Intubated Women

Last week I was on a panel at NYU titled, "The Gender and Sexual Politics of End of Life Care," an event hosted by NYU’s The Center for the Study of Gender and Sexuality, along with Amber Hollibaugh, Susan Gerbino and Ai-jen Poo, brilliant women doing phenomenal work in the areas of LGBT rights, palliative care and domestic workers’ rights. Click here to read the (rather rough) text of my talk, which addresses Catholic hospitals and the use of feeding tubes.

Provider Refusal and Hospital Visitation Rights.

The Centers for Medicare and Medicaid Services today announced that all hospitals are required to issue policies for visitation rights that do not discriminate.

I wonder if the "conscience clause" as imposed by Bush W. in his last month in office will still allow providers to refuse visitation by those they are morally or religiously opposed to? Namely, same sex partners. Cohabitating partners?

Reports from the Annual Catholic Health Association Assembly

I wasn't able to attend because I'm not a CHA member and, for some reason, couldn't muster up a sponsor, but the reports are now coming in from the event which was held on the 13th through the 15th of this month in Denver.

From U.S. Catholic, an article about the assisted suicide panel:

Proponents of assisted suicide are using the U.S. church's own revised ethical directives as "propaganda to promote" their cause, a physician and Franciscan brother told a workshop at the Catholic Health Association convention June 14.

Compassion & Choices, a national organization created from the merger of the former Hemlock Society and Compassion in Dying in 2005, is telling people that the "Ethical and Religious Directives for Catholic Health Care Services" now require that "everyone will have a feeding tube rammed down their throat" at Catholic health facilities, said Franciscan Brother Daniel P. Sulmasy.

Brother Sulmasy, a medical doctor who also holds a doctorate in philosophy, is a professor of medicine and ethics at the University of Chicago. He was joined by two other speakers in a panel discussion on "Responding to the Advance of the Physician-Assisted Suicide Agenda" at the CHA convention in Denver.

"Assisted suicide is bad ethics, bad medicine and bad public policy," he told the session. "If it wasn't for that, I'd be all for it."

Reviewing the various efforts to make assisted suicide legal beyond Oregon and Washington states, Brother Sulmasy said that although most efforts have been in the courts or state legislatures, Compassion & Choices also has been conducting a public relations campaign that misrepresents the Catholic directives on withdrawal of food and water that were revised in 2009.

Debating The Priority of Conscience.

A recent panel at Boston College included Fr. J. Bryan Hehir, secretary of health and social services for the Boston Archdiocese (and the Mongomery Professor of the Practice of Religion and Public Life at Harvard’s Kennedy School of Government), Michael F. Greene, a professor at Harvard Medical School and chief of obstetrics at Massachusetts General Hospital, and Melissa Rogers, a lawyer who directs the Center for Religion and Public Affairs at Wake Forest University. The panel is described in an article at Boston College Magazine.

The subject of discussion was conscience exemptions, or provider refusal laws, that allow doctors to deny accepted medical procedures to patients because of religious or moral objection, including information about such available services or meaningful referrals for them. While the subject of "conscience clauses" most often arises when discussing women's reproductive services (abortion, emergency contraception), they also concern other areas of treatment including STD, pregnancy and AIDS prevention services for gays and lesbians, fertility services for lesbians, and end of life choices for terminal patients. I've long been pushing for more awareness regarding how these laws are practiced at Catholic hospitals because they are the second largest provider of health care in the country.

Because the Catholic church is a strong opponent of gay rights, end of life choice and women's reproductive rights, they have hidden behind such religious exemptions as a manner of forwarding their religious health care mission -- often refusing to comply with informed consent or referral ethics, while working to maintain their pronounced role in health care while infringing on patients' rights. In defense of such conscience clauses, "pro-life" advocates often claim that the conscience of the doctor or care-giver is morally superior to that of the patient and should be protected. Yet the web of laws that protect individuals have crept, over the years, to include the consciences of institutions. In other words, as Diogenes writes at Catholic Conscience, the church is able to use the shield of provider refusal laws to impose discriminatory care that they see as immoral. If you can't overturn Roe v Wade, the reasoning goes, limiting access to abortion and other services is the next best strategy.

