Directives for Catholics Concerning Artificially Administered Nutrition and Hydration
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1. When a loved one nears death there are many questions regarding what type of medical interventions should be provided. As Catholics we desire to make decisions in accord with the teachings of the Church who is our mother and guide. A Catholic is bound to preserve one’s life but need not prolong it. Simply put, a person should die from one’s illness and not because a basic necessity of life was denied them.
The United States Conference of Catholic Bishops’ “Ethical and Religious Directives”
2. Catholics are guided by the particular bishop whom God has entrusted to them. In 2001 the United States Conference of Catholic Bishops promulgated a document, “The Ethical and Religious Directives for Catholic Health Care Services, 4th Edition,” which gives the framework for ethical decisions concerning medical care. Bishop Olmsted desires for Catholics in the Diocese of Phoenix to be guided by this document when making decisions concerning medical treatment.
3. There are a number of directives from this document that are relevant concerning hospice care. They are as follows:
56. A person has a moral obligation to use ordinary or proportionate means of preserving his or her life. Proportionate means are those that in the judgment of the patient offer a reasonable hope of benefit and do not entail an excessive burden or impose excessive expense on the family or the community.
57. A person may forgo extraordinary or disproportionate means of preserving life. Disproportionate means are those that in the patient’s judgment do not offer a reasonable hope of benefit or entail an excessive burden, or impose excessive expense on the family or the community.
58. There should be a presumption in favor of providing nutrition and hydration to all patients, including patients who require medically assisted nutrition and hydration, as long as this is of sufficient benefit to outweigh the burdens involved to the patient.
59. The free and informed judgment made by a competent adult patient concerning the use or withdrawal of life-sustaining procedures should always be respected and normally complied with, unless it is contrary to Catholic moral teaching.
60. Euthanasia is an action or omission that of itself or by intention causes death in order to alleviate suffering. Catholic health care institutions may never condone or participate in euthanasia or assisted suicide in any way. Dying patients who request euthanasia should receive loving care, psychological and spiritual support, and appropriate remedies for pain and other symptoms so that they can live with dignity until the time of natural death.1
Artificial Nutrition and Hydration and the Teaching of the Catholic Church
4. Food and water are basic necessities of life and should be provided to a person even if he or she is unable to manually feed themselves. In fact, it would be inhumane to deprive someone who is thirsty a drink of water no matter who he or she is, or in what condition we find him or her. In short, a person should not die because of being deprived of nutrition and hydration, even if that nutrition and hydration is administered artificially.
5. The Pontifical Council for Pastoral Assistance to Health Care Workers said in 1995 that, “The administration of food and liquids, even artificially, is part of the normal treatment always due to the patient when this is not burdensome for him or her; their undue interruption can have the meaning of real and true euthanasia.”2
6. In 1998, Pope John Paul II addressed a group of Bishops from the United States drawing attention to the question of nutrition and hydration. “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.”3
7. The Congregation for the Doctrine of the Faith stated in 2007 that, “The provision of water and food, even by artificial means, always represents a natural means for preserving life, and is not a therapeutic treatment.”4 Therapeutic treatment is medical care which is focused on the particular disease(s) of the patient. Food and water should not be thought of as medicine, rather, basic care that all people have a right to be provided.
8. Catholics are to be provided nutrition and hydration so long as that nutrition and hydration continues to be assimilated by the person’s body and does not contribute to further grave complications and burdens.
9. For instance, in a situation where a person is actively dying, one’s death being imminent (presumably within a few days), to place a tube for artificial nutrition and hydration would be unnecessary and unduly burdensome. In this circumstance it is not the denial of nutrition and hydration that will be the cause of the person’s death. Therefore, given this context, it is not obligatory to place a tube for nutrition and hydration.
10. What if it is possible that a person may live indefinitely but need to be artificially fed? Then he or she must be provided nutrition and hydration even artificially. In this situation to deny one nutrition and hydration would hasten one’s death and would be immoral. In short, a person should die because of one’s illness, not because of a lack of nutrition and hydration.
11. What if, after a feeding tube is placed, the nutrition and hydration is not being assimilated into the person’s body? In this situation the nutrition and hydration is entering the person’s body but because of underlying medical conditions, it is not actually helping. In some cases it could actually be negatively affecting them by causing further medical complications. In this circumstance the nutrition and hydration being given no longer act as such and may be discontinued.
12. What if, after a feeding tube is placed, grave medical complications arise because of the presence of the feeding tube? If the complications are grave enough such that they are causing further suffering and/or additional adverse medical conditions the tube may be removed.
13. Although not every circumstance related to artificial nutrition and hydration has been taken into account in this document, it is most desirable that Catholics understand that human life has an intrinsic value that must be respected at every stage of existence. The foundation of this value has its source in the creation and eternal destiny of man. Each person is created in the image and likeness of God. Man is created by God and for God. God is the Author of Life and is the only One who can determine its limits.
The administration of nutrition and hydration, even when provided artificially, upholds this inherent dignity and value of the human person and ought to be based on the Catholic principles provided in this document.
+ Thomas J. Olmsted
Bishop of Phoenix
Sister Jean Steffes, C.S.A.
Promulgated – September 1, 2009
1 United States Conference of Catholic Bishops, Ethical and Religious Directives for Catholic Health Care Services. 15 June 2001
2 Pontifical Council for Pastoral Assistance to Health Care Workers, Charter for Health Care Workers, 1995 (#120).
3 Pope John Paul II, “Address Of The Holy Father Pope John Paul II To The Bishops Of The Episcopal Conference Of The United States Of America.” 2 October 1998 (No. 4)
4 Congregation for the Doctrine of the Faith, Commentary on “Responses to Certain Questions of the United States Conference of Catholic Bishops Concerning Artificial Nutrition and Hydration.” 1 August 2007
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