Bioethics in Faith and Practice, Volume 2, Number 1

Bioethics in Faith and Practice ⦁ 2016 ⦁ Volume 2 ⦁ Number 1 5 Bioethics in Faith and Practice vol. 2, no. 1, pp. 5-22. ISSN 2374-1597 © 2016, Gregory Smith, licensed under CC BY-NC-ND ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ) Method in Catholic Bioethics: ANH and PVS Patients Gregory James Smith Graduate Student Neiswanger Institute for Bioethics Loyola University Chicago Imagine a 300 bed Catholic hospital with all beds supporting PVS patients maintained for months, even years, by gastrostomy tubes…An observer of the scenario would eventually be led to ask: ‘Is it true that those who operate this facility actually believe in life after death? ’ 1 Introduction: In this paper, I discuss the methods used in Catholic Social Teaching (CST), a part of the Catholic Moral Tradition (CMT), as applied to bioethical problem solving and decision-making. In order to apply CST to a concrete bioethical problem and to analyze the methods used in CST, I address the nature and extent of the obligation to provide artificial nutrition and hydration (ANH) to patients in a persistent vegetative state (PVS). In particular, I focus upon the extent to which providing ANH to PVS patients is considered morally obligatory. In this effort, I discuss the current official view of the Roman Catholic Church (Church), as evidenced for the United States by the changes made in 2009 to Directive 58 of the Ethical and Religious Directives for Catholic Health Care Services (ERD), 2 as well as contrary viewpoints. ANH is referred to in the ERD as ‘medically assisted nutrition and hydration’ (sometimes abbreviated MANH in other literature published on this subject), but in both Church documents and other sources cited in this paper, the terms ANH and MANH are often used interchangeably. I have chosen to use the term ANH for convenience here. The methodology of CST, which includes the balancing of benefits-burdens , is a practical and ethical way to resolve difficult bioethical cases, including those where care decisions need to be made for patients in a PVS. In making this case, I argue that the Church has departed from its traditional approach in bioethical decision-making , 3 which included a presumption for providing ANH but emphasized the importance of the particular patient's circumstances. The current version of Directive 58 seemingly prescribes a new definitive obligation to provide ANH to all PVS patients with very limited exceptions . 4 While the motives that prompted the changes made to Directive 58 are laudable and understandable, given the vulnerability of PVS patients, the rationale for the change to a less flexible approach is not persuasive, at least insofar as applied to the majority of PVS patients in the United States. The Problem and Some Definitions: For convenience, I will refer here to the Fourth Edition of the ERD issued in 2001 as ERD4 and the Fifth Edition issued in 2009 as ERD5. The version of Directive 58 in ERD4 reads as follows: