New Haven Register
By Ed Stannard, Register Metro Editor
March 9, 2010

HARTFORD — The question of whether a doctor can be charged with manslaughter for helping a patient end his life came before a Superior Court judge Monday.

The state, represented by Associate Attorney General Perry Zinn-Rowthorn, sought to persuade Judge Julia Aurigemma that a suit by a right-to-life group should be dismissed.

On the other side, Daniel Krisch, representing two doctors who sued the state, argued a doctor helping a terminally ill patient die with dignity should not be arrested under the state’s assisted-suicide law.

The law says helping someone commit suicide is second-degree manslaughter, a Class C felony. The plaintiffs claim a doctor prescribing medication to a terminally ill, mentally competent patient is providing end-of-life care, not aiding suicide.

Zinn-Rowthorn said the suit, seeking a declaratory judgment from Aurigemma, is improper because it is asking the judge to legislate. Ruling for the doctors, he said, would “risk serious harms to public health and it would intrude on the legislators’ prerogative” to decide public policy.

Among Zinn-Rowthorn’s reasons were that there is no patient who is in imminent need, so the medical state of anyone requesting this assistance is unknown.

He said the General Assembly has refused to change the law to make an exception for doctors, but a bill introduced last year had “14 pages of definitions, of restrictions, oversight, check that were built into the legislation.”

There would be no such protections if aid in dying was approved by a judge’s order rather than legislation, he said.

Krisch argued “there is a growing consensus” in the medical community differentiating suicide from aid in dying. “This is an appropriate medical treatment option for patients to be able to discuss with their doctors,” he said.

He said the doctors involved have had patients request medication to end their lives, people who are “suffering real, horrible diseases … facing very real, very hard choices.”

Watch the video of patient Sheldon Smith at the New Haven Register>>

Krisch said if doctors were allowed to prescribe lethal medications the legislature would create needed safeguards. “Doctors are not going to go around willy-nilly. Doctors are bound by medical ethics,” he said.

“It won’t be the Wild West of aid in dying.”

READ OUR PRESS RELEASE HERE>>

Washington Death with Dignity Report for 2009 Shows Death with Dignity is working as expected.

Compassion & Choices of Washington (C&C), a nonprofit organization advocating for better end-of-life care, patient-centered care, and end-of-life choice, today reported on its 2009 experience with the Washington Death With Dignity Act (DWDA).

Listen to the press conference.

Two Washington physicians and a terminally-ill Issaquah woman told a Seattle Public Library news conference marking the one-year anniversary of the Act that patients have benefited from the peace of mind the Act provides.

“Our experience has been that terminally-ill patients and their families are benefiting from physician aid in dying,” said Dr. Tom Preston, Medical Director of C&C of Washington. “With those terminal patients who have qualified to use the Death With Dignity Act, I have observed peaceful dying. There has been overwhelming gratitude from patients and their families. Because the family is with the patient at the end of their life, all can say their goodbyes. As studies of the Oregon experience have found, families are more at peace with the loved-one’s death than families of other patients.”

Kathy Sparks of Issaquah, a former hospice nurse with Stage 4 Melanoma, told the news conference that the Death With Dignity Act provides her with peace of mind. “I have witnessed many deaths working in hospice: some peaceful, some painful. Now, with my own terminal illness, I’m very grateful for our Death With Dignity Act. I don’t want to die; I’m trying very hard to live. I’ve undergone chemotherapy several times. I’m going through experimental treatment now to gain some time,” Kathy said. “The spiritual part of me is hopeful for the very best in my final days. The nurse part wants to be prepared for the worst. I’m very grateful that my own doctor will respect my end-of-life decisions. I intend to acquire a prescription to provide me with peace of mind and some measure of control for a peaceful death. I don’t know if I’ll even take the prescription. But having it and the choice to use it to aid in achieving a peaceful death is of great benefit to me.”

“Aid in dying practice in Washington has been safe, legal and rare,” said Dr. Preston. “Patients can discuss this with their physicians as one of a full spectrum of care options at the end of life. It is never too early to begin a discussion with your doctor about the options you would want to consider if you were diagnosed with a terminal illness.”

The Washington State Department of Health reported that during 2009 more terminal patients received prescriptions than used those prescriptions to help ease their imminent deaths. Based on total Washington mortality for 2008, deaths under the law represent less than 1/10th of one percent.

“The report’s data on the circumstances of death sketch a peaceful picture. Most of the patients were enrolled in hospice and died at home. Almost all those who took their medication achieved unconsciousness within ten minutes and there were virtually no ill side effects,” said Barbara Coombs Lee, President of Compassion & Choices, the national organization that serves terminal patients and their families throughout the U.S. “It is hard to draw too much from statistics, but most of the participants cited loss of autonomy and loss of dignity as concerns, and the data on circumstances suggest they maintained a sense of both at the end.”

Dr. Robert Thompson, MD, is a General Practitioner Internist in Seattle. Three of Dr. Thompson’s terminally-ill patients have asked him for aid in dying and each benefited from the option in different ways. “One is still alive today. One died in her sleep, but was greatly reassured by having her prescribed medications in case she needed them for a peaceful death. The third was himself a physician, with metastatic cancer in his bones. He took the medication and died peacefully according to his own values and choices,” Doctor Thompson said.

“The reports required under Washington’s DWDA confirm the safety of physician aid in dying. The law is working as voters intended,” said Dr. Tom Preston. “Doctors can feel safe responding to requests from their patients for aid in dying. The practice is having a significant, positive impact on Washingtonians’ end-of-life experience, even though being infrequently used. Knowing they can access prescribed medication and take control of their dying if suffering becomes intolerable, improves patients’ quality of life in their final days.”

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Two prominent newsmen bared their souls – and their stories of a loved one near death from a devastating illness. British broadcaster Ray Gosling divulged a hospital visit years ago. Responding to the intolerable pain of his lover, near death, Gosling said he “picked up the pillow and smothered him until he was dead.” Wednesday, MSNBC’s Keith Olbermann shared the story of the crisis that led his father to ask Keith for any relief, even death. Olbermann had the presence of mind to approach a physician, and request the sedative that relieved his father’s pain and panic.

I have no desire to contrast the acts of these two men. Their stories touch us deeply, but we stand in no position to second-guess their actions in a desperate situation. But we have much to learn from their stories because there is every chance that each one of us will find ourselves in a similar room, pleading for relief, or standing by the bedside searching for the best response.

Gosling told his story briefly as the camera followed his walk through a graveyard. His partner was suffering from AIDS. “In a hospital one hot afternoon, the doctor said ‘There’s nothing we can do,’ and he was in terrible, terrible pain.”

Western medicine is a remarkable profession and I practiced as a physician assistant for over twenty years. Its culture rests on diagnosis and treatment. When people’s bodies go wrong, we find the cause and fix it. But the third, indispensable thread in the culture is caring, and relief of suffering. When their inability to find a cure frustrates physicians and they forget to care, their patients and those close to their patients feel abandoned, which can be harder to bear than death itself.

Too many terminally ill patients suffer with under-treated pain. Too many feel abandoned because their physicians forget about their duty to relieve suffering and conflate “incurable illness” with “hopeless situation.” And too many loved ones resort to extreme, violent and desperate acts when support is lacking and legal options seem inadequate. Instead of counting on a family member to pick up a pillow, patients should be able to talk with their doctors about a range of legal, safe, peaceful options for easing a painful dying process. Suffering, from the patient’s perspective, should be as much the doctor’s concern as machines and lab results.

Olbermann spoke at length about the long fight his father waged against a series of infections and complications. “Pneumonia, three or four times — I’ve lost count. Kidney failure, liver failure . . .” Five nights before his broadcast, Olbermann found his father thrashing in his bed, repeatedly mouthing, “Help,” “Stop this” and eventually, “Kill me.”

When I went to see the Surgical Intensive Care Unit resident I told him my Dad had hit his wall. That he couldn’t take any other work, that it was now terrifying torture, that he needed it to stop. But I said, look, I’m his health proxy, we’ve had conversations about end-of-life care — we’ve had them in here, we’ve had them when he was home and well, I’m not operating in the dark here. I said I think he really wants the one word he keeps mouthing: He wants help. Is there any medical reason not to give him some sedation, a little mental vacation from being a patient?

The sedation worked. Olbermann reports his father remains comfortable and breathing well, but has not awakened.

He’s not being sedated anymore; he only has the strength to fight off the infections, or wake up — not both. We’re hoping he does the first, then the latter. We’re prepared for the probability that he will do neither. His team and I had another “life panel” discussion not six hours ago. And thank God I had those conversations with my father.

