A Terminal Child's Ventilator Removed

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Christian_Mommy

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(Thank you to all my Catholic friends for their responses about my tubal pregnancy question!) šŸ™‚

I work in a childrenā€™s hospital as a respiratory therapist (I will graduate in 6 months) and since we deal with ventilators on quite a frequent basis, our jobs often involve ā€˜terminal weaningā€™, or removing certain critical patients from ventilators (after theyā€™ve been given ample sedatives or pain killers, of course).
I work also in an adult hospital and have seen a great many solemn things in the year and a half that Iā€™ve been introduced to the health care field.
My question, however, involves a 9-year-old girl with cystic fibrosis who died the first day I was hired to work at the hospital. I have treated many cystic patients who are alive well into their teens and early twenties, but this little girl was particularly critical. Doctors had a session with her tearful parents, and it was obvious that the child would have no quality of life while she waited for a lung transplant-- which can take many years. The situation, I am told, was also explained to the little girl, who was coherent, but weakening and no longer able to speak. It was decided that she should be removed from her ventilator and allowed to pass away to Jesus (the parents were Christian, though I donā€™t know if they were Catholic).
Removal of the ventilator, in most cases, is the respiratory therapistā€™s job and is done under the supervision of a physician.
IF am am required to perform such an act in the future, can it be compatible with my new Catholic faith?
The decision was not made due to cost or inconvenience, but to end a life of suffering for the little girl, a life which would stretch on for an undetermined amount of time while she waited for a new pair of lungs. Would Jesus approve of this to keep her from years of pain? Or would my refusal to perform this act be more cruel than ā€œletting her goā€?
The hospital, though not a religious one, does allow employees to object and, in most cases, refuse to perform certain duties that conflict with oneā€™s faith-- though not when it would interfere with the well-being of the patient.
Are there any thoughts on this matter? What does the Catholic Church teach about it? I donā€™t think that it really compares with the ā€œassisted suicideā€ in the adult world. ā€¦Or does it?
It is quite obvious that only God has the right to take human life. But does this mean we must extend it in these severe cases?
 
Christian_Mommy said:
(Thank you to all my Catholic friends for their responses about my tubal pregnancy question!) šŸ™‚

I work in a childrenā€™s hospital as a respiratory therapist (I will graduate in 6 months) and since we deal with ventilators on quite a frequent basis, our jobs often involve ā€˜terminal weaningā€™, or removing certain critical patients from ventilators (after theyā€™ve been given ample sedatives or pain killers, of course).
I work also in an adult hospital and have seen a great many solemn things in the year and a half that Iā€™ve been introduced to the health care field.
My question, however, involves a 9-year-old girl with cystic fibrosis who died the first day I was hired to work at the hospital. I have treated many cystic patients who are alive well into their teens and early twenties, but this little girl was particularly critical. Doctors had a session with her tearful parents, and it was obvious that the child would have no quality of life while she waited for a lung transplant-- which can take many years. The situation, I am told, was also explained to the little girl, who was coherent, but weakening and no longer able to speak. It was decided that she should be removed from her ventilator and allowed to pass away to Jesus (the parents were Christian, though I donā€™t know if they were Catholic).
Removal of the ventilator, in most cases, is the respiratory therapistā€™s job and is done under the supervision of a physician.
IF am am required to perform such an act in the future, can it be compatible with my new Catholic faith?
The decision was not made due to cost or inconvenience, but to end a life of suffering for the little girl, a life which would stretch on for an undetermined amount of time while she waited for a new pair of lungs. Would Jesus approve of this to keep her from years of pain? Or would my refusal to perform this act be more cruel than ā€œletting her goā€?
The hospital, though not a religious one, does allow employees to object and, in most cases, refuse to perform certain duties that conflict with oneā€™s faith-- though not when it would interfere with the well-being of the patient.
Are there any thoughts on this matter? What does the Catholic Church teach about it? I donā€™t think that it really compares with the ā€œassisted suicideā€ in the adult world. ā€¦Or does it?
It is quite obvious that only God has the right to take human life. But does this mean we must extend it in these severe cases?
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As a parent, my thought on this is that if the little girl would die naturally without medical intervention, there is no sin in letting nature take itā€™s course. Iā€™m not saying if there was a simple operation that would save her in a year that this would be the best course of action, but this is just accepting natureā€™s way. I always had in my birth plans that if my baby was born quite prematurely, I wanted them to try to save my baby BUT I did not want any heroics in trying to save her. Just what was fair and reasonable. I simply donā€™t believe in saving lives at any cost when it is contrary to what would happen naturally without medical intervention. Iā€™m sure the parents made the most loving decision. No parent is going to let their child go if there is a good chance of being able to make a difference.

