Do feeding tubes inflict pain and suffering?

[Joe_5859]

No, undue burden can be factors other than physical. See the quote from the Congregation of the Doctrine of the Faith I provided above.

Could you please elaborate on this? I reread the quotes you provided from the CCC and the Declaration on Euthanasia and I couldn’t find where you are getting this. I think these quotes are a bit misleading, as they are both referring to the use of extraordinary means, not ordinary means, like food and water. Thus, they do not directly apply to cases such as the topic of this thread. For that, the CDF has clearly spelled things out in its doctrinal note and commentary. It seems that it would be better to use the document that speaks specifically to this situation.

Also, although it might seem like hair splitting, the Church does not teach that hydration and nutrition are, with only specific, outlined, exceptions, always “ordinary means”. The Church teaches that, as a general principle, nutriation and hydration are not extraordinary. We have to be careful not to overstate the teaching as an absolute, lest we put to much pressure on the people the Church has charged with the ultimate moral decisions.

Well, if we’re getting into hair splitting, I think you’re making a false distinction here, or rather, drawing a distinction in the wrong place. The CDF is quite clear is saying that nutrition and hydration is always ordinary means. It’s not as though food and water is ordinary care for some people and extraordinary care for others. It is always ordinary.

Where the distinction is drawn between the general principle and specific exceptions is on the moral obligation to use artificial means for this ordinary care. What they say is that artificial means is morally obligatory in principle, but then they list three exceptions. The third exception is where they speak about burden:

Finally, the possibility is not absolutely excluded that, in some rare cases, artificial nourishment and hydration may be excessively burdensome for the patient or may cause significant physical discomfort, for example resulting from complications in the use of the means employed.

They only mention physical discomfort in this exception. Also note that it speaks of what is burdensome to the patient, not what is burdensome to the family. Now, I realize that they aren’t going to list every possible instance that would qualify as burdensome. However, it is telling that they do not list things such as “psychological factors” or anything else. It would not have been difficult to mention something general like that. Or even a completely generic “or other factors”. Nothing like that is mentioned.

There is also a condition for not utilizing artificial means for food and water because of physical discomfort. It is not simply that the patient is suffering physically. It is that the very means to give them food and water is what is causing the pain. Thus, they cannot simply be starved to death because their illness is causing them physical pain.

It is also telling that they say such exceptions are rare. As in, not the norm. It seems that someone could easily come up with something that is “burdensome” for any case. This would seem to indicate that it should be interpreted narrowly rather than broadly. Unless the Church is like the Supreme Court with Roe v Wade where the health “exception” can pretty much be anything you want it to be. If that were the case, the document would basically be meaningless.

 

[rpp]

Could you please elaborate on this? I reread the quotes you provided from the CCC and the Declaration on Euthanasia and I couldn’t find where you are getting this. I think these quotes are a bit misleading, as they are both referring to the use of extraordinary means, not ordinary means, like food and water. Thus, they do not directly apply to cases such as the topic of this thread. For that, the CDF has clearly spelled things out in its doctrinal note and commentary. It seems that it would be better to use the document that speaks specifically to this situation.

Well, if we’re getting into hair splitting, I think you’re making a false distinction here, or rather, drawing a distinction in the wrong place. The CDF is quite clear is saying that nutrition and hydration is always ordinary means. It’s not as though food and water is ordinary care for some people and extraordinary care for others. It is always ordinary.

Where the distinction is drawn between the general principle and specific exceptions is on the moral obligation to use artificial means for this ordinary care. What they say is that artificial means is morally obligatory in principle, but then they list three exceptions. The third exception is where they speak about burden:

They only mention physical discomfort in this exception. Also note that it speaks of what is burdensome to the patient, not what is burdensome to the family. Now, I realize that they aren’t going to list every possible instance that would qualify as burdensome. However, it is telling that they do not list things such as “psychological factors” or anything else. It would not have been difficult to mention something general like that. Or even a completely generic “or other factors”. Nothing like that is mentioned.

There is also a condition for not utilizing artificial means for food and water because of physical discomfort. It is not simply that the patient is suffering physically. It is that the very means to give them food and water is what is causing the pain. Thus, they cannot simply be starved to death because their illness is causing them physical pain.

It is also telling that they say such exceptions are rare. As in, not the norm. It seems that someone could easily come up with something that is “burdensome” for any case. This would seem to indicate that it should be interpreted narrowly rather than broadly. Unless the Church is like the Supreme Court with Roe v Wade where the health “exception” can pretty much be anything you want it to be. If that were the case, the document would basically be meaningless.

:clapping:

Joe, your response to the distortions your are responding to are very good. I admire your patience.

 

[DVIN_CKS]

There is also a condition for not utilizing artificial means for food and water because of physical discomfort. It is not simply that the patient is suffering physically. It is that the very means to give them food and water is what is causing the pain. Thus, they cannot simply be starved to death because their illness is causing them physical pain.

It is also telling that they say such exceptions are rare. As in, not the norm. It seems that someone could easily come up with something that is “burdensome” for any case. This would seem to indicate that it should be interpreted narrowly rather than broadly. Unless the Church is like the Supreme Court with Roe v Wade where the health “exception” can pretty much be anything you want it to be. If that were the case, the document would basically be meaningless.

YOU ROCK JOE!!

You explained everything I didn’t have the time to. What you wrote is exactly how I interpreted the documents you posted. Thanks for taking the time to explain things clearly. I only wish the priest I spoke to (not the same one my MIL and husband sat down with) could have done as good a job. Even my MIL’s priest didn’t explain things as clearly as he probably could have – or SHOULD have. I walk away from this KNOWING that priests need more training in this area of counseling. It’s not as “gray” as they try and tell you it is. Yes, every case is different and has circumstances that must be examined carefully. There is no “one size fits all” when it comes to what we’re talking about. But it sure helps if you go into the conversation with the doctor, caregiver, advocate, etc…clearly knowing what the Church teaches and know that you must apply the guidelines as best you can to your situation.

I can only guess at my MIL’s motives for not wanting to get more information from the doctor before deciding that all artificial feeding options were ruled out. I cannot judge her or try and get her to second guess her decision. My opinion hasn’t been asked and until it is I’ll keep my mouth shut. However, I do know that she didn’t want the hassle of having to move my FIL to a nursing home which is where he would have to be if he needed to be on a feeding tube. Money isn’t the problem. She can well afford top notch care.

Perhaps the patient’s potential physical pain and discomfort resulting from inserting a stomach feeding tube (I have no way of knowing how he’d handle this type of feeding tube…his doctor would know best) combined with the fact that he would not be a “cooperative patient” (i.e. he’d try to pull it out) can justify the decision not to feed him by artificial means. That’s how I’m looking at it right now. I’m at peace with that.

Thanks again Joe…I think if everyone reads carefully the links you provided they will better understand the “fine hairs” that have to be split.

 

[Joe_5859]

:clapping:

Joe, your response to the distortions your are responding to are very good. I admire your patience.

YOU ROCK JOE!!

Thanks! :blushing: I do what I can!

In all fairness to the priests you mentioned, the CDF’s document did just come out last year. It’s possible they are not familiar with it.

I’m glad you are at peace with where things are at. I will continue to keep you and your family in my prayers.

 

[SoCalRC]

Could you please elaborate on this? I reread the quotes you provided from the CCC and the Declaration on Euthanasia and I couldn’t find where you are getting this. I think these quotes are a bit misleading, as they are both referring to the use of extraordinary means, not ordinary means, like food and water. Thus, they do not directly apply to cases such as the topic of this thread. For that, the CDF has clearly spelled things out in its doctrinal note and commentary. It seems that it would be better to use the document that speaks specifically to this situation.

But it doesn’t, it speaks only of a persistent vegetative state. That is not the case here. And the first link contains the caveat “in principle”, so even in that case the Church is leaving some room. Also, notice that the documents are talking about the removal of a the treatments, not the acceptance of NG tubes, etc. to begin with.

The first relevent question would seem to be: Can hydration and nutrition, particulary by artificial means, ever be extraordinary? Based on the Congregation of the Doctrine of the Faith and speeches from John Paul II, the answer would appear to be yes. You also find a lot of theological articles, including here at CAF, that come to the same conclussion.