Below is an excerpt from the article:

In addition to providing an overview of religious exemptions, the panelists suggested ways to move toward a societal consensus—the “fair adjudication” hoped for by Hehir—while quieting the noisy, sometimes angry debates between those who believe the state must honor any claim of conscience made by a health care provider and those who think the state should automatically deny such claims. Hehir called for “civility, attention to evidence in the arguments, making the arguments on the basis of reason, not on innuendo and ad hominem.” He also said that providers should claim exemptions “only for essential issues, not capaciously.”

Greene echoed this point when he chided doctors who won’t even refer a patient for a procedure that they refuse, on religious grounds, to perform themselves. He compared these doctors’ reasoning with that underlying a mythical court case against a farmer whose corn was made into whiskey that, in turn, fueled the misdeeds of someone the farmer never met. “There has to be a limit,” Greene asserted, “to the reach and realm of conscience.” He also cited doctors’ ethical duty to avoid situations where moral conflict might arise. “If . . . you have an objection to providing emergency contraception or abortion care services,” he quipped, “you shouldn’t volunteer” at your local Planned Parenthood office.

Rogers, too, advocated “early disclosure” by physicians of their religious objections to any procedure that they might be called on to perform. “That should not be something [the patient discovers] down the road,” she said, “in a crisis, in a conflict.” In addition, she called for a balancing of the provider’s right of conscience with the patient’s right to treatment. “We need to respect the moral autonomy of both patients and health care providers,” she said. Of pharmacists who refuse to provide morning-after contraception, she said, “If there’s [another] pharmacy close by that can provide the service . . . that would be a mere inconvenience. But it’s something else where there’s an actual lack of access, and we need to differentiate between those” situations. In the political debate over religious exemptions, “we often see a complete unwillingness to recognize” the other side’s point of view, Rogers added, and thus she called for respectful dialogue, conducted outside the political arena, between people on all sides of the issue, with a goal of finding “common ground principles” that could then be presented as model legislation.

Tobin Removes Hospital From CHA Network

In a well-known rift during the health care debate, the Catholic Health Association supported the bill, the US Conference of Catholic Bishops did not. Now Bishop Thomas Tobin has removed a Providence Rhode Island hospital, St. Joseph's Health Services, from the CHA network, proving the power that ultra-conservative bishops have over localized health care delivery. Tobin's called St. Joseph's affiliation with CHA "embarassing." You can read the entire story at HuffPo.

Tobin's famous for his condemnation of Catholic legislators who don't toe the increasingly conservative doctrinal line. Last summer he had a very public spat with Representative Kennedy over Kennedy's stance on abortion, saying that the legislator should refrain from taking communion and examine his faith.

According to the article, only one other hospital has broken with CHA since the health care debate. The name of that hospital has not been released.

Blurring Fiction and Non-fiction in Medical Care.

Today WaPo's Ron Charles reviews Lionel Shriver's latest drag-you-through-the-truth novel, So Much For That.

The first part of the novel plays out while Terri Schiavo hovers on TV, with Republicans vowing to spare no expense to maintain her brain-dead body even as millions of conscious Americans are denied health coverage. Meanwhile, Glynis's treatment produces a double helix of hospital bills and insurance statements as bewildering as the cancer treatment itself. Shep is willing to spend whatever it takes to heal his wife -- every chapter begins with an updated statement from his dwindling Merrill Lynch account -- but what is the monetary value of a single life? What are another three months of pain worth?

And setting aside the novel's politics and economics, I've never read anything that made me so cringingly self-conscious about the way we respond to friends who are seriously ill. Granted, Glynis is a particularly unpleasant patient, angry and bitter about her feeble artistic career, but that only makes her more real. "Umbrage was her drug of choice," and she delivers a scathing diatribe on the culture of cheer that's built up around cancer treatment. She rages against "these nauseating speeches . . . the upchucking reminiscences . . . All this -- sentimentality!" Echoing Barbara Ehrenreich's similar complaints last year in "Bright-Sided," Shriver rips into the guilt-inducing support-group lingo: "hanging tough. Refusing to let go. Not giving up. Going the last mile. You'd think they were organizing a grammar-school sports day. . . . After all this military talk she now equates -- dying -- with dishonor. With failure. With personal failure."

