The Catholic Moral Tradition on Providing Food and Fluids

Declaration on Euthanasia, The Sacred Congregation for the Faith. Vatican City, May 5, 1980, in Deciding to Forego Life-Sustaining Treatment. President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, (Washington, DC: U.S. Government Printing Office, 1983), pp. 300–307.

See Gerald Kelly S.J. , “The Duty to Preserve Life,” Theological Studies. XI, 1950, p. 554, on the “good Catholic” attitude, where he says about “many religious and … devout lay Catholics” that “they believe that the important thing is to die holily, and they frankly say that there are limits to what must or should be done in order to prolong temporal life.”

James J. , McCartney O.S.A. M.S., M.A. , “The Development of the Doctrine of Ordinary and Extraordinary Means of Preserving Life in Catholic Moral Theology Before the Karen Quinlan Case,” Linacre Quarterly. August, 1980, pp. 215–224, has a brief history of these terms.

Kelly , op. cit., p. 550.

Cronin Daniel A. , “The Moral Law in Regard to the Ordinary and Extraordinary Means of Conserving Life”, Rome: Typis Pontificae Universitatis Gregorianae, 1958, quoted in McCartney, p. 219.

Pius X.I.I. , Allocution “Le Dr. Bruno Haid,” [to an international congress of physicians and anesthesiologists]. Acta Apostolicae Sedes, 49, 1957, pp. 1031–1032.

Kelly , op. cit., p. 553.

The Ethical and Religious Directives for Catholic Health Facilities were promulgated by the National Council of Catholic Bishops in 1971 and amended slightly in 1975. This document is a code intended for Catholic health care institutional providers which is subject to the interpretation of each bishop within his diocese. A short history of the Directives can be found in Ethics Committees, by Robert P. Craig, Carl L. Middleton and Laurence J. O'Connell (St. Louis: Catholic Health Association. 1986), pp. 21–29.

the available modes of artificial nutrition and hydration are (I) peripheral IV, which cannot provide sufficient nutrition to sustain life over a long period of time: (2) superior vena cava IV. which allows for adequate nutrients, but because it is more invasive, carries the risks of thrombosis, lung puncture and infection; (3) nasogastric tube, which allows feeding via the gastrointestinal system, but is uncomfortable for the patient, especially when it has been in for some time; and (4) gastrostomy, a tube inserted surgically into the stomach. This last procedure is less uncomfortable for the patient, but is initially the most invasive of all of the available methods. See Watts David T. , and Christine M.D. , Cassel K. M.D. , “Extraordinary Nutritional Support”. Journal of American Geriatrics Society, Vol. 32, No. 3 (March, 1984), pp. 237–242.

Fifty-six of the 84 patients at New England Sinai Hospital where Paul Brophy is being fed by means of a gastrostomy, were on artificial feeding regimes of various kinds at the time of the Brophy hearing in 1985. Brophy, at sec. 56. Cf. also Rebecca S. , Dresser J.D. , and Boisaubin Eugene V. Jr., M.D. , “Ethics Law and Nutritional Support.” Archives of Internal Medicine, Vol. 145, January, 1985, p. 122.

Bayer Edward J. S.T.D. , “Intravenous Food and Fluids for the Dying.” Ethics and Medics, Vol. 9, No. 6, June, 1984, p. 1, commenting on Kenneth C. Micetich. M.D., Patricia H. Steinecker, M.D. and David C. Thomasma, Ph.D., “Are Intravenous Fluids Morally Required for a Dying Patient?” Archives of Internal Medicine, Vol. 143, May. 1983, pp. 975-978.

Callahan Daniel , “On Feeding the Dying,” Hastings Center Report, 13, 1983, p. 22 and Alexander Morgan Capron, “Care of the Dying: Withholding Nutrition,” Hastings Center Report, October, 1984, pp. 32-35.

Padilla Geraldine V. Ph.D. , and Marcia M. Grant R.N., M.S.N. , “Psychosocial Aspects of Artificial Feeding,” Cancer, Vol. 55. No. 1, January supplement, 1985, p. 301.

Enteral systems are tube feeding systems. Parenteral ones provide nutrients and fluid intravenously.

David W. Meyers. J.D., L.L. M., lists the argument, usually brought forward to justify providing nourishment in all cases and shows that each of these arguments fails in certain cases because of the circumstances and desires of the individual patient. See “Legal Aspects of Withdrawing Nourishment from an Incurably III Patient,” Archives of Internal Medicine, Vol. 145. January, 1985, pp. 125–128. See also Bayer, p. 2.

Paul Brophy is a patient in New England Sinai Hospital in a “persistent vegetative state.” Judge Kopelman refused to authorize his wife to withdraw a feeding tube. According to the judge. “It is ethically inappropriate to cause the preventable death of Brophy by the deliberate denial of food and water which can be provided to him in a non-invasive non-intrusive manner which causes no pain and suffering, irrespective of the substituted judgment of the patient. The proper focus should be on the quality of treatment furnished to Brophy and not on the quality of Brophy's life. Otherwise the Court is pronouncing judgment that Brophy's life is not worth preserving. The quality of life is an incorrect focus because there are no manageable criteria for making such a judgment.” Brophy v. New England Sinai Hospital. No. 85E0009-GI (Mass. Prob. Ct., Norfolk Div., Oct. 21, 1985).

Quoted in Dresser and Boisaubin, loc. cit., p. 123.

See e.g., Brodeur Dennis , “Feeding Policy Protects Patients’ Rights. Decisions,” Health Progress, June, 1985, pp. 38–43; Kevin O'Rourke, O.P., “The AMA Statement on Tube Feeding: Ethical Analysis.” Ethical Issues in Health Care, VII/8, April, 1986; Pope Pius XII's Allocution cited above, while not mentioning feeding, does say that no one is obliged to take on a “grave burden” because to do so would “render the attainment of a higher good too difficult.” The Pope seems to assume that the patient is still vital enough to struggle for his good.

Claire Conroy was an 84-year-old woman suffering from a number of serious and progressively debilitating conditions. She was minimally responsive to the gestures of care givers and to other stimuli in her environment. The Supreme Court of New Jersey ruled that life-sustaining treatment, including nutrition and hydration, could be withheld from a patient such as Conroy if (1) the person deciding on her behalf had clear evidence that she would have refused such treatment, if (2) there was some indication she would have refused and the surrogate decision-maker determined that the “burdens of the patient's continued life with the treatment outweigh the benefits of that life”, or if in the absence of any indications as to her wishes (3) the patient's burdens “clearly and markedly” outweighed the benefits of continuing to treat her. The court determined that there was not sufficient evidence presented by the case to have justified the withdrawal of a feeding tube from Conroy.

Office for Pro-Life Activities. National Conference of Catholic Bishops, 1312 Massachusetts Ave., N.W., Washington. DC 20005.

Siegler Mark , and Alan M.D. , Weisbard J. J.D. , “Against the Emerging Stream,” Archives of Internal Medicine, Vol. 145, January, 1985, pp. 129–131.

In re Conroy, 486 A. 2nd 1209 (NJ, 1985).

Dresser , and Boisaubin , loc. cit., p. 123.

David T. Watts M.D. , Cassell Christine K. M.D. , loc. cit., p. 241.