Is it always euthanasia to cease hydration and feeding?

[pohickgeezer]

The “other” that you mention is just the area I am concerned with. Where is the line between vegetative state and someone who is actively dying? Someone who has a stroke related to old age could conceivably carry on for some time. If they were never intubated or if the feeding tubes were removed, they would die sooner. Are they actively dying of natural causes, or are they in a vegetative state.

 

[Joe_5859]

The “other” that you mention is just the area I am concerned with. Where is the line between vegetative state and someone who is actively dying? Someone who has a stroke related to old age could conceivably carry on for some time. If they were never intubated or if the feeding tubes were removed, they would die sooner. Are they actively dying of natural causes, or are they in a vegetative state.

That’s where it gets trickier. It’s difficult for the Church to draw a clearly defined line. That’s why the Church tends to stick to general principles rather than super-specific examples. It is up to us, in conjunction with medical professionals and our pastor, to make these decisions on a case-by-case basis.

 

[Corki]

The “other” that you mention is just the area I am concerned with. Where is the line between vegetative state and someone who is actively dying? Someone who has a stroke related to old age could conceivably carry on for some time. If they were never intubated or if the feeding tubes were removed, they would die sooner. Are they actively dying of natural causes, or are they in a vegetative state.

It isn’t that complicated. Someone is actively dying when the disease or injury is killing them. Cancer, kidney failure, heart failure, loss of blood, etc. all have a state where there is no recovery and death is happening “now” not as a future event.

If removing the feeding or hydration will cause death when death is not otherwise imminent, it is illicit. If something else causes the death, it may be ok to remove the hydration/nutrition. If someone has a stroke and survives the first few days, it won’t be the stroke that eventually causes his/her death. My grandfather had a stroke, which caused his lungs to function poorly, which led to pnemonia. It was the pneumonia that killed him, not the stroke. Same thing with removing hydration or nutrition. If that becomes the cause of death, it is illicit. If the person is imminently dying, with or without hydration/nutrition, it is licit to remove the hydration/nutrition, especially when it is no longer doing any good.

 

[Ridgerunner]

If the person is imminently dying, with or without hydration/nutrition, it is licit to remove the hydration/nutrition, especially when it is no longer doing any good.

Let me quibble with this just a bit. It’s entirely possible that a person who is in the process of dying might be able to tolerate hydration (less likely nutrition) and might actually be relieved of some suffering because of it. So, I’m not persuaded that someone who is imminently dying should not receive nutrition or hydration, particularly the latter. I have seen people in the “imminent dying process” who were nevertheless hydrated. The hydration did not seem to delay or hasten death (though who would really know?) but we cannot be sure what it might have done with the comfort level, barring some obvious counterindication like increasing ascites.

They teach nurses to be careful what they say in the presence of even a seemingly comatose dying person, because one can never be sure that hearing is not functioning or that the brain is not functioning. If that instruction makes any sense, and I think it does, then the dying person might well suffer from thirst, and ought to be hydrated, unless there is some clear reason why the patient should not receive it.

 

[pohickgeezer]

Thanks for all the feedback. I have in mind an actual historical case and, therefore, want to prepare for any future similar occurence, which is possible. So all your (name removed by moderator)ut has been useful. I think the bottom line is to talk to the doctors and the priest when the time comes.

 

[WillieWonka]

*"The administration of food and water even by artificial means is, in principle, an **ordinary *and proportionate means of preserving life."
CDF

I’d love to see a list of what they consider ordinary means. Does anyone know of a means that is not ordinary?

 

[Newbie2]

I read somewhere that intubation could be discontinued if there was evidence of pain and discomfort. Is this worth discussing?

Absolutely.

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.

“…may hasten death” is perhaps a better way to put it

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.

That can be true.

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.

Yep.

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.

Exactly. That why medicine is part art and part science. It’s not always black and white.

That’s where it gets trickier. It’s difficult for the Church to draw a clearly defined line. That’s why the Church tends to stick to general principles rather than super-specific examples. It is up to us, in conjunction with medical professionals and our pastor, to make these decisions on a case-by-case basis.

Exactomundo.

It isn’t that complicated. Someone is actively dying when the disease or injury is killing them. Cancer, kidney failure, heart failure, loss of blood, etc. all have a state where there is no recovery and death is happening “now” not as a future event.