At this writing we still hope for his recovery. If he does not, we wish his family peace, and a measure of consolation in the small triumph, that when Dad was speechless yet crying for help, they were able to ease his pain.

Too many suffer needlessly. Too many endure unrelenting pain. Too many turn to violent means. We can, we must, do better.

Keith Olbermann, MSNBC

Compassion & Choices, the nation’s oldest and largest nonprofit working to expand end-of-life care and choice, today applauded the intent of a Massachusetts measure to legalize physician aid in dying, but expressed doubts that the Legislature will vote to support patients’ rights to make their own end-of-life decisions. “Too many Americans suffer needlessly and endure unrelenting pain,” said Barbara Coombs Lee, president of Compassion & Choices. “This measure contains good, proven public policy that is now the law in Oregon, Washington and Montana. It’s unfortunate that so many politicians fail to serve the people who want and need this choice.” Not all citizens have the opportunity to vote directly on Death with Dignity proposals, like those in Washington State, which passed it by a large margin.

Oregon’s 11-year experience teaches that end-of-life choice has benefited not only the patients who used the law, but all Oregonians facing the end of life. All dying patients in the state benefited from improved care from physicians and health care providers, increased use of medical morphine, increased referrals to hospice, the lowest rates of in-hospital deaths and the greatest opportunity to die at home among loved ones in the nation.

National surveys over twenty years have shown a large majority of Americans support making physician aid in dying a legal choice. “Americans want choices in all aspects of their lives. The right to choose how we die echoes the right to choose how we live,” said Coombs Lee. “Because such an overwhelming majority holds this view, one day everyone will know the comfort of choice and control. It is time for federal and state governments to honor the will of the people and legalize aid in dying.”

READ THE PRESS RELEASE HERE >>

Compassion & Choices, the nation’s largest and oldest nonprofit organization working to improve care and expand choice at the end of life noted today that it has been named a resource in USA Today’s The Mom’s Guide to Wills & Estate Planning.

READ THE PRESS RELEASE HERE >>

By JEFF BARNARD Associated Press Writer
Feb 16, 2010
GRANTS PASS, Ore. (AP) — The Catholic Church is ending its long-standing relationship with St. Charles Medical Center in Bend over a surgical birth-control technique.

Diocese of Baker Bishop Robert Vasa said Tuesday the church can no longer sponsor the hospital because it continues to offer tubal ligation, which leaves women unable to get pregnant and is specifically prohibited by church teachings. “Pregnancy itself is not a disease, even though in our culture we treat pregnancy as a disease,” Vasa said. “So this prevents the function of a properly functioning organ under the guise of health care.

“It would be misleading for me to allow St. Charles Bend to be acknowledged as Catholic in name while I am certain that some important tenets of the Ethical and Religious Directives are no longer being observed.” Catholic Mass will no longer be celebrated in the hospital chapel, and church property not needed by the hospital will be returned, Vasa said.

The name of the hospital remains St. Charles, and the decision does not apply to affiliated facilities in Redmond and Prineville, which never were tied to the church, Vasa added. The hospital does about 235 tubal ligations a year, and Vasa and the hospital had been in negotiations over the issue for a few years. They finally decided that neither could bend from their positions.

“We just felt we have been offering these procedures for decades and we have an obligation to the patients in our community to offer the procedures they need,” said James Diegel, president and CEO of Cascade Healthcare Community President, the hospital’s parent company. “This should have no impact on our operations or finances or anything. It’s just a severing of an historical relationship that has been in place for 90-plus years.

“The hospital was founded in 1918 by the Sisters of St. Joseph of Tipton, Ind., and the order’s last administrator retired in 1988, serving on the board until 2000. The hospital was taken over by a local nonprofit organization in the 1970s. The hospital would continue to look to church directives for guidance, Diegel added.

“This doesn’t change who we have been, who we are and who we will continue to be going forward,” Diegel said.

