Catholic patients, doctors face living will dilemma

A dialogue is urged to interpret the "practical implications" of the Pope's statement on feeding tubes.

By Andis Robeznieks, amednews staff. April 26, 2004.

The promotion of living wills may have hit a roadblock as Pope John Paul II's call to continue care for patients in a prolonged vegetative state has led to confusion over what the church allows and what living wills can do.

The Kansas City, Mo.-based Midwest Bioethics Center said the Pope's statement that continuing nourishment was "morally obligatory" contradicts past papal declarations, but Catholic Medical Assn. past president George Isajiw, MD, disagreed.

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Dr. Isajiw said the Catholic Church allows removal of feeding tubes or refusal of "extraordinary" treatments if death is imminent and would be the result of the patient's disease or injuries -- and not removal of the tube.

Midwest Bioethics Center President and CEO Myra J. Christopher cheered the Pope's call to treat patients in a vegetative state with dignity, but said she would have problems if his statement leads to ignoring patients' advance directives to not prolong their lives by providing food and water through a feeding tube.

"All people have the right to refuse and choose medical treatment consistent with their goals and values," she said. "And, when known, those wishes should be honored."

Christopher added that she will leave the task of interpreting the religious meaning of the Pope's statement to theologians. The Catholic Health Assn. recently released a statement of its own saying that it was in the process of doing just that.

"The guidance contained in his remarks has significant ethical, legal, clinical, and pastoral implications that must be carefully considered," the statement read. "This will require dialogue among sponsors, bishops, and providers, especially with regard to practical implications for those patients who are not in a persistent vegetative state."

Christopher and her organization provided legal counsel in a landmark 1990 U.S. Supreme Court case that recognized a patient's right to refuse treatment and helped draft the federal Patient Self-Determination Act.

Dr. Isajiw, an internist near Philadelphia, said many patients don't understand living wills.

"Half the people sign these things and don't know what they mean. Your living will may say you don't want a feeding tube if permanently unconscious, but a living will does not go into effect unless you're terminal."

ADDITIONAL INFORMATION:

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Speech by Pope John Paul II to "Life Sustaining Treatments and Vegetative State: Scientific Advances and Ethical Dilemmas" International Congress (www.vegetativestate.org/discorso_papa.htm)

AMA Policy E-2.225 Optimal Use of Orders-Not-To-Intervene and Advance Directives (www.ama-assn.org/apps/pf_new/pf_online?f_n=browse&doc=policyfiles/HnE/E-2.225.HTM)

AMA Virtual Mentor, "Departed, Jan. 11, 1983; At Peace, Dec. 26, 1990" (www.ama-assn.org/ama/pub/category/print/3054.html)

Midwest Bioethics Center "Caring Conversations" end-of-life care program (www.midbio.org/mbc-cc.htm)