Question about use of respirators for the seriously ill

[momof8]

Hi,

My dd and I have been trying to understand “brain death” and the Church’s teaching on the care of the ill. The discussion began when we read Peter Singer’s statements on the change in the standard used for the definition of death. Doctors used heart activity to determine death in the past, but they now use “brain death”. (Peter Singer argues that “brain death” should include anyone whose higher mental abilities are no longer working, so that if only the brain stem is functioning, the person would no longer be considered alive - which would mean, as he argues, that if necessary the brain stem should be forced to stop functioning - obviously, that is euthanasia. It is interesting reading because he is really arguing that the change to “brain death” basically was an ethical, not a medical decision, and if you apply the ethical reasoning that was stated by those who proposed this definition of death, then you would find his arguements carry the same weight.)

We keep getting confused on the use of a respirator. In a nutshell, it is my understanding that nutrition and hydration MUST be given to every patient unless the patient’s body is unable to use the food or the use of such treatment would actually harm the patient, that is, when the person’s body is truly shutting down and food of any kind can no longer be processed by the body. However, it has been my understanding that there is no directive that a respirator MUST be used. It is not the Church’s teaching that a person’s body MUST be kept alived by machinery alone, so that in particular cases the person would simply not be allowed to die. For instance, when a pregnant woman has experienced a severe illness or trauma that would have killed her, but she may be kept alive so that the baby can be brought to term; that treatment is