USCCB: Bishops vote to tighten rules on artificial nutrition and hydration

By JOHN L. ALLEN JR.
Orlando, Florida

In effect, the U.S. bishops voted today to amend their directives on Catholic health care to make clear that providing artificial nutrition and hydration to patients in a persistent vegetative state, as well as other debilitating conditions, is generally obligatory.

Technically, this morning’s vote simply authorized the Committee on Doctrine to begin work on revisions to the Ethical and Religious Directives for Catholic Health Care Services, the primary document governing the operation of Catholic hospitals and health care facilities in the United States.

In reality, however, it’s clear that Committee on Doctrine intends to reflect the content of two recent Vatican statements on the issue of providing food and water: a March 2004 address by Pope John Paul, and an August 2007 document from the Congregation for the Doctrine of the Faith in response to questions posed by the U.S. bishops.

The latter text asserted that providing food and water, even by artificial means, is “an ordinary and proportionate means of preserving life” and is therefore generally “obligatory.”

The subject of artificial nutrition and hydration has been deeply controversial in Catholic circles in recent years, with some moral theologians arguing that the withdrawal of food and water from patients in a persistent vegetative state can be justified on the basis of the long-standing distinction between “ordinary” and “extraordinary” means.

In some cases, these ethicists have argued, keeping a patient alive indefinitely, without realistic hope of recovery, amounts to an extraordinary measure and thus may be discontinued. Critics of that view argue that it amounts to a violation of human dignity, treating certain lives as no longer worth defending.

The drift of the two recent Vatican statements, however, is that unless food and water can no longer be assimilated by a patient, or the provision of food and water is causing serious physical difficulty such as chronic infections, it is an obligatory aspect of routine care.

Sources say that is likely to be the effect of the revisions to the Ethical and Religious Directives, which Lori said could be ready for a vote by the bishops as early as next November.

Cardinal Justin Rigali of Philadelphia, chair of the bishops’ Committee on Pro-Life Activities, and Bishop William Lori of Bridgeport, chair of the Committee on Doctrine, recently published an article in Health Progress, a publication of the Catholic Health Association, on the subject of artificial nutrition and hydration.

Rigali and Lori suggested that the recent Vatican statements on the obligation to provide food and water apply more broadly, beyond cases of a persistent vegetative state. They cited, for example, quadriplegia, mental illness or Alzheimer’s diseases – cases of what they called “chronic but stable debilitating conditions.”

Lori told the bishops this morning that the Committee of Doctrine intends to consult with Dr. John Hass of the National Catholic Bioethics Center as well as the Catholic Health Association in preparing its revisions.

Speaking from the floor, Archbishop Daniel Pilarczyk urged Lori to consult as widely as possible – not so much because the content of the revisions is in doubt, but for what he called the “political” objective of making it go down easier.

“We do not want it to seem that we’re handing this down from on high, and that people haven’t had their say,” Pilarczyk said.

“The issue is reasonably clear, but we will do ourselves favor if we have as much input as we can possibly get for reasons of acceptability and making the final product that much more ‘receivable,’” he said.

Lori said that was “good advice and well-taken.”

Lori also noted that the Vatican is currently working on a successor document to Donum Vitae, a lengthy text on a variety of bioethical issues. Among other things, the new document is expected to deal with artificial nutrition and hydration.

Rather than waiting for that document to appear, however, Lori said his committee felt it's important to offer "up-to-date and authoritative guidance in the here-and-now."