Bishops change feeding tube guidelines

[momor]

You are wrong about morphine. It does depress the person’s ability to breathe but that is a reversible effect and death is not a natural consequence of taking morphine, unless large doses are given. It’s not like the longer you keep a person on morphine the closer you take them to death. So the comparison does not apply.

Also, if a person’s brain is ‘in a fatal condition’ then they will die when the brain stops functioning. Food/water does not keep a fatally injured brain alive.

I’m afraid you are also wrong about morphine.
In doses often necessary at end of life, the respiratory depression caused by morphine can lead to pneumonia which is often the immediate cause of death. It can cause the almost complete shut down of the digestive system. If someone is receiving a lot of morphine they don’t move around as much which also contributes to pneumonia and can cause nasty blood clots that go to the lungs and cause death.
In the case of end-stage congestive heart failure or emphysema a person may be suffering unbearable shortness of breath and morphine reduces that suffering by reducing a person’s natural drive to breathe, which leads to a downward spiral toward death.
We accept those side effects in order to lessen other, worse suffering and because we don’t give morphine to cause death even though we know it can contribute greatly.

There can be a fine line between prolonging life and prolonging death.

 

[seekerz]

I’m afraid you are also wrong about morphine.
In doses often necessary at end of life, the respiratory depression caused by morphine can lead to pneumonia which is often the immediate cause of death. It can cause the almost complete shut down of the digestive system. If someone is receiving a lot of morphine they don’t move around as much which also contributes to pneumonia and can cause nasty blood clots that go to the lungs and cause death.
In the case of end-stage congestive heart failure or emphysema a person may be suffering unbearable shortness of breath and morphine reduces that suffering by reducing a person’s natural drive to breathe, which leads to a downward spiral toward death.
We accept those side effects in order to lessen other, worse suffering and because we don’t give morphine to cause death even though we know it can contribute greatly.

There can be a fine line between prolonging life and prolonging death.

I agree morphine depresses the systems and may contribute to other conditions that ultimately lead to death but it does not cause those fatal complications directly (it is not the infectious agent in pneumonia and did not cause the emphysema/COPD) nor does it lead to death directly unless given in large doses, something that admittedly may be hard to avoid near the end of life.

On the other hand, removal of a feeding tube directly results in starvation/dehydration unless sustenance is provided by some other means, so the comparison is not an apt one.

 

[momor]

On the other hand, removal of a feeding tube directly results in starvation/dehydration unless sustenance is provided by some other means, so the comparison is not an apt one.

It is the other means, which I outlined in a prior post, that I advocate for those near the end-of-life (e.g., severe strokes in the elderly), even when those means are known to be inadequate to support life long-term.
We must also be careful to judiciously use heroic measures (e.g., no CPR for frail elderly) so we do not prolong the dying process. Prolonging life at any cost seems to me to be a denial of the glory of heaven. We should live our lives so we are not afraid to die. And we should love others enough to let them die naturally, especially if that is their wish.

 

[kalt]

Feeding tubes do not prevent people from dying, they just prevent starvation from being the cause of death.

And ventilators don’t prevent people from dying, they just prevent suffocation from being the cause of death.

 

[kalt]

You are wrong about morphine. It does depress the person’s ability to breathe but that is a reversible effect and death is not a natural consequence of taking morphine, unless large doses are given. It’s not like the longer you keep a person on morphine the closer you take them to death. So the comparison does not apply.

Also, if a person’s brain is ‘in a fatal condition’ then they will die when the brain stops functioning. Food/water does not keep a fatally injured brain alive.

You disagree with the doctor who gave my aunt the morphine, then. Unless you’re a better doctor than the doctore in the intensive care unit at the hospital, I’m going with his opinion.

It’s opinions like yours, though, that point out how little most people know about end-of-life issues. Someone who doesn’t know that morphine in doses given to ease the suffering before death (in hospitals, hospice units, and at home) promote death, doesn’t know enough to make an informed decision for himself and certainly shouldn’t be telling others what care is and isn’t valid at the end of life. I’m not singling you out. I think most people don’t know much about the topic. Unless you’ve studied it or have had close family members who needed this kind of care, how would you know?

