Do feeding tubes inflict pain and suffering?

[Eilish_Maura]

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.

Yet they can lead to situations where someone is forced into procedures they object to - like insertion of a food tube into the stomach. It sometimes comes across that it is ok per the Church to force feed someone who objects to invasive processes (part of what happened in the situation with my friends’ mother).

 

[DVIN_CKS]

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?

My husband went with his mother and he told me what the priest said.

The priest I spoke to was not the same priest. He was from a different parish.

Both priests though did not explain the Church’s teaching as thoroughly as they could have - IMHO. Doesn’t make them bad priests…just shows that not every priest is an expert in educating the faithful on end of life issues such as this one.

 

[Eilish_Maura]

My husband went with his mother and he told me what the priest said.

The priest I spoke to was not the same priest. He was from a different parish.

Both priests though did not explain the Church’s teaching as thoroughly as they could have - IMHO. Doesn’t make them bad priests…just shows that not every priest is an expert in educating the faithful on end of life issues such as this one.

Just keep in mind you are working with less than the best information. Getting what was presented 2nd hand is not the same as being there.

At this point, given what has been said, both those priests could have been far more correct than anyone here 2nd guessing them.

 

[DVIN_CKS]

Yet they can lead to situations where someone is forced into procedures they object to - like insertion of a food tube into the stomach. It sometimes comes across that it is ok per the Church to force feed someone who objects to invasive processes (part of what happened in the situation with my friends’ mother).

If someone is against EVER having artificial feeding administered to them (i.e. they never want to be force fed against their will), then they should make those wishes known to their medical advocate. It would then be for the advocate to decide if he/she could carry out that request. I, for one, could not carry out a request like that. Even if it was my husband. I would never assist in starving him to death, even if those were his wishes. It boils down to euthanasia by omission of the basic provisions of food and water. My conscious will not allow me to assist in what I see as mercy killing.

If you or someone you love doesn’t want to ever be force fed, be sure they put it in writing and get an advocate that will not have a moral problem carrying out their wishes.

 

[Eilish_Maura]

If someone is against EVER having artificial feeding administered to them (i.e. they never want to be force fed against their will), then they should make those wishes known to their medical advocate. It would then be for the advocate to decide if he/she could carry out that request. I, for one, could not carry out a request like that. Even if it was my husband. I would never assist in starving him to death, even if those were his wishes. It boils down to euthanasia by omission of the basic provisions of food and water. My conscious will not allow me to assist in what I see as mercy killing.

If you or someone you love doesn’t want to ever be force fed, be sure they put it in writing and get an advocate that will not have a moral problem carrying out their wishes.

Wish it could be that easy- the woman whose mother was forced against her will not only for that but for additional surgery (because it was seen as suicide by failure to ‘treat’ an additional condition in this Catholic Hospital and the country’s laws) was able to speak for herself and knew she was dying of cancer. Her specific wishes were ignored/over-ruled. We have much the same here when family tries to say the person is no longer able to make these choices if they say this is truly what they want (no invasive treatment for even hydration/nutrition).

 

[DVIN_CKS]

Just keep in mind you are working with less than the best information. Getting what was presented 2nd hand is not the same as being there.

At this point, given what has been said, both those priests could have been far more correct than anyone here 2nd guessing them.

I trust that my husband got it right. You’re right that it’s not the same as being there, but I don’t think I missed much in the translation.

I agree that the conclusion that the priests arrived at (agreeing with my MIL to refuse artificial feeding) could be correct in the final analysis. I’m not second guessing their conclusion. I’m disappointed in their lack of explanation on how they arrived at it. I do not believe that my MIL walked away from her meeting with the priest with a solid understanding of how to determine just how far her “moral obligation” goes regarding the care of her husband. I certainly didn’t walk away from the meeting I had with my priest fully understanding the exceptions to the moral obligation. He couldn’t tell me. I had to learn it from the CDF documents provided by another poster on this forum. That tells me a lot! I did leave copies of the CDF documents with my priest. Hopefully, he’ll read them and gain some added insight.

 

[DVIN_CKS]

We have much the same here when family tries to say the person is no longer able to make these choices if they say this is truly what they want (no invasive treatment for even hydration/nutrition).

Is a stomach feeding tube considered “invasive treatment” by the medical profession? As another poster said, feeding someone isn’t “treating” anything. It won’t cause a cure for a disease.

 

[Eilish_Maura]

Is a stomach feeding tube considered “invasive treatment” by the medical profession? As another poster said, feeding someone isn’t “treating” anything. It won’t cause a cure for a disease.

If something unnatural (tubes for example) have to be inserted, sometimes surgically, into the body then yes it is invasive even though it is not ‘treatment’ (as in a cure - but then pain meds would not be ‘treatment’ using that kind of guideline).

 

[DVIN_CKS]

If something unnatural (tubes for example) have to be inserted, sometimes surgically, into the body then yes it is invasive even though it is not ‘treatment’ (as in a cure - but then pain meds would not be ‘treatment’ using that kind of guideline).

Couldn’t an IV then be considered “invasive”? I realize it doesn’t require surgery but some folks could just as easily forbid it and then they would not be able to be hydrated properly.

