Catholic healthcare authorities in the United States are coming under fire over revised directives on care for patients in a persistent vegetative state. Back in November, US Catholic bishops updated their health care guidelines after the Vatican declared that such patients should be given nutrition and hydration, except in some exceptional circumstances. The news passed largely unnoticed.

But this week the Chicago Tribune asked whether a Catholic hospital would honour a patient’s advance directives if they stipulated that no food and water should be given. It interviewed elderly Catholics who were horrified at the thought of lingering unconsciousness. "My pleasure is in being part of the human race," said one of them. "If that's gone, if I can't interact with other people, even if they could give me nutrition and keep me hydrated, I'm not interested in being preserved."

However, the view of the bishops is that food and water, like cleanliness and avoiding bedsores, are ordinary care, not exceptional treatment, and they should be provided as long as they are not burdensome for the patient. Pope John Paul II sketched out this principle in a 2004 speech, and the Vatican made further clarifications in 2007. A new edition of the guidelines incorporates those positions in Directive 58 of the US bishops' Ethical and Religious Directives for Catholic Health Care Services. 

The head of Compassion and Choices, a prominent lobby group for assisted suicide, attacked the Church for not respecting patients’ autonomy. In her blog, its president, Barbara Coombs Lee, said that the guidelines were arrogant and authoritarian and hinted that she would fight them. “We must increase public awareness of the threats to their rights in Catholic institutions and take steps to stop the Vatican from unilaterally ignoring legally executed advance directives,” she wrote.

However, Catholic authorities told the Tribune that they did not foresee problems. "I have never seen an advance directive that says, 'If I am in a persistent vegetative state, I ask that you withdraw food and water,'” said Erica Laethem, a director of clinical ethics at Resurrection Health Care, Chicago's largest Catholic health care system. ~ Chicago Tribune, Feb 8; HT to Sheila Liaugminas