Shep, meanwhile, notices "with an acrid taste in his mouth" that the initial pledges "to help in any way possible" are never followed by any actual assistance. "Their friends and family alike had poor emotional endurance," he realizes. "No parent had ever sat them down to explain that this is what you do and say when someone you at least claim to care about is deathly ill. It wasn't in the curriculum." If you've gone through this shocking evaporation of human contact, you know how true it is. When my daughter was born with severe brain damage 20 years ago, we were effectively ostracized by our community. My wife worried that we'd be overwhelmed by offers of assistance from fellow church members. None. Zip. One of our best friends told us later, "I sensed something was wrong, so I didn't call." But then as a friend of mine died last year across the street, I was too embarrassed to do anything besides send a brief note of encouragement. This is a novel that irradiates such sins of omission with shame.

As our chronic debate on health care reform drags on -- that hacking political cough that gets no better -- here is a novel that dramatizes what middle-class families are really suffering. "So Much for That" is a furious objection to watching the dream of health, financial security and old-age companionship wither and die. It's a bitter pill, indeed, but take it if you can.

Why We Let Catholic Health Care Discriminate.

The Moderate Voice has a great discussion going about the benefits and detriments of Catholic health care in the US. If you read here often, you know that the Catholic Church controls the services provided at the 624 hospitals - and hundreds of long-term care, hospice care and other institutions - in the US.

The post is a little long and emotional, as well as full of disinformation. But the comments area is fascinating and gives a good look at the high emotions that surround this issue.

For decades the Catholic church has worked to perpetuate the belief that they are too big a part of health care to be forced to operate without discrimination. What would the country do if the church pulled out of hospital operation?? In fact, they have worked in this field for centuries as part of their mission to care for the poor and sick. While I believe that the purpose is sincere, nonetheless, they discriminate against patients by not providing the full spectrum of legal, medically sound services. And they refuse to provide proper informed consent or referrals. In essence, they use the reverence that society has given the moral goodness of the church to discriminate against women, gays, elders and the poor by deciding what "conscience" those patients should have.

Here's my comment on the site:

Fantastic discussion. A couple of corrections: Catholic hospitals get 50% of their funding from the government, just like every other non-profit hospital. Less than 3% of their income is from donation so they are clearly not providing Catholic health care with Catholic donations. And Catholic hospitals - all 624 of them - statistically do no more "charity" work than other non-profits. In fact, all hospitals are required by federal law to treat the uninsured.

The best analogy is a company town. The company provides the jobs, the housing, the schools, even owns the grocery story. They are "too big to fail" in that town. One can say, oh thank god for the company, without it we would have no jobs or schools or groceries. But the truth is that the company then dictates all aspects of the town's life. And if the company says women should not be able to plan how many children they have or that a terminal patient can't be removed from artificial nutrition and hydration when they wish, the company is exercising it's size and monopoly to the detriment of employees rights.

When a pluralistic society finds itself subject to the doctrine of a religious health care institution, patients' rights are violated. Those who suffer the most are the poor and minorities in society. But we are bashful about calling out this issue because we give reverence to the "good intentions" of the Catholic church and those of us with voices have the resources to go elsewhere.

Reproductive services clinics have risen over the past 38 years to provide what Catholic and other denominational hospitals have not. They serve the poor and provide services unobtainable elsewhere.

I do believe that denominational healthcare is a discriminatory practice in the US but I also accept that the dictates of the Catholic hierarchy are not necessarily what's practiced in Catholic hospitals. Yet, that dissent cannot erase the fact that Catholic Ethical and Religious Directives discriminate against the poor, women, elders, gays and others by not informing patients' of all legal and medically-sound treatments and providing meaningful referrals. If we continue to privilege provider (and institutional) conscience over patients' conscience, we perpetuate this discrimination. Denying this is dishonest and a disservice to equality and individual conscience in this country - as well as a violation of equal rights.

Denver Struggles to Keep Reproductive Services at Hospitals Slated for Catholic Takeover.

From NonProfitInformation.com, a story on the battle raging in Denver about the Catholic takeover of three secular hospitals:

The unexpected delay by the Federal Trade Commission to bless the transaction may provide local critics with a last gasp effort to continue fighting the deal. Community members and medical professionals contend the transfer would unfairly subject comprehensive reproductive health and end-of-life care to church doctrine over patients’ needs. The Catholic church considers abortion, contraception, elective sterilization and termination of invasive life support as “intrinsically evil” and refuses to provide these medical services or respect patients’ advance directives.

