The Vatican’s recent pronouncement about end-of-life issues has raised new questions, and posed new challenges, for a lot of Catholics.

And Robert McClory has decided to take a hard look at them in the Chicago Tribune:

For severely ill patients, particularly Catholic ones, the choice of hospital has suddenly become more complicated.

Following a declaration from the Vatican, Catholic medical facilities will be required to use feeding tubes and other means to keep alive patients in a persistent vegetative state. This holds even if the insertion of a feeding tube goes against a patient’s living will or the family’s wishes.

Catholic hospital officials are downplaying the declaration’s effect. But some theologians are predicting that patients may feel compelled to leave or avoid Catholic hospitals and nursing homes. That goes especially for elderly people who might normally use a Catholic medical facility but do not want their end-of-life wishes contradicted.

The issue is complicated. This, after all, is the Vatican.

Last month, the Congregation for the Doctrine of the Faith, with the approval of Pope Benedict XVI, issued what it called a “clarification.” It said “the administration of food and water,” usually by feeding tube, “is in principle an ordinary and proportionate means of preserving life.”

“Therefore,” the statement went on, the measure was “morally obligatory … for as long as it is shown to accomplish” its goal.

Some theologians see the declaration not as a “clarification” of a moral tradition but as a step backward on a basic question: how best to respect human dignity in the last days of life. If the document was intended to bring Catholic unanimity on the subject, it clearly has not done so.

“I’ve talked to more than seven medical ethicists around the country, and we’re all aware of a degree of consternation in the Catholic community,” said Rev. Kenneth Himes, chairman of theology at Boston College. He deemed the Vatican statement a “bizarre turn of events.”

But Rev. Michael Place, senior vice president for social ministry for Resurrection Health Care, which oversees many Chicago health facilities, said the Vatican statement “should not be a source of concern.”

A persistent vegetative state is extremely rare, Place said. It is in a medical category that is not easily or readily defined. And, Place said, each case must be weighed individually, and there is a wide range of possible exceptions to the general principle.

Nonetheless, Place acknowledged that if a definite diagnosis of persistent vegetative state has been made and all the possible disqualifying conditions are absent, a patient must be kept on a feeding tube indefinitely regardless of the patient’s stated wishes and those of the family.

“Yes, that is the current Catholic position,” Place said.

Himes and Place are in basic disagreement about the declaration’s legitimacy.

For some 400 years, Himes said, “Catholic tradition did not demand that everything that can be done must be done to keep persons alive.”

“The church distinguished between ‘ordinary’ and ‘extraordinary’ means of preserving life, and the distinction was not between the various medical techniques to be used, such as artificial hydration and nutrition,” Himes said.

Rather, Himes said, the basis was the subjective benefit to the patient, versus the burden of the treatment to the patient or family.

Thus, if a feeding tube or other intervention could conceivably help restore health or improve quality of life, it should be used, he said; if it did not achieve such ends, merely keeping the patient technically alive, the tube was considered extraordinary and could be rejected by the patient or by another with authority to act in the patient’s name.

Pope John Paul II gave mixed signals on the issue. In his 1995 encyclical, “Evangelium Vitae,” he seemed to endorse the position that a feeding tube was extraordinary, saying, “Certainly the life of the body in its earthly state is not an absolute good for the believer.” Yet in 2004 he indicated otherwise.

The lack of clarity, and lobbying by the National Right to Life Committee and others over the Terri Schiavo case in 2005, brought calls from the U.S. Bishops Conference for a ruling. That came last month. And it left little wiggle room.

Check out the rest and see what you think.