One important aspect of advanced-care planning is determining whether feeding tubes for artificial hydration and nutrition should be used, especially for those with severe disabilities or who are in a vegetative state.
The U.S. Conference of Catholic Bishops gave guidance on this question when it revised its Ethical and Religious Directives for Catholic Health Care Services in November 2009.
The directives had last been revised in 2001. The changes incorporated Pope John Paul II’s March 2004 address on "Life-Sustaining Treatments and the Vegetative State" and the Vatican Congregation for the Doctrine of the Faith’s August 2007 response to questions the USCCB had posed on the subject.
In order to determine how artificial hydration and nutrition should be used, one first needs to determine whether the person is living or dying, explained Jann Armantrout, life-issues coordinator for the Diocese of Rochester.
If a person has not begun the process of dying and can be reasonably expected to live indefinitely, that person must be fed and given water even if the person has chronic and irreversible disabilities, including being in a persistent vegetative state, Armantrout said.
She noted that the insertion of a feeding tube has become commonplace as a convenience for medical professionals and has led to debate about whether hydration and nutrition should be withdrawn if a person has no hope of recovery.
In a Sept. 22 talk with Catholic doctors and health-care providers at St. Bernard’s School of Theology and Ministry in Pittsford, Dr. John Sullivan noted that doctors must take care not to commit euthanasia by withholding or withdrawing food and water from such individuals.
In his 2004 speech, Pope John Paul II said that providing a person with water and food is a natural means of preserving life, not a medical act, noted Sullivan, an associate professor of pediatrics at the University of Rochester Medical Center who also is certified in Catholic health-care ethics through the National Catholic Bioethics Center.
Although food and water are obligatory for the living, Sullivan noted that ceasing to eat and drink is part of the dying process. As the organs begin to fail during death, the body loses the ability to process food and water, Armantrout explained.
The revised directives quote from the Congregation for the Doctrine of the Faith’s response to the USCCB’s questions stating: "Medically assisted nutrition and hydration become morally optional when they cannot reasonably be expected to prolong life or when they would be ‘excessively burdensome for the patient or [would] cause significant physical discomfort, for example resulting from complications in the use of the means employed.’ For instance, as a patient draws close to inevitable death from an underlying progressive and fatal condition, certain measures to provide nutrition and hydration may become excessively burdensome and therefore not obligatory in light of their very limited ability to prolong life or provide comfort."
Armantrout said the directives aim to honor all people — no matter what stage of life they are in and no matter what capabilities they have.
"We do not exclude people from the human family or devalue their life because of their functioning capacity," she said.
People in a persistent vegetative state are in greatest need of advocates for their rights, Sullivan said.
"I view them as the least of our patients, and the most in need of someone to speak for them," he said.