What is the Church's teaching on extaordinary care for the sick?

My brother-in-law recently suffered a heart attack. He is now comatose with almost no upper (conscious) brain activity. He has been like this for about 2 weeks and the doctors estimate he has a 1% chance of any recovery beyond his current state (vegetative) and a 50% chance of death within 12 months. He is on a ventilator and will probably need a feeding tube in the near future.

The doctors want to remove the ventilator to see if he can breathe on his own. If he can’t breathe then re-intibation will be necessary and possibly more extensive medical measures just to keep him breathing.

I have read what I can find about this topic and we want to be ready for the decisions before they need to be made. My questions are:

In this type of situation are we morally required to do everything possible if reintibation of the breathing tube is required for him if he can’t breathe on his own?

Secondly is a feeding tube considered an extroadinary measure or is it a burden? Are we morally driven to have it inserted or to not have it inserted?

I extend our condolences to you and your family. You are in our prayers.

The Catechism of the Catholic Church (CCC) provides some general teaching in this area:

“Those whose lives are diminished or weakened deserve special respect. Sick or handicapped persons should be helped to lead lives as normal as possible.

“Whatever its motives and means, direct euthanasia consists in putting an end to the lives of handicapped, sick, or dying persons. It is morally unacceptable.

”Thus an act or omission which, of itself or by intention, causes death in order to eliminate suffering constitutes a murder gravely contrary to the dignity of the human person and to the respect due to the living God, his Creator. The error of judgment into which one can fall in good faith does not change the nature of this murderous act, which must always be forbidden and excluded.

“Discontinuing medical procedures that are burdensome, dangerous, extraordinary, or disproportionate to the expected outcome can be legitimate; it is the refusal of “over-zealous” treatment. Here one does not will to cause death; one’s inability to impede it is merely accepted. The decisions should be made by the patient if he is competent and able or, if not, by those legally entitled to act for the patient, whose reasonable will and legitimate interests must always be respected.

“Even if death is thought imminent, the ordinary care owed to a sick person cannot be legitimately interrupted. The use of painkillers to alleviate the sufferings of the dying, even at the risk of shortening their days, can be morally in conformity with human dignity if death is not willed as either an end or a means, but only foreseen and tolerated as inevitable. Palliative care is a special form of disinterested charity. As such it should be encouraged” (CCC 2276-2279).

Also, in the Address of John Paul II to the Participants in the International Congress on “Life –Sustaining Treatments and Vegatative State: Scientific Advances and Ethical Dilemmas (March 20, 2004), Pope John Paul II made it clear that feeding tubes should be considered ordinary care so long as they serve their intended purposes: “[T]he administration of water and food, even when provided by artificial means, always represents a natural means of preserving life, not a medical act. Its use, furthermore, should be considered, in principle, ordinary and proportionate, and as such morally obligatory insofar as and until it is seen to have attained its proper finality, which in the present case consists in providing nourishment to the patient and alleviation of his suffering.”

It is understandable if you need counseling and assistance in making moral decisions during this difficult time. I recommend that you contact the National Catholic Bioethics Center.

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