The second question is then, who decides when it is moral to refuse medical treatment? We’ve already looked at that question. The question is a complicated one balancing our right to accept our human nature and “die with Christian dignity” and our obligation to treasure the infinitely value gift of our lives.

My point is only that the Church is correct, these are incredibly complicated situations and best decided by the patient, when able, using his/her Christian concience. The alternative, that we can judge these situations with certainty from afar, without knowing things like the pain threshold of the individual or the total theraputic result, is, in of itself, seemingly quite un-Christian. We are called not to judge and make relative moral comparisons between ourselves and others. That is why I am simply reinforcing the idea that no matter how certain we are from a distance, our ultimate responsibility is love and compassion for all involved.

If you are reading more into my posts than just this simple caution about harsh judgement and a lack of compassion for people who are in a terribly difficult position, please don’t. I am not trying to weaken the Church’s position, only noting that it is not an absolute and the Church has noted that refusal of medical care is a complex moral decision. More fundementally, I am trying to remind folks of one of the Beatitudes.

 

[DVIN_CKS]

In the ‘Commentary’ document the CDF goes into more detail and doesn’t limit its comments just for the person in a “vegetative state”. The situation I’ve presented in this thread would fall more specifically to relating to the gravely ill and dying. Here’s what they say: “There remains the strict obligation to administer at all costs those means which are called ‘minimal’; that is, those that normally and in usual conditions are aimed at maintaining life (nourishment, blood transfusions, injections, etc…). The discontinuation of these minimal measures would mean in effect willing the end of a patient’s life” (no. 2.4.4). Empahsis is mine.

I understand this to mean that we are morally obligated to consider all feeding options (artificial and natural) that may be used to preserve a patient’s life. We are not morally obligated to administer this care if there is an inability for the body to assimilate food and liquid (which would make the provision of food and water useless) or if artificial nourishment is “excessively burdensome for the patient” or causes “significant physical discomfort”.

I believe, in my FIL’s case, that an artificial feeding tube would fall under the “excessively burdensome” and “significant physical discomfort” categories. But I won’t know that for sure because my MIL will not consult her husband’s doctor about the different feeding options. We have no idea at this point how well he would or would not tolerate a stomach feeding tube. The fact that she doesn’t feel “morally obligated” to look into this concerns me. Dismissing the whole idea based on her husband’s reaction to an NG tube doesn’t seem like she is trying to administer the minimal provisions “at all costs”. The fact that he CAN still take food naturally by mouth may play a big part in her decision. I’m sure we might be looking at a different scenario if he couldn’t eat by mouth AT ALL.

IMHO, according to the CDF document it seems that my MIL could have done more before determining that a feeding tube was not to be used to help provide the additional nutrition that the hospital said he needed. Maybe she is just trying to honor her husband’s wishes (assumming he once told her he never wanted to be hooked up to a feeding tube. I don’t know, just a guess).

I’m not trying to come down hard on my MIL. At her age, I don’t really expect her to know all the ins and outs of moral theology. That is what she goes to the priest for. And since she’s already gone to a priest and he told her that she made the right decision, then all I can do is support her. And of course pray.

 

[Eilish_Maura]

I’m not trying to come down hard on my MIL. At her age, I don’t really expect her to know all the ins and outs of moral theology. That is what she goes to the priest for. And since she’s already gone to a priest and he told her that she made the right decision, then all I can do is support her. And of course pray.

For all the times you say you not trying to come down hard on your MIL it seems you are doing just that in many parts of your posts.

Didn’t you indicate she spoke to her priest? If so – are you also 2nd guessing his understanding of moral theology?

You admit to not having intimate knowledge of all the things your MIL is using to base these decisions on – please, pray to truly be at peace with what is happening.

 

[dalesmom]

I am a registered nurse and I can tell you that a nasogastric tube inserted through the nose into the stomach is very painful. A confused patient is also prone to pull it out requiring reinsertion. It can be anchored to the nasal septum to keep them from pulling it out. This causes even more pain.

A gastric tube inserted through the abdomen into the stomach is not so painful. It can be easily pulled out as well and must be reinserted in interventional radiology to ensure it is in the right place. Aspiration pneumonia can occur if the stomach is overfilled or the patient’s head is not elevated during and after feeding.

Death is a natural process that we will all go through unless we die suddenly. Sometimes these tubes are inserted to make the family feel better rather than providing any benefit to the patient. When a person’s kidneys and other organs begin to shut down they develop fluid overload if they continue to receive feedings or fluid which causes them to get fluid in their lungs and to develop tremendous swelling. They also are prone to develop diarrhea that causes the skin on their backside to break down painfully.

Starving a patient who is unable to eat and forcing food into a body that is shutting down are both wrong. The issue is whether the tube will harm him or add to his suffering. My grandmother had a tube in her abdomen because she could not swallow but was not dying. Depending on the patient’s physical state the feeding can actually harm them or shorten their life through the effects I described above.

+JMJ+

From one nurse to another…WELL SAID!!!

 

[Joe_5859]

But it doesn’t, it speaks only of a persistent vegetative state. That is not the case here. And the first link contains the caveat “in principle”, so even in that case the Church is leaving some room. Also, notice that the documents are talking about the removal of a the treatments, not the acceptance of NG tubes, etc. to begin with.

The fact that the doctrinal note specifically addresses those in a vegetative state does not change the fact that it still says nutrition and hydration, even by artificial means, is considered ordinary care. Is there some reason this would apply to those in a vegetative state but not to those who aren’t?

The first relevent question would seem to be: Can hydration and nutrition, particulary by artificial means, ever be extraordinary? Based on the Congregation of the Doctrine of the Faith and speeches from John Paul II, the answer would appear to be yes. You also find a lot of theological articles, including here at CAF, that come to the same conclussion.

I have not come across any Church document that has described nutrition and hydration by artificial means as anything but ordinary care. Can you can point me to one (a specific quote would be helpful)?

The second question is then, who decides when it is moral to refuse medical treatment? We’ve already looked at that question. The question is a complicated one balancing our right to accept our human nature and “die with Christian dignity” and our obligation to treasure the infinitely value gift of our lives.

My point is only that the Church is correct, these are incredibly complicated situations and best decided by the patient, when able, using his/her Christian concience. The alternative, that we can judge these situations with certainty from afar, without knowing things like the pain threshold of the individual or the total theraputic result, is, in of itself, seemingly quite un-Christian. We are called not to judge and make relative moral comparisons between ourselves and others. That is why I am simply reinforcing the idea that no matter how certain we are from a distance, our ultimate responsibility is love and compassion for all involved.

I agree with you here. However, again, a patient (or those making decisions for them) may have a right to refuse certain kinds of medical treatment, but I wouldn’t classify food and water as a “medical treatment.” It’s not medicine, it’s just a basic necessity. Food and water won’t cure someone from a terminal illness. It just stops them from starving to death.

If you are reading more into my posts than just this simple caution about harsh judgement and a lack of compassion for people who are in a terribly difficult position, please don’t. I am not trying to weaken the Church’s position, only noting that it is not an absolute and the Church has noted that refusal of medical care is a complex moral decision. More fundementally, I am trying to remind folks of one of the Beatitudes.

I’m not trying to read into your posts anything that is beyond your stated intent. I do believe you that you sincerely want to avoid this harsh judgment of those who find themselves in these situations. I certainly agree with you. I am not trying to condemn the OP’s MIL (and I hope she already knows that! ). I also agree that these can be complex moral decisions. Thus, even if we make a wrong one, God will hopefully be merciful so long as we do the best we can.

I simply question your belief that there are cases where food and water by artificial means is classified as extraordinary means. I have not come across any statement of the Church that would lead me to believe that is what the Church teaches on the subject (and the only statments I have seen lead me to the opposite conclusion). We both agree that there are situations where it may not be morally obligatory to use these means, but I don’t think that changes the fact that it is ordinary care.

 

[Eilish_Maura]

Does the Church support forcing nutrition/hydration on someone?

 

[Joe_5859]

For all the times you say you not trying to come down hard on your MIL it seems you are doing just that in many parts of your posts.

The OP came here to talk it out. I don’t think she’s come down hard on her MIL at all. She seems very much to want to give her the benefit of the doubt

Didn’t you indicate she spoke to her priest? If so – are you also 2nd guessing his understanding of moral theology?

I think we all know that not every priest has a perfect understanding of moral theology. I think it’s okay to ask questions, as the OP has done here. I agree with your sentiment, though, that, if we don’t have all the facts, it is better to presume good will rather than bad will.