The disputed takeover in Denver exemplifies the very serious implications for the 127 non-denominational hospitals that succumbed to merger fever with cash-flush Catholic health care systems in the 1990s. According to a study by Catholics for Choice, half of merged secular-Catholic hospitals suspended most or all of their reproductive health care services. Eighty-two percent denied emergency contraception to rape victims — and more than a third refused to provide a referral.

But for some tax-exempt, nonprofit hospitals co-owned by secular and church interests, there was little more than a wink and a nod to church mandates on care. Comprehensive reproductive healthcare services quietly remained available.

These practices received higher scrutiny in 2001 when the U.S. Conference of Catholic Bishops revised its Ethical and Religious Directives for medical care to address “misinterpretation and misapplication of the principle of cooperation with other-than-Catholic organizations.” In other words, the church would no longer turn a blind eye to reproductive health and end-of-life care at its secular partner facilities that did not meet strict Catholic orthodoxy.

More importantly, the local hospital policymaking was a little noticed precursor to the bare knuckles strategy on recent display with the church’s relentless lobbying for the 2009 Stupak and Nelson amendments to further restrict access to abortion care via publicly-subsidized health insurance plans. At the same time, the Catholic Archdiocese of Washington, D.C., threatened to end social service programs for tens of thousands of poor residents if the city council approved a same-sex marriage ordinance.

Now, the Denver hospital takeover is offering a glimpse of the intense pressure being brought to bear by the church on its healthcare partners. The Vatican’s renewed insistence on complete doctrinal influence on patient care is bolstered by very real threats to hold desperately needed institutional capital funds hostage until its theological demands are met.

It's a great article, full of helpful facts and information. You can read the entire piece here.

Catholic Hospitals Falling Away.

A fantastically telling article from Sue Ellen Browder at the National Catholic Register on Catholic hospitals not really telling the whole truth to their bishops. There are more than 600 Catholic hospitals in the U.S., making them the second largest deliverer of health care in the country. In order to be "Catholic" a hospital has to abide by the 72 Ethical and Religious Directives the Catholic church imposes.

But some keep the Catholic only in name - perhaps for the seemingly good reputation that such an affiliation brings? Dissent is not a new thing to the Catholic hierarchy, they've been battling misbehaving parishioners for centuries. And when their discriminatory dictates overlap with modern medicine, doctors, patients, and nurses all chafe.

Another sign that the hyper-right current leadership of the Catholic church are out of touch? Of course. Can we start calling for Vatican III? Who's stopped calling for it since Vatican II?

St. Charles Medical Center in Bend lost the title “Catholic” on Feb. 15 due to its refusal to stop doing tubal ligations to sterilize women. Founded by the Sisters of St. Joseph in 1918 but no longer run by them, St. Charles is Oregon’s only Level II trauma center in the central and eastern part of the state.

“The crux of the conflict was the hospital and ethics board’s intentional misinterpretation of ‘direct’ and ‘indirect’ sterilizations,” said Diocese of Baker Bishop Robert Vasa. After several years of negotiations with St. Charles, Bishop Vasa made the difficult decision to strip the hospital of its “Catholic” status.

Tubal ligation, informally known as “getting one’s tubes tied,” is always a direct form of female sterilization not permitted in Catholic health-care institutions. But, based on the Catholic principle of double effect, other procedures that indirectly induce sterility — the removal of cancerous fallopian tubes or ovaries, for example — are permitted in situations where no simpler remedy is available.

“The heart of my conflict here is that the hospital and the ethics board identified all of these 200 to 250 sterilizations they do a year as indirect,” Bishop Vasa said.

A typical case at issue would be that of a mother with three children. A doctor may decide it could be “dangerous” for her to get pregnant again. In such a circumstance, St. Charles’ hospital and ethics board claimed it was permissible under the directives for a surgeon to sterilize the mother with the “indirect” intention of keeping her healthy.

“Clearly, that’s a direct sterilization with the secondary hope of preserving her health,” Bishop Vasa said. “So it was in my mind an intentional misrepresentation and misinterpretation of that teaching.”

Further, the bishop stated, “It is possible that this teaching about sterilization may be misunderstood and misrepresented in a number of Catholic hospitals nationwide.”

