Roman Catholics have a long tradition of evaluating medical treatment at the end of life to determine if proposed interventions are proportionate and morally obligatory or disproportionate and morally optional. There has been significant debate within the Catholic community about whether artificially delivered nutrition and hydration can be appreciated as a medical intervention that may be optional in some situations, or if it should be treated as essentially obligatory in all circumstances. Recent statements from the teaching authority of the church (...) have attempted to clarify this issue, especially for those with a condition known as the persistent vegetative state. I argue that these recent teachings constitute a “general norm” whereby artificial nutrition and hydration are considered obligatory for most patients, but that these documents allow for exception in cases of complication from the means used to deliver nutrition and hydration, progressive illness, or clear refusal of such treatment by patients. While the recent clarifications do not constitute a major deviation from traditional understanding and will rarely conflict with advance directives or legal statutes, there may be rare instances in which remaining faithful to church teaching may conflict with legally enshrined patient prerogatives. Using the Texas Advance Directives Act as an example, I propose ways in which ethics committees can remain faithful to their Roman Catholic identity while respecting patient autonomy and state law pertaining to end of life health care. (shrink)

This article looks at the late John Paul II's allocution on artificial nutrition and hydration (ANH) and the implications his statement will have on the ordinary-extraordinary care distinction. The purpose of this article is threefold: first, to examine the medical condition of a persistent vegetative state (PVS); second, to examine and analyze the Catholic Church's tradition on the ordinary-extraordinary means distinction; and third, to analyze the ethics behind the pope's recent allocution in regards to PVS patients as a matter of (...) conscience. Rather than providing clarification, I argue that the papal allocution has raised many difficult questions. People in situations where decisions must be made about withdrawal or continued ANH are in need of guidance. Moreover, additional analysis is needed to determine whether the papal allocution is in conflict with the traditional Catholic medical ethics understanding of the ordinary-extraordinary care distinction. (shrink)

Amidst the wealth of literature on the topic of moral distress in nursing, a single citation is ubiquitous, Andrew Jameton’s 1984 book Nursing practice. The definition Jameton formulated reads ‘... moral distress arises when one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action’. Unfortunately, it appears that, despite the frequent use of Jameton’s definition of moral distress, the definition itself remains uncritically examined. It seems as if the context (...) of how moral distress arises (i.e. anger, frustration etc.) has been co-opted as its definition. This current work suggests that the current definition is not moral distress as defined by Jameton, but rather, in large part, nursing’s discomfort with moral subjectivity in end-of-life decision making. A critical examination of how the Catholic tradition’s normative ethical framework accounts for moral subjectivity in end-of-life decision making serves to aid nursing’s discomfort and as a starting point to recontextualize moral distress. (shrink)

The implications of Pope John Paul II's 2004 Allocution on vegetative states remain unclear despite dozens of articles and a recent clarifying statement from the Vatican. Yet few have considered its implications for those with end-stage progressive dementia, such as Alzheimer's disease. Although recent studies suggest tube feeding is burdensome and not beneficial for such patients, the Allocution would nonetheless seem to forbid patients from forgoing it. But this seems to be in tension with the Catholic bioethical tradition as a (...) whole and may therefore be a consequence that the pope did not intend. Because the recent Vatican clarification specifically addresses Alzheimer’s, it is especially important to know what duties it intends to impose on those with dementia. Problems with how it would apply to such patients casts doubt on whether it should be applied to patients in vegetative states at all. (shrink)

The Catholic moral tradition has consistently offered the distinction between ordinary and extraordinary means as a framework for making end-of-life decisions. Recent papal allocutions, however, have raised the question of whether providing artificial nutrition to patients in a persistent vegetative state is to be considered ordinary and thus morally obligatory in all cases. I argue that this “revisionist” position is contrary to Catholic teaching and that enforcing such a position would endanger the ability of Catholic health care institutions to minister (...) to all their constituents. (shrink)