A group of experts are highlighting papal teaching that people in persistent comas should be nourished regardless of the cost, as an ordinary duty of persons to one another.
This was affirmed in an article published this month in the journal of the National Catholic Bioethics Center, Ethics and Medics, signed by a group of 15 scholars.
Some of the contributing scholars are: Robert George, jurisprudence professor at Princeton University; William May, retired moral theology professor at the John Paul II Institute for Studies on Marriage and Family; Christian Brugger, moral theology professor at St. John Vianney Theological Seminary; and Father Thomas Berg, executive director of Westchester Institute for Ethics and the Human Person.
I certainly disagree with this, and I am definitely against euthanasia. Medically, we live in a insane environment that tries deny the inevitability of death and when it comes we try to hide it away. Keeping people “alive” with artificially with tube feeding is not benign. The patients have all sorts of unpleasant medical problems, including bed sores that one can put your fist in. I have taken care of these “patients” tangentially. The families are in complete denial. Instead of having a pleasant death, they have this bizarre protracted process. There isn’t grieving when the patient finally expires, rather a gradual detachment has taken place and when death comes, it is met with indifference.
Why not let these people go? It is natural. It is compassionate.
Robroy, It is important to note that artificial hydration and nutrition are not required in all circumstances. If it would only increase the patient’s suffering or if the patient’s body can not assimilate it. The Church does recognize that at the end of life the body will start shutting down and that part of this process is the rejection of hydration and nutrition. But what this addresses is not the natural process but the withdrawal of hydration and nutrition to bring on death.
RESPONSES TO CERTAIN QUESTIONS
OF THE UNITED STATES CONFERENCE OF CATHOLIC BISHOPS
CONCERNING ARTIFICIAL NUTRITION AND HYDRATION
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?
Response: Yes. The administration of food and water even by artificial means is, in principle, an ordinary and proportionate means of preserving life. It is therefore obligatory to the extent to which, and for as long as, it is shown to accomplish its proper finality, which is the hydration and nourishment of the patient. In this way suffering and death by starvation and dehydration are prevented.”
As a physician, I’ve struggled with this concept. However, I believe there is wisdom in it, as deeming any life unworthy of all our attention leads pell-mell down a very slippery slope – the demented, the developmentally disabled, the pre-born….
Well I’m catholic and I’m a physician and I certainly disagree with this statement. My sister has a durable power of attorney that permits her to yank feeding tubes, unplug ventilators, disconnect ivs and allow me to die if I am unable to live a meaningful life.
And I am definately against euthanasia of any kind. Similarly I opose the sort of health care rationing that will be inevitable under the current administration.
However allowing comatose people to die in peace by witholding artificial means of support is not euthanasia. We are all going to die eventually. As it is, folks in their last two years of life consume 50% of costs, and in most cases, people in America who are unlucky enough to die of a chronic illness (the majority) spend their last six months bouncing in and out of the hospital. What we need is to have an open, national discussion of what “normal” death is. Because normal death is not what you see on TV where the folks just peacefully die in bed. Normal death in the US is spent in the hospital being nursed around six or seven times from first a pneumonia then renal failure then congestive heart failure with delerium and hallucinations, etc. etc. I would much rather die in my own home or in hospice with all the lines unplugged. Dehydration (with its associated renal failure) is a pretty peaceful way of going. One of my teachers (a very brilliant neurologist who had pancreatic cancer) chose this death. He simply insisted on being DNR, and had adequate pain medications, but refused feeding tubes and IVs. Once he was too sick to feed himself or drink he ate and drank less. He was not hungry or thirsty, most dying people aren’t. He died at home. My goal is to do likewise if I ever have a terminal illness.
Most people who have watched real death as opposed to TV death would prefer to die at home, rather than in the hospital. The pope should get out more.
Who decides what meaningful life is? Clueless this is not as I said before about withholding hydration and nutrition from patients who are in the process of dying. I understand how in dying patients this can actually be a burden and cause more suffering. This is about people who would not die except for the act of witholding such normal standard of care from them. It is about whether food and water delivered by means other than mouth should be regarded as extraordinary care disproportionate to the outcome or if it is the minimal norm we owe to those in our care. In certain cases it can indeed be the former. But for a patient who is in a vegatative state such care is regarded as the minimal norm.
Bottom line we as Catholics are not allowed to starve and or dehydrate people to death. And in the example you gave of end stage renal failure artificial hydration would certainly cause more suffering that would not change the final outcome.
Whoops I see I misunderstood Clueless in his example the dehydration came first not the renal failure.
Clueless, thank you for your valuable perspective. As a lay person, I first encountered this situation several years ago when a close family member was dying of cancer (albeit originally diagnosed 21 years before). I was shocked when the palliative care specialist suggested suspension about two days before death. But he carefully explained the situation as Cluless did. So we made the difficult decision to follow his advice, although it was quite counterintuitive.
Paula writes, “This is about people who would not die except for the act of withholding such normal standard of care from them.” Standard of care for a kid with a good prognosis is not the same as for someone who has had an anoxic brain injury and their cerebral cortex has infarcted away (like Terry Schiavo). IV fluids and tube feeds is appropriate for the former but not the later.
I certainly don’t want these artificial interventions. In my dad’s case, we did give him IV fluids, but not tube feeds and he died a peaceful death.
I am not a doctor so I hope I do not seem too uppity. But I will abide by Church teaching. 1. because I am Catholic. 2. because I believe She is right in this matter. 3. and if I had doubts about number 2 I would see number 1.