READ THE PRESS RELEASE HERE >>

 Jacob M. Appel, Bioethicist and medical historian

The Huffington Post

Posted: February 10, 2010 05:31 PM

Catholic hospitals, which boast a long and admirable history of caring for the seriously ill and indigent in the United States, have for many years finessed the challenges of serving two disparate and often incompatible masters. On the one hand, the nation’s 573 Church-run hospitals and their physicians are not permitted by Vatican policy to offer services or advice to patients when doing so violates Catholic teaching. In theory, prohibited activities range from providing abortions and assisting suicides to urging patients with HIV to wear condoms when engaged in unprotected sex or telling bipolar women on lithium to use contraceptives to prevent birth defects. On the other hand, these hospitals–which serve about one third of all patients in the nation–are also quasi-public institutions, and their physicians and nurses are bound by the same ethical obligations that govern all other members of their professions. They must obtained informed consent, honor patient autonomy, and offer medical care in line with the clinical standards of their colleagues at secular institutions. While a latent tension often exists between these competing allegiances, two recent developments relating to Church policy have set medical ethics and Catholic doctrine on an unfortunate collision course.

The first of these disturbing Church salvos against mainstream medical ethics is to be found in the newly promulgated Directive 58 of the United States bishops’ body governing Catholic health care services. This edict states that, barring certain specific circumstances, such as imminent death, Church doctrine prevents competent patients from refusing artificial nutrition and hydration. William Grogan, a religious advisor to Cardinal Francis George of Chicago, explained to the media that death would have to be expected within two weeks for a patient to turn down a feeding tube. In other words, according to current Catholic teaching, a cancer patient in a coma with a life expectancy of four weeks must now be force-fed–no matter what his prior instructions stated and without regard to his family’s wishes. All comatose and vegetative patients will be required to accept nutrition and hydration indefinitely, even if they leave behind air-tight living wills objecting to such “heroic” and invasive measures. This extreme policy apparently applies to all patients receiving care in Catholic-run hospitals, whether or not they are Catholic. Since United States courts have consistently accepted that mentally-competent patients have a right to refuse care if their wishes are clear and documented, these rules may well be illegal. However, even if Directive 58 is not a violation of the law, it is a gross breach of accepted standards of medical ethics. No doctor or nurse in the United States may provide such unwanted nutrition and hydration without defying a well-established code of professional conduct. It is likely that any provider who acted in this paternalistic and unequivocally immoral manner would lose his or her license. In the very least, the provider would become a pariah among his colleagues.

A second Church-instigated challenge to medical ethics has arisen as a result of a grass roots protest by anti-abortion organizations in Pennsylvania against the well-regarded St. Mary’s Medical Center of Langhorne. In this case, Dr. Stephen Smith of St. Mary’s performed an ultrasound on an expecting mother and confirmed that the fetus had polycystic kidney disease, a fatal condition in infants. Smith recommended an abortion. When the pregnant women sought a second opinion, a midwife at Mother Bachman Maternity Center in nearby Bensalem, operated by the St. Mary’s, also recommended termination. The mother refused, which was certainly her prerogative, and the infant died two hours after birth. When local abortion opponents publicized Smith’s advice, a private citizen named Joseph Trevington demanded a formal review of St. Mary’s by the local archdiocese. The results of this ethics investigation are not yet publicly known, and may never be revealed, although a diocese spokesman stated that changes in the hospital policies are to be expected.

The very decision to conduct such a moral audit displays a chilling new direction in Church practice. As a matter of doctrine, Catholic hospitals require employees to “respect and uphold the religious mission” of their institutions as “a condition for medical privileges and employment.” So, in theory, any physician endorsing abortion (or vasectomies, birth control, withdrawal of life support, etc.) while on the hospital premises should be relieved of his duties. As a matter of Catholic doctrine, Trevington and his anti-abortion brethren appear to have the better half of the theological argument, at least when it comes to consistency and the letter of the law. At the same time, allowing Church dogma to dictate the medical practices of physicians clearly violates the most basic tenets of healthcare ethics. Dr. Smith had a duty to offer advice to his patient based upon his best independent professional judgment–which he apparently did. The Hobson’s choice that he faced–either to follow the Catholic “law” enshrined as policy or to adhere to medical obligation–was unreasonable and unacceptable.