Another example - if my child was in a coma and there was even a remote chance of them coming out of it I would keep them on life support. But if a good period had passed and there was no chance they would come out of it, and the only way they could survive was on medical support, I would probably decide with great pain that it should be turned off. Iā€™m not talking about a situation where the patient would be starved to death or a euthanasia decision. Iā€™m talking about natural death coming about.
 
I am quite relieved! It might seem silly, but I guess I expected to be snarled at for asking-- I know the issue of when a life should end, especially in a hospital setting, is a difficult oneā€¦ i am just apalled at some of the comments that I hear from other therapists sometimes. ā€œI canā€™t believe we had to intubate that 90-year-old man,ā€ they say. ā€œFor Godā€™s sake, why doesnā€™t the family just let him go?ā€ Thatā€™s all well and good, and yes, I know that placing elderly people on ventilators (or anyone, for that matter) predisposes them to pneumonias or infections. It can be difficult to get these people off of ventilators, and intubation is traumatic. But how do these whiny employees know that this man doesnā€™t want to live? Suppose heā€™s eighty five and has another fifteen more years to go? Who are they to whine about why ā€˜some old guyā€™ is upstairs on a ventilator because they think itā€™s time for him to go? I shudder to think of future rules if these people ever got into politics.
 
A ventilator is what is called ā€˜extrordinary meansā€™, and it is entirely acceptable to Catholic ethics to remove a ventilator in this instance. As an RT, btw, you will be intimately involved in end of life scenarios at the hospital where you work. You will be a major player in codes, and you will be routinely carrying out orders to extubate patients whose likely outcome will be death. Therefore, I advise you to familiarize yourself with Catholic medical ethics.

In my opinion, this forum is not a good resouce for this information, because the average prolife layperson will often lump some end of life issues with the ā€˜culture of deathā€™ in an over reaction to the expediancy they see in the secular culture. Therefore, please seek expert opinions of Catholic ethicists who have a better grasp of the subtile moral nuances of these issues.
 
very good idea, thank you! However, I am only days old to the Catholic faith and wanted to know what other Catholics believed about this. (There are quite a few Christians where I work although I think most of them are evangelical protestants.) My husband just bought a catechism for me, and I think I will consult itā€¦ pray for me that I do well in my career! Thankfully, Iā€™m told that at the childrenā€™s hospital where I work, we deal with far less codes than at the adult hospital where I work-- itā€™s a huge place and quite intense.
 
Dear Christian mommy,
In the absence of a POLST form, or some other written expression of the patientā€™s expressed wishes, decision making often falls to the next of kin, and they have this legal right. The Church recognizes this. Pts personal wishes are paramount, and in absence of these, either the next of kin or the physician must step in. It is not unreasonable to assume that in the absence of written evidence of a 90 yr old patientā€™s written wishes regarding whether they desire intubation or not if terminally ill, that the decision be made to allow nature to take itā€™s course.
 
I agree. it is only that most other therpaists speak disdainfully about families that make a decision for a ā€œFull Codeā€ in their elderly loved oneā€™s crisis.
 
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spiritblows:
Dear Christian mommy,
In the absence of a POLST form, or some other written expression of the patientā€™s expressed wishes, decision making often falls to the next of kin, and they have this legal right. The Church recognizes this. Pts personal wishes are paramount, and in absence of these, either the next of kin or the physician must step in. It is not unreasonable to assume that in the absence of written evidence of a 90 yr old patientā€™s written wishes regarding whether they desire intubation or not if terminally ill, that the decision be made to allow nature to take itā€™s course.
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Christian_Mommy:
I agree. it is only that most other therpaists speak disdainfully about families that make a decision for a ā€œFull Codeā€ in their elderly loved oneā€™s crisis.
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Youā€™ll understand this attitude once youā€™ve worked for several years. These experienced RTs have seen everything. They are battle worn, it comes with the territory.
 
