When the news reached Compassion & Choices in November that the US Council of Catholic Bishops (USCCB) had ordered Catholic institutions to disregard certain advance directive instructions or family wishes regarding tube feeding, I asked myself where, in this affront to personal choice, we could place our hope.

I have written about the Bishops’ new Directive #58, about its arrogance in coercing patients to either comply with their dogma or check out of their institutions, and about the long shadow the Bishops cast over healthcare in America.

Since November various commentators have offered differing visions of hope for those troubled by having an authoritarian church, possibly not even of their religion, impose treatment against their wishes should they ever be permanently unconscious. An article in Atlanta’s Sunday Paper December 20 discusses the legal, ethical, religious and autonomy issues at length.

The Catholic Health Association of the United States (CHA), apparently hopes that only in unusual cases will a Catholic facility overrule patient or family wishes. They write:

“In the vast majority of cases, patients’ advance directives will be honored. … There may be the occasional situation, such as some patients in a persistent vegetative state, when what the patient is requesting through his or her advance directive is not consistent with the moral teaching of the Church. In these few cases, the Catholic health care facility would not be able to comply.”

The number of patients who fall into a permanently unconscious state is, of course, small compared to the 5.5 million who receive treatment each year in Catholic hospitals. The CHA offers the hope you or someone you love will not be among the unfortunate few.

Some offer hope that the new Directive does not really mean what it says. Alan Sanders, director for the Center for Ethics as Atlanta’s St. Joseph’s Hospital, emphasizes that patients’ wishes are considered an important part” of the decision-making process.

He points to language in the Directives pertaining to a person’s right to “forgo extraordinary or disproportionate means of preserving life,” as protection of a patient’s right to have his or her wishes considered in the event they are faced with a chronic and irreversible condition such as being in a long-term coma.

According to the Directives, proportionate means are “those that in the judgment of the patient offer a reasonable hope of benefit and do not entail an excessive burden or impose excessive expense on the family or community.”

Sanders believes that patients’ or their surrogates’ concerns about matters arising from being maintained in a PVS could constitute the sort of undue burden recognized by the Directives, making it acceptable to remove a feeding tube.

Unfortunately Sanders’ hope is false. The new Directive #58 is quite specific, and as such, overrides any general language appearing elsewhere in the Directives Document. And the Directives specify that an “undue burden” is only one that would “cause significant physical discomfort, for example resulting from complications in the use of the means employed.”

Father Thomas G. Weinandy, executive director for the Secretariat of Doctrine at the USCCB, offers the hope that you or your family members, guided by the Bishops’ wisdom, will accept Catholic doctrine and change your mind:

“Whoever was speaking on behalf of the hospital would tell [the patient’s representative] what the Catholic Church’s teaching is and why it holds to that,” he says. “If they want that [patient’s] directive followed, they’d need to move them to another health care facility where that directive would be followed.”

How hard hospital staff might push the family to submit to Catholic doctrine goes unstated. So you can also hope that your family has the courage and determination to stand up to those in the position of power, and what may seem like undue influence and coercion. You’ll also need to hope that in your town there is another hospital (though some areas are served only by Catholic health care) ready to honor your wishes and that the transfer will not be too traumatic for either patient or family.

Might you place your hope in the legal system?

Alan Meisel, founder and director of the University of Pittsburgh’s Center for Bioethics and Health Law, wonders if Catholic hospitals could be compelled by law to respect patients’ advance directives, regardless of the Church’s moral stance. He says it is not clear whether the legally binding power of an advance directive would outweigh the Church’s right to administer medicine in accordance with its beliefs:

“[If] the hospital seeks to impose a treatment on a patient which that person does not want, to impose that treatment is battery,” he says, but adds a caveat: “One could say since you’ve admitted yourself to a Catholic hospital, that’s a form of consent.

“If I were a patient with a directive," he continues, "I would probably add to it that I didn’t want to be taken to a Catholic hospital."

Father Weinandy believes the Directives handed down by the Church are not only legal, but protected by the United States Constitution.

“I would like to think that for the government to require Catholic hospitals to abide by these [patient] advance directives would be against the First Amendment freedom to practice one’s religion without being intimidated or coerced into doing something that is opposed to one’s religion,” he says.

A patient’s constitutional right not to be intimidated or coerced into accepting treatment in opposition to their belief system is not Father Weinandy’s concern. And Father Weinandy’s stance is gaining ever-greater legal protection, elevating the rights of providers, and the authorities that direct them, above the rights of patients.

My hope is to keep alive, even in the darkest days, the flickering light of personal liberty. I believe in accepting, even embracing each other’s differences, and in the right of each individual to a free and responsible search for truth and meaning. And I believe that those who choose a path of community service, like health care, owe their patients dignity and respect for deeply held values and beliefs — even those that differ from their own.

At Compassion & Choices, we hope that in the future, that light will burn brighter; patients will expect, providers will recognize and our laws will insure — that the beliefs and choices of patients and their families are paramount. I hope each of us will be able to choose a hospital, nursing home and insurance plan that honors our moral decisions instead of imposing their own. I hope for a time when all Americans can live and die as free people, in dignity and according to their own spiritual beliefs.