If removing the feeding or hydration will cause death when death is not otherwise imminent, it is illicit. If something else causes the death, it may be ok to remove the hydration/nutrition. If someone has a stroke and survives the first few days, it won’t be the stroke that eventually causes his/her death. My grandfather had a stroke, which caused his lungs to function poorly, which led to pnemonia. It was the pneumonia that killed him, not the stroke. Same thing with removing hydration or nutrition. If that becomes the cause of death, it is illicit. If the person is imminently dying, with or without hydration/nutrition, it is licit to remove the hydration/nutrition, especially when it is no longer doing any good.

Well, that’s the question, isn’t it? What’s “Iminent”? Hours? Days? A week? Again, it’s frequently unclear, especially when we don’t always have a good indication of when someone is going to expire. But your point is well taken.

*“The administration of food and water even by artificial means is, in principle, an **ordinary ***and proportionate means of preserving life.”
CDF

I’d love to see a list of what they consider ordinary means. Does anyone know of a means that is not ordinary?

How about if a person in very poor health and in a state of severe, permanent dementia keeps pulling out their feeding/hydration tube, and needs physical or chemical restraint in order to keep it in i.e. the physician would have to keep them in nearly a vegetative state in order to be able to maintain hydration and nutrition? Tough call.

 

[Corki]

Let me quibble with this just a bit. It’s entirely possible that a person who is in the process of dying might be able to tolerate hydration (less likely nutrition) and might actually be relieved of some suffering because of it. So, I’m not persuaded that someone who is imminently dying should not receive nutrition or hydration, particularly the latter. I have seen people in the “imminent dying process” who were nevertheless hydrated. The hydration did not seem to delay or hasten death (though who would really know?) but we cannot be sure what it might have done with the comfort level, barring some obvious counterindication like increasing ascites.

They teach nurses to be careful what they say in the presence of even a seemingly comatose dying person, because one can never be sure that hearing is not functioning or that the brain is not functioning. If that instruction makes any sense, and I think it does, then the dying person might well suffer from thirst, and ought to be hydrated, unless there is some clear reason why the patient should not receive it.

Wow! I don’t think I said that right. Nutrition and water should never be removed if they are still benefiting the patient; whether by increasing comfort or aiding in the health of the patient. When a loved one of mine was dying, eventually the IV nutrients were turned off. He was almost drowning in his own fluids. The IV was kept open just enough for the pain medication. BUT, we kept giving him, with the nurses’ encouragement, enough water orally to keep him from thirst or the discomfort of dry mouth/lips. Adding fluid to the bloodstream via IV, was no longer efficatious since his kidneys had shut down.

In most cases of natural death, the organs shut down one-by-one. When the kidneys go, significant IV fluid will no longer help and may increase discomfort. This is the one reservation I have about hospice care. I have very limited experience with hospice but in the case of my one relative, she never saw a doctor once they sent her home with hospice care. A home health care worker was the one to decide when to stop IV fluids and nutrition. I am just not convinced that the assessment was as accurate as when I lost the one in the paragraph above. He died in ICU because he was too fragile to move. Even though recovery was possible only with a true miracle, his condition was checked several times and hour as decisions were made on such things as the IV.

The point in my mind is that most people don’t die from comas. Being in a coma, even a persistant one is not, by itself, dying. Ordinary care, such as hydration and nutrition, should never be witheld in these cases, regardless of the possibility (or lack of) recovery.

 

[pohickgeezer]

These thoughtful responses make it seem fruitless to try to anticipate and decide, but plan we must. Every day we develop advance directives and our resultant designated medical reresentatives must ponder these legal and ethical questions so that we/they are prepared with appropriate responses when called on to do so.

I think this subject is every bit as important as, say, stem cell research, but folks seem reluctant to openly discuss planning for last illnesses, perhaps for fear of learning too much.

 

[Corki]

Well, that’s the question, isn’t it? What’s “Iminent”? Hours? Days? A week? Again, it’s frequently unclear, especially when we don’t always have a good indication of when someone is going to expire. But your point is well taken.

Once the major organs start shutting down, it is hours or, at most, a few days.

How about if a person in very poor health and in a state of severe, permanent dementia keeps pulling out their feeding/hydration tube, and needs physical or chemical restraint in order to keep it in i.e. the physician would have to keep them in nearly a vegetative state in order to be able to maintain hydration and nutrition? Tough call

Is this a real scenario or are you trying to stretch a hypothetical to it’s max? I don’t see how physical restraint = vegitative state. Neither does medicine to keep a person from being so agitated, he/she pulls out tubes. Many patients are sedated during feeding, that’s not a good reason to discontinue nutrition.

Quality of life is never an excuse to actively kill someone. Ever. **Causing **a person to die of dehydration or malnutrition is not moral.

 

[Newbie2]

Once the major organs start shutting down, it is hours or, at most, a few days.

I guess we need to further define “shutting down”, which is a very vague term. Even the term “failure” is somewhat vague. I have patients with chronic renal failure that have lived good quality lives for years.

Is this a real scenario or are you trying to stretch a hypothetical to it’s max? I don’t see how physical restraint = vegitative state.

Hypothetical. No, I didn’t mean physical, rather chemical restraint.

Neither does medicine to keep a person from being so agitated, he/she pulls out tubes.

Depends on what’s used. Seems to me that under certain unfortunate circumstances, the decision might be made to just keep such patients “Whacked-out” with sedatives. That’s more what I’m referring to by a “vegitative state” i.e. where a person needs to be so sedated that there is little if any cognitive function.
Many patients are sedated during feeding, that’s not a good reason to discontinue nutrition.

I agree; however there are those who find themselves in situations where they cannot re-insert feeding tubes themselves and cannot afford to have medical care personel available to do so.

Quality of life is never an excuse to actively kill someone. Ever. **Causing **a person to die of dehydration or malnutrition is not moral.

Again, we have to be careful how we define “quality of life”. Some think that “being hooked up to tubes and machines” is a poor quality of life, and the Church would agree that under such circumstances where there is no reasonable chance for recovery, disconnecting life support is a moral decision. However, there are those who would consider a persistant vegetative state, such as with Terry Schiavo (sp?) an unacceptable quality of life, but the Church would disagree on witholding feeding/hydrating.

I agree that purposeful witholding of nutrition or hydration is immoral.

 

[anode]

It is up to the patient’s advance directives and those that she or he has designated to carry them out to determine what shall be the actions performed at the end of the patient
s life.

Persons who are concerned with the morality of tubes, artificial feeding and hydration should make their views perfectly clear, both in writing and to their designated loved ones. Only one person should be responsible, not a committee, tp carry out the directives, but several persons should be designated in order, in case the first one, or the second or the third is not available. Most states have advance directives written in very clear language so that the individual can state or outline precisely how he or she wants to be treated, from full advanced support in all situations to less interventional solutions.

It is important to designate your executor in these situations, as it may not be your next of kin, who is usually your spouse, and after that your children. For ex, if these disagreed with you, you might want to choose a more distant relative or friend to execute your wishes, which need to be clearly stated. All of this should be written down, dated and witnessed before you get terminally ill, and updated from time to time.

No one likes to to this, but it is important for everyone to do it, including young people who don’t have a will. You don’t have to have a will or to be old or sick to do this. You can also do it without spending any money. Ot my knowledge it can be done online, though I don’t know the websites or the mechanism. I have always donte this when I updated my will, also when I entered a hospital for any reason.

In case you think that Obama is behind all this, it has been a requirement for a number of years that you must designate and sign an advance directive before you are electively admitted to any hospital in the United States. Before my last two surgeries, I signed the form used in Missouri, and thought it so well-written and clear that I incorporated it into my own advance directives in my home state.

 

[Newbie2]

It is up to the patient’s advance directives and those that she or he has designated to carry them out to determine what shall be the actions performed at the end of the patient
s life.

Persons who are concerned with the morality of tubes, artificial feeding and hydration should make their views perfectly clear, both in writing and to their designated loved ones. Only one person should be responsible, not a committee, tp carry out the directives, but several persons should be designated in order, in case the first one, or the second or the third is not available. Most states have advance directives written in very clear language so that the individual can state or outline precisely how he or she wants to be treated, from full advanced support in all situations to less interventional solutions.

It is important to designate your executor in these situations, as it may not be your next of kin, who is usually your spouse, and after that your children. For ex, if these disagreed with you, you might want to choose a more distant relative or friend to execute your wishes, which need to be clearly stated. All of this should be written down, dated and witnessed before you get terminally ill, and updated from time to time.

No one likes to to this, but it is important for everyone to do it, including young people who don’t have a will. You don’t have to have a will or to be old or sick to do this. You can also do it without spending any money. Ot my knowledge it can be done online, though I don’t know the websites or the mechanism. I have always donte this when I updated my will, also when I entered a hospital for any reason.

In case you think that Obama is behind all this, it has been a requirement for a number of years that you must designate and sign an advance directive before you are electively admitted to any hospital in the United States. Before my last two surgeries, I signed the form used in Missouri, and thought it so well-written and clear that I incorporated it into my own advance directives in my home state.

This is not true! I’ve had at least 5 elective procedures in the last 8 or so years and it was not required. Perhaps in other states, but not in Michigan.

It’s a very good idea, though.

 

[Corki]

This is not true! I’ve had at least 5 elective procedures in the last 8 or so years and it was not required. Perhaps in other states, but not in Michigan.

