End-of-life care differs

By Michelle Martin
staff writer

Jesuit Father Myles Sheehan, a gerontologist and associate dean at Loyola University’s Stritch School of Medicine, said people who make decisions about feeding and hydration tubes must consider the pope’s words carefully.

“I appreciate the statement for its reminder to all of us about the value of life, no matter how difficult the circumstances,” said Sheehan, who drafted the Illinois bishops’ 2001 pastoral letter on end-of-life care. “I find it an extension of previous teaching, in that it is now required that artificial nutrition and hydration be provided for patients in per-
sistent vegetative states. The previous teaching was only that there was a presumption in favor if it.”

But the statement, Sheehan noted, applies only to those patients who are in persistent vegetative states, not those who are approaching the end of life from cancer or other terminal illnesses. Persistent vegetative state is a relatively rare condition, he said.

Franciscan Father Thomas Nairn, professor of moral ethics at Catholic Theological Union, agreed.

In the past, he said, moralists have often used Catholic teaching about end-of-life care to patients in persistent vegetative states because the model for making ethical decisions in those cases just didn’t work very well. The model calls for looking at the benefits and burdens of an intervention, to decide whether it should be considered “ordinary” and required, or “extraordinary,” and not required. But when a patient cannot communicate, accurately assessing the benefits and burdens of any intervention becomes a problem, so moralists have sometimes applied end-of-life standards to those in persistent vegetative states.

What many ethicists are doing now is taking the pope’s statement about patients in persistent vegetative states and trying to apply it to end-of-life situations, Nairn said. Are they going too far?

“Yes,” he said. “We’re talking about a small minority of patients here. The pope did not address end-of-life care.”

Indeed, for Nairn, the most important passage in the pope’s statement says that feeding and hydration tubes only are required so long as they are providing nourishment and alleviating suffering. For some cancer patients nearing death, feeding tubes actually increase their pain without extending life.