Advance Directives for Healthcare

[AndyinIndiana]

I have an ethical dilemma. I am a 36 year-old “cradle Catholic” who is married to a wonderful woman. 16 years ago I sustained major head trauma leaving me in a coma for a month and the hospital for half a year. Thanks to an amazing group pf therapists, a caring family, and prayers from near and far, I have regained a great amount of functional capacity.

I understand the sancity of life thing…everything in God’s time and all, but continue to be challenged with a quality of life issue. Should I sustain further damage to my neurological system the damage, being cumulative in nature, may result in lifelong lack of personal function and possibly a coma lasting decades until my organs run their course, and I expire.

As a result of my original injuries, I settled with an insurance company with a portion of the settlement being an monthly annuity payment that will last until I expire or until I’d be 76 for my surviving beneficiaries. This annuity would pose a problem if I should need long-term care while in a coma state.

As rules presently stand, it would make me ineligible for Medicaid (insurance for the poor and indigent) here in the United States that would otherwise pay for my treatment. This would present a hardship for my wife. The potential for leaving a coma state after remaining comatose for an extended period could be great, and to once again regain a functional life of personal independence is slim to none.

Is it unethical to have an advance directive for health care that directs artificial nutrition and hydration to be suspended if I am in a state of coma beyond six months? I really need to know. I don’t want to leave my wife with hardship instead of love.

 

[Newbie2]

Good question. I don’t know.

I would tend to lean toward yes, it would be OK if you were 77 and had a limited life expectancy or were otherwise in not-so-good health. In that case, though, if you were to refuse just medical treatment (in advance, of course), it would be more likely that such a medical condition would be more likely to do you in than starvation or dehydration in that 6 month period.

On the other hand, if you were to slip into a coma at 39, you’d have a better chance (I’d think) of recovery than at 77.

Such a moral question would not be, methinks, best answered on the basis of financial considerations alone.

Again, very good moral question; wish I had a better answer.

 

[1ke]

Is it unethical to have an advance directive for health care that directs artificial nutrition and hydration to be suspended if I am in a state of coma beyond six months? I really need to know.

Yes, Andy. It is. The Catholic Church is clear in its teaching on nutrition and hydration. This is not extraordinary care, and it cannot be withdrawn.

I don’t want to leave my wife with hardship instead of love.

Andy, stop and think. You are asking your wife to kill you by withholding food and water.

I’d sit by my husband’s side every day for 50 years were he in a coma, pay off his medical bills for the rest of my life or declare bankruptcy.

I would never withhold food and water, in essense murdering him, nor would I ever want him to ask me to do something so horrible.

 

[AndyinIndiana]

Thank you for your (name removed by moderator)ut, Newbie2 and 1ke. This is something with which I struggle. My wife would indeed sit by my bedside every day and go bankrupt in the process until I would expire naturally. Bankruptcy; however, can only occur every 7 years. The question of quality of life is not just for me. It is for her as well. While I know that my wife would feel horrible about “killing me” if it happened to be a planned contingency the decision to suspend sustenance would be mine alone, and should be followed by my attending objective medical provider. Maybe I need to find a Catholic biomedical ethicist to answer this question. If you know of one, please direct them to me.

Andy

 

[mommyof4]

Andy, I wonder if this article would help you with this:

ewtn.com/expert/answers/end_of_life_decisions.htm

 

[SoCalRC]

End of life issues are always difficult. In principle, the Church views the removal of hydration and nutrition as direct euthanasia. However, even hydration and nutrition can be “extraordinary means”. The Church gives some guidance here:

vatican.va/roman_curia/congregations/cfaith/documents/rc_con_cfaith_doc_19800505_euthanasia_en.html

I would also strongly encourage you to talk to your parish priest, or even your bishop. However, the ultimate decision on refusing medical treatment is up to you, or the person or persons you designate to make these decisions for you if you are unable (this is reiterated in the Catechism).

That said, I should warn you that, based on the little you’ve told us, that some Catholic hospitals would resist enacting the directive you describe.

Whatever you decide, I know I am not the only one here who will be remembering you and your family in prayer.

Peace

 

[1ke]

Thank you for your (name removed by moderator)ut, Newbie2 and 1ke. This is something with which I struggle. My wife would indeed sit by my bedside every day and go bankrupt in the process until I would expire naturally. Bankruptcy; however, can only occur every 7 years. The question of quality of life is not just for me. It is for her as well.

Actually, the question isn’t “quality of life” at all. You have allowed secular humanist thinkin to invade. That is not a Catholc approach to the issue at all.

While I know that my wife would feel horrible about “killing me” if it happened to be a planned contingency the decision to suspend sustenance would be mine alone, and should be followed by my attending objective medical provider.

You’ve missed the point. If my DH tried to set any sort of directive to have himself killed I would be beside myself with grief, worry, and despair. First, I would stop it if I could, so even if he set out to have himself killed I would try to prevent it. If I could not, I would worry for (a) his immortal soul and (b) the souls of the doctors who carry out such a horrible act. Thirdly, I would be in despair about my inability to stop this directive.

It really puts a huge burden on your wife, one that (ironically) you think you are sparing her from.

Maybe I need to find a Catholic biomedical ethicist to answer this question. If you know of one, please direct them to me.

ncbcenter.org/

 

[AndyinIndiana]

Thanks all. You provide much insight. I have sent a message to the National Catholic Bioethics Center. I will abide as directed from there. I believe that their answer will be in accord with what has been offered here, and my directives will be changed.

 

[Daniel_Kane]

The National Catholic Bioethics Center will undoubtedly say that withholding food and water is contrary to Catholic though in every circumstance even if the delivery of such nutrition is via “artificial” or assisted means.

In reality, the chances of a 35 y.o. person falling into a persistent vegetative state and surviving over 10 years is 1 in 75,000; given your history and the cumulative effects of neurological injury, it is unlikely that such an event would be a survivable event in the long term.