I’ve seen 2 people treated with morphine at the end. One had emphysema. Giving morphine, which depresses breathing, to someone with compromised breathing to start with certainly hastens death. Some will say that that’s not the same as causing death, but that’s an invalid statement. If the peson died sooner than he would have because he had morphine, action was taken that caused the death. No one in his right mind would say that giving the morphine was murder, though.

Luckily, all 3 family members who needed end-of-life care like this had living wills. They all chose a natural death to prolonging death by being hooked up to ventilators and feeding tubes, if there was no reasonable hope of recovery.

Some have said that there is always hope. True, but there is realistic and unrealistic hope. Should we prolong death because someone else has unrealistic hope that a patient will recover or that a miracle will happen? IMO, if God is going to perform a miracle, when the tube (of whatever kind) is removed, the person will recover. God wouldn’t let someone lay in that condition for years just to test the faith of the person’s family, and reward them with the patient’s recovery only after years of prayers and medical treatments.

 

[seekerz]

And ventilators don’t prevent people from dying, they just prevent suffocation from being the cause of death.

Methinks you will agree that ventilation is much more supportive of life than artificial methods of feeding. Ventilators actively take over a significant part of the function of a vital organ (the lungs), feedings tubes are a passive means of getting food into the stomach; they do not take over the function of the stomach/intestines. It’s pretty easy to see why the former is considered extraordinary means and the latter not.

 

[seekerz]

You disagree with the doctor who gave my aunt the morphine, then. Unless you’re a better doctor than the doctore in the intensive care unit at the hospital, I’m going with his opinion.

It’s opinions like yours, though, that point out how little most people know about end-of-life issues. Someone who doesn’t know that morphine in doses given to ease the suffering before death (in hospitals, hospice units, and at home) promote death, doesn’t know enough to make an informed decision for himself and certainly shouldn’t be telling others what care is and isn’t valid at the end of life. I’m not singling you out. I think most people don’t know much about the topic. Unless you’ve studied it or have had close family members who needed this kind of care, how would you know?

I’ve seen 2 people treated with morphine at the end. One had emphysema. Giving morphine, which depresses breathing, to someone with compromised breathing to start with certainly hastens death. Some will say that that’s not the same as causing death, but that’s an invalid statement. If the peson died sooner than he would have because he had morphine, action was taken that caused the death. No one in his right mind would say that giving the morphine was murder, though.

Luckily, all 3 family members who needed end-of-life care like this had living wills. They all chose a natural death to prolonging death by being hooked up to ventilators and feeding tubes, if there was no reasonable hope of recovery.

Some have said that there is always hope. True, but there is realistic and unrealistic hope. Should we prolong death because someone else has unrealistic hope that a patient will recover or that a miracle will happen? IMO, if God is going to perform a miracle, when the tube (of whatever kind) is removed, the person will recover. God wouldn’t let someone lay in that condition for years just to test the faith of the person’s family, and reward them with the patient’s recovery only after years of prayers and medical treatments.

The disease the person has is what takes them to their death, morphine may exacerbate breathing problems but is not the cause of death unless it is given in large doses. People have actually been prosecuted (sometimes I think unfairly, given how hard it can become to strike a balance between what is needed and what is too much) for overdosing terminal patients with morphine. If given as intended though, it is not meant to bring anyone closer to death but to make the process of death less distressing/painful.

 

[St_Francis]

You disagree with the doctor who gave my aunt the morphine, then. Unless you’re a better doctor than the doctore in the intensive care unit at the hospital, I’m going with his opinion.

It’s opinions like yours, though, that point out how little most people know about end-of-life issues. Someone who doesn’t know that morphine in doses given to ease the suffering before death (in hospitals, hospice units, and at home) promote death, doesn’t know enough to make an informed decision for himself and certainly shouldn’t be telling others what care is and isn’t valid at the end of life. I’m not singling you out. I think most people don’t know much about the topic. Unless you’ve studied it or have had close family members who needed this kind of care, how would you know?

I’ve seen 2 people treated with morphine at the end. One had emphysema. Giving morphine, which depresses breathing, to someone with compromised breathing to start with certainly hastens death. Some will say that that’s not the same as causing death, but that’s an invalid statement. If the peson died sooner than he would have because he had morphine, action was taken that caused the death. No one in his right mind would say that giving the morphine was murder, though.

Luckily, all 3 family members who needed end-of-life care like this had living wills. They all chose a natural death to prolonging death by being hooked up to ventilators and feeding tubes, if there was no reasonable hope of recovery.

