New document addresses medical ethics

Directives provide moral, ethical guidance for families and health care organizations

By Joyce Coronel | Sept. 3, 2009 | The Catholic Sun

Bishop Thomas J. Olmsted issued a new document this week to help Catholics make tough decisions concerning artificially administered nutrition and hydration that are consistent with Church teaching. 

Titled “Directives for Catholics Concerning Artificially Administered Nutrition and Hydration,” the document specifically addresses providing artificial hydration and nutrition for those facing illness who require artificial assistance.

It comes at a time when the faithful have questions about their obligations vis-à-vis end-of-life issues, said Fr. John Ehrich, STL, an expert in bioethics who serves on the ethics committee at St. Joseph’s Hospital and Medical Center in Phoenix.

“People have a desire to be faithful to the teachings of the Church and are not always sure if medical institutions are able to help them toward this goal,” he said, adding that priests get a lot of calls from parishioners about such matters.

“Medical professionals are sometimes not well educated in ethics and, more specifically, they are often unsure of the specific ethical teachings of the Church,” Fr. Ehrich said.

Bishop Olmsted’s document, which was released to the public as well as health care institutions, addresses questions and confusion about artificial hydration and nutrition that surfaced after the controversial death of Terry Schiavo, a brain-damaged woman whose husband successfully fought for the right to discontinue her artificial nutrition and hydration. Schiavo died March 31, 2005, 13 days after doctors withdrew nutrition and hydration.

A wide array of critics and pro-life activists decried Schiavo’s demise as murder. Bishop Olmsted describes the death as “tragic” in an introductory letter to priests, deacons and religious of the Diocese of Phoenix.

“Etched in our memories are the photos and video images of Terri Schiavo as well as the knowledge of the horrible way in which her life ended,” the bishop wrote. “Terri was not dying and the ultimate reason her life ended was because she was not provided with food and water. She died of dehydration.”

The letter states that Catholics are not obligated to extend their lives, but they are obligated to preserve them. A person is not to do anything — or omit anything — that may hasten death.

“If a person is able to continue living but merely needs the basic necessities of life, then they should be provided to them,” the bishop wrote. “Food and water, nutrition and hydration — even if administered artificially — are basic necessities of life.”

Fr. Ehrich said that the death of Terry Schiavo was an instance of euthanasia, something condemned by the Church.

Bishop Olmsted also referred to a 1998 meeting John Paul II had with bishops in the United States in which the late pope stated that “The omission of nutrition and hydration intended to cause a patient’s death must be rejected and that, while giving careful consideration to all the factors involved, the presumption should be in favor of providing medically assisted nutrition and hydration to all patients who need them.”

Fr. Ehrich called attention to the distinction between preserving life and prolonging life.

People have a duty to “avail themselves of the ordinary care which preserves their life,” he said. “Nutrition and hydration is this kind of care, even if administered artificially.”

But that doesn’t mean prolonging life when it’s clear that death is imminent.

“Most people don’t desire to either starve to death or die because of dehydration, but they also do not desire to submit to every possible medical intervention as they approach death,” Fr. Ehrich stated.

“A person should die because of their illness or the illnesses that are present, not because they were denied nutrition and hydration,” he said. The directives do not represent new teaching, but are rather the application of existing Church teaching to specific circumstances.

The directives state that “Catholics are to be provided nutrition and hydration so long as that nutrition and hydration continue to be assimilated into the person’s body and do not contribute to further grave complications or burdens.” In cases in which a person is actively dying or death is imminent, artificial nutrition and hydration “would be unnecessary and unduly burdensome” and not obligatory.

“The faithful should seek to have a well-formed conscience which can only be attained if they know the definitive teaching of the Church. This is the starting point,” Fr. Ehrich said, suggesting that people could give a copy of the bishop’s directives to their doctor or nurse and tell them that they want to make sure that their loved one is treated according to their principles.

Fr. Ehrich also said those same principles should be included in any advance directives Catholics have in order for their loved ones and medical professionals to know how they want to be treated at the end of their lives.

“The only way to be sure of doing the right thing is to follow the teachings of the Church in this area. Most people act in good faith, but often decisions of this kind are made based upon emotions or upon a desire to end a loved one’s suffering,” Fr. Ehrich said. “This reality is understandable, but it also can lead to errors of judgment.”

Bradley L. Hahn, an East Valley estate-planning attorney who focuses on counseling families on end-of-life issues, said people need to learn what the Church teaches regarding euthanasia. He said there is an ongoing effort both here and across the nation to legalize what is euphemistically termed “death with dignity.”

“We have to stand up for our beliefs in Christ,” Hahn said. “We have to stand up and say we are not going to be pressured into ending our loved one’s life prematurely.”