Saturday, April 3, 2004

Hospitals stand pat on living wills

By Matt Leingang
The Cincinnati Enquirer

In the wake of Pope John Paul II's declaration that hospitals should never remove feeding tubes and hydration from patients who are in a vegetative state, the nine Catholic hospitals in Greater Cincinnati say they will continue to honor end-of-life directives unless otherwise told.

But the ramifications of the pope's comments, released in English Thursday, are unclear, and local hospital officials say they are confused about whether policies need to be revised.

Among the questions:

• Will Catholic hospitals and long-term care facilities continue to honor living wills made by people who state in advance that they do not want medical treatments to prolong their life?

• What about durable power of attorney, which authorizes another person to make health care decisions for individuals should they become unable to make their own?

• And is the pope's declaration merely a guide or meant to set policy for all Catholic health care providers?

Catholic Healthcare Partners, which includes the five Mercy hospitals in Cincinnati and the three St. Elizabeth hospitals in Northern Kentucky, said Friday that it continues to honor living wills and durable power of attorney.

The pope's teachings are respected and "remind us of our responsibilities to provide compassionate care to the sick and dying," said Greg Smith, spokesman for Catholic Healthcare Partners.

The implications "will be carefully considered by Catholic bishops and health care organizations," Smith said.

Good Samaritan Hospital in Clifton is also sticking to its policy to honor living wills and durable power of attorney. The hospital needs additional time to better understand the pope's meaning and intent, spokesman Joe Kelley said.

The Mercy and St. Elizabeth hospitals, along with Good Samaritan, are all members of the Catholic Health Association, an umbrella group for 565 hospitals in the United States.

CHA's current policy considers feeding tubes for people in a persistent vegetative state "medical treatment," which could be provided or discontinued, based on evaluating the benefits and burdens on patient and family.

Many public and private hospitals have taken this stance since 1990, when the Supreme Court ruled that feeding tubes are medical treatments never intended to keep someone alive forever in an unconscious state.

But the pope declared such support "basic care" and "not a medical act." He called the removal of feeding tubes "euthanasia by omission."

That position is fundamentally at odds with the way medicine is practiced in the United States, even among many Catholic physicians, said Arthur Caplan, director of the University of Pennsylvania's Center for Bioethics and a leading author on the subject.

Caplan suspects that the pope's comments were prompted by the Terri Schiavo case in Florida.

Schiavo is the focus of an intense battle between her husband, who wants her feeding tube removed, and her parents, who don't. Last year, Gov. Jeb Bush and the Florida Legislature aggressively intervened and, despite several court rulings, passed legislation mandating that Schiavo must continue to receive medical nutrition and hydration.

No hospital is legally required to honor living wills or durable power of attorney, said Marshall Kapp, an attorney and professor at Wright State School of Medicine.

But institutions that accept Medicare and Medicaid funding, which includes many Catholic hospitals, are required to make their policies on end-of-life care known to patients so that they can shop around, Kapp said.

"The pope's statements have the potential to create a lot of chaos for both patients and Catholic institutions who may feel compelled to revise their policies on feeding tubes," said Kapp, who added that this should spur the general public to be very specific on their living wills about what kind of end-of-life care they desire.

Doctors are required to follow a patient's wishes, Kapp said. If those wishes conflict with a doctor's personal or religious beliefs, patients have the right to be transferred.

The Rev. Robert Hurd, a physician who teaches bioethics at Xavier University, said he doesn't see the need for controversy. He interpreted the pope's comments as a "guide" for Catholic hospitals.

The pope is encouraging physicians and ethicists to better understand the conditions of patients who are in a persistent vegetative state and to develop systems that will help families cope with this long-term difficulty, Hurd said.



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