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Rigali intervenes: feeding tube must stay

NCR Staff

Archbishop Justin Rigali of St. Louis has barred removing a feeding tube from a man in a persistent vegetative state, forcing a Catholic hospital to alter its usual practice.

Rigali’s stance handed a victory to anti-euthanasia groups picketing the hospital, but evoked dismay from prominent ethicists who say the intervention violates sound Catholic medical ethics.

Specifically, Rigali required that artificially administered food and water be given Steven G. Becker as long as he remained in a Catholic hospital. Becker, 29, removed Oct. 5 from St. John’s Mercy Medical Center in St. Louis, died Oct. 10 at home.

The controversy underscores a complex bioethical debate: Should a feeding tube be considered medical treatment, which Catholic ethicists agree may, in some cases, be refused? Or is it basic care, due as long as the body can assimilate it?

In an opinion piece published Aug. 24 in the St. Louis Post-Dispatch, Dominican Fr. Kevin O’Rourke, a moral theologian and expert on the issues, said most medical professionals consider feeding tubes treatment. In a telephone interview, he described Rigali’s recent stance as troubling and “idiosyncratic.”

O’Rourke said Rigali had catered “to the vitalist position,” the “extreme pro-life view.”

James Drane, Catholic bioethicist in Pennsylvania, said it even more strongly. Use of a feeding tube “to extend a process that can only end in death without recovery is a violation of basic principles of Catholic moral teaching about end-of-life care,” he said.

A hospital official testified, and several sources reported, that the hospital would normally not have refused to remove a feeding tube in such cases. The controversy over the Becker case was reminiscent of other protracted legal battles in Missouri over feeding tubes but marks the first such controversy involving a patient in a Catholic hospital.

A court had cleared the way for the tube to be withdrawn, as Becker’s wife, Christie Blair-Becker, had requested -- in keeping with her husband’s wishes, she had testified -- and as the hospital’s ethics committee had advised. Becker’s mother, Marjorie Sutter, had gone to court to block removal.

Other facts are as follows:

Becker’s wife took him to St. John’s in February, where tests showed a cyst that had caused a fluid buildup in his brain. Becker lost consciousness after a surgical procedure and was eventually diagnosed as in “a persistent vegetative state.”

When conflict developed among Becker’s family members, St. Louis County Probate Judge Mark D. Siegel, granted legal guardianship to his wife, paving the way for the feeding tube to be removed. Also on the table, though, was a June directive from Rigali, which called for presumption in favor of feeding tubes. Privately, Rigali insisted Becker’s feeding tube could not be removed as long as he remained in the Catholic facility, sources said.

Ethical and Religious Directives for Catholic Health Care Services, promulgated by U.S. bishops, are ambiguous on removal of feeding tubes. Most clinical ethicists and many bishops interpret the directives as supporting removal in cases such as Becker’s, but some conservative bishops disagree. Statements by two regional bishops’ groups illustrate the divergence.

Catholic bishops of Pennsylvania, in a statement revised in 1999, said it would be “morally wrong to discontinue nutrition and hydration” for a person in a persistent vegetative state “when they are within the realm of ordinary means.” A feeding tube rarely poses a serious burden to a patient and should be provided, the bishops said.

Catholic bishops of Texas, on the other hand, issued a statement in 1990 supporting removal of feeding tubes for persons in a persistent vegetative state. Such removal, presuming careful deliberation, signals acceptance “of the fact that the person has come to the end of his or her journey and should not be impeded from taking the final step,” the bishops wrote.

Lasalette Fr. Edward Richard, who teaches moral theology at Kenrick Seminary in St. Louis and consults with Rigali on bioethics, noted, however, that Pope John Paul II, during an ad limina visit by U.S. bishops in October 1998 said feeding tubes constitute “ordinary” care and should rarely be withheld. Richard believes that the pope’s statement trumps the Texas stance. Moral theologians on the other side cite long church tradition, including relevant teachings by Pope Pius XII.

The “ultimate goal” of Catholic medical care, O’Rourke said, is “to help people strive for eternal life.” To exaggerate the importance of a person’s physical existence, when that person has been deprived of intellect and will, undermines human dignity, “a proximate goal to eternal life,” he said.

O’Rourke has been directly involved in cases similar to Becker’s. He supported removing a feeding tube from Nancy Beth Cruzan, subject of a protracted legal battle from 1983, when an automobile accident left her in a persistent vegetative state. Her feeding tube was removed in 1990, permitting her to die.

Drane described Rigali’s recent intervention as “another instance of a turn in the church hierarchy away from Catholic moral teachings toward an exaggerated pro-life kind of philosophy that ignores all of the subtleties and distinctions of a rational pro-life position.” Ignoring such distinctions can only lead to increased societal support for assisted suicide and euthanasia, Drane warned.

Drane is Russell B. Roth professor of clinical bioethics at Edinboro University of Pennsylvania.

Pamela Schaeffer’s e-mail address is pschaeffer@natcath.org

National Catholic Reporter, October 20, 2000