Both of these events expose the dark and unspoken (although widely understood) secret that enables Catholic hospitals to practice first-class medicine: Official Church policy on matters such as contraception and end-of-life care, like much Catholic doctrine more generally, is largely honored only in the breach. I have known many excellent physicians over the years, both religious and secular, who work at Church-run hospitals. All of them advise women taking medications that cause birth defects to use contraception and tell HIV-infected patients to use condoms. Many offer direct counseling on abortion, certainly when fetal prognosis is grim. I cannot imagine any of these gifted doctors would force-feed an unwilling cancer patient in violation of an advance directive or a health care proxy’s wishes. Much like the absurd loyalty oath that New York’s college professors–myself included–take to uphold the state’s constitution, any pledge to support Catholic doctrine on medical matters is broadly viewed as a formality to be agreed to and then summarily ignored. Historically, the Church has looked the other way. Now, by challenging this longstanding system of benign neglect, bishops and grass roots zealots may believe they will achieve ideological purity. What they are actually doing is jeopardizing both the welfare of Catholic hospitals and the public health.

Some concrete thinkers may argue that since Catholic hospitals are “private” institutions, the Vatican can impose any rules that it wants. The claim belies the inherently public nature of the American hospital system. Catholic hospitals–like virtually all other hospitals in the Unites States–are only able to function as a result of a swath of government handouts and subsidies. Medicare and Medicaid pay the bills of almost half their patients. Federal funding supports the salaries of their medical residents. NIH Grants sponsor their research and clinical care. Many of the hospital buildings themselves were erected will federal construction dollars providing by the Hill-Burton Act of 1946. Private businesses may have a claim to considerable leeway in formulating their own rules and policies–although even “mom & pop” stores are reasonably prevented from excluding African-American customers and are often required to accommodate disabled shoppers. In theological matters, the Pope is certainly free to issue any decree he likes and those who wish to follow his dictates are entitled to do so. In contrast, Catholic hospitals function as public entities that serve people of all faiths and traditions. A patient in a medical emergency is taken by ambulance to the nearest hospital, not the nearest hospital that shares his social values. A system that operated otherwise would lead to logistical chaos and increased mortality. Once one accepts the premise that Catholic hospitals are public institutions, they have a moral obligation to comply with generally accepted standards of patient care and professional ethics. Today’s hospitals are far more Caesar’s than they are God’s.

One of the greatest triumphs of modern health care in the United States is the rise of nonsectarian service. In an earlier era in New York City, for example, Jews sought care at Mount Sinai while Protestants preferred Presbyterian Hospital and Catholics chose St. Vincent’s. Now, most patients–and all wise ones–choose their health care providers for clinical skills and personal attributes, not religious labels. As a result, the majority of patients at Catholic hospitals are not Catholic. To impose orthodox Catholic doctrine on these non-Catholic individuals at the most vulnerable moments of their lives would be the most significant Church intervention in the lives of non-adherents since the Inquisition. Doing so would also threaten the ability of physicians to practice at Catholic hospitals without violating their professional codes of ethics. In light of these developments, any patient currently receiving care in a Catholic-run hospital should immediately clarify with her doctor whether this physician will follow the patient’s own end-of-life wishes regarding so-called heroic measures if they come into conflict with Directive 58.

The Catholic Church has every right to announce and publicize its views on certain medical interventions and to declare that Catholics who engage in certain conduct are violating the rules of the Church. It’s the Pope’s club. He can make the by-laws. He does not have any business imposing such rules on third parties who do not wish to follow them. It will be a sorry day if American patients seeking the best medical care are forced to avoid Catholic hospitals for fear of having their living wills ignored or their doctors’ counsel dictated from Rome. The Church would be wise to focus its energies on theology and to leave the practice of medicine to the professionals.

Read this post at its original site at The Huffington Post.

Directive says food and water must be given to patients in persistent vegetative state

Chicago Tribune
By Judith Graham, Tribune reporter
February 8, 2010

If ever Carol Gaetjens becomes unconscious with no hope of awakening, even if she could live for years in that state, she says she wants her loved ones to discontinue all forms of artificial life support.

But now there’s a catch for this churchgoing Catholic woman. U.S. bishops have decided that it is not permissible to remove a feeding tube from someone who is unconscious but not dying, except in a few circumstances.

Erica Laethem of Resurrection Health Care talks with resident physician Harjyot Sandhu during the rounds at Intensive Care Unit of the St. Mary's of Nazareth Hospital in Chicago. (Tribune photo by Zbigniew Bzdak / January 28, 2010)

People in a persistent vegetative state, the bishops say, must be given food and water indefinitely by natural or artificial means as long as they are otherwise healthy. The new directive, which is more definitive than previous church teachings, also appears to apply broadly to any patient with a chronic illness who has lost the ability to eat or drink, including victims of strokes and people with advanced dementia.

