Ethicists: Vatican text encourages British docs to defy living wills

By Simon Caldwell
19/9/2007

Catholic News Service

LONDON (CNS) – Medical ethicists in Britain said a Vatican document reiterating that it is a moral obligation to provide food and water to patients in a vegetative state will encourage doctors to defy living wills.

Anthony Ozimic, political director of the Society for the Protection of Unborn Children, said the document released Sept. 14 by the Vatican's Congregation for the Doctrine of the Faith was "highly significant" for England and Wales, where the Mental Capacity Act will take effect Oct. 1.

The act "runs directly contrary to the (Vatican) statement's principles," he said in a written statement Sept. 18.

"The Mental Capacity Act allows, and in some cases requires, food and water to be denied to mentally incapacitated, nondying persons," Ozimic said.

"This will place conscientious health workers in a serious dilemma," he added. "They may be forced to choose between continuing to feed patients and participating in a regime of starvation and dehydration."

Ozimic said health workers who refuse to withdraw nutrition and hydration "may face disciplinary action, dismissal or even criminal prosecution."

"We hope that this timely statement from the Vatican will be backed up with pastoral action here to support health care workers of any faith resisting pressure to cooperate in the killing-by-omission of their patients," he said.

The Vatican reiterated church teaching that nutrition and hydration, even by artificial means, cannot simply be terminated because doctors have determined that a person will never recover consciousness.

Exceptions may occur when patients are unable to assimilate food and water or in rare cases when nutrition and hydration become excessively burdensome for the patient, it said.

The Mental Capacity Act allows patients to instruct doctors that they wish to refuse treatment if their condition worsens. It will give legally binding force for the first time to living wills, under which patients can record their wish to refuse treatment if they become seriously or terminally ill.

It also includes new provisions for patients to give "lasting powers of attorney" to a friend or relative, who would be able to instruct doctors to terminate nutrition and hydration for the patient if he or she became incapacitated.

Those refusing to obey the instructions would be open to prosecution for assault.

According to reports in the British media, some doctors already have indicated that they are willing to go to jail rather than obey directives they claim will oblige them to kill patients by withdrawing food and fluids, which have been classified in Britain as "treatment" since 1993.

Dr. Philip Howard, a member of the Guild of Catholic Doctors, said he hoped the Vatican document would help to clear up "a lot of confusion" among professionals about whether the withholding of food and fluid from stroke victims and those with brain damage was legitimate.

"Because strokes are so common among the elderly, a denial of tube feeding will lead to the premature deaths of many, many people," he told Catholic News Service in a telephone interview Sept. 18.

"I know it causes a great deal of distress among nursing staff," he said. "There is a moral obligation under most circumstances to provide hydration and nutrition. In my view we should never cause a patient to die."

Elspeth Chowdharay-Best of the anti-euthanasia group ALERT told CNS Sept. 18 that practitioners who felt under pressure from the government "to get rid of bed-blockers" would "draw great encouragement" from the Vatican document.

But Julia Quenzler of SOS-NHS Patients in Danger, a group formed by bereaved relatives of patients who have died in hospitals as a result of deliberate dehydration, told CNS Sept. 18 that the Vatican document did not address the reality of the situation in Britain.

"Those most at risk are elderly patients who are not terminally ill or unconscious, who are able to swallow and communicate, but are rendered incapacitated by having food and water withheld, resulting in death from dehydration and the consequences of malnutrition," she said.

"Of course, that's not what it will say on the death certificates," Quenzler added. "If these deaths took place anywhere but in a hospital setting, those responsible would face criminal charges."