Tuesday, February 9, 2010

Finally, Legacy Media Picks Up On New Catholic Directive.

While the US Conference of Catholic Bishops changed their Ethical and Religious Directives in November to now consider artificial nutrition and hydration "obligatory" care, few major media outlets have picked up the story. Yesterday, the Chicago Tribune finally ran a long article covering the issue.

They do the usual two-sides-to-every-story bit, primarily citing Catholic "experts" but slip in a quote from Barbara Coombs Lee of Compassion & Choices. My concerns with the story are many, including: the down-play of who ultimately gets to make decisions (the good-intentioned doctors at your friendly local Catholic hospital); little is made of why Catholic hospitals are allowed to make these decisions for patients; and the writer make no mention of how large the Catholic health care system is in the US - second only to Veterans' Affairs and serving 1 in 5 patients annually.

The comments from readers are resoundingly opposed to this imposition. We can only hope that this article and others like it will begin to spread. The more light shed on this draconian, paternalistic, authoritative new directive the better. And the more people aware of the Catholic Church's heavy grasp of health care delivery in this country - via provider refusal laws - the better a chance that elders and the public at large will fight it.

Here's a clip on PVS patients:

People in a persistent vegetative state, the bishops say, must be given food and water indefinitely by natural or artificial means as long as they are otherwise healthy. The new directive, which is more definitive than previous church teachings, also appears to apply broadly to any patient with a chronic illness who has lost the ability to eat or drink, including victims of strokes and people with advanced dementia.

Catholic medical institutions — including 46 hospitals and 49 nursing homes in Illinois — are bound to honor the bishops' directive, issued late last year, as they do church teachings on abortion and birth control. Officials are weighing how to interpret the guideline in various circumstances.

What happens, for example, if a patient's advance directive, which expresses that individual's end-of-life wishes, conflicts with a Catholic medical center's religious obligations?

Gaetjens, 65, said she did not know of the bishops' position until recently and finds it difficult to accept.

"It seems very authoritarian," said the Evanston resident. "I believe people's autonomy to make decisions about their own health care should be respected."

The guideline addresses the cases of people like Terri Schiavo, a Catholic woman who lived in a persistent vegetative state for 15 years, without consciousness of her surroundings. In a case that inspired a national uproar, Schiavo died five years ago, after her husband won a court battle to have her feeding tube removed, over the objections of her parents.

The directive's goal is to respect human life, but some bioethicists are skeptical.

"I think many (people) will have difficulty understanding how prolonging the life of someone in a persistent or permanent vegetative state respects the patient's dignity," said Dr. Joel Frader, head of academic pediatrics at Children's Memorial Hospital in Chicago and professor of medical humanities at
Northwestern University's Feinberg School of Medicine.

On the various interpretations of the new directive:

There are several important exceptions. For one, if a person is actively dying of an underlying medical condition, such as advanced diabetes or cancer, inserting a feeding tube is not required.

"When a patient is drawing close to death from an underlying progressive and fatal condition, sometimes measures that provide artificial nutrition and hydration become excessively burdensome," said Erica Laethem, a director of clinical ethics at Resurrection Health Care, Chicago's largest Catholic health care system.

Some ethicists are interpreting that exception strictly. The Rev. William Grogan, a key health care adviser to
Cardinal Francis George and an ethicist at Provena Health, based in Mokena, said death must be expected in no more than two weeks — about the time it would take someone deprived of food and water to die.

But Joseph Piccione, senior vice president of mission and ethics at OSF Health Care in Peoria, said that if a patient knows she is dying of, say, incurable metastasized ovarian cancer but is several months from death, she can decline to have a feeding tube inserted if she anticipates significant physical or emotional distress from doing so.

Of course the Catholic media have done their job in spreading the over-dramatized Rom Houben story and the new study of PVS patients that suggests few are able to hear and experience brain waves that respond to questions from researchers. Both cases have been repeated and spread in an effort to promote the Church's - and Fundamentalist and Evangelical fellow-travelers' - "pro-life" stance. A commenter brings up Houben's case as justification for the new policy.

And a clip of the questions that follow the article:

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.

For the record: the decision is now not up to the patient. That should scare the hell out of us all.

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Blogger Mary Valle said...

Ann, this is terrifying! Must amend emergency info. "Do not take me to a Catholic hospital!"

February 10, 2010 at 5:59 AM  
Blogger L A Neumann said...

Great to hear from you Mary. I tell friends to post a note on their refrigerator of a non-Catholic hospital in their area - and to carry a similar one in their wallet.

I thought of you the other day - which seems presumptuous and tangential because we've had little contact. But I'll send on the passage that made me wonder what you would make of it. Or maybe I'll post it, it was so fine.

Very best, Ann

February 10, 2010 at 9:28 AM  
Blogger Carla said...

Mary and Ann:

If you have an advance directive, you may wish to note on the document that you don't want to be taken to a Catholic facility, should you not be able to speak for yourself.

Compassion & Choices is working to update all of our downloadable state approved advance directives with that very language, but the project isn't completed yet.

Carla Axtman
Online Community Builder
Compassion & Choices

February 10, 2010 at 12:56 PM  
Blogger L A Neumann said...

Thanks Carla. Let me know when it's up and running. I'll spread it far and wide!

Best, best, A

February 10, 2010 at 1:01 PM  

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