title: Artificial nutrition and hydration in Catholic healthcare: balancing tradition, recent teaching, and law.
abstract: Roman Catholics have a long tradition of evaluating medical treatment at the end of life to determine if proposed interventions are proportionate and morally obligatory or disproportionate and morally optional. There has been significant debate within the Catholic community about whether artificially delivered nutrition and hydration can be appreciated as a medical intervention that may be optional in some situations, or if it should be treated as essentially obligatory in all circumstances. Recent statements from the teaching authority of the church have attempted to clarify this issue, especially for those with a condition known as the persistent vegetative state. I argue that these recent teachings constitute a "general norm" whereby artificial nutrition and hydration are considered obligatory for most patients, but that these documents allow for exception in cases of complication from the means used to deliver nutrition and hydration, progressive illness, or clear refusal of such treatment by patients. While the recent clarifications do not constitute a major deviation from traditional understanding and will rarely conflict with advance directives or legal statutes, there may be rare instances in which remaining faithful to church teaching may conflict with legally enshrined patient prerogatives. Using the Texas Advance Directives Act as an example, I propose ways in which ethics committees can remain faithful to their Roman Catholic identity while respecting patient autonomy and state law pertaining to end of life health care.
authors: Seton Medical Center, Austin, TX 78759, USA. d.zientekmd@gmail.com
authors: David M
authors: DM
authors: Zientek
mesh_terms: D016223:Advance Directives / Q000941:ethics / Q000331:legislation & jurisprudence; D002410:Catholicism; D006801:Humans; D008020:Life Support Care / Q000941:ethics / Q000331:legislation & jurisprudence; D009014:Morals; D018529:Nutritional Support / Q000941:ethics*; D018458:Persistent Vegetative State / Q000628:therapy; D012068:Religion and Medicine; D013727:Terminal Care / Q000941:ethics; D013781:Texas
references: Hastings Cent Rep. 2001 Nov-Dec;31(6):14-25
references: 12945451
references: Christ Bioeth. 2006 Apr;12(1):65-82
references: 16830414
references: Health Prog. 2010 Jan-Feb;91(1):70-2
references: 20108640
references: N Engl J Med. 2000 Jan 20;342(3):206-10
references: 10639550
references: N Engl J Med. 1994 May 26;330(21):1499-508
references: 7818633
references: N Engl J Med. 2005 Dec 15;353(24):2607-12
references: 16354899
references: Neuropsychol Rehabil. 2005 Jul-Sep;15(3-4):290-306
references: 16350973
references: JAMA. 1999 Oct 13;282(14):1365-70
references: 10527184
references: Christ Bioeth. 2006 Apr;12(1):83-97
references: 16830415
references: Origins. 2004 Apr 8;33(43):737, 739-40
references: 15139351
references: J Am Geriatr Soc. 2002 Mar;50(3):544-50
references: 11943054
references: N Engl J Med. 1994 Jun 2;330(22):1572-9
references: 8177248
references: Health Prog. 2007 Nov-Dec;88(6):44-7
references: 18062374