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	Kansas Bishops Release Feeding Tube Directive By Bill Tammeus The Kansas City Star February 25, 2006 http://www.kansascity.com/mld/kansascity/news/local/13953437.htm Hospitalized Catholics with serious illnesses face renewed and difficult questions about health care. That's because bishops in Kansas have issued a recent statement that raises again the end-of-life issues the late Pope John Paul II addressed almost two years ago. The four Kansas bishops said in a letter that Catholics should consider signing a newly revised "Catholic Declaration of Life and Natural Death." Patients can use that document to describe the treatment they want if they're dying, although one Catholic ethicist says the Kansas document amounts to little more than a "living will" and isn't much use. The bishops said that in view of the legal battle last year over whether to withdraw feeding tubes from a brain-damaged Florida woman, Terry Schiavo, Catholics should think anew about all of this. The Kansas "Declaration" says food and water tubes "are not medical treatments, nor medical procedures, but ordinary means of preserving life." That's the position John Paul II took in March 2004 for patients in "persistent vegetative states," though many Catholic health-care workers and ethicists took exception to that view. They said it could result in an undue burden on patients and families. So far, the directives issued for Catholic health-care workers in the United States have not changed to reflect the pope's view. And it's unlikely they will be changed until the Vatican, now under a new pope, clarifies its position. So Catholic hospitals are operating under the current directives, which say "a person may forgo extraordinary or disproportionate means of preserving life." But Sister Judith Jackson, a vice president of the Sisters of Charity of Leavenworth Health System, said the group's Kansas hospitals will have the new "Declaration" available for patients. The Kansas statement said there are circumstances in which food and water tubes can be removed. The Rev. Kevin O'Rourke, who teaches ethics at Loyola University in Chicago, says the Kansas "Declaration" is not very helpful because it has no place for people to designate someone to make health-care decisions for them if they are unable to. "That's why the advance directive is what they need," he said. An advance directive designates someone to make health-care decisions. O'Rourke said the Kansas statement uses "ambiguous terms" such as "ordinary means of preserving life." He says health-care workers can't even determine what ordinary means are until the patient's condition is known because those means will differ from patient to patient. Kentucky bishops took a different approach in a document published last September, "Kentucky's Advance Health Care Directives and Organ Donation: A Catholic Perspective." In it, the bishops said "one is not obliged to use 'extraordinary' means, that is, means which offer no reasonable hope of benefit or which involve excessive hardship." They also said a patient's condition "may affect the moral obligation of providing artificial nutrition and hydration." And, the Kentucky bishops said, such food and water tubes may be removed if they are "unduly burdensome for the patient." In both the Kansas and Kentucky statements, bishops emphasized that "there should be a presumption in favor of providing nutrition and hydration to all patients." Richard Doerflinger of the Secretariat for Pro-Life Activities of the United States Conference of Catholic Bishops said the current directives for Catholic health-care workers already contain the presumption of the use of food and water tubes. What may need revision in those directives, Doerflinger said, is a note that says American bishops are waiting for "further reflection" from the Vatican on whether the feeding-tube rules apply to patients in persistent vegetative states. Patients are defined that way when they are awake but unaware of themselves or their surroundings and have been in that condition for a year or more. O'Rourke said he doesn't know what the Vatican will say about this issue now, but "if they come out with the same kind of statement that the bishops of Kansas have, that will mean anyone anyplace who doesn't use (feeding tubes) is doing something wrong, and that's ridiculous." On the Web • The Kansas bishops' letter and the "Declaration": www.kscathconf.org • The Kentucky bishops' statement: tinyurl.com/d6oap • The "Ethical and Religious Directives for Catholic Health Care Services": .shtml
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