Is it always euthanasia to cease hydration and feeding?

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After Terri Sciavo’s death, the Catholic Bishops asked for guidance from the Holy See and the reply may have made previous discussions obsolete. However, I have not found much discussion on this subject, although it should be on everyone’s mind - what if…?

While feeding tubes are regarded as normal means of sustaining life, not heroic, extra-ordinary measures, quality of life may factor into the equation. If a person no longer has awareness and can no longer know and worship God, can artificial hydration and feeding be stopped? Under what circumstances may artificial means be stopped, if at all?
 
I recently asked my doctor about this. He said there are three separate medical conditions that people frequently confuse:
  1. Coma.
  2. Brain death. When true brain death occurs, somatic death follows in a matter of hours.
  3. Persistent vegetative state. This is frequently confused with #2 above. This is basically total paralysis of the voluntary muscles. The person is still in there, and as far as can be told, conscious, but cannont communicate.
 
bpbasilphx said:
I recently asked my doctor about this. He said there are three separate medical conditions that people frequently confuse:
  1. Coma.
  2. Brain death. When true brain death occurs, somatic death follows in a matter of hours.
  3. Persistent vegetative state. This is frequently confused with #2 above. This is basically total paralysis of the voluntary muscles. The person is still in there, and as far as can be told, conscious, but cannont communicate.
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Those are some simple, yet very important distinctions, that get overlooked far too often. Thanks for posting that.
 
Well, after reading the reply from the Holy See and the CDF commentary, it looks like artificial hydration and feeding cannot be removed if it will result in death. I think this will pose serious problems for Catholics who are torn by pain and discomfort of loved ones who they know will never improve to any quality of life - even in the case, say, of massive stroke.

I read somewhere that intubation could be discontinued if there was evidence of pain and discomfort. Is this worth discussing?
 
In an article under the heading, “End-of-Life Ethics” by Kenneth R. Overberg, SJ, that appeared in the American Catholic Newsletter in August 2006, is stated in part that the obligation to prolong life may cease “if prolonging life does not help the person strive for the purposes of life. Pursuing life’s purposes implies some ability to function at the level of reasoning, relating and communicating. If efforts to restore this cognitive-affective function can be judged useless or would result in profound frustration (that is a severe burden) in pursuing the purposes of life, then the ethical obligation to prolong life is no longer present.”

Is this trumped by the Holy See’s reply and the resultant CDF commentary, or is it still a valid position?
 
pohickgeezer said:
Well, after reading the reply from the Holy See and the CDF commentary, it looks like artificial hydration and feeding cannot be removed if it will result in death. I think this will pose serious problems for Catholics who are torn by pain and discomfort of loved ones who they know will never improve to any quality of life - even in the case, say, of massive stroke.
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It may be difficult, but we as Catholics we are obligated to follow the moral precepts of the Church.

The Church is not in the business of making determinations on a person’s “quality of life”. It’s not as though we can draw a line and say, “When a person falls below this line, their life is no longer worth living and they may be disposed of by any means we wish.”

The fact is, it is never in keeping with the dignity of the human person to let someone starve to death.
pohickgeezer said:
I read somewhere that intubation could be discontinued if there was evidence of pain and discomfort. Is this worth discussing?
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It is certainly worth discussing. The answer depends on what you mean by pain and discomfort, though. 🙂 I think that the final two paragraphs of the CDF’s Commentary are the most pertinent to such a discussion:
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.
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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.
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In other words, there are three times when an exception can be made:

  1. *]"…the possibility that, in very remote places or in situations of extreme poverty, the artificial provision of food and water may be physically impossible…"
    *]"…due to emerging complications, a patient may be unable to assimilate food and liquids, so that their provision becomes altogether useless."
    *]"…in some rare cases, artificial nourishment and hydration may be excessively burdensome for the patient or may cause significant physical discomfort…"

    You seem to be asking about situations that fall under exception #3. I think it is important to note the word “rare”. We’re not talking about mild discomfort (which would likely be part of any use of an artificial feeding tube). We’re talking about “significant physical discomfort.”
 
Thank you for your continued participation. I hope you will bear with me and respond as well to my reply pointing to an article that appeared in August 2006 on the matter.

So far I understand and agree with your answers.
 
bpbasilphx said:
I recently asked my doctor about this. He said there are three separate medical conditions that people frequently confuse:
  1. Coma.
  2. Brain death. When true brain death occurs, somatic death follows in a matter of hours.
  3. Persistent vegetative state. This is frequently confused with #2 above. This is basically total paralysis of the voluntary muscles. The person is still in there, and as far as can be told, conscious, but cannont communicate.
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Joe_5859 said:
Those are some simple, yet very important distinctions, that get overlooked far too often. Thanks for posting that.
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:sad_yes:
 
Joe_5859 said:
It may be difficult, but we as Catholics we are obligated to follow the moral precepts of the Church.

