Ethical and Religious Directives for Catholic Health Care Services
This month the bishops of the United States will vote whether to clarify when artificial nutrition and hydration (ANH) are morally obligatory.
Can food and drink ever be considered a medical treatment, and if so, are they equivalent to other medical therapies such as chemotherapy, surgery, etc.? Do artificial nutrition and hydration ever become “extraordinary” treatments?
If artificial nutrition and hydration are considered medical treatments, many argue they can be stopped or not started with the same moral and practical evaluation given to other medical treatments. They may be refused along with any or all medical measures if they offer little hope of benefit, or if the burdens outweigh the benefits.
If, however, nutrition and hydration can never be considered a medical treatment, they cannot be denied to the sick and dying if the technology is available to share. Even in extremis, instructions loosely spoken of as “do nothing,” do not mean eliminating the comforts owed someone who is sick: pain relief, clothing, warmth, human contact, prayer, cleanliness, etc. Those who believe ANH never can be considered a medical treatment, include ANH among the never-to-be-denied components of compassionate care we owe each other.
What exactly are the benefits of ANH? What is the purpose for which ANH are begun? If the underlying disease for which they may be necessary is incurable, does that make ANH useless or irrelevant? The Church has answered: No, ANH are only useless when medically contraindicated or when death is imminent. Keeping someone alive with reasonably inexpensive, non-painful and easily managed care is not extraordinary and never useless, just as the life it supports cannot be seen as useless because it may not be productive.
Can nutrition and hydration be a compassionate comfort we owe each other under normal circumstances and become a medical treatment if and when it is provided with a tube? This is one of the sticking points.
Can the meaning of food change depending on how it is delivered? Why is food special? Why don’t we have this difficulty with air and respirators? Just as Catholic teaching allows for discontinuing or not starting artificial ventilation under certain circumstances, why can’t the same rules apply to nutrition and hydration? I remember being challenged by an ethicist to explain the difference between food delivered by a feeding tube from air delivered by a respirator. He really didn’t wait for an answer, his point was that there is none.
It’s a great question - what is the difference between food and air? It got me thinking and praying and I think the answer has a lot to do with Eucharist.
We don’t gather at our family dining tables and pass around oxygen. We lavish care and attention on food preparation and its serving and we all know how important food becomes as a extension of care and love. We Catholics especially, gather each week to share a meal and a sacrifice, bread and wine which becomes the Body and Blood of Christ and though we worship and adore it at a distance, we also consume it. The Eucharist isn’t a symbol, it is the Body and Blood of Christ. We take seriously those who cannot join in the meal; we take communion to their homes, hospitals and nursing homes. And though while it is true we don’t as a matter of practice give Eucharist through feeding tubes or to the unconscious, we surely take seriously the physical and spiritual dimensions of food as an expression of God’s love and the community’s concern. It is I think, because we are a sacramental people that we puzzle over the meaning of food and water by tubes and fret about whether it can be discontinued.
Sacramental theology, medicine and moral theology can each contribute to an understanding of the pastoral care, including feeding of the sick, though not necessarily dying patient. Let us pray for our bishops and the guidance of the Holy Spirit as they discern God’s path for the church.