Care of the dying patient

[Halami]

Good evening. I am new to this forum, but anxiously hoping for an answer to a recent dilemna. I am a registered nurse. I work at a local hospital on a med/surg (medical surgical) unit. As a new Catholic (only 3 years) I am lacking in many areas with regards to Catholic doctrine. More specifically, the care of the dying patient. Last week I was assigned to a 90 year old woman who was being given “comfort care” due to her medical diagnosis. She was in a coma and the decision was made by her family and physician for the type of care she was to receive. She had already been there approximately 5 days before I first cared for her. My question is this: isn’t there a minimum of care that the Church deems necessary for the care of the dying patient? This particular woman was not receiving any hydration or feeding. We were only to make sure she was turned and cared for hygenically. When I left at the end of my shift, I felt sick because of what little I had actually done for her and because she had no one there with her ( no family came to visit). I did not receive Communion Sunday because of this incident…I felt in my heart that I had been complicit in something horrendously wrong.

Should I have refused to take her as a patient and asked for another assignment because of this? What are the Church’s teachings on death and dying. I am heartsick.

Halami

 

[Lisa4Catholics]

Oh,NO! Hurry and go to the apologist section. It is my understanding that hydration and food even intraveniously must be provided. You need to go to the apoligist or ewtn’s forum,the question and answers section.God Bless You and when you get an authorative answer start a thread so everyone can be informed on the teaching in these situations.God Bless

 

[Listener]

It is possible that you’re looking at a grey area here. I don’t know what you could do. If the patient is in a coma, there is no way you could sneak her a drink of water or a bite of food. I remember when my father was dying, he had signed a statement that he didn’t want a feeding tube. Our priest, however, said that he should have water. I brought this idea up at the nurse’s station. They said that water is the last thing you want when a patient is dying. Later, I insisted that the doctor hook him up to a water supply (hydration tube). A few weeks later, the doctor called and said he had to remove the tube because his body was becoming waterlogged and his kidneys weren’t processing the water. All of this happened before the Pope came out with that statement that a patient always has to have food and water. Even so, the Pope may have made an exception for people who are actually in the process of dying (when there is no hope for their recovery). I don’t think you should be too hard on yourself, since you probably don’t have the authority to hook the patient up to a tube without the doctor’s prescription. You might want to speak to a priest for reassurance.

 

[Trelow]

Food and water are all thats required in reasonable circumstances. And at 90 years old I would wager that’s all that is necessary.

You cannot let starvation or dehydration be the reason their body goes into shock.

Well I would say exposure too, but I have no idea if the Church spoke on it, seems like ordinary care to keep someone reasonably clothed to me.

 

[Dr.Colossus]

If food and water are all that are necessary to keep the patient alive, then they must never be denied. However, if a patient is dying of natural causes, and food and water will not help them, I don’t think it’s morally wrong to withhold them. If a person’s body has shut down, such that they cannot make use of the nutrition being given to them, it is not wrong to accept this. However, if depriving them of food and water will cause their death prematurely, it is wrong.

 

[wabrams]

Just out of curiousity, does this patient have any higher brain activity, or has this ceased? If their brain is still function on a high level, then I can defiantely see your dellima. But if there really isn’t any brain activity, I don’t why they shouldn’t be allowed to die in peace.

 

[Elizabeth_B]

Halami,

Your community is very blessed to have such a compassionate nurse in their midst.

Last year, my father passed away and we were in a similar situation as this woman’s family. There are not sufficient words to describe the compassion and care the medical and support staff provided our entire family.

Information on the condition of the patient is necessary to determine if food and water is necessary. When my dad’s kidneys and digestive system shut down ( a normal part of the dying process) his body could no longer process food and water. Continuing to provide food and water in this circumstance would have caused other painful problems – such as aspiration of the food and water into the lungs.

 

[ThyKingdomCome]

But is there a difference between witholding food or water and just not forcing it? Are we required to tube feed? I thought (with very little confidence in this opinion) that if a person already had a feeding tube in them you couldn’t remove it without good reason, but that if it wasn’t already in, you didn’t have to give them one - or maybe I’m just thinking of secular medical ethics???

What about giving a dying person pain medication that suppresses their consciousness so much that they don’t eat and it is the actual starvation that kills them before the disease can? Is this ever moral depending on how imminently they are dying?

 

[Dr.Colossus]

ThyKingdomCome:

But is there a difference between witholding food or water and just not forcing it? Are we required to tube feed? I thought (with very little confidence in this opinion) that if a person already had a feeding tube in them you couldn’t remove it without good reason, but that if it wasn’t already in, you didn’t have to give them one - or maybe I’m just thinking of secular medical ethics???