The Church is not in the business of making determinations on a person’s “quality of life”. It’s not as though we can draw a line and say, “When a person falls below this line, their life is no longer worth living and they may be disposed of by any means we wish.”

The fact is, it is never in keeping with the dignity of the human person to let someone starve to death.

It is certainly worth discussing. The answer depends on what you mean by pain and discomfort, though. 🙂 I think that the final two paragraphs of the CDF’s Commentary are the most pertinent to such a discussion:

In other words, there are three times when an exception can be made:

  1. *]"…the possibility that, in very remote places or in situations of extreme poverty, the artificial provision of food and water may be physically impossible…"
    *]"…due to emerging complications, a patient may be unable to assimilate food and liquids, so that their provision becomes altogether useless."
    *]"…in some rare cases, artificial nourishment and hydration may be excessively burdensome for the patient or may cause significant physical discomfort…"

    You seem to be asking about situations that fall under exception #3. I think it is important to note the word “rare”. We’re not talking about mild discomfort (which would likely be part of any use of an artificial feeding tube). We’re talking about “significant physical discomfort.”
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  1. If a person were in end stage renal disease, continuing feedings and hydration (IV fluids) would hasten death.

    Multi-system organ failure frequently occurs in terminal illness.
 
pohickgeezer said:
In an article under the heading, “End-of-Life Ethics” by Kenneth R. Overberg, SJ, that appeared in the American Catholic Newsletter in August 2006, is stated in part that the obligation to prolong life may cease “if prolonging life does not help the person strive for the purposes of life. Pursuing life’s purposes implies some ability to function at the level of reasoning, relating and communicating. If efforts to restore this cognitive-affective function can be judged useless or would result in profound frustration (that is a severe burden) in pursuing the purposes of life, then the ethical obligation to prolong life is no longer present.”

Is this trumped by the Holy See’s reply and the resultant CDF commentary, or is it still a valid position?
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Yes, the Holy See and CDF always trump a newsletter.
 
pohickgeezer said:
In an article under the heading, “End-of-Life Ethics” by Kenneth R. Overberg, SJ, that appeared in the American Catholic Newsletter in August 2006 . . .
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Just for the sake of discussion, suppose the Holy See and the CDF had made no statements and issued no guidance on this topic, before we accepted Fr.Overberg’s conclusions wouldn’t we be required to look into his life? What I mean is, whatever his credentials may be, and what knowledge he may have and studies he may have done prior to writing this article, couldn’t it be incumbent on us to look at all of his articles and books and investigate his life and reputation, before saying, “Oh, a Priest said this and a highly educated Priest at that, so it must be okay?”

Lots of religious say lots of things about lots of topics that are in total disagreement with each other. Fr. Overberg may be a very wise and very saintly man, I have no knowledge about him and I have not read his article and I have no opinion about him one way or another, my thoughts here are simply theoretical - how do we know who we can trust on some of these issues (barring a clear Statement from Rome).
 
I don’t know the cited priest, nor his personal reputation. Sad to say, but these days I won’t hang my hat on the argument of ANY Jesuit unless I’ve already seen things from him that make me believe he’s trustworthy. I know that may be a bit unfair, but its darn hard to tell the wolves from the shepherds these days.

It is my understanding from listening to guests from the National Catholic Bioethics Center on Relevant Radio (a source I trust), that food and water CAN sometimes be withdrawn from a patient rapidly approaching death even if it hastens that death. But the GOAL cannot be to hasten death and end the suffering. We can never withold food and water with the intent to cause or hasten death. It is only appropriate in circumstances when it will alleviate suffering in a patient that will very soon die regardless of whether he gets food and water or not.
 
When I asked if the Holy See and the CDF trumped the newsletter, I wasn’t questioning authority, but was really meaning to ask if their responses contradicted the position in the newsletter. Your opinion seems to be that intubation can be continued to alleviate pain, but not with the intent to hasten death. What if you know that death is likely to occur sooner if the feeding tube is removed, but you’re goal is to reduce pain and suffering? I’m hoping respondents can back up their opinion with some acceptable reference.

Thank you for your interest and feedback.
 
Yes, what you said is OK based on what I heard on catholic radio. In some cases, hydration can actually increase suffering in the little time the patient has left.

IIRC the guest was from the National Catholic Bioethics Center. Perhaps try googling them and seeing what you can find?
 