You admit to not having intimate knowledge of all the things your MIL is using to base these decisions on – please, pray to truly be at peace with what is happening.

It seems she already has (from her previous posts). From everything I’ve seen her post here, it seems she has handled the whole situation quite well!

 

[Joe_5859]

Does the Church support forcing nutrition/hydration on someone?

See my previous post #8 for links to what the Church says about nutrition and hydration by artificial means. The second to last paragraph of the Commentary outlines the exceptions under which one is not morally obligated to utilize these means.

 

[DVIN_CKS]

For all the times you say you not trying to come down hard on your MIL it seems you are doing just that in many parts of your posts.

Didn’t you indicate she spoke to her priest? If so – are you also 2nd guessing his understanding of moral theology?

You admit to not having intimate knowledge of all the things your MIL is using to base these decisions on – please, pray to truly be at peace with what is happening.

I will admit that I am frustrated with THE DECISION my MIL has made, If I seem to be coming down hard, it is directed at her decision and not her personally. I know this has been a very hard thing for her to deal with and I respect her decision even if I don’t agree with it.

Yes, I am second guessing the priest’s understanding of moral theology. I think he could have elaborated more on how the Church views or defines “ordinary care” and explain what her “moral obligation” would or would not be in her situation. The priest I went and spoke to personally was NOT in line with Church teaching on this matter based on comments he had regarding the “mercy killing” of Terri Shiavo. So, if I seem to be second guessing here, it’s because I’ve been given reason to.

As I stated in a previous post, I am at peace. God is a God of mercy and I trust in Him.

 

[Eilish_Maura]

Yes, I am second guessing the priest’s understanding of moral theology. I think he could have elaborated more on how the Church views or defines “ordinary care” and explain what her “moral obligation” would or would not be in her situation. The priest I went and spoke to personally was NOT in line with Church teaching on this matter based on comments he had regarding the “mercy killing” of Terri Shiavo. So, if I seem to be second guessing here, it’s because I’ve been given reason to.

Did you go with your MIL to see the priest? Did you hear what she heard? I get the impression you did not.

Was the priest you spoke to the same priest?

 

[Eilish_Maura]

See my previous post #8 for links to what the Church says about nutrition and hydration by artificial means. The second to last paragraph of the Commentary outlines the exceptions under which one is not morally obligated to utilize these means.

One of the problems with so much wording used is that it seems to eliminate the option for a person to refuse treatment - any kind of treatment - or have the person they designate make these decisions if they are unable to do it for themselves.

I have a friend whose mother was essentially tortured in her last days because of this screwed up sense of ‘morally obligated’ when a Catholic hospital in a Catholic European country forced additional surgery on her because they were required by law to do so.

When in Ireland I read newspaper accounts of similiar things - people forced against their will to undergo this treatment or that because of a messed up ‘moral obligation’ that became law and eliminated the freedom of will regarding health care treatment.

 

[KathleenElsie]

The fact that the doctrinal note specifically addresses those in a vegetative state does not change the fact that it still says nutrition and hydration, even by artificial means, is considered ordinary care. Is there some reason this would apply to those in a vegetative state but not to those who aren’t?
Those in a “vegetative” state don’t tend to try to pull the tubes out and open themselves up to many of the medical problems that comes from the tube insert and reinsert.

I have not come across any Church document that has described nutrition and hydration by artificial means as anything but ordinary care. Can you can point me to one (a specific quote would be helpful)?

I agree with you here. However, again, a patient (or those making decisions for them) may have a right to refuse certain kinds of medical treatment, but I wouldn’t classify food and water as a “medical treatment.” It’s not medicine, it’s just a basic necessity. Food and water won’t cure someone from a terminal illness. It just stops them from starving to death.

At times it can make the person even sicker as in the case of my mother. This issue is covered with the burdensome part of the information the Church gives.

I’m not trying to read into your posts anything that is beyond your stated intent. I do believe you that you sincerely want to avoid this harsh judgment of those who find themselves in these situations. I certainly agree with you. I am not trying to condemn the OP’s MIL (and I hope she already knows that! ). I also agree that these can be complex moral decisions. Thus, even if we make a wrong one, God will hopefully be merciful so long as we do the best we can.

I simply question your belief that there are cases where food and water by artificial means is classified as extraordinary means. I have not come across any statement of the Church that would lead me to believe that is what the Church teaches on the subject (and the only statments I have seen lead me to the opposite conclusion). We both agree that there are situations where it may not be morally obligatory to use these means, but I don’t think that changes the fact that it is ordinary care.

 

[rinnie]

There are alot of questions we dont have answers for. But I believe rpp said he was on a feeding tube and it wasnt painful and didnt cause him any suffering. So i would say we are luck enough to have a answer to this one and i wuld go with rpp. He would be the one to know since he experienced this. And thanks rpp because this is something eveyone should know.

 

[KathleenElsie]

When stating that the administration of food and water is morally obligatory in principle, the Congregation for the Doctrine of the Faith does not exclude the possibility that, in very remote places or in situations of extreme poverty, the artificial provision of food and water may be physically impossible, and then ad impossibilia nemo tenetur. However, the obligation to offer the minimal treatments that are available remains in place, as well as that of obtaining, if possible, the means necessary for an adequate support of life. Nor is the possibility excluded that, due to emerging complications, a patient may be unable to assimilate food and liquids, so that their provision becomes altogether useless. Finally, the possibility is not absolutely excluded that, in some rare cases, artificial nourishment and hydration may be excessively burdensome for the patient or may cause significant physical discomfort, for example resulting from complications in the use of the means employed.
These exceptional cases, however, take nothing away from the general ethical criterion, according to which the provision of water and food, even by artificial means, always represents a natural means for preserving life, and is not a therapeutic treatment. Its use should therefore be considered ordinary and proportionate, even when the “vegetative state” is prolonged.

Sometimes we try to make things simpler by breaking down the long paragraphs into sentences. So I am posting the actual words from the Commentary mentioned in POST #8.

 

[Joe_5859]

One of the problems with so much wording used is that it seems to eliminate the option for a person to refuse treatment - any kind of treatment - or have the person they designate make these decisions if they are unable to do it for themselves.

I have a friend whose mother was essentially tortured in her last days because of this screwed up sense of ‘morally obligated’ when a Catholic hospital in a Catholic European country forced additional surgery on her because they were required by law to do so.

When in Ireland I read newspaper accounts of similiar things - people forced against their will to undergo this treatment or that because of a messed up ‘moral obligation’ that became law and eliminated the freedom of will regarding health care treatment.

Okay, let us first be clear on what these documents are talking about and what they are not talking about. The CDF doctinal note and commentary are talking about nutrition and hydration by artificial means. That is all. The only moral obligation it speaks of in those documents is the moral obligation to feed and give water to people, even by artificial means. Of course, there are exceptions, and it lists those in the second to last paragraph of the commentary.

Nothing in these documents in any way advocates forced surgeries or medical treatements. That is a completely different topic of conversation, and you would have to look to other documents to respond to them (such as the Declaration on Euthanasia). People do have a right to refuse certain medical treatments, but food and water are not a medical treatment. They will not cure someone from a terminal illness. All it does is prevent a person from starving to death.

Now, if by using these artificial means, it causes great problems or the body is too far gone to even process the food and water, then one is dispensed from the moral obligation. These are the exceptions that are mentioned in the second to last paragraph of the Commentary. The Church is not asking anyone to put someone through great physical pain to give food and water to someone whose body is already rejecting it.

 

[Joe_5859]

Thank you, Kathleen Elsie, for posting the paragraph in question. I guess I should have done that from the get-go!

Those in a “vegetative” state don’t tend to try to pull the tubes out and open themselves up to many of the medical problems that comes from the tube insert and reinsert.

Yes, this is a difference that would impact how burdensome it would be. Something that would not be a burdensome for someone in a PVS could be burdensome for a patient not is a PVS. However, this does not change the fact that food and water by artificial means is considered ordinary care for both types of patients, which is the point I was making. Perhaps, then, the exceptions are less rare for those not in a PVS, which might be a valid point.

At times it can make the person even sicker as in the case of my mother. This issue is covered with the burdensome part of the information the Church gives.

Yes, I agree. I hope I didn’t come off otherwise!