The part about “if it wasn’t already in, you didn’t have to give them one” sounds secular. The key here is that it cannot be the withholding of food and water that kills the person. If they are already dying, and their body cannot process food and water, you can remove a feeding tube because its presence no longer has any effect on the patient’s health.

What about giving a dying person pain medication that suppresses their consciousness so much that they don’t eat and it is the actual starvation that kills them before the disease can? Is this ever moral depending on how imminently they are dying?

This would basically be a form of euthanasia. Anything that hastens the death of a terminally ill patient prematurely must be rejected.

 

[vern_humphrey]

Dr. Colossus:

The part about “if it wasn’t already in, you didn’t have to give them one” sounds secular. The key here is that it cannot be the withholding of food and water that kills the person. If they are already dying, and their body cannot process food and water, you can remove a feeding tube because its presence no longer has any effect on the patient’s health.

This would basically be a form of euthanasia. Anything that hastens the death of a terminally ill patient prematurely must be rejected.

The relevant paragraphs of the Catechism are:

[2278](javascriptpenWindow(‘cr/2278.htm’) Discontinuing medical procedures that are burdensome, dangerous, extraordinary, or disproportionate to the expected outcome can be legitimate; it is the refusal of “over-zealous” treatment. Here one does not will to cause death; one’s inability to impede it is merely accepted. The decisions should be made by the patient if he is competent and able or, if not, by those legally entitled to act for the patient, whose reasonable will and legitimate interests must always be respected. 2279 Even if death is thought imminent, the ordinary care owed to a sick person cannot be legitimately interrupted. The use of painkillers to alleviate the sufferings of the dying, even at the risk of shortening their days, can be morally in conformity with human dignity if death is not willed as either an end or a means, but only foreseen and tolerated as inevitable Palliative care is a special form of disinterested charity. As such it should be encouraged.

 

[Halami]

I want to thank everyone who has posted their thoughts on this. The past week I have spoken with my parish priest, read literature (ie The Winning Side by Charles E. Rice), and discussed this with our parish pro-life representative. My husband has been concerned because I have not been receiving Communion since this situation first occurred. In the above mentioned book, the author states, as many of you have, that the law recognizes the legal right of a competent adult to refuse any and all forms of medical treatment, including food and water. With an incompetent patient, the law recognizes that patient’s PREVIOUSLY expressed intent (ie living will, et al). The dilemna rises when caring for those patients, as a Christian and more importantly, as a Catholic-where does our responsibility lie. And if we can’t legally intervene, what then do we do. This particular woman was in a coma (responsive only to “painful” stimuli). I have not been back to work since I last cared for her on Saturday (I work only weekends), so I don’t know her fate. I do know this, I have been praying for her daily.

Finally, this whole incident has made me much more aware of what I should be looking for with regards to any dying patient. This is the first time I have encountered a situation where IV hydration was removed. When we take oaths as nurses and physicians, we make a promise to do “no harm”. That should stand out foremost in our minds as we care for those placed in our charge.

Do I feel I received a diffinitive answer to this situation? Not really. And could I have intervened to change it, probably not. But, I will in the future ask questions of the physician if it ever occurs again. And I suppose the feeling of “guilt” is something I should be thankful for…it is my cross and hopefully will provide me the strength in the future to make a difference.

Halami

 

[vern_humphrey]

Halami:

Finally, this whole incident has made me much more aware of what I should be looking for with regards to any dying patient. This is the first time I have encountered a situation where IV hydration was removed. When we take oaths as nurses and physicians, we make a promise to do “no harm”. That should stand out foremost in our minds as we care for those placed in our charge.

My wife is a Registered Nurse, and has worked in nursing homes for about 30 years. I know of at least one incident of a patient who had a severe stroke, and paramedics rescuscitated – far too late to prevent severe brain damage – and brought him into the hospital with tubes already in. I knew the patient personally – he was a retired physician and he had a living will forbidding such treatment. He was transferred to the nursing home.

His family wanted the tubes removed, and no one would do it. Finally a nephew, who was also a physician came and removed them.

Halami:

Do I feel I received a diffinitive answer to this situation? Not really. And could I have intervened to change it, probably not. But, I will in the future ask questions of the physician if it ever occurs again. And I suppose the feeling of “guilt” is something I should be thankful for…it is my cross and hopefully will provide me the strength in the future to make a difference.

I think you have just given us the definitive answer. Perhaps you should also consider talking to the physician in question and letting him know how your feel.