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Posted: February 16th, 2023

Ethical and Religious Directives for

Catholic Health Care Services

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Sixth Edition

UNITED STATES CONFERENCE OF CATHOLIC BISHOPS

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Ethical and Religious Directives for Catholic Health Care Services, Sixth Edition

This sixth edition of the Ethical and Religious Directives for Catholic Health Care Services was

developed by the Committee on Doctrine of the United States Conference of Catholic Bishops (USCCB)

and approved by the USCCB at its June 2018 Plenary Assembly. This edition of the Directives replaces

all previous editions, is recommended for implementation by the diocesan bishop, and is authorized for

publication by the undersigned.

Msgr. J. Brian Bransfield, STD

General Secretary, USCCB

Excerpts from The Documents of Vatican II, ed. Walter M. Abbott, SJ, copyright © 1966 by America

Press are used with permission. All rights reserved.

Scripture texts used in this work are taken from the New American Bible, copyright © 1991, 1986, and

1970 by the Confraternity of Christian Doctrine, Washington, DC, 20017 and are used by permission of

the copyright owner. All rights reserved.

Digital Edition, June 2018

Copyright © 2009, 2018, United States Conference of Catholic Bishops, Washington, DC. All rights

reserved. No part of this work may be reproduced or transmitted in any form or by any means, electronic

or mechanical, including photocopying, recording, or by any information storage and retrieval system,

without permission in writing from the copyright holder.

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Ethical and Religious Directives for Catholic Health Care Services, Sixth Edition

Contents

4 Preamble

6 General Introduction

8 PART ONE

The Social Responsibility of

Catholic Health Care

Services

10 PART TWO

The Pastoral and Spiritual

Responsibility of Catholic

Health Care

13 PART THREE

The Professional-Patient Relationship

16 PART FOUR

Issues in Care for the Beginning of Life

20 PART FIVE

Issues in Care for the Seriously Ill

and Dying

23 PART SIX

Collaborative Arrangements with

Other Health Care Organizations and Providers

27 Conclusion

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Ethical and Religious Directives for Catholic Health Care Services, Sixth Edition

Preamble

Health care in the United States is marked by extraordinary change. Not only is there

continuing change in clinical practice due to technological advances, but the health care system

in the United States is being challenged by both institutional and social factors as well. At the

same time, there are a number of developments within the Catholic Church affecting the

ecclesial mission of health care. Among these are significant changes in religious orders and

congregations, the increased involvement of lay men and women, a heightened awareness of

the Church’s social role in the world, and developments in moral theology since the Second

Vatican Council. A contemporary understanding of the Catholic health care ministry must take

into account the new challenges presented by transitions both in the Church and in American

society.

Throughout the centuries, with the aid of other sciences, a body of moral principles has

emerged that expresses the Church’s teaching on medical and moral matters and has proven to

be pertinent and applicable to the ever-changing circumstances of health care and its delivery. In

response to today’s challenges, these same moral principles of Catholic teaching provide the

rationale and direction for this revision of the Ethical and Religious Directives for Catholic

Health Care Services.

These Directives presuppose our statement Health and Health Care published in 1981.1

There we presented the theological principles that guide the Church’s vision of health care,

called for all Catholics to share in the healing mission of the Church, expressed our full

commitment to the health care ministry, and offered encouragement to all those who are

involved in it. Now, with American health care facing even more dramatic changes, we

reaffirm the Church’s commitment to health care ministry and the distinctive Catholic identity

of the Church’s institutional health care services.2 The purpose of these Ethical and Religious

Directives then is twofold: first, to reaffirm the ethical standards of behavior in health care that

flow from the Church’s teaching about the dignity of the human person; second, to provide

authoritative guidance on certain moral issues that face Catholic health care today.

The Ethical and Religious Directives are concerned primarily with institutionally based

Catholic health care services. They address the sponsors, trustees, administrators, chaplains,

physicians, health care personnel, and patients or residents of these institutions and services.

Since they express the Church’s moral teaching, these Directives also will be helpful to Catholic

professionals engaged in health care services in other settings. The moral teachings that we

profess here flow principally from the natural law, understood in the light of the revelation

Christ has entrusted to his Church. From this source the Church has derived its understanding

of the nature of the human person, of human acts, and of the goals that shape human activity.

