A statement by Pope John Paul II that health care providers are morally obliged to provide food and water to patients in persistent vegetative states has left church officials uncertain what impact it would have at the nation's more than 600 Catholic hospitals.
The statement, made March 20 but translated into English on Thursday, raised major questions in the church's decades-long debate over how far health care providers should go to keep alive people who have been in deep comas for long periods.
Among them: How might the pope's stance affect a patient who has made an advanced directive ordering physicians to remove feeding tubes after he or she has slipped into an irreversible coma?
Catholic officials said it could be months or longer before the United States Conference of Catholic Bishops - the American church's governing body - or the Vatican provided clarification on how Catholic hospitals should apply the pope's words.
"We are waiting for an analysis from our moral theologians, who will look at every angle," said Cardinal William H. Keeler, who oversees the six Catholic hospitals in the Archdiocese of Baltimore. "As to its full implications, I'm really not clear yet."
Even if the pope's speech, which does not have the authority of a papal encyclical, is interpreted strictly, Catholic health officials suggested it might not affect many patients.
The Rev. Michael Place, president of the Catholic Health Association of the United States, which oversees the nation's 624 Catholic hospitals, said he doubted many of the patients they treat fit the kind described in the pope's speech.
"Anecdotally, my impression is that Catholic health care probably does not have a large number," Place said in a phone interview yesterday. Place added that the church's long-term care facilities do not typically provide the kind of services such patients require.
Larry Beck, president of Good Samaritan Hospital of Maryland, said that he, too, had rarely encountered instances in which patients are kept alive for years by artificial means - like the widely publicized case of Terry Schiavo, the Florida woman whose family members are battling one another and the state over whether to remove her feeding tube.
Usually, he said, patients in vegetative states die from other health problems. Those who don't are often moved to state-run chronic care facilities.
"That's an unusual situation," said Beck, who had not read the pope's speech. "I don't have a patient like that at Good Samaritan Hospital. I can't remember the last time I had a patient like that."
The pope's comments came last month after a Vatican-sponsored symposium on the scientific and ethical issues surrounding people in vegetative states. In his speech, the pontiff said that even such people retain human dignity and have a right to be monitored for clinical signs of eventual recovery. Denying food and water would constitute "euthanasia by omission," he said.
"The administration of water and food, even when provided by artificial means, always represents a natural means of preserving life, not a medical act," the pope said. "Its use, furthermore, should be considered, in principle, ordinary and proportionate, and as such morally obligatory."
Bolstering a position
The pope's statements do not alter church doctrine, church officials say, but reinforce and clarify an earlier position made by the U.S. Conference of Catholic Bishops in 1992 that strongly favored continuing to feed people in vegetative states.
In the past, some theologians have publicly disagreed with this position. Church officials said that last month's speech marked the first time the pope had weighed in so definitively.
"To have the pope speak on this and speak his mind is something people on both sides of the question have been waiting for for years," said Richard Doerflinger, deputy director of the conference's Secretariat for Pro-Life Activities. "The theological stakes have now been raised."
Doerflinger continued: "How much this changes actual practice in Catholic hospitals remains to be seen. It does not remove all practical judgments about whether a feeding tube in an individual case is doing more harm than good. It means we have to make very careful, case-by-case decisions."