We are not allowed to practice euthanasia either by acts of commission or ommission. Acts of commission are rather clear cut. Acts of ommission depend greatly on the patients prognosis, stage of illness, and our rather limited knowledge of the human brain. The Church regards the giving of food and/or water an ordinary means of care in cases where such does not increase suffering or create an undue burden. It does not consider them artificial means of pro longing life in face of inevitable outcome. Such as keeping a brain dead person on a breathing machine.
Any person would die if we starved or dehydrated them beyond the point of no return. So again the question remains is it the act of with holding this care that causes the death or is it the disease process itself (which not only makes with holding such care the right choice in some circumstance) that will be the cause of death?
I am Catholic and I am a doctor.
I will not abide by this teaching because
1. It is a doctrine given by a band of theologians with few if any physicians present, and does not have the imprimature of being infallible truth (relatively few things do in the Catholic church).
2. I do not consider death an unnatural intrusion into an immortal physical life to be feared and avoided at all costs, but a normal part of life, that indeed my Savior embraced for my sake.
3. Having observed at this point a large number of families who have elected to let their dying relative succumb to the inevitable death that awaits us all, as well as a number of other familites whose relatives have been maintained on feeding tubes, and iv lines, with increasing decubitus ulcers, I believe that prolonging life in the terminally ill in this fashion, is insofacto an “undue burden” both to the patient and even more so to the family. I will not condemn my family to this burden, and I certainly will not pretend that it is morality or even obedience that requires me to do this. If a patient’s family insists on feeding tubes and iv hydration for their permanently comatose relatives (and I discuss this with them at length) I honor their wishes. However I believe them to be misguided.
4. I continue to refuse to engage in euthanasia. Refraining from placing a feeding tube does not keep the patient or his family from encouraging their relatives to eat or drink anything that could be spoonfeed into them.
5. But finally, unlike most Americans, I am not afraid of death. When my time comes, (hopefully after my kids are on their feet) I will welcome my death as I would any old friend whom I had seen many times before. It is after all, only the beginning of the only life that actually matters.
Amen. I wonder who these guys are who wrote the report?
Clueless, I guess this could segue into just what an infallible teachign is. Too many Catholics are unaware infallibility teachings not always being pronounced Ex Cathedra.
It is an infallible teaching that we are to protect life from conception to natural death. We can all agree on when conception occurs (at least I assume so). But defining natural death is rather more difficult. And I don’t think it is going to get easier.
And I think we are more in agreement than not. You use the term pro longing the life of the terminally ill. I assume you mean the terminally ill who are in the end stage of their disease. Where any means of providing hydration and nutrition actually are injurious to the patient at that stage since the body in the natural process of shutting down usually stops these functions on its own. ( I know I am putting that badly, but I guess I mean the body can not be bothered with digesting food or eliminating waste at that point).
But if I read this correctly this does not necessarily address terminally ill patients who are in the end stage of their disease. But is concerned with patients who would continue to live in either a coma or vegatative state as long as hydration and nutrition are provided (it being assumed there is no undue burden for this particular argument). In that scenario the way the substanance is delivered is not at issue because no matter the means hydration adnd/or nutrition are regarded as normal minimal standards of care.
And I do have a question for you and Robroy. How long would you be willing for it to take a patient to die after hydration and nutrition are withdrawn. I do mean with pallative care being fully available and used. I ask this because in the case of some comatose patients I believe it can take days or weeks.
The findings do pertain only to patients in persistant vegatative or comatose states. So I think in most of the scenarios offered by Clueless and Robroy the obligation would not apply. The findings are also consistent with Church teaching on the matter and say nothing new.
I am very grateful for physicians such as Clueless and Robroy. And fully understand their goal is to alleviate suffering and to protect the dignity of their patients. I know all they do is a testament to their full faith and hope in our Savior, Jesus Christ.
“providing hydration and nutrition actually are injurious to the patient at that stage since the body in the natural process of shutting down usually stops these functions on its own. ( I know I am putting that badly, but I guess I mean the body can not be bothered with digesting food or eliminating waste at that point).”
That is not the case. The body can continue to digest food long after the cancer has eaten through most of the spine, and the patient is paralyzed and even patient controlled morphine pumps are unable to control the pain. We are programmed to digest food. The turn off mechanism in the dying, is not the ability to digest food, but the lack of hunger and thirst which is the natural accompaniment of end stage disease (end stage heart, kidney and liver failures as well as end stage cancer). We would not force feed a dying patient orally. We would think it cruel and unusual to force feed patients the way some farmers fatten geese. (It has been done to prisoners for centuries).
We do we insist on force feeding a dying patient via feeding tubes? Lack of hunger and lack of thirst is a good thing in someone who is dying. It is like pneumonia in the dying which used to be called “the old man’s friend” in the age before ventilators.
“How long would you be willing for it to take a patient to die after hydration and nutrition are withdrawn. I do mean with pallative care being fully available and used. I ask this because in the case of some comatose patients I believe it can take days or weeks. ”
If somebody is alert then thirsting for 24 hours is as painful as thirsting for 24 days. If somebody is comatose then by definition he/she does not thirst. Or hunger. Or sense pain. Why should there be a time limit after which comatose patients should be fed?
In general, without fluids death will take less than a week, however. If a comatose patient is not fed but is hydrated it can take more than a month. Jesus fasted for more than a month.
Thanks Clueless, I was basing what I wrote on how hospice explained things to us when my mother was dying. They did also say my mom did not hunger or thirst. But their main explanation was that giving her water by tube would unduly increase the burden to her kidneys (she was in the end stages of cirhossis). And this would actually increase the likelyhood of her suffering.