To be called “Catholic,” a health-care institution must follow the “Ethical and Religious Directives for Catholic Health Care Services” issued by the U.S. Conference of Catholic Bishops. Paragraph 53 of the directives states: “Direct sterilization of either men or women, whether permanent or temporary, is not permitted in a Catholic health-care institution.” A second sentence reads: “Procedures that induce sterility are permitted when their direct effect is the cure or alleviation of a present and serious pathology and a simpler treatment is not available.”

This second sentence is often made the illegitimate pretext for sterilizations at Catholic hospitals.

Don't miss this bit on the new directive regarding artificial nutrition and hydration:

Nevertheless, Hamel is executive editor of the quarterly CHA publication Health Care Ethics USA: A resource for the Catholic health ministry, which until Feb. 24, 2010, was posted on CHA’s website. In one article, Hamel posed the question, “The CDF Statement on Artificial Nutrition and Hydration: What Should We Make of It?” in which he personally interpreted the Vatican’s position on the matter.

Speaking as CHA’s senior director of ethics, Hamel wrote that there are “questions about the accuracy of the medical assumptions in the CDF statement and commentary.” An unsigned “primer” on the Vatican’s statement published in the same issue stated that if a patient has “objective discomfort that a reasonable person would describe as unacceptable subjective discomfort, the withdrawal of [artificial nutrition and hydration] would appear to be permissible.”

Another Health Care Ethics USA article, not authored by Hamel, stated, “The ethical distinction between allowing-to-die and euthanasia depends, for the most part, on the medical condition of the patient,” while a third article noted that the “autopsy after [Terri Schiavo’s] death belied any thought that she would have recovered.”

The fall 2007 issue of Health Care Ethics USA published “A Resource for Evaluating Levels of Authority in Church Teaching,” with the “pope’s [sic] ordering of a document’s publication” by the Congregation for the Doctrine of the Faith said to carry the least “theological weight.”

The title page of Health Care Ethics USA grants permission to Catholic Health Association members “to copy and distribute” the publication free “for educational purposes.”

Fundraising on Fears of Health Care.

In my inbox today, a call for donations from the Catholic Advocate president Deal Hudson. Boy, the health care scare must be good for collections! I'm always talking about how organized and prepared and funded the groups who are fighting to limit women's right to patients' rights are and here is a look at how they round up their resources.

By acting like the new bill will expand federal funding of abortion (a phrase that exists only in their minds: the Hyde amendment specifically - and discriminatorily - limits abortion funding in Medicaid, and the prohibition of funding for abortion in health care for government employees wasn't enacted until 2005), they've got the "pro-life" groups around the country rabid with fear that they're losing their game under our new "socialist" president. Nothing could be farther from the truth.

As women move from private health care plans or as women receive government subsidy for their health care insurance, the new guidelines will require new and excessive payment obstacles for women with plans that cover abortion. Currently 87% of women have plans that cover abortion services. The new health care bill is an enormous set back. It says that women have no right to their own consciences. It says that they can't be trusted to make their own decisions about their families and reproductive health.

It says that women are not equal in society and must be told how to act. Deal Hudson plans to tell them.

Dear Friend,

At Catholic Advocate we are committed to the cause of preserving the Sanctity of Life from conception until natural death. We know that there is an army of Catholics working tirelessly at the local level, devoting prayer and action to saving the lives of millions of children per year. We believe it is our mission to provide a vibrant community where those on the ground can get up-to-the minute information on the impact of their work in Washington and on a national level. We also believe that it is our mission to provide a strong, national voice to those who understand how important it is to preserve the lives of the most innocent in our society. Faithful Catholics MUST speak out and be heard on candidates, on issues, on legislation...and on their Church!

Our mission needs your support. In order to be effective advocates and to provide quality resources for grassroots Catholic activists, we count on the generosity of our members and supporters.

Your online donation of $25, $50, $100 or $500 will help us grow to become the resource and voice the Catholic grassroots community deserves - the resource that will help committed Catholics to actively participate in the political process and help them support elected officials and policies that remain consistent with the teachings of the Catholic Church.

CLICK HERE TO DONATE RIGHT NOW!

Your donation goes to support strong initiatives that are bringing Catholic issues to the forefront in Washington DC and in our own Catholic hierarchy. Just this week, Catholic Advocate kicked off a major pro-life push that, when accomplished, will provide grassroots pro-life advocates with the financial and personal support they so desperately need.

