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Consortium of Jesuit Bioethics Programs’
Symposium on Artificial Nutrition and Hydration
The Consortium of Jesuit
Bioethics Programs holds a virtual symposium each year on a topic
related to biomedical ethics or biomedical or behavioral research. These
symposia bring to bear the considerable expertise and clinical experience in
ethics that characterizes the consortium members.
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Introduction to the Commonweal Publication, "Undue Burden? The Vatican &
Artificial Nutrition & Hydration"
James M. DuBois, PhD, DSc, Hubert Mäder Chair and Department Chair,
Department of Health Care Ethics, Saint Louis University.
The
Consortium of Jesuit Bioethics Programs has published a statement on the use
of artificial hydration and nutrition (ANH) in Commonweal: A Review of
Religion, Politics, and Culture. The topic of ANH received broad attention
in US society and Catholic circles during the highly publicized case of
Terri Schiavo, who was declared to be in a permanent vegetative state. In
the midst of the controversy surrounding Terri Schiavo, Pope John Paul II
issued a statement (or allocution) on the use of ANH with patients in a
permanent vegetative state. The statement taught that ANH “always represents
a natural means of preserving life, not a medical act,” and thus should be
considered “morally obligatory.” In light of this teaching, the United
States Conference of Catholic Bishops (USCCB) plans to revise the current
edition of the Ethical and Religious Directives for Catholic Healthcare
Services. Moreover, some bishops have argued that John Paul II’s teachings
regarding ANH might be applied to patients in medical conditions other than
a permanent vegetative state.
The Consortium shares John Paul II’s affirmation of the dignity of all
patients and agrees that health care workers should not unilaterally
withhold treatments based on their judgments regarding a patient’s quality
of life. However, Consortium members are also concerned by the
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prospect that some
patients could suffer if teachings regarding the provision of ANH to
patients in a persistent vegetative state are generalized to other patient
groups, such as those with advanced Alzheimer’s disease. In an effort to
inform deliberations on the moral question of ANH—both deliberations
regarding Church directives and deliberations at the bedside regarding the
use of ANH—the Consortium pooled together its intellectual resources to
address the following questions.
Is the placement of a PEG tube (a percutaneous endoscopic gastrostomy tube)
a medical treatment? What kind of surgery does it involve?
What are some of the medical complications of ANH? What are the costs? What
are some of the unintended consequences of ANH for some patients?
Does US law typically view ANH as a medical treatment that requires the
informed consent of a patient?
Are there diagnoses for which spoon or hand feeding is preferable to ANH,
even when patients have difficulty consuming adequate calories?
The current version of the Ethical and Religious Directives grants to
patients, family members, and physicians considerable discretion in
discerning when treatments are insufficiently beneficial or too burdensome
to be considered morally obligatory. We believe that the medical, legal, and
ethical reflections that we offer justify preserving this discretion. As a
general rule, patients, families, and physicians want what is best for a
patient and they are generally in the best position to apply general ethical
principles and values to a specific situation, with all of its nuances and
vagaries.
For a copy of the Consortium statement, please visit the
Commonweal
website. For a brief overview of the development of Catholic teaching on
ANH, please see the contribution of Dr. James Walter to this symposium. For
additional information on specific questions surrounding the use of ANH, see
the symposia contributions of individual Consortium members on this website.
Mark Kuczewski, PhD, Director of the Consortium of Jesuit Bioethics Programs
2009. |
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Updated:
09/10/09