But must this always mean an attitude of cynicism and hostility? Perhaps it is because Iā€™m just a novice RTā€¦ but I tend to be a very small, quiet, shy, and sensitive person, and people have told me on more than one occasion that they donā€™t see how a person like me could have chosen such a career.
Iā€™ll be honest with youā€” I wouldnā€™t have chosen it for myself, and some days I am literally terrified to go to work, but the Lord wanted me here. And I love my patients. These same experienced RTs were the ones complaining that Terry Sciavoā€™s family should have just ā€œlet her goā€ when all that was going on. They all speak of life so callously.
 
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Christian_Mommy:
But must this always mean an attitude of cynicism and hostility? Perhaps it is because Iā€™m just a novice RTā€¦ but I tend to be a very small, quiet, shy, and sensitive person, and people have told me on more than one occasion that they donā€™t see how a person like me could have chosen such a career.
Iā€™ll be honest with youā€” I wouldnā€™t have chosen it for myself, and some days I am literally terrified to go to work, but the Lord wanted me here. And I love my patients. These same experienced RTs were the ones complaining that Terry Sciavoā€™s family should have just ā€œlet her goā€ when all that was going on. They all speak of life so callously.
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Thatā€™s because they have experienced the complex family dynamics surrounding end of life scenarios. They donā€™t see that case through a black and white lens, since they have been intimately present in many deathbed scenes with warring family factions. RTs have seen human sufferering brought on by medical technology closer up than any but ICU nurses.
 
I donā€™t know if ā€œquality of lifeā€ can be a factor when it comes to deciding whether or not to remove someone from the ventilator. I used to know what the reasons the Catholic Church considered as legitimate reasons were, but I have forgotten them. If I can find them somewhere, I will post them. In the meantime, I suggest asking an apologist. I believe that they have knowledge of a website that would also help you(and others) in situations like this.
 
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Christian_Mommy:
very good idea, thank you! However, I am only days old to the Catholic faith and wanted to know what other Catholics believed about this. (There are quite a few Christians where I work although I think most of them are evangelical protestants.) My husband just bought a catechism for me, and I think I will consult itā€¦ pray for me that I do well in my career!
Click to expand...
People gave some good advice, but no links.

The CCC is a great general resource, but given your profession I think youā€™d want something more specifically applicable. The best source I know of for education of medical professionals on the whole spectrum of the kinds of issues youā€™d be seeing is the National Catholic Bioethics Center. These people are sharp and they know their stuff. Iā€™ve had the privelege of meeting Fr. Pacholczyk, and he is as brilliant as they come. If you have any further questions, they have a range of publications and even seminars and certifications, if you desire.

Good luck! It is always good to know that there are people in the medical profession that have their heads and hearts in the right place. Thanks for you service.
 
Mom of one:
I donā€™t know if ā€œquality of lifeā€ can be a factor when it comes to deciding whether or not to remove someone from the ventilator. I used to know what the reasons the Catholic Church considered as legitimate reasons were, but I have forgotten them. If I can find them somewhere, I will post them. In the meantime, I suggest asking an apologist. I believe that they have knowledge of a website that would also help you(and others) in situations like this.
Click to expand...
Since a ventilator is considered ā€œextraordinary meansā€ (unlike food and hydration, which are always ordinary means) the only consideration is the wishes of the patient. If they cannot be solicited, then it is up to those legally responsible for them.
 
I posted this just recently in another thread:

A grabbed a quick quote from:
catholicculture.org/docsā€¦cfm?recnum=598 to help communicate ā€œextraordinary meansā€:
A person may, but is not bound to, use extraordinary means ā€” those means which primarily are not considered ordinary care or common medical treatments. These means do not offer reasonable hope of benefit and may be excessively burdensome to either the patient or the family. Factors to consider in determining whether a treatment is extraordinary include the type of treatment, the degree of complexity, the amount of risk involved, its cost and accessibility, and the state of the sick person and his resources. One would weigh the proportion of pain and suffering against the amount of good to be done. Granted, in our world today, exactly what constitutes extraordinary medical care becomes harder and harder to define. For instance, accepting an artificial heart is clearly experimental and would be extraordinary, whereas the usage of a respirator or ventilator is oftentimes a standard procedure to aid the patientā€™s recovery.
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