Some have said that there is always hope. True, but there is realistic and unrealistic hope. Should we prolong death because someone else has unrealistic hope that a patient will recover or that a miracle will happen? IMO, if God is going to perform a miracle, when the tube (of whatever kind) is removed, the person will recover. God wouldn’t let someone lay in that condition for years just to test the faith of the person’s family, and reward them with the patient’s recovery only after years of prayers and medical treatments.

It is Catholic teaching that painkillers can be administered in sufficient quantities to ease pain even if that amount will hasten death. The goal of giving the painkiller is to ease pain and the possible resulting death is a side effect. (This is the priniciple of double effect.)

Using painkillers is therefore not comparable to withdrawing nutrition and hydration, because the end or goal of each is different. If the patient is benefitting from N&H, then the very act of withdrawing them will result in death. There is no reason other than causing death to withdraw them; therefore, it is wrong to withdraw them.

The state of the patient is immaterial; it is the state of the souls of those treating the patient which is at question.

 

[St_Francis]

…If a natural death was good enough for PJPII, it’s good enough for all Catholics.

You do know that the Pope had a feeding tube during the last days of his life?

 

[seekerz]

You do know that the Pope had a feeding tube during the last days of his life?

…and that he died regardless when his time had come.

 

[kalt]

It is Catholic teaching that painkillers can be administered in sufficient quantities to ease pain even if that amount will hasten death. The goal of giving the painkiller is to ease pain and the possible resulting death is a side effect. (This is the priniciple of double effect.)

Using painkillers is therefore not comparable to withdrawing nutrition and hydration, because the end or goal of each is different. If the patient is benefitting from N&H, then the very act of withdrawing them will result in death. There is no reason other than causing death to withdraw them; therefore, it is wrong to withdraw them.

The state of the patient is immaterial; it is the state of the souls of those treating the patient which is at question.

Right. But you aren’t arguing against anything I’ve said. Withdrawing a feeding tube is the same as stopping other death-delaying medical treatment - chemo, ventilators, anti-biotics.

As with other conditions, someone who is brain damaged and can’t eat will be given comfort measures.

Most of you don’t seem to realize that people in the last stages don’t routinely eat. When they’re taking that kind of morphine, they aren’t sitting up for lunch. The dying process might last only a few hours or days. Sometimes it goes on for a week or two.

 

[kalt]

You do know that the Pope had a feeding tube during the last days of his life?

I don’t believe that report. The Church is a religion, but it’s also a business, and politics plays a part. The Vatican refused to comment on what measures were being taken at the time, answering only to the question of his not being in a hospital. They said that they had all the medical equipment needed. Feeding tubes was a huge issue just before his death. If he had had a feeding tube inserted, they would have said.

Also, when someone is expected to die within hours (meaning less than a week), they don’t bother with feeding tubes. If he had a feeding tube (which I highly doubt) it was inserted very late and uselessly, cruely. There was no reason to inflict that on the man. Of course, it may be that he had ordered it before he was that sick, as a symbol to others. At any rate, a feeding tube in his condition was pointless. If it was done, it was done for show, not for medical reasons. Medical procedures for show seem a bit unethical. No?

Also, when someone is very close to dying, they are less able to digest. Introducing food would cause problems.

 

[seekerz]

Right. But you aren’t arguing against anything I’ve said. Withdrawing a feeding tube is the same as stopping other death-delaying medical treatment - chemo, ventilators, anti-biotics.

These measures are not all equivalent. Only ventilators substitute for a major bodily function: regular and adequate movement of air into the lungs. Chemo and antibiotics treat disease processes which may be the cause or a contributing factor to, death.

As with other conditions, someone who is brain damaged and can’t eat will be given comfort measures.

There is a difference between being able to chew/swallow food and being able to digest it. Is it a comfort measure to withhold food/water if it can be digested? A brain damaged person may or may not be dying just like a person with damage to any part of the body. Brain-damage is not equivalent to a death sentence.

Not really sure what comfort measures mean to a starving/thirsty person.

 

[momor]

Part of the problem with a one size fits all feeding tube guideline is that situations vary widely.

My frail 90 year old mother has requested that she not receive a feeding tube in the event of a catastrophic event, such as a severe stroke, which leaves her comatose and unable to eat. As an RN and as her medical representative (POA) I support that. Since we will not allow one to be placed we will never have to deal with having one removed.

