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Questions About Medically Assisted Nutrition And Hydration

7. Who should make decisions about medically assisted nutrition and hydration?

"Who decides?" In our society many believe this is the most important or even the only important question regarding this issue, and many understand it in terms of who has legal status to decide. Our Catholic tradition is more concerned with the principles for good moral decision making, which appiy to everyone involved in a decision. Some general observations are appropriate here.

A competent patient is the primary decision maker about his or her own health care and is in the best situation to judge how the benefits and burdens of a particular procedure will be experienced. Ideally the patient will act with the advice of loved ones, of health care personnei who have expert knowledge of medicai aspects of the case, and of pastorai counselors who can help explore the moral issues and spiritual values involved. A patient may wish to make known his or her general wishes about life support in advance; such expressions cannot have the weight of a fully informed decision made in the actual circumstances of an illness, but can help guide others in the event of a later state of incompetency. [40] Morally even the patient making decisions for himself or herself is bound by norms that prohibit the directly intended causing of death through action or omission and by the distinction between ordinary and extraordinary means.

When a patient is not competent to make his or her own decisions, a proxy decision maker who shares the patient's moral convictions, such as a family member or guardian, may be designated to represent the patient's interests and interpret his or her wishes. Here, too, moral limits remain relevant - that is, morally the proxy may not deliberately cause a patient's death or refuse what is clearly ordinary means, even if he or she believes the patient would have made such a decision.

Health care personnei should generally follow the reasonable wishes of patient or family, but must also consult their own consciences when participating in these decisions. A physician or nurse told to participate in a course of action that he or she views as clearly immoral has a right and responsibility either to refuse to participate in this course of action or to withdraw from the case, and he or she should be given the opportunity to express the reasons for such refusal in the appropriate forum. Social and legal policies musr protect such rights of conscience.

Finally, because these are matters of life and death for human persons, society as a whole has a legitimate interest in responsible decision making.[41]