It’s a very good idea, though.

Agreed. I have had elective surgery in Texas and NJ and do not have an AD. I had to sign an acknowledgement that I was informed that such instruments were available but even if I wanted to, I couldn’t have legally exectued one since I had already been given the first sedative when they brought the forms.

 

[marypar]

My mom has alzheimers and I contacted Judie Brown of ALL and got a response that a feeding tube should be given to alzheimer’s last stage patient (meaning not eating, only sleeping, not talking, not walking) as long as their body is still assimilating food and there is a blood test to show if that is true. What do you think about alzheimer’s last stage? The Alzheimer’s boards specifically say never to give a feeding tube, but I say I am planning to do so for my mom. If the tube keeps her alive for another 2-3 years, then she needed the food and water - it makes sense.

 

[anode]

My mom has alzheimers and I contacted Judie Brown of ALL and got a response that a feeding tube should be given to alzheimer’s last stage patient (meaning not eating, only sleeping, not talking, not walking) as long as their body is still assimilating food and there is a blood test to show if that is true. What do you think about alzheimer’s last stage? The Alzheimer’s boards specifically say never to give a feeding tube, but I say I am planning to do so for my mom. If the tube keeps her alive for another 2-3 years, then she needed the food and water - it makes sense.

It depends on your mother’s wishes when she was mentally intact. I know that my mother, father and at least one brother would have not wanted feeding tubes, even though none of them signed anything- they either died too suddenly or trusted me as next-of-kin.

I myself don’t think it is wise to place feeding tubes in patients with advanced Alz, as a feeding tube through the nose is uncomfortable, and a lot of things can go wrong with surgically implanted feeding tubes, including reflux and pneumonia.

However, it depends on your mother’s wishes or your understanding and perception of her wishes. I do feel that the next-of-kin should honor the wishes of their loved ones, even if those wishes run counter to those of the next-of-kin.

I am not aware of the ‘blood test’ in question.

 

[Joe_5859]

It depends on your mother’s wishes when she was mentally intact. I know that my mother, father and at least one brother would have not wanted feeding tubes, even though none of them signed anything- they either died too suddenly or trusted me as next-of-kin.

I myself don’t think it is wise to place feeding tubes in patients with advanced Alz, as a feeding tube through the nose is uncomfortable, and a lot of things can go wrong with surgically implanted feeding tubes, including reflux and pneumonia.

However, it depends on your mother’s wishes or your understanding and perception of her wishes. I do feel that the next-of-kin should honor the wishes of their loved ones, even if those wishes run counter to those of the next-of-kin.

I am not aware of the ‘blood test’ in question.

I agree that it is ordinarily best to do everything we can to honor the wishes of our loved ones in these matters, however it is important to keep in mind that a person’s wishes do not trump the moral law. If one of my loved ones told me it was their wish to have me smother them with a pillow because of their illness, it would be very wrong of me to honor their wish in that regard. I would be rightly prosecuted if I attempted to comply with their request.

 

[anode]

No, you don’t have to comply with your loved one’s wishes by performing a felony.

However, I do think that one should comply with a reasonable desire or wish, particularly if it is expressed clearly in writing while the person in question is of sound mind, and those wishes are made clear to the next of kin. If there is an insurmountable disagreement, the person can designate another individual, related or not, to carry out his/her health care directives.

 

[pohickgeezer]

Complying with expressed wishes is what planning is all about. The person issuing advance directives needs to do their homework on moral and ethical boundaries. Prospective medical surrogates need to do the same and make sure they are not being asked to compromise their beliefs before agreeing to take on the surrogate role. This has been valuable discussion.

 

[Corki]

My mom has alzheimers and I contacted Judie Brown of ALL and got a response that a feeding tube should be given to alzheimer’s last stage patient (meaning not eating, only sleeping, not talking, not walking) as long as their body is still assimilating food and there is a blood test to show if that is true. What do you think about alzheimer’s last stage? The Alzheimer’s boards specifically say never to give a feeding tube, but I say I am planning to do so for my mom. If the tube keeps her alive for another 2-3 years, then she needed the food and water - it makes sense.

If your question is whether the situation you describe is an exception to the prohibition on euthanasia, then the answer is “no”. A person in the late stages of alzheimer’s is still deserving of dignity and protection of life. If her body is still assimilating nutrition and hydration, withholding them would result in starving her to death. Of course, as with any fatal disease, extraordinary measures need not be used to keep her alive such as resucitation, breathing machines, etc. but nutrition and hydration are ordinary, not extraordinary measures.