US Catholic bishops asked the Pope's office about tube feeding, and the Pope's office answered,
"First question: Is the administration of food and water (whether by natural or artificial means) to a patient in a 'vegetative state' morally obligatory except when they cannot be assimilated by the patient's body or cannot be administered to the patient without causing significant physical discomfort?
Official Commentary: vatican.va/roman_curia/congregations/cfaith/documents/rc_con_cfaith_doc_20070801_nota-commento_en.html
Another article discusses the compatibility of this Catholic teaching with the Los Angeles guidelines, discussed above, which tell doctors they do not need to offer artificial feeding to certain patients, even if the patients need artificial feeding to live.
Do End-of-Life Guidelines in Los Angeles Differ from Catholic Teaching?
The article on Ethics has a section on guidelines in Los Angeles and southern California, including Providence, a Catholic hospital chain.
Fr. Luke Dysinger has been kind enough to explain how these guidelines that doctors "are not obliged to offer" feeding tubes relate to Catholic teaching that providing food is obligatory "even by artificial means." Fr. Dysinger is a professor at a Catholic seminary, and was on the program for a press conference announcing the Los Angeles guidelines. Nine major health systems adopted the guidelines in May 2014, including a Catholic group which runs 6 hospitals, Providence Health & Services.
The joint guidelines say that doctors "are not obliged to offer" tube feeding:
The Vatican said in 2007 (approved in 2007 by Pope Benedict XVI, building on earlier teaching by Popes John Paul II and Pius XII):
Official Commentary: www.vatican.va/roman_curia/congregations/cfaith/documents/rc_con_cfaith_doc_20070801_nota-commento_en.html
Fr. Dysinger wrote:
Thank you for your question concerning Catholic teaching on the necessity of nutrition and hydration at the end of life. The short answer to your question lies in the very important words "in principle" within the statement you quoted. The original Italian for this phrase is "in linea di principia" (Pope John Paul II, "Life Sustaining Treatment..." Mar. 20, 2004; reference and citation below) which, as I understand it, can also be translated as "normally", or "generally speaking". Thus the statement does not – and in fact could not – make an absolute statement that artificial nutrition and hydration must always be used in any clinical setting. There is not, nor could there ever be, such a thing as a "Vatican-approved" list of modalities that are always obligatory or always optional for all Catholics. Everything depends on the unique circumstances of the case and the informed desires and moral intentions of the patient. A key summary of Catholic moral teaching on this point may be found in the Catechism of the Catholic Church:
For many centuries the Catholic Church has emphasized that the definition of "burden" in any particular setting can only be made by the patients themselves (i.e. not by the physician or the clinical ethicist), and that as long as the patient does not intend to cause or hasten death by refusing treatment (whether understood as "medical acts" or "natural means") , such refusal may be permissible if the patient finds the means or acts morally repugnant (St. Alphonsus M. de Liguori Theologia Moralis Tractate 4. On the Fourth and Sixth Precepts [of the Decalog]. Ch. 1, "What is forbidden by the Precept: You shall not kill", § 366-372. original text with translation: http://ldysinger.stjohnsem.edu/ThM_590_Intro-Bioeth/03_hist-devt/05_enlightenment.htm#4._ALPHONSUS_LIGOURI_ )
So the short answer to the polemical question "Are dying Catholics obliged to have feeding tubes," is "no, they are not, unless they want them." I have never met a trained provider of palliative care who recommended or encouraged parenteral feeding for the dying; and it should be added that the Catholic Church is extremely supportive of palliative care, as is stated quite strongly in the Catechism:
The pope also pointed out that PVS is a syndrome rather than a disease, that it is often misdiagnosed, and that we do not, in fact, know with certainty what level of consciousness may be present, even in patients who are correctly diagnosed as being in a persistent vegetative state. This last point is crucial, since a fundamental difference (from the standpoint of care) between dying patients and those who are not dying, is that the dying often refuse food and water, yet do not suffer from a subjective sense of thirst or hunger. This would not be the case in an apparently-"vegetative-state" person who nevertheless retained some level of awareness and sensation. There can be little doubt that such a person would, in fact, suffer very great pain from dehydration and starvation if artificial feeding were simply stopped. Recent research published in reputable medical journals (Neurology, the New England Journal of Medicine) has revealed the pope to have been alarmingly correct: a significant percentage of correctly-diagnosed PVS patients are apparently able to understand and properly respond to verbal commands. Needless to say, ethicists who formerly argued that PVS patients should not be provided with nutrition and hydration ought to more carefully nuance their arguments on the basis of these findings:
Fr. Dysinger makes a strong point above that Catholicism teaches tube feeding is a moral choice for patients to make:,