I do not hold the same view for a younger, healthy person with a severe head injury, even if fully comatose. There is still hope for someone like that long-term.

 

[St_Francis]

I don’t believe that report.

The more-extensive reports I have seen of the Pope’s death included the information that he had had one. Do you have evidence that he did not?

The Church is a religion, but it’s also a business, and politics plays a part. The Vatican refused to comment on what measures were being taken at the time, answering only to the question of his not being in a hospital. They said that they had all the medical equipment needed. Feeding tubes was a huge issue just before his death. If he had had a feeding tube inserted, they would have said.

Why? They weren’t giving all the information they had, mostly just reporting on his condition. ETA: In general, when a person as high-profile as the pope is very ill, the reports for the public are generally not pessimistic until the condition is very very bad.

Also, when someone is expected to die within hours (meaning less than a week), they don’t bother with feeding tubes.

And if they are not expected to die within a week, then they would have no qualms about inserting one, would they?

By all accounts, he seems to have had the tube inserted before his condition worsened.

If he had a feeding tube (which I highly doubt) it was inserted very late and uselessly, cruely. There was no reason to inflict that on the man.

This is slanderous. You have no way of knowing that this was at all the case.

Of course, it may be that he had ordered it before he was that sick, as a symbol to others. At any rate, a feeding tube in his condition was pointless. If it was done, it was done for show, not for medical reasons. Medical procedures for show seem a bit unethical. No?

It is quite obvious that you are speculating about his condition, his motives, and everything else.

Also, when someone is very close to dying, they are less able to digest. Introducing food would cause problems.

if someone dies rapidly, then they may continue to digest until quite close to their death, no?

 

[St_Francis]

Right. But you aren’t arguing against anything I’ve said. Withdrawing a feeding tube is the same as stopping other death-delaying medical treatment - chemo, ventilators, anti-biotics.

Your statements have been ambiguous, and do not clearly delineate the difference between withdrawing actual medical aid and withdrawing nutrition and hydration.

Fro example, you wrote: It’s not about comfort. I think there’s ample evidence that a person in a vegetative state isn’t suffering. In fact,the statement I read said that the tube may be removed if it causes suffering.

A person in a vegetative state cannot morally have N&H removed *unless *he or she is *in *a condition in which N&H are not helping the person to stay alive. It is not that the N&H help the person to recover.

And it has nothing to do with the person’s suffering. The person *may *be in a state in which he or she does not suffer, but 1. we do not know that considering that some people have recovered sufficiently from a state like this to tell us that they were aware during that time; and 2. whether the patient suffers or not, we still cannot *kill *the patient by keeping N&H away from him or her.

You then wrote: This is about allowing a natural death. The brain injury is a fatal condition. These people are being kept alive artificially.

They are not being kept alive artificially through N&H–they are being cared for that way.A brain injury might be fatal, but many are not fatal. Some do leave the patient in a state of unconsciousness; and some patients would have died except for medical intervention and are left in that state.

If a person is in an accident and is treated for a head injury and so does not die, but does not recover consciousness, the fact that a *past *medical intervention prevented death is not an excuse to withdraw food and water *now. *If the patient is stable and alive, he or she *must *be fed and given water or the patient will die of dehydration, not the brain injury.

You further wrote: FWIW, giving a person dying of cancer (or some other painful disease) enough morphine to keep him comfortable, promotes death. The drug depresses the systems. A person would live longer without that much morphine in his system. *Of course the goal of giving morphine isn’t to promote death, but that is what happens. *

You see that giving morphine has a goal other than death…

And likewise, removing a feeding tube isn’t about trying to kill someone. It’s about allowing the person to die naturally. If there is any discomfort from the dying process, it can be handled as humanely as the dicomfort of dying from cancer is.
…but you do not see that removing a feeding tube *except when the patient is already dying *is *causing *the patient’s death and in that context can have no other goal than to cause death. The patient is *not *dying a natural death, the patient is being killed by starvation and dehydration.

I cannot tell by the way you are writing whether you *are *talking about withdrawal of N&H at a point close to death and regretting that relatives are unable to understand that the N&H are not necessary for the patient anymore, or if you are including people who are *not *dying but unconscious in with those people.