by Archbishop Joseph F. Naumann
Recently, I was asked by a relative for some advice regarding the language for a Durable Power of Attorney for Health Care Decisions and an advance directives document. Specifically, she wanted to know, according to Catholic moral principles, what is permissible and not permissible regarding the issue of assisted feeding. My relative’s question is an ethical decision that confronts many individuals and families today.
The church teaches that the provision of food and water (nutrition and hydration), no matter how it is provided, should be considered basic comfort care and not a medical intervention. One is not always necessarily required to have a feeding tube surgically inserted, although it is a very simple medical procedure. But once a feeding tube is in place, it is not morally permissible to stop feeding a person — thus starving or dehydrating a person to death.
Actually, spoon-feeding a person, when this is possible, is in many ways preferable to tube-feeding. First of all, spoon feeding allows much more human interaction with the person being fed and the one who assists them. Oftentimes, tube-feeding is used because it is easier and less time consuming for the care providers, not because the individual can no longer be fed orally.
There are conditions where an individual can no longer swallow or take food by mouth, but will do quite well with tube-feeding. Unless there is some other reason why tube-feeding creates a true burden for the individual, the minor surgery required to insert the tube is outweighed by the good provided by assisted feeding. On the other hand, there are also conditions — e.g., the body is no longer able to assimilate food — when continuing to feed the person either orally or by tube actually adds to the person’s discomfort and no longer provides a benefit. In these instances, the person should be kept as comfortable as possible, but they should obviously not be fed.
Sometimes individuals lose the desire to eat — not because of a medical issue, but because of depression. In such instances, the causes of the depression — e.g., loneliness, loss of independence, grief, etc. — need to be addressed. In the case of an elderly person, whose bodily systems are shutting down, it may not be advisable or necessary to admit them to a hospital in order to have a feeding tube inserted, which may only add to their confusion and bodily burdens at this time. However, every effort must be made to continue to feed them by mouth and to surround them with love and care.
In the case of a cancer patient, who is experiencing severe pain, every effort should be made to provide them with the best pain management care possible. In most cases, pain can be greatly alleviated. It is even permissible to hasten death unintentionally by providing adequate pain medication. However, it is never permissible to kill a person intentionally by overdosing them with pain medication. Nor is it permissible to kill a person by starvation or dehydration as a “means” for alleviating pain.
In ancient Rome, suicide was viewed as actually a “noble act” in the face of dishonor or ignoble suffering at the hands of an enemy. The early Christians, while exalting martyrs as true heroes who bore suffering bravely and were fearless in the face of death, drew a bright line of separation between martyrdom and the taking of one’s own life.
Christianity has always rejected suicide as an act of fortitude, but has always understood it to be an act of injustice against God who is the author of life. Though suicide must have been tempting as a means to avoid the cruel tortures devised by the persecutors of the early Christians, it was always rejected as a moral option. In fact, these early heroes of Christianity rejoiced to be found worthy to suffer for the name of Jesus. They saw suffering as means to unite themselves in some way with the Passion of Jesus.
Christians have always understood suffering, whether inflicted by an enemy of the faith or by illness, as having redemptive power when borne with faith and love. The Catechism of the Catholic Church, in its treatment of the meaning of the sacrament of the sick, speaks to the matter of redemptive suffering: “By the grace of this sacrament the sick person receives the strength and the gift of uniting himself more closely to Christ’s Passion: in a certain way he is consecrated to bear fruit by configuration to the Savior’s redemptive Passion. Suffering, a consequence of original sin, acquires a new meaning; it becomes a participation in the saving work of Jesus.” (no. 1521)
In many living wills, advance directives instruments and/or Durable Power of Attorney documents, assisted feeding is treated like a medical intervention that a patient can decline for any reason. This is not consistent with Catholic moral teaching.
Many, if not all of us, do not want to become a “burden” for others. Yet, our natural instinct to avoid suffering and our admirable desire not to make the lives of our children or others difficult by our physical care are not morally acceptable reasons to end our lives by refusing normal comfort care. Our acceptance of physical limitations and the sufferings they impose can be a powerful witness to others about the sanctity of all human life as well as a powerful means of intercessory prayer for the good of others.
Just as a parent would never consider it an undue burden to feed an infant or young child, who is incapable of feeding himself, then an adult child can never rightfully consider the care of an aged or infirmed parent as a burden. Through the eyes of faith, we see both circumstances as precious opportunities to love and to serve another. Rather than seeing our infirmity as an unjust burden imposed on another, we need to pray for the humility to allow our physical weakness to be used as an opportunity for holiness and grace for those whom we love.