Starvation Not Allowed In Oklahoma Catholic Hospitals

Starvation not allowed, say Catholic hospitals, Apr. 4, 2010.

Tulsa's Catholic hospitals will abide by their patients' end-of-life wishes, but will never allow them to die from starvation or dehydration, say two Tulsa physician ethicists.

"If a patient is not going to die of disease, we are not going to let them die of malnutrition or dehydration," said Dr. H. William Allred, vice president of medical affairs and chairman of the medical ethics committee at St. John Medical Center.

The bottom line? Catholic hospitals refuse to starve their patients to death.

"How is this really different from assisted suicide or euthanasia?" said Dr. Kevin Donovan, a pediatric specialist and founder and director of the Oklahoma Bioethics Center at the University of Oklahoma in Tulsa.

"Withdrawing nutrition or hydration is the modern-day ice floe," he said.

In November, the U.S. Conference of Catholic Bishops released the fifth edition of its ethical and religious directive that has sparked nationwide concerns that patients' advance directives will not be followed, particularly when it comes to withholding nutrition and hydration.

Compassion and Choices, a national nonprofit group advocating for end-of-life choice, is one of the directive's sharpest critics. It
says most Americans would not want artificial hydration and nutrition if they were in a vegetative state.

"The bishops' order fails to respect settled law that empowers patients with the right to refuse or direct the withdrawal of life-prolonging care," said group president Barbara Coombs Lee. "It will apply irrespective of your religious faith, your stated wishes in an advance directive, or the instructions of your family. This substitutes the wishes of the bishops for the stated wishes of families and the patients themselves."

But Catholic hospitals say the directive only clarified what they have always practiced and that the Catholic stance mirrors Oklahoma law, which presumes patients want food and water in the absence of specifying otherwise.

Oklahoma law does not allow assisted suicide. Only Washington, Oregon and Montana have passed legislation allowing it.

"When a patient goes to one of these facilities, they don't know that they're choosing Catholic dogma. The bishops see the hospitals as an extension of their ministry," Lee said.

Sixth commandment

But Bishop Edward J. Slattery of the Catholic Diocese of Tulsa said Catholic hospitals must follow the sixth commandment — thou shalt not kill.

"The Catholic church has to be consistent with its basic moral standards," he said. "To refuse any food or drink is to starve them to death. It's nothing more complicated than that."

Many groups who oppose the directive promote euthanasia, he said.

"Some people think they have a right to commit suicide. We do not have the right to commit suicide because we belong to God," Slattery said.

He also said many opponents call providing food and water, whether intravenously or by a feeding tube, an "extraordinary measure."

"It is perfectly natural to provide food and drink. It's really a question of respecting life," Slattery said.

"In a Catholic hospital, the underlying disease must be the cause of death. In many cases, providing nutrition and hydration to a dying person would cause pain or discomfort, and physicians are under no obligation to provide it.

"If people are not stable and dying, this (directive) is irrelevant for them," Donovan said.

Patients who are not dying but want hydration and nutrition withheld may be transferred elsewhere, he said.

"The patient has the autonomy to transfer to a different facility if they want us to withhold food and water," Allred said. "We're not going to hold them hostage."

But Lee of Compassion and Choices says many families have no other choice but Catholic medical care.

"In many cities and towns, if you don't get Catholic health care, you don't get health care," she said. "Patients' families have to muster their will and their courage to do what they know Mom would want, or what the advance directive says. They're very vulnerable to the kind of duress and shame that a policy like this would inflict. Decisions on feeding tubes are hard enough without adding this extra adversity."

'Die with dignity'

Hillcrest Medical Center and SouthCrest Medical Center are non-Catholic Tulsa hospitals.

Donovan said nutrition and hydration issues rarely come into play in hospitals.

"This will come up maybe once or twice a year in a hospital where they die acute deaths, not chronic deaths," he said. "It is more of an issue for nursing homes or hospices."

Unfortunately, many people don't fully understand the advance directive, Allred said.

"The only time we invoke it is when you as a patient cannot communicate with us," he said.

Fewer than 25 percent of Oklahomans have legally specified in an advance directive what kind of end-of-life care they want, Donovan said.

"I've always been a supporter of advance directives, but I also recommend that people take the option of appointing a proxy rather than writing down rigid rules that can't be changed or discussed with them later," he said.

Donovan urges people to think carefully about what they truly want.

"A lot of times, we think we'd say something is intolerable. But in hindsight, we may think 'It's the life I've got, and it's not that bad.'"

What generally comes to mind when thinking about medically assisted nutrition and hydration is the feeding tube, Allred said. But intravenous lines and food and mouth support can't be ignored, he said.

"Nobody's going to force food and hydration on a person who's dying and isn't going to benefit from it anyway," Donovan said.

Said Allred, "Generally speaking, as a Catholic institution, we want to help people die with dignity."

By Kim Archer, TulsaWorld