Food and water, even when supplied by medical means, are ordinary and necessary care, and may not be withdrawn, if death will directly result. To do so would be an intrinsically evil sin of omission, the sin of murder.

“Euthanasia in the strict sense is understood to be an action or omission which of itself and by intention causes death, with the purpose of eliminating all suffering… euthanasia is a grave violation of the law of God, since it is the deliberate and morally unacceptable killing of a human person.” Evangelium Vitae, n. 65.

The act of withholding food and water, so that death directly and deliberately results, is a type of murder because it is the direct and voluntary killing of an innocent human person. The fact that this occurs by omission, rather than by commission does not make the act any less sinful. As with all intrinsically evil acts, good intentions and dire circumstances can never cause the act to be morally permissible, nor anything less than an objective mortal sin.

See the address of Pope John Paul II on the subject:
lifeissues.net/writers/doc/doc_33vegetativestate.html
 
According to the NCBC’s 9/14/07 statement on the CDF’s “Responses to Certain Questions Concerning Artificial Nutrition and Hydration,” there are some exceptions including: “In rare cases, it is also possible that nutrition and hydration will be excessively burdensome for a patient, for example, when their administration by tube causes medical complications.” The other exceptions are also narrowly defined, leaving very little room for varying interpretations.
 
pohickgeezer said:
According to the NCBC’s 9/14/07 statement on the CDF’s “Responses to Certain Questions Concerning Artificial Nutrition and Hydration,” there are some exceptions including: “In rare cases, it is also possible that nutrition and hydration will be excessively burdensome for a patient, for example, when their administration by tube causes medical complications.” The other exceptions are also narrowly defined, leaving very little room for varying interpretations.
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I am not a physician, but I have read a lot of medical records and have discussed this with medical people whose opinions I respect. It is my impression that it is not at all rare to have a situation in which artificial feeding and hydration serve no purpose but to cause greater discomfort to the patient, even to hasten death. It is extremely common for people close to death to suffer multi-system failure, and one has to be very careful to know when that occurs and what its consequences are. With some, nothing can be processed digestively and attempting it can have horrific consequences. With some, fluid intake only accelerates ascites and congestive heart failure.

But I think it can be a tricky business, medically. Sometimes it’s obvious what the consequences of feeding and hydration would be. Sometimes it isn’t.

I should clarify that I do not, in any way, favor withdrawing either nourishment or hydration in a case like that of Terry Schiavo’s.
 
Ridgerunner said:
I am not a physician, but I have read a lot of medical records and have discussed this with medical people whose opinions I respect. It is my impression that it is not at all rare to have a situation in which artificial feeding and hydration serve no purpose but to cause greater discomfort to the patient, even to hasten death. It is extremely common for people close to death to suffer multi-system failure, and one has to be very careful to know when that occurs and what its consequences are. With some, nothing can be processed digestively and attempting it can have horrific consequences. With some, fluid intake only accelerates ascites and congestive heart failure.

But I think it can be a tricky business, medically. Sometimes it’s obvious what the consequences of feeding and hydration would be. Sometimes it isn’t.

I should clarify that I do not, in any way, favor withdrawing either nourishment or hydration in a case like that of Terry Schiavo’s.
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The CDF commentary and the responses were specific to cases of people in a “vegatative state”. For those people, the conditions where removing hydraton or nutrition would be licit are extremely rare. They are not actively dying and they would be effectively starved to death. With the nutrition and hydration these patients often live for many years.

The conditions you describe sound more like someone who is actively dying. It is, as you point out, not all that rare for someone to reach a point where the feeding tubes and hydration are causing pain or where the nutrients are no longer being absorbed. While some might say that removing hydration might hasten death, it would likely be by a matter of minutes or a few hours, not by years. This is completely licit.
 
Corki said:
The CDF commentary and the responses were specific to cases of people in a “vegatative state”. For those people, the conditions where removing hydraton or nutrition would be licit are extremely rare. They are not actively dying and they would be effectively starved to death. With the nutrition and hydration these patients often live for many years.

The conditions you describe sound more like someone who is actively dying. It is, as you point out, not all that rare for someone to reach a point where the feeding tubes and hydration are causing pain or where the nutrients are no longer being absorbed. While some might say that removing hydration might hasten death, it would likely be by a matter of minutes or a few hours, not by years. This is completely licit.
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Exactly. When removing nutrition and hydration (AKA “food and water”) from someone in a PVS (like Terry Shiavo), the result is that they starve/dehydrate to death. In other, non-PVS cases, removing artificial nutrition and hydration, even when it hastens death, is not (by itself) the cause of death of someone who otherwise would have lived for many more months or years.
 
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