If ever Carol Gaetjens becomes unconscious with no hope of awakening, even if she could live for years in that state, she says she wants her loved ones to discontinue all forms of artificial life support.
But now there’s a catch for this churchgoing Catholic woman. U.S. bishops have decided that it is not permissible to remove a feeding tube from someone who is unconscious but not dying, except in a few circumstances.
People in a persistent vegetative state, the bishops say, must be given food and water indefinitely by natural or artificial means as long as they are otherwise healthy. The new directive, which is more definitive than previous church teachings, also appears to apply broadly to any patient with a chronic illness who has lost the ability to eat or drink, including victims of strokes and people with advanced dementia.
Catholic medical institutions — including 46 hospitals and 49 nursing homes in Illinois — are bound to honor the bishops’ directive, issued late last year, as they do church teachings on abortion and birth control. Officials are weighing how to interpret the guideline in various circumstances.
The bishops seem to have succumbed to the argument that “extraordinary” technological intervention has become “ordinary”. Would that it were that simple. I do understand the concern of the bishops about people using feeding tubes as easily available and accessible euthanasia tools, but I wish there had been a more thoughtful analysis of the incredible gray areas that modern medicine has gotten us into.
I’m afraid these are merely talking points of a certain segment of Catholic moral theologians. They have been whining that the Pope changed the terms for end of life care on them without consulting them ever since shortly before JPII’s death. He gave a speech in which he reiterated that a feeding tube is “ordinary care.” The guild of (moderately liberal) Catholic medical ethicists had just, so they thought, achieved a consensus with Catholic hospitals that would have permitted withdrawing feeding tubes more readily and they had talked themselves into believing that it was consistent with the Magisterium. When the pope gave the speech, they cried foul, “we weren’t consulted,” “he can’t do this to us,” “he’s pulling the rug out from under us.” I know. I sat in meetings in which some of my colleages complained in this fashion.
But the fact was that their “consensus” already played fast and loose with magisterial teaching in place for decades. The reason he gave the speech was to clarify that. They were fooling themselves with their belief that they were following the Magisterium and never bothered to check definitively (perhaps because deep down they knew they’d be called on their disingenuousness.)
With recent developments in PVS knowledge–specifically, the ability not merely to verify that brain activity is going on but actually to communicate by posing questions and noting particular brain activity as an answer, not to mention the guy in England who suddenly woke up and said that for 20 years he heard everything people were saying about him but was unable to signal that he could hear–talk about frustration
with these developments and more certainly to come, I think we should have some humility in thinking that we even begin to understand what’s actually going on in a person in PVS (even when properly, clinically, diagnosed). I think we need to err on the side of caution because it just may be the case that a thinking person is actually being starved and dehydrated to death, not a vegetable being permitted to die.
Yes, each case is different and incredibly complex. But for that very reason, we need to err on the side of caution.
Moreover, the Magisterial teaching on this simply does not baptize extraordinary intevention as ordinary. It is not hamfisted. It does, however, make the claim that a feeding tube is relatively low-tech, a simple extension of spoon feeding. I think that’s a pretty fair commonsense principle. To describe the official Vatican teaching on this over three decades as being unaware of gray areas is, I think, a statement unaware of gray areas.
Sorry, Trad Catholic, but I still think Vatican thinking on this matter still succumbs to its regarding the extraordinary as ordinary. I’m not suggesting we disregard caution, but I am suggesting that each individual case needs to be decided on its merits. I have seen too many cases where the extraordinary has become an agonizing life-prolonging ordeal for both the patient and the family. I have made it clear in writing that if in the end stages of cancer or any other illness, I lapse into a coma, I am not to be force fed. (An iv tube, by the way, is not in my view, analogous to spoon feeding.) I understand the concern about the so-called “persistent vegetative state” and the need to be very careful. However, the Vatican might better publicize and argue its case rather than issuing decrees which are open to misunderstanding and misinterpretation.
An IV and a feeding tube are two different things. The story is about whether feeding tubes for people who cannot feed themselves but are not dying are ordinary. An IV in a patient who is suffering from terminal renal failure is a very different thing and, let me assure you, the Vatican documents make that distinction, which you do not.
Have you actually read the Vatican instructions or are you depending on these news accounts and the claims made by the American medical ethics people.
My main point was that their claim that the Vatican pulled the rug out from under them is false. They were playing a disingenous game by which they claimed that they were following the existing instructions when they were not and when called on it, they got all wee weed up and blamed the Vatican for changing the rules and the media basically swallows their version of it, as you also seem to do.
Very few people with “chronic but terminal illnesses” can be expected to die in 2 weeks. Some of my ALS patients who are slowly dying have told me they do not wish ventilators, CPR or feeding tubes. If I were to insist, cajole, etc them into feeding tubes (and I’m sure I could be persuasive enough, if I chose) they would spend the last year of their life, flaccid unable to roll over to scratch their itches or to take the pressure off their hips. They would all get bedsores no matter what we did.
Malnutrition and the pneumonias and renal failure that come with it used to be called “the old man’s friend”. It provided a graceful death. I would rather die of aspiration pneumonia or renal failure than by the slow asphixiation [edited]. It does model Christ’s death on the cross, but to what cost?
There is a difference between active euthanasia and permitting folks to die with no more resources than can be managed by a nurse with a cup, spoon, and medications to manage pain or infection.
[Edited by Elf – we have a variety of commenters here, please be careful how you express things – thanks]
[Comment deleted by Elf]
Actually on further reflection, I think the positives outweigh the negatives. Part of the problem is the powers that be’s drive to label EVERYTHING a terminal illness. There is now a push to “recognise” that dementia is a “terminal illness”. Further, palliative care has gotten remarkably aggressive in some institutions, so that anybody who has a “terminal illness” or those with a large stroke who are likely to have a “bad outcome” is not only made DNR, but is given “comfort care” which includes snowing them with morphine and benzodiazepines. The sedative/pain meds seem to be given not just to those who have obvious pain, but those who have no clear discomfort but who could conceivably have “subclinical distress”.
I must say that a few weeks ago I was wondering how long I could practice Neurology without having my conscience forced, and being required to participate in calling folks who were simply mildly disabled (whether from dementia or stroke or whatever) “terminal” in order to keep from being targeted as giving “unnecessary care”.
If “terminal” can include a patient with mild Alzheimer’s disease who could live for a good 5-10 years more, and if palliative care with aggressive comfort measures is used every time they are admitted with a pneumonia, then the only thing that prevents them from being essentially euthnized in the name of “good medicine” would be the insistance that food and hydration be given.
And on reflection, this ruling, which does protect my patients with Alzeheimer’s disease, stroke and other disabilities, does not condemn those of my patients who are near death (for example, those with ALS )to slow death by torture. I have already spoken to my (Catholic) pastor about this sort of thing, and he assures me that if a patient or his family does not wish a feeding tube, it is not necessary for me to put one in. Similarly, if I am near death and do not wish a feeding tube (or if my sister, who holds my durable power of attorney for medical care if I am disabled) feels I should not have a feeding tube, whether this is a good thing or a bad thing can be discussed, like Christians, among the family with the counsel of the clergy as well as the physicians. If I’m going to die anyway, I will not get it.
It’s a good ruling. I’m glad they so ruled. I recall thinking, a few weeks ago, when we were discussing how “dementia is a terminal illness” that I would probably be forced out of medicine in under five years.