On Monday, Catholic Advocate called upon the US Conference of Catholic Bishops to establish a National Collection for Life. On Monday, Catholic Advocate President Deal W. Hudson and Vice President Matt Smith delivered a personal letter to Cardinal Daniel DiNardo, Chairman of the Committee on Pro-Life Activities and Bishop Kevin Farrell (Dallas), Chairman of the Committee on National Collections, asking that the USCCB dedicate monies received in church collections the Sunday before the annual March for Life to national pro-life activities. This collection would provide a huge financial boost to grassroots pro-life efforts nationwide by expanding the resources of the Committee on Pro-Life Activities. This will open up fantastic opportunities to promote the sanctity of life at all stages.

Without the help of our community, such an initiative is not possible. DONATE TODAY to be part of a bright future!

Sincerely,

Deal W. Hudson, President, Catholic Advocate

More Reporting on the New Artificial Nutrition and Hydration Policy.

This time from New Jersey News Room. The word is getting out, but slowly.

The writer, Harris Meyer, does a good job of summarizing the issues though I always want to hear more in these articles about the size of the Catholic health care delivery system and the reasons why these facilities are able to operate outside the established laws regarding artificial nutrition and hydration. It seems no one is willing to ask the difficult questions about how Catholic hospitals are able to establish their own practices outside national law - despite separation of church and state.

Here's a clip:

If a patient or family didn't want a feeding tube "and the reason they don't want it is they basically want to die, then the Catholic institution would explain to them they can't cooperate with that and they would have to go to another institution," said the Rev. Thomas G. Weinandy, executive director for doctrine at the bishops' conference, who helped draft the policy.

Experts say no other large health systems in the U.S. have nutrition and hydration policies like those governing Catholic facilities.

Catholic officials have said the directive is consistent with previous doctrine. But the revised language eliminates what many Catholic ethicists viewed as flexibility in its application to patients in a persistent vegetative state. The previous policy said "there should be a presumption in favor of" use of feeding tubes, rather than an "obligation."

Morever, according to Catholic officials and outside experts, the directive may well apply to a wider range of patients, those that it describes as having "chronic and presumably irreversible conditions," though the organization representing Catholic health facilities downplays the impact. Experts say this affected group could include those with massive strokes, advanced Alzheimer's disease, traumatic brain injury and Lou Gehrig's Disease.

"If someone had a stroke and the doctor says he won't die though he may be very sick, then they should give him nutrition and hydration," Weinandy said. "You can't just starve him to death. It's hard to know whether someone can regain consciousness or not."

Dr. Lachlan Forrow, a Harvard University medical ethicist and palliative care specialist, expressed strong concern about the new policy, stressing its potentially broad scope. "That gets to be a very, very large number of people," said Forrow, who heads a panel developing recommendations for the state of Massachusetts on end-of-life care.

Forrow also said Catholic health facilities haven't met a key ethical test - adequately informing the public of their policy. If they don't do so, "patients and their families will arrive at the hospital in crisis and find that the care they want and need and have a right to as Americans is being refused."

Weinandy said "obviously the public should know what the directives say," and patients and relatives "can easily download the directives or get a copy."

The revised directive arises from statements made by Pope John Paul II in 2004 during the legal battle surrounding Terry Schiavo, the Florida woman kept alive on a feeding tube for nearly 15 years, and from clarifying statements by Vatican officials in 2007.

Sister Carol Keehan, executive director of the Catholic Health Association representing hospitals and other facilities, said the bishops' point is "you don't have the right to just stop feeding them because their life is a burden." But the new policy, in her view, would come into play infrequently, mainly in cases involving a persistent vegetative state. For that reason, said the CHA senior director for ethics, Ron Hamel, "There probably was not much publicizing" of the revised directive by Catholic facilities.

There are more than 600 Catholic hospitals and hundreds of nursing homes and other facilities; the hospitals alone admit nearly six million patients a year. Keehan doesn't see much potential for conflict between patients' and families' end-of-life wishes and the new directive. "Advance directives are held in great respect in Catholic hospitals," she said in a recent interview. "Some might like to say there's a terrible problem, but there isn't."

Most states require honoring a patient's advance directive or the designated proxy's decisions in end-of-life situations — or else transferring the patient to a facility that will honor those wishes. It is against the law in every state to place a feeding tube or provide other medical treatments against the expressed wishes of the patient.