The Directives have been refined through an extensive process of consultation with bishops,

theologians, sponsors, administrators, physicians, and other health care providers. While providing

standards and guidance, the Directives do not cover in detail all of the complex issues that confront

Catholic health care today. Moreover, the Directives will be reviewed periodically by the United

States Conference of Catholic Bishops (formerly the National Conference of Catholic Bishops), in

the light of authoritative church teaching, in order to address new insights from theological and

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After studying the course materials located on Module 7: Lecture Materials & Resources page, answer the following:

  1. Cure / care: compare and contrast.
  2. Basic care: Nutrition, hydration, shelter, human interaction.
    • Are we morally obliged to this? Why? Example
  3. Swallow test, describe; when is it indicated?
  4. When is medically assisted N/H indicated?
    • Briefly describe Enteral Nutrition (EN), including:
      • NJ tube
      • NG tube
      • PEG
    • Briefly describe Parenteral Nutrition (PN), including:
      • a. Total parenteral nutrition
      • b. Partial parenteral nutrition
  5. Bioethical analysis of N/H; state the basic principle and briefly describe the two exceptions.
  6. Case Study: Terry Schiavo (EXCEL FILE on Module 7: Lecture Materials & Resources page). Provide a bioethical analysis of her case; should we continue with the PEG or not? Why yes or why not?
  7. Read and summarize ERD paragraphs #:  32, 33, 34, 56, 57, 58.

Submission Instructions:

  • The paper is to be clear and concise and students will lose points for improper grammar, punctuation, and misspelling.
  • If references are used, please cite properly according to the current APA style. Refer to your syllabus for further detail or contact your instructor.

***************************************************************************************************

Syllabus

WEEK 7: NUTRITION AND HYDRATION /PERSISTENT VEGETATIVE STATE (PVS)
Module 7
Watch:
https://www.youtube.com/watch?v=8yxIRjW9x7w&t=3437s  BIO 603 3 24 18
ERD 32, 33, 34, 56, 57, 58
1. Cure / care: compare and contrast.
2. Basic care: Nutrition, hydration, shelter, human interaction.
a. Are we morally obliged to this? Why?
3. Swallow test, describe; when is it indicated?
4. When is medically assisted N/H indicated?
a. Briefly describe Enteral Nutrition (EN), including:
i. NJ tube
ii. NG tube
iii. PEG
b. Briefly describe Parenteral Nutrition (PN), including:
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i. Total parenteral nutrition
ii. Partial parenteral nutrition
5. Bioethical analysis of N/H; state the basic principle and briefly describe the two exceptions.
6. Case Study: Terry Schiavo (EXCEL FILE IN CANVAS). Provide a bioethical analysis of her case; should we
continue with the PEG or not? Why yes or why not?

