Making Sense of the Roman Catholic Directive to Extend Life Indefinitely

In November 2009, the U.S. Conference of Catholic Bishops issued "Ethical and Religious Directives for Catholic Health Care Services," requiring that all patients--including those in the so-called persistent vegetative state--be provided with artificial hydration and nutrition if such care could extend life indefinitely. (1) The directives--particularly directive 58--prompted outcry from death-with-dignity movements and confusion within hospital ethics committees. Barbara Coombs Lee, president of Compassion and Choices, was quoted as saying that the new directive could potentially create "300,000 Terri Schiavo cases," equal to the number of feeding tubes inserted in the United States each year. (2) Some hospital ethics committees debated whether their hospitals would be obliged to accept patients who refused such treatment as transfers from local Catholic hospitals. These discussions raise several questions with direct bearing on patient care: Do the bishops have authority over Roman Catholic health care institutions? Do the bishops' directives represent a departure from--or even a radicalization of--traditional Catholic teaching? How might these directives change clinical practice?