catholic teaching against euthanasia” and by John Paul’s observation that providing food and water “always represents a natural means of preserving life, not a medical act.”

The issue of whose wishes will be observed — the patient’s or the bishops’ — is certain to be raised. And in the case of a comatose patient, having someone else to advocate in one’s behalf will be critical.

Catholic hospital officials say the November decree isn’t rigid and leaves room for accommodating patients’ wishes. But the bishops’ language appears to conflict with a hospital’s legal duty to follow a patient’s instructions to withdraw life support, as expressed in an advance written directive or by a close relative or friend who knows the patient’s intentions.

Courts have ordered hospitals to disconnect feeding tubes when an unconscious patient’s wishes were clearly established. The best-known case involved Terri Schiavo, the Florida woman who died in 2005 after 15 years in a coma and unsuccessful attempts by her parents and Republicans in Congress to keep her alive.

The decree itself does not require life-sustaining care that would be “excessively burdensome for the patient” or would cause “significant physical discomfort.” If those exemptions don’t apply, a hospital will send a patient elsewhere rather than violate his or her expressed wishes, the (Catholic hospitals) organizations said.

The Catholic Health Association of the United States, which represents both hospitals and nursing homes, said a facility’s ethics committee would probably meet with the doctor and the patient’s representative to “explore the alternatives” whenever a patient’s decision to withdraw life support clashed with Catholic doctrine.”In some instances, this might include the transfer of the patient to another facility,” the association said.

Considering the number of Catholic hospitals, nursing homes, doctors and nurses under the bishops’ directive and the number of people who would not choose to spend their final weeks and months hooked up to tubes and wires, ethics committees are going to be very busy. It is hard to make sense of this across-the-board imposition of one religion’s views on countless patients whose own wishes may differ.

New Catholic mandate on comatose patients.

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