Catholic Health Care: A Rare Success Story.

I write a lot about the discrimination in Catholic hospitals, enforced by the Church's Ethical and Religious Directives that prevent women, gays, and elders from receiving certain health care services.

Here's a little success story that came my way today from a friend out West:

Bishop Robert Vasa of Baker announced that the church will no longer officially sponsor St. Charles of Bend. The hospital serves about a quarter of a million people in central Oregon. To be considered Catholic it had to adhere to a list of guidelines. Bishop Vasa says the hospital was openly breaking guideline number 53 by providing a form of sterilization called tubal ligation. Several hundred women underwent the procedure each year.

Vasa: "The issue of sterilization because it was so prominent and prevalent at the hospital was one that they deemed they could not alter and I deemed I could not accept."

A spokesperson for the hospital says St. Charles is the only hospital serving Bend and the surrounding rural community. So board members felt they needed to provide the procedure. St. Charles did not receive any funding through the Catholic church, but Catholic Mass will no longer take place at the hospital. The cross on top of the building will remain.

Got that? A Catholic bishop told a "Catholic" hospital where to go because it continued to perform tubal ligations.

This is a success story for two reasons: 1. Women in that area, where St. Charles is a sole provider of health care services, can still access the medically-sound, legal tubal ligation procedure; and 2. What does the hospital lose? Nothing! The Catholic church provides no funding.

But my follow-up to that second point is more measured: If the Catholic church offers hospitals under it's control no benefits, why would hospitals remain affiliated with the church? Reputation in a community? Tradition? Faith?

This is the larger, more important question we should be having with regard to patients' rights and Catholic health care. If you've got an answer, let me know.

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 atNorthwestern 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.

Dementia and Futile Feeding Tubes.

Update: The GeriPal post on this subject is well worth reading.

From EurekAlert, a new study to be published in tomorrow's Journal of the American Medical Association shows that many patients suffering demential are given futile feeding tubes at end of life.

This study, conducted over 8 years by Brown University and Harvard Medical School, will hopefully draw attention to the Catholic Church's new Ethical and Religious Directive - used to govern more than 624 hospitals in the US - that considers artificial nutrition and hydration to be "obligatory" care, thus defying patients' advance directives (living wills) regarding end of life choices and enforcing futile care.

From EurekAlert:

Their position follows an eight-year study, which found that the use of feeding tubes varies widely. Among their major findings: At 25 percent of the nation's acute-care hospitals, this vulnerable population had a one in 10 chance of having a feeding tube inserted. Twelve percent of acute-care hospitals did not insert a feeding tube at all.

Medical evidence has long suggested that feeding tubes do not improve survival or overall outcomes in patients with dementia, a terminal illness that affect a patient's mind and eventually the ability to eat.

Details of the study are outlined in the Feb. 10, 2010, issue of JAMA, the Journal of the American Medical Association.

"Our results suggest that decisions to insert a feeding tube in persons with advanced dementia are more about which hospital you are admitted to than a decision-making process that elicits and supports patient choice," said Dr. Joan M. Teno, lead author and professor of community health and medicine at the Warren Alpert Medical School of Brown University.

The range of feeding tube use varies widely. Researchers found the rate of feeding tube insertions per 100 hospital admissions varied from 0 to 39, depending on the hospital. On average, 6.5 out of every 100 admissions resulted in a feeding tube insertion.

Teno and the other researchers conducted their study by looking at nearly 2,800 acute-care hospitals. They sifted through Medicare claim files involving more than 280,000 admissions from 2000 to 2007 to determine the rate of feeding tube insertions among hospitalized nursing home residents over age 66 with advanced dementia. They looked at hospitals with at least 30 admissions involving nursing home residents with advanced dementia during that period.

Hospitals with a culture of aggressive care at the end of life were nearly three times more likely to insert a feeding tube, according to the study. Larger or for-profit hospitals tended to use them more. Smaller, rural hospitals not affiliated with medical schools used them far less frequently.

Second author Dr. Susan Mitchell, associate professor of medicine at Harvard Medical school, said the data points to a clear need to examine how treatment decisions are made for patients with advanced dementia.

"Our results call for acute-care hospitals to examine how decisions are made for nursing home residents with advanced dementia, to ensure the decisions reflect patient wishes and values," Mitchell said.