It's unclear what impact, if any, will come from the pontiff's stance on sustaining life with feeding tubes.
By LISA GREENE
Published May 1, 2004
Even people in a vegetative state have a right to food and water, and it is morally wrong to deny them a feeding tube, Pope John Paul II said last month.
It seems clear that the pope's words would apply to Terri Schiavo, the 40-year-old Pinellas County woman in a vegetative state who has been kept alive with a feeding tube for more than 14 years.
But whether the pope's remarks include thousands of other people with feeding tubes - not just those in vegetative states, but those with other diseases, such as dementia or terminal cancer - has become a heated debate.
U.S. Catholic leaders, and local Catholic hospitals, have had little to say on the subject, stressing the need for lengthy study and review of the pope's words. But others are split, from experts who say they could change policies at Catholic hospitals across the nation to those who say they will have little impact.
"That is an earthquake in terms of what it means for end-of-life care," said Arthur Caplan, chairman of the medical ethics department at the University of Pennsylvania School of Medicine. "This is a very important statement from the pope, although I think it's very erroneous."
But Father John Paris, Walsh professor of bioethics at Boston College, said the pope's remarks were tailored to a specific audience and will have little impact.
"I think the best thing to do is ignore it, and it will go away," Paris said. "It's not an authoritative teaching statement."
The pope's speech, Paris said, is "causing mischief" and being interpreted with too much alarm by those who aren't Catholic.
"The problem is that non-Catholics think when the pope says "Jump,' we all say, "How high?' " he said.
Although the pope's speech stressed reverence for life, Father James McCartney, assistant philosophy professor at Villanova University, said he is concerned it might be misinterpreted by some Catholics - with a very different effect.
"It might lead them to ask for physician-assisted suicide," McCartney said. "Because people will worry that they will be prolonged (with a feeding tube) for years and years, slowly dying."
At the U.S. Conference of Catholic Bishops, theologians and bishops will study the pope's words before the bishops decide whether any policies at Catholic hospitals, nursing homes and health care institutions should change, said Father John Strynkowski, executive director of the secretariat for doctrine and pastoral practices. About 625 Catholic hospitals are in the United States.
"What's involved is a process of study and reflection, looking at the pope's statement in the light of previous statements," Strynkowski said. "Theologians will have to study that whole chain of documents."
The process probably will take about a year, Strynkowski said.
Not all of the pope's speech, which took place at a religious meeting called to discuss vegetative states, is controversial. One of his most important points was to emphasize that people in a vegetative state still fall under "the loving gaze of God" and must be treated with dignity, McCartney said.
"We can't lose sight of the fact that these people are still human beings," McCartney said.
The meaning of other points may need more interpretation. Strynkowski said, at first, that the pope's words should apply only to those in vegetative states.
"The pope's statement was quite precise, that he was dealing with patients in a vegetative state," he said. "Nothing beyond that."
But in the speech, the pope said giving water and food "always represents a natural means of preserving life, not a medical act." When asked whether that passage would apply more broadly, as Caplan says it would, Strynkowski said he hadn't looked at that passage and couldn't respond.
"The way it's stated, it's broad," Caplan said. "I think if the pope really meant what he said . . . they will not be removing those things."
In Tampa, Dr. Ronald Schonwetter, chief medical officer at LifePath Hospice, said he thinks feeding tubes are medical treatment, not normal care. He's worried that patients and families will be confused about making end-of-life choices.
"Persistent vegetative state is not that common," Schonwetter said. "But it's the slippery slope - will it affect other chronic and terminal illnesses about not using artificial nutrition?"
If Catholics aren't supposed to remove feeding tubes, Caplan and Schonwetter said, it's possible that patients at Catholic-run facilities might have to transfer to others to have a tube removed or that Catholic doctors might refuse to take out a tube.
Although the speech could be interpreted to include all patients, looking at it in the context of the pope's previous teachings makes it more clear that it is directed only toward those in a vegetative state, McCartney said.
Until the question is resolved, officials at some local Catholic hospitals and nursing homes, as well as at the national Catholic Health Association, said their policies remain the same. Catholic health institutions generally follow a set of religious directives sanctioned by the church.
Those directives hold that suicide and euthanasia are never acceptable but that life-prolonging procedures do not have to be used. Food and water, including a feeding tube, can be withdrawn if they do not provide nourishment or comfort to a dying person.
Feeding tubes provide liquid nutrition to people who can't eat. They generally are surgically inserted into the stomach. About 344,000 people in the United States have them, one national nutrition group said.
When patients and family members begin talking with hospital chaplains about feeding tubes, it's often just one of a host of hard questions they grapple with.
"Sometimes it's the first time people have begun to deal with mortality in a hospital setting," said Father Terry Fleming, director of pastoral care for St. Joseph's Hospital in Tampa and St. Anthony's Hospital in St. Petersburg. "They ask very serious questions about the meaning of their lives."
But so far, Fleming said, family members have not asked about the pope's recent remarks.
"It's a case of waiting and seeing just how this will be interpreted," Fleming said.