Catholic medical institutions - including 46 hospitals and 49 nursing homes in Illinois - are bound to honor the bishops’ directive, issued late last year, as they do church teachings on abortion and birth control. Officials are weighing how to interpret the guideline in various circumstances.

What happens, for example, if a patient’s advance directive, which expresses that individual’s end-of-life wishes, conflicts with a Catholic medical center’s religious obligations?

Gaetjens, 65, said she did not know of the bishops’ position until recently and finds it difficult to accept.

“It seems very authoritarian,” said the Evanston resident. “I believe people’s autonomy to make decisions about their own health care should be respected.”

The guideline addresses the cases of people like Terri Schiavo, a Catholic woman who lived in a persistent vegetative state for 15 years, without consciousness of her surroundings. In a case that inspired a national uproar, Schiavo died five years ago, after her husband won a court battle to have her feeding tube removed, over the objections of her parents.

The directive’s goal is to respect human life, but some bioethicists are skeptical.

“I think many (people) will have difficulty understanding how prolonging the life of someone in a persistent or permanent vegetative state respects the patient’s dignity,” said Dr. Joel Frader, head of academic pediatrics at Children’s Memorial Hospital in Chicago and professor of medical humanities at Northwestern University’s Feinberg School of Medicine.

Gaetjens, a hospice volunteer and instructor at Northwestern University, has thought long and hard about illness and the meaning of life after struggling with multiple sclerosis for 40 years.

She said she has told her sister and a close friend that she does not want “heroic measures” undertaken on her behalf at the end of life. But she acknowledged that she has not studied Catholic teachings on the subject or thought through all the implications of her position.

“My pleasure is in being part of the human race,” she said. “If that’s gone, if I can’t interact with other people, even if they could give me nutrition and keep me hydrated, I’m not interested in being preserved.”

Some experts are advising that a similar stance is no longer tenable for devout Catholics. Church members should steer away from advance directives that make blanket statements such as “I don’t want any tubes or lifesaving measures,” said the Rev. Tadeusz Pacholczyk, director of education for the National Catholic Bioethics Center in Philadelphia.

The church’s view is that giving food and water to a person through a feeding tube is not a medical intervention but basic care, akin to keeping the patient clean and turning him to prevent bedsores, Pacholczyk said.

Pope John Paul II articulated the principle in a 2004 speech, and the Congregation for the Doctrine of the Faith, an arm of the Vatican, expanded on it in a 2007 statement. The new guideline incorporates those positions in Directive 58 of the U.S. bishops’ Ethical and Religious Directives for Catholic Health Care Services.

There are several important exceptions. For one, if a person is actively dying of an underlying medical condition, such as advanced diabetes or cancer, inserting a feeding tube is not required.

“When a patient is drawing close to death from an underlying progressive and fatal condition, sometimes measures that provide artificial nutrition and hydration become excessively burdensome,” said Erica Laethem, a director of clinical ethics at Resurrection Health Care, Chicago’s largest Catholic health care system.

Some ethicists are interpreting that exception strictly. The Rev. William Grogan, a key health care adviser to Cardinal Francis George and an ethicist at Provena Health, based in Mokena, said death must be expected in no more than two weeks - about the time it would take someone deprived of food and water to die.

But Joseph Piccione, senior vice president of mission and ethics at OSF Health Care in Peoria, said that if a patient knows she is dying of, say, incurable metastasized ovarian cancer but is several months from death, she can decline to have a feeding tube inserted if she anticipates significant physical or emotional distress from doing so.

A second exception has to do with bodily discomfort. If infection develops repeatedly at the site of the feeding tube, for instance, artificial nutrition and hydration can be refused or discontinued, Catholic ethicists agree.

A third exception is allowed when inserting or maintaining a feeding tube becomes “excessively burdensome” for a patient. That would apply, for instance, if a person regurgitates the food and develops pneumonia when it enters the lungs, Grogan said.

Under traditional Catholic teachings, patients may refuse medical interventions when anticipated burdens outweigh potential benefits.

“Decisions are made case by case,” and that will continue, said Ron Hamel, senior director of ethics at the Catholic Health Association of the United States.

Of particular concern is whether Catholic medical centers will honor an advance directive stating broadly that a person does not want a feeding tube inserted.

Compassion & Choices, a group that supports the right of dying people to end their lives, suggested the potential for conflict is significant.

“Now, (Catholic) hospitals and nursing homes have no choice but to enforce Catholic doctrine universally over patient wishes,” the group’s president, Barbara Coombs Lee, wrote on her blog.

But most ethicists said they do not see a significant problem. Disagreements, they say, usually can be resolved by discussing people’s end-of-life concerns, such as fear of being abandoned, fear of living in pain or fear of becoming entirely dependent on others.

It is rare for people to be very specific about their wishes.

“I have never seen an advance directive that says, ‘If I am in a persistent vegetative state, I ask that you withdraw food and water,’” Laethem said.

“We will be very attentive to patients’ advance-care planning,” Piccione said.

That offers some solace to people like Jim Lindholm, 69, who is struggling with a recurrence of non- Hodgkin’s lymphoma and attends St. Nicholas Catholic Church in Evanston.

“If there is no hope of recovery for me, if I’ve lost my active mental life, I don’t see any reason to keep my body alive,” he said. “I would prefer to die a peaceful death.”

Lindholm speaks from deep personal experience. A dozen years ago, his father suffered a stroke and lost the ability to feed himself and speak for himself. Attempts to feed him by hand did not succeed. His advance directive was clear: no extraordinary measures.

The doctors offered a feeding tube; Lindholm’s mother said, “My husband wouldn’t want that,” so Lindholm’s dad died of lack of food and water.

Lindholm still struggles with it. Did his father really want to starve to death? If his mother had agreed to the feeding tube, how long might he have lived?

“We owe it to those who survive us to make it very, very clear what we mean by ‘do not resuscitate,’” Lindholm said.

Although medical institutions are legally bound to respect patients’ advance directives, exceptions exist for providers who object by reason of conscience or religious belief, said Charles Sabatino, head of the American Bar Association’s Commission on Law and Aging.

The bishops’ guidelines specify that “advance directives are to be followed, so long as they do not contradict Catholic teachings,” said John Haas, president of the National Catholic Bioethics Center. How those teachings will be interpreted has yet to be resolved.

jegraham@tribune.com

—————

Questions and answers about Directive 58

Q. What did the bishops actually say?

A. This quote from Directive 58 gives the gist: “In principle, there is an obligation to provide patients with food and water, including medically assisted nutrition and hydration for those who cannot take food orally. This obligation extends to patients in chronic and presumably irreversible conditions (e.g., the ‘persistent vegetative state’) who can reasonably be expected to live indefinitely if given such care. 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.’”

Q. Is this an entirely new position?

A. An earlier version of the directive, published in 2001, spoke of a “presumption” in favor of giving food and water to patients in a vegetative state; the new version speaks of an “obligation” to do so and appears to extend to patients with other chronic conditions. Precedent for the position comes from a 2004 statement from Pope John Paul II and a 2007 statement from an important advisory group at the Vatican.

Q. What inspired the change?

A. Church leaders oppose assisted suicide and euthanasia and wanted to affirm strongly that the lives of severely disabled people have value.

Q. Does it apply to Catholics only?

A. The guideline affects all patients who seek care at Catholic medical centers, regardless of their religion, said Stan Kedzior, director of mission integration at Alexian Brothers Health System.

Q. Who decides if a feeding tube is “excessively burdensome” and therefore not warranted?

A. That’s up to the patient, but it isn’t as simple as, “I don’t like it and I don’t want it.” There have to be discernible physical, emotional or financial hardships for the patient, according to Joseph Piccione of OSF Health Care. Those hardships must outweigh the potential benefits.

Q. Does this mean Catholics must pursue all medical interventions at the end of life?

A. “No. We mustn’t all die with tubes,” said John Haas of the National Catholic Bioethics Center. “The Catholic Church has never taken that position.” Church members may refuse interventions they deem excessively burdensome.

For instance, someone with advanced kidney failure is not obligated to pursue dialysis, said the Rev. William Grogan, a health care adviser to Cardinal Francis George. Someone who has lost the ability to breathe is not required to use a ventilator.

Read the story at its original site on the Chicago Tribune website.

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