Decisions about end-of-life medical care are often fraught with difficulty. Decisions about withdrawing life support are especially difficult. Catholic individuals and health care institutions try to apply the Catholic Church's ethical teachings to this area of decision-making. However, advances in medical technology have complicated the task of applying traditional Catholic teachings to contemporary health care quandaries. Indeed, the principal document guiding American Catholics in this area, "Ethical and Religious Directives for Catholic Health Care Services," has been revised four times since 1971.
Life and Death Decisions
The basic Catholic principle about end-of-life health care is that "we have a duty to preserve our life and to use it for the glory of God, but the duty to preserve life is not absolute," according to the "Ethical and Religious Directives for Catholic Health Care Services." Therefore it is OK to "reject life-prolonging procedures that are insufficiently beneficial or excessively burdensome." However, suicide and euthanasia are always considered unacceptable. In general, the Catholic approach emphasizes the "inherent dignity of the human person" rather than focusing on quality of life -- especially when someone other than the patient is making the latter assessment. When considering withdrawal of life support, there are two different categories of life support to consider: the artificial provision of food and water, and other extraordinary means of prolonging life.
Artificial Nutrition and Hydration
The Catholic position on medically assisted nutrition and hydration is that they should be provided to all patients who need nutrition and hydration but that they "are not morally obligatory in certain cases." These measures are not obligatory when they are "excessively burdensome" or "cause significant physical discomfort." For example, artificial hydration and/or nutrition could be discontinued when they cannot be expected to prolong the patient's life and there are "complications in the use of the means employed" that make the process very painful.
Other Means of Life Support
With respect to other kinds of life support, such as ventilators, the basic Catholic principle is that "a person may forgo extraordinary or disproportionate means of preserving life." It is important to note that this assessment -- of what is extraordinary or disproportionate -- is the patient's prerogative. Of course, if the patient is unable to express his wishes, a surrogate must make the assessment. One approach to this very difficult decision is that such life supports should be withdrawn when "such measures provide no real benefit to the patient because death is inevitable and imminent."
Room for Debate
While bishops articulate Catholic moral principles with respect to withdrawing life support, these principles do not clarify each and every circumstance. The rapid advances in medical technologies, and the great variety of ailments and treatments, make some ethical quandaries complex and difficult. Indeed, there are sometimes disagreements among Catholic bishops and theologians about what is ethically appropriate. One thing individuals can do to ease the decision-making process is to create an advance health care directive. One form of directive is a "living will," which specifies instructions for end-of-life treatment. Another is a "health-care power of attorney," which assigns decision-making power to a surrogate. Both of these actions help family members and health care providers to make appropriate decisions about withdrawal of life support for Catholic patients who are incapable of clearly expressing a decision.
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