Sheet2

1963 BORN 3-Dec-63
Theresa (Terri) Marie Schindler is born in Pennsylvania.
10-Nov-84
1984 MARRIED Terri Schindler, 20, and Michael Schiavo, 21, are married at Our Lady of Good Counsel Church in Southhampton, Pennsylvania. The union is now among the “celebrity marriages” featured at About.com, a Website about marriage.
(20 Y/O) 1986
The couple move to St. Petersburg, where Ms. Schiavo’s parents had retired.
25-Feb-90
1990 COLLAPSE Ms. Schiavo suffers cardiac arrest, apparently caused by a potassium imbalance and leading to brain damage due to lack of oxygen. She was taken to the Humana Northside Hospital and was later given a percutaneous endoscopic gastrostomy (PEG) to provide nutrition and hydration. Police report
PEG 12-May-90
(26 Y/0) Ms. Schiavo is discharged from the hospital and taken to the College Park skilled care and rehabilitation facility.
18-Jun-90
Court appoints Michael Schiavo as guardian; Ms. Schiavo’s parents do not object.
30-Jun-90
Ms. Schiavo is transferred to Bayfront Hospital for further rehabilitation efforts.
Sep-90
Ms. Schiavo’s family brings her home, but three weeks later they return her to the College Park facility because the family is “overwhelmed by Terri’s care needs.”
Nov-90
Michael Schiavo takes Ms. Schiavo to California for experimental “brain stimulator” treatment, an experimental “thalamic stimulator implant” in her brain.
Jan-91
The Schiavos return to Florida; Ms. Schiavo is moved to the Mediplex Rehabilitation Center in Brandon where she receives 24-hour care.
19-Jul-91
Ms. Schiavo is transferred to Sable Palms skilled care facility where she receives continuing neurological testing, and regular and aggressive speech/occupational therapy through 1994.
May-92
Ms. Schiavo’s parents, Robert and Mary Schindler, and Michael Schiavo stop living together.
Aug-92
1992 1/4 M AWARD Ms. Schiavo is awarded $250,000 in an out-of-court medical malpractice settlement with one of her physicians.
Nov-92
1992 1 M AWARD The jury in the medical malpractice trial against another of Ms. Schiavo’s physicians awards more than one million dollars.  In the end, after attorneys’ fees and other expenses, Michael Schiavo received about $300,000 and about $750,000 was put in a trust fund specifically for Ms. Schiavo’s medical care.
(750Th TRUST) 14-Feb-93
Michael Schiavo and the Schindlers have a falling-out over the course of therapy for Ms. Schiavo; Michael Schiavo claims that the Schindlers demand that he share the malpractice money with them.
29-Jul-93
Schindlers attempt to remove Michael Schiavo as Ms. Schiavo’s guardian; the court later dismisses the suit.
1-Mar-94
First guardian ad litem, John H. Pecarek, submits his report.  He states that Michael Schiavo has acted appropriately and attentively toward Ms. Schiavo.
6-May-97
Michael Schiavo’s attorney Deborah Bushnell writes to the Circuit Court to request that the Schindlers receive notice of all filings in the guardianship proceeding, in anticipation of a forthcoming request to withdraw Ms. Schiavo’s PEG tube.
May-98
~1990 INFIDELITY  Michael Schiavo was in a relationship with Jodi Centonze, and had fathered their first child. He said he chose not to divorce his wife and relinquish guardianship because he wanted to ensure her final wishes (not to be kept alive in a PVS) were carried out.
1998 MICHAEL Michael Schiavo petitions the court to authorize the removal of Ms. Schiavo’s PEG tube; the Schindlers oppose, saying that she would want to remain alive.  The court appoints Richard Pearse, Esq., to serve as the second guardian ad litem for Ms. Schiavo.
PET PEG OUT 20-Dec-98
1998 TERRI The second guardian ad litem, Richard Pearse, Esq., issues his report in which he concludes that Ms. Schiavo is in a persistent vegetative state with no chance of improvement and that Michael Schiavo’s decision-making may be influenced by the potential to inherit the remainder of Ms. Schiavo’s estate.
PVS OFFICIAL January 24-27, 2000
Trial begins with Pinellas-Pasco County Circuit Court Judge George Greer presiding.
2000 JUDGE GREER 11-Feb-00
REMOVE PEG Judge Greer rules that Ms. Schiavo would have chosen to have the PEG tube removed, and therefore he orders it removed, which, according to doctors, will cause her death in approximately 7 to 14 days.
2-Mar-00
2000 SCHINDLERS The Schindlers file a petition with Judge Greer to allow “swallowing” tests to be performed on Ms. Schiavo to determine if she can consume—or learn to consume—nutrients on her own.
PET SWALLOW 7-Mar-00
2000 GREER Judge Greer denies the Schindlers’ petition to perform “swallowing” tests on Ms. Schiavo.

 

 

SOLUTION

The Ethical and Religious Directives for Catholic Health Care Services provide guidance and norms for Catholic health care institutions and their personnel in carrying out their ministry of healing. The Directives are based on Catholic moral principles, the teachings of the Catholic Church, and the dignity of the human person.

The Directives cover a wide range of topics, including the protection and promotion of human life, the provision of care for the sick and dying, the use of medical treatments and procedures, and the role of Catholic health care institutions in the community.

In addition to providing guidance for Catholic health care institutions, the Directives also address the responsibilities of individual health care professionals, including physicians, nurses, and other caregivers. The Directives emphasize the importance of respecting the dignity of every person, regardless of their age, health, or social status.

Overall, the Ethic

 

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