From the intriguing new website Big Questions Online here is a thought-provoking piece by Susan Jacoby. In this extract she sets the stage:
My mother, at 89, lives with a sound mind in a failing and frail body. She has had a living will for decades, and it specifies that no extraordinary medical measures — including artificial feeding — be used to prolong her life if there is no hope of recovery. She has explicitly told my brother and me, who have the legal power to make her health-care decisions if she is no longer able to do so, that she wants nothing done to keep her alive if her mind is gone. You can’t get much clearer than that.
In spite of the advance planning for which my mother is legendary, she might be in real trouble if she were unfortunate enough to be taken in an unconscious state to an emergency room at a Roman Catholic hospital. The moral values of the U.S. Conference of Catholic Bishops — not her own values — could dictate her care.
The bishops’ most recent health-care directives, issued near the end of 2009, make it clear that they consider it the duty of Catholic health-care providers to impose artificial nutrition and hydration on patients in persistent vegetative states. My brother and I would, of course, take immediate steps to have our mother removed from a setting where her wishes would be ignored. But what if she had no living children or, like some two-thirds of Americans, had procrastinated about putting her instructions in writing?
Here is an issue involving the separation of church and state that is, at its core, a question of whether individual liberty of conscience really means liberty for all…
Discuss among yourselves
What the bishops say and what is done in practice are two different things.
I’m a physician employed by a large Catholic hospital group (incidentally, in ten years never once has anyone inquired about my religious views, or lack thereof). We follow the same rules/guidelines as other hospitals in these situations. If someone has a living will/valid healthcare power of attorney, we will follow their directions/guidance completely (which is both legally and ethically required).
Obviously we don’t perform abortions and we don’t prescribe birth control pills (though they can be used for other accepted medical reasons, such as hormonal therapy for ovarian cysts). Otherwise, there is absolutely no difference between us and other secular facilities (except that, given our mission, we provide a lot more uncompensated care)
In many circumstances, even a living will isn’t enough. Living wills are often ignored, especially if family members want to keep the person alive. I find this quite disturbing.
Ideally, anytime anyone signed up for a healthcare plan, they would fill out a form indicating under what circumstances they would be kept alive. The patient’s choice would be sacrosanct, and the neither the family nor doctors would get a say.
For children under 18, it gets harder, but for adults, the patient should have absolute discretion.
Living wills are not sufficient. A durable power of attorney is far superior to a living will in dealing with these kinds of issues. In cryonics, for example, it is recommended that any living will be backed by a durable power of attorney in ensure that your wishes are carried out.
In the absence of written directions, or a properly authorized representative, the hospital has to make a decision. I see nothing wrong with the hospital making a choice based on its owners’ values when the patient’s desires are unknown.
in the short run, it isn’t always obvious whether the patient’s condition is permanent, which argues in favor of attempting to continue life.
I note the apparent concern for persons who might receive sustaining medical treatment they might not want.
What about people who may be deprived of sustaining medical treatement they do way?
Or who are at risk of involuntary euthanasia?
“Obviously we don’t perform abortions and we don’t prescribe birth control pills (though they can be used for other accepted medical reasons, such as hormonal therapy for ovarian cysts). Otherwise, there is absolutely no difference between us and other secular facilities (except that, given our mission, we provide a lot more uncompensated care)”
Oh, right, *obviously*. Other than not providing two legal treatments because of religious doctrine, there’s no difference between the Catholic hospital you work for and a secular one. Yup, no difference at all.