 

[rpp]

Wish it could be that easy- the woman whose mother was forced against her will not only for that but for additional surgery (because it was seen as suicide by failure to ‘treat’ an additional condition in this Catholic Hospital and the country’s laws) was able to speak for herself and knew she was dying of cancer. Her specific wishes were ignored/over-ruled. We have much the same here when family tries to say the person is no longer able to make these choices if they say this is truly what they want (no invasive treatment for even hydration/nutrition).

You have repeatedly mentioned that in some countries people are forced against their will to undergo medical procedures. (You have also been reminded that that is not Catholic teaching and ignored that as well.)

I find it hard to believe that a person would be **forced **to undergo medical procedures anywhere. Please provide a citation to a news story or legal documentation to back up your assertions. Specifically which countries are you referring to. You have made a rather bold claim. Please back it up with evidence.

 

[fix]

Wish it could be that easy- the woman whose mother was forced against her will not only for that but for additional surgery (because it was seen as suicide by failure to ‘treat’ an additional condition in this Catholic Hospital and the country’s laws) was able to speak for herself and knew she was dying of cancer. Her specific wishes were ignored/over-ruled. We have much the same here when family tries to say the person is no longer able to make these choices if they say this is truly what they want (no invasive treatment for even hydration/nutrition).

We really need more information but I wanted to ask you if you think it is just for one person to try to bind another person to murder them?

Is it just when some person claims they want to be starved to death and then signs a paper asking their loved ones to starve them under the general heading of follow my wishes?

 

[mmch66]

Any treatment that involves inserting something into a person’s body is considered invasive treatment. An IV is invasive, as is a urinary catheter, surgery, etc.

In American hospitals patients have the right to refuse ANY treatment, whether it is a pill, an IV, a transfusion, etc. They also have the right to designate a medical power of attorney and/or to write a living will. Hospitals are required to provide information and the means of designating an MPOA or making a living will without any charge. Patients also have the right to a second opinion and to have all their questions answered before agreeing to any treatment. I also highly recommend that people making difficult decisions have someone with them who is less emotionally involved because stress makes it hard to process and retain the information.

No rule can take into account all possibilities in the treatment of disease and the dying. I am sure this is not a decision the OP’s MIL took lightly and that it is absolute torture to her to anticipate her husband’s death. We are all capable of second guessing when we are not directly involved. It is amazing how we can see the mote in our brother’s eye. My impression is that the OP came here seeking an outlet and some peace of mind. I pray that she can be at peace with her MIL’s decision. The poor MIL has consulted a priest and without explicit details as to the FIL’s medical status we have no ability or right to judge her. I have seen things like this tear families apart at a time when they really need each other.

Rather then picking apart the MIL’s decision we need to pray for the entire family and especially for the FIL’s soul.

 

[rinnie]

By the logic of “let’s just let nature take it’s course”, someone could say that about their infant child and let him or her starve to death (since babies can’t feed themselves, either). Would that be “natural”? Certainly not! Starving to death is not natural.

The reason the Church documents I previously referenced make special note of patients in a vegetative state is because that is where most people end up confused. If a patient is not in a permanent vegetative state, it seems all the more obvious that food is part of their ordinary care.

I know that working with family on situations like this can be very stressful. It seems like you’re doing everything you can (by talking to a priest and a nutritionist). You and your family are in my prayers!

I have to say i agree with Joe on this one. He I feel has put it as clear as anyone could.

 

[DrPiano]

For my two cents :twocents: as a future medical professional (3 years away from my MD) and future Catholic highly interested in medical ethics:

For me, what makes this situation different is that the patient in question can feed himself (and is doing so). It may even be possible for him to obtain the right caloric intake (if he’s given the right food) by mouth. Is there a way you could convince his caregiver to seek out the advice of a nutritionist to see how his diet can be supplemented orally (if at all)? I know with the sheer number of different formulas out there that can be given (like Boost, Ensure, etc.) this is frequently possible.

In general the paradigm that we’re learning in school is “If the patient can take it in by mouth, then this is the preferred method.” Particularly in this case, where the patient is likely to pull out any tubes that have been inserted, it would be wise to exhaust options of feeding him orally before attempting to feed him artificially. While I agree with the other posters that your MIL has an obligation to make sure he’s getting fed adequately while his body can tolerate the food, I think that this does not necessarily mean that she must feed him artificially before other options have been exhausted.

I hope that makes sense. Anyway, my real question is, have you been able to convince decision makers to consult a nutritionist about supplementing his intake orally? Also, is there any way that the OP could consult a nutritionist herself and take that information to the caregiver?

 

[KathleenElsie]

For my two cents :twocents: as a future medical professional (3 years away from my MD) and future Catholic highly interested in medical ethics:

For me, what makes this situation different is that the patient in question can feed himself (and is doing so). It may even be possible for him to obtain the right caloric intake (if he’s given the right food) by mouth. Is there a way you could convince his caregiver to seek out the advice of a nutritionist to see how his diet can be supplemented orally (if at all)? I know with the sheer number of different formulas out there that can be given (like Boost, Ensure, etc.) this is frequently possible.

In general the paradigm that we’re learning in school is “If the patient can take it in by mouth, then this is the preferred method.” Particularly in this case, where the patient is likely to pull out any tubes that have been inserted, it would be wise to exhaust options of feeding him orally before attempting to feed him artificially. While I agree with the other posters that your MIL has an obligation to make sure he’s getting fed adequately while his body can tolerate the food, I think that this does not necessarily mean that she must feed him artificially before other options have been exhausted.

I hope that makes sense. Anyway, my real question is, have you been able to convince decision makers to consult a nutritionist about supplementing his intake orally? Also, is there any way that the OP could consult a nutritionist herself and take that information to the caregiver?

Well said thank you.

 

[Joe_5859]

Rather then picking apart the MIL’s decision we need to pray for the entire family and especially for the FIL’s soul.

I don’t know if this comment is directed at specific posters (like me ) or if you are just making a general statement. It’s never been my intent to pick apart anyone’s decision, but only to respond to the questions posed by the OP (and then to clarify those responses when it seems necessary). The OP asked in the very first post whether a feeding tube is “extraordinary means.” The CDF doesn’t seem to think so, and that is the main point I have been trying to make.

I am well aware that I do not know everything about the particular situation and I would pass no judgment on the MIL. But I think we can still comment on general moral principles and try to apply them to specific cases as best we can with the information available. I’m not trying to pass judgment, just help along the conversation.

I don’t think I’ve pointed fingers at anyone or accused anyone of mortal sin.

 

[Joe_5859]

For my two cents :twocents: as a future medical professional (3 years away from my MD) and future Catholic highly interested in medical ethics:

For me, what makes this situation different is that the patient in question can feed himself (and is doing so). It may even be possible for him to obtain the right caloric intake (if he’s given the right food) by mouth. Is there a way you could convince his caregiver to seek out the advice of a nutritionist to see how his diet can be supplemented orally (if at all)? I know with the sheer number of different formulas out there that can be given (like Boost, Ensure, etc.) this is frequently possible.

In general the paradigm that we’re learning in school is “If the patient can take it in by mouth, then this is the preferred method.” Particularly in this case, where the patient is likely to pull out any tubes that have been inserted, it would be wise to exhaust options of feeding him orally before attempting to feed him artificially. While I agree with the other posters that your MIL has an obligation to make sure he’s getting fed adequately while his body can tolerate the food, I think that this does not necessarily mean that she must feed him artificially before other options have been exhausted.

I hope that makes sense. Anyway, my real question is, have you been able to convince decision makers to consult a nutritionist about supplementing his intake orally? Also, is there any way that the OP could consult a nutritionist herself and take that information to the caregiver?

Good point, and one that we have not spent too much time discussing. Thanks for bringing it up!

 

[DVIN_CKS]

Anyway, my real question is, have you been able to convince decision makers to consult a nutritionist about supplementing his intake orally? Also, is there any way that the OP could consult a nutritionist herself and take that information to the caregiver?

I haven’t approached my MIL about consulting a nutritionist, but I plan to plant a seed or two about it. It has been suggested to her to try to get her husband to drink something like Ensure or Boost but we were told that it may be difficult since my FIL aspirates any liquid that he tries to drink. They would have to thicken it up and probably spoon it to him, but that is certainly an option.

 

[SoCalRC]

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?

Of course. The Church is talking about a specific medical situation, but still hedging - because even these situations are complex.

When you start talking about patients in other conditions, tradeoffs of theraputic value can change. Let’s take a patient with a degenerative, non treatable, neurological disorder. Because of problems with appetite and motor planning, the patient is not getting enough calories.

So, an NG tube is placed. But the patient has bouts of dementia, doesn’t understand the tube during those periods, and reacts to the pain, causing complications like an esophageal perforation. So the patient is next restrained for periods, which results in other self injurious behavior, so next is heavy medication…

At some point, the burden of the treatment may outweigh the theraputic benefits. For example, in our hypothetical, the burden is not just loss of mobility, pain, and terror, but also, because of medication and esophageal perforation, the loss of remaining lucid moments and conversation with loved ones or time for prayer and reconcilliation. Where, precisely, that point is is very hard to say, hence the Church’s official position on the refusal or discontinuation of treatment.

This purely hypothetical (and simple/exaggerated case) is different from the specific case given by the Church in several ways. But the most obvious difference is, again, the theraputic cost to the patient, in terms of the inalienable rights of the human person. I believe that is why the Church was very specific, not general, in the documents you cited.

Peace

 

[DVIN_CKS]

If a patient cannot tolerate an NG tube and will pull it out (which could cause other medical problems) then the Church would not require the patient be “strapped down” and forced to keep it in. In this situation, other artificial feeding methods would have to be discussed with the doctor and determine if they were appropriate for the patient given his/her medical condition. If a stomach tube or intestinal tube were ruled out due to the condition of the patient, then I guess the only option is to try and keep the patient as comfortable as possible while the body undergos the effects of starvation. I believe these cases would be rare. If the caregiver has exhausted ALL the possibilities of trying to provide the basic provisions of food and water then I guess the only thing you can do at that point is let go and let God.