Thursday, February 25, 2010

Forced Feedings: The Bishops and Artificial Nutrition and Hydration.

Judith Graham at the Seattle Times has a great article today on the Catholic Bishops' latest dictatorial health care guideline - that the church decides when patients are removed from (or added to) artificial nutrition and hydration, not the patients. Graham writes:

The new directive, 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 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, Ill., resident. "I believe people's autonomy to make decisions about their own health care should be respected."

Part of the reason the Catholic church gets away with making these decisions for patients is because so few know how Catholic health care is regulated, by the church. About the history of this new policy on artificial nutrition and hydration, the case of Terri Schiavo is cited, an event that I would say is one of the primary roots of the church's recent restrictions:

The guideline addresses the cases of people such as Terri Schiavo, a Catholic woman who lived for 15 years in a persistent vegetative state, 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.


The church's view is that giving food and water through a feeding tube is not a medical intervention but basic care, akin to keeping the patient clean and turned to prevent bedsores, he said.

Pope John Paul II articulated the principle in a 2004 speech, and the Congregation for the Doctrine of the Faith, an arm of the Vatican, expanded on it in a 2007 statement.

The new guideline incorporates those positions in Directive 58 of the U.S. bishops' Ethical and Religious Directives for Catholic Health Care Services.

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.

A second exception has to do with bodily discomfort. If infection develops repeatedly at the site of the feeding tube, for instance, artificial nutrition and hydration can be refused or discontinued, Catholic ethicists agree.

A third exception is allowed when inserting or maintaining a feeding tube becomes "excessively burdensome" for a patient.

Under traditional Catholic teachings, patients may refuse medical interventions when anticipated burdens outweigh potential benefits.

"Decisions are made case by case," and that will continue, said Ron Hamel, senior director of ethics at the Catholic Health Association of the United States.

Of particular concern is whether Catholic medical centers will honor an advance directive stating broadly that a person does not want a feeding tube inserted.

Compassion & Choices, a group that supports the right of dying people to end their lives, suggested the potential for conflict is significant.

"Now, [Catholic] hospitals and nursing homes have no choice but to enforce Catholic doctrine universally over patient wishes," the group's president, Barbara Coombs Lee, wrote on her blog.

But most ethicists said they do not see a significant problem. Disagreements, they say, usually can be resolved by discussing people's end-of-life concerns, such as fear of being abandoned, fear of living in pain or fear of becoming entirely dependent on others.

It is rare for people to be very specific about their wishes.

"I have never seen an advance directive that says, 'If I am in a persistent vegetative state, I ask that you withdraw food and water,' " Laethem said.

The bishops' guidelines specify that patients' "advance directives are to be followed, so long as they do not contradict Catholic teachings," said John Haas, president of the National Catholic Bioethics Center. How those teachings will be interpreted has yet to be resolved.

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Britain's Ed Balls Tackles Sex Education with New Bill.

A new British bill, introduced by Ed Balls and being lashed by every conservative organization in the country, would tackled discrimination and issues of informed consent in religious schools, making illegal the instruction of only religious ideology.

John Smeaton of the hyper-conservative Society for the Protection of Unborn Children about loses it on the bill:

Mr Balls's statements today not only confirm, but add further truth to the warnings that SPUC has been issuing for months about the government's plans - and the English and Welsh Catholic bishops'complicity in those plans. Please make sure that you have read andacted upon SPUC's latest campaign alert on the Commons debate later today.

(P.S. The reason why the Catholic Church's teaching on homosexuality is so important for the pro-life cause can be found in Pope John Paul II's
Evangelium Vitae. In paragraph 97, Pope John Paul teaches that it is an illusion to think that we can build a true culture of human life if we do not offer adolescents and young adults an authentic education in sexuality, and in love, and the whole of life according to their true meaning and in their close interconnection.)

Yup, the end of the world as we know it comes just after children are exposed to fags!

Here's what Today reported Balls saying the bill would do:

  • "If you are currently a Catholic school ... you could choose to teach only to children that contraception is wrong, homosexuality is wrong. That changes radically with this bill." (at 06:30 mins)
  • "A Catholic faith school can say to their pupils we believe as a religion contraception is wrong but what they can't do is therefore say that they are not going to teach them about contraception to children, how to access contraception, or how to use contraception. What this changes is that for the first time these schools cannot just ignore these issues or teach only one side of the argument. They also have to teach that there are different views on homosexuality. They cannot teach homophobia. They must explain civil partnership. They must give a balanced view on abortion, they must give both sides of the argument, they must explain how to access an abortion, the same is true on contraception as well." (from 07:20 to 08:47 mins)
  • "To have the support of the Catholic Church andArchbishop Nichols in these changes is, I think, very, very important, is a huge step forward." (at 09:05 mins)
  • "[Catholic schools] cannot teach that homosexuality is wrong and that therefore it is OK to discriminate on homosexuality" (at 10:42 mins)
  • "[T]he Catholic Church, which I really welcome, is supporting, for the first time, compulsory sex education with an opt out at 15" (at 12:25 mins) (JS: Mr Balls knows that the opt-out i.e. parental right to withdraw children from SRE classes, ends at 15, not starts. Also, what is unappreciated is that no child of any age will be able to withdraw themselves from SRE.)
But now Balls is lightening up on the strictures for religious schools - in Britain 1 in 3 - an issue that has worried those who praised the enlightened nature of the initial bill.

Extra credit: Just imagine a bill of this sort here in the U.S.?!

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Britain's DPP, Kier Starmer, Publishes Assisted Suicide Guidelines.

Director of Public Prosecutions, Kier Starmer, has released his much-anticipated guidelines regarding prosecution of those who assist in the suicide of another person.

From Sky News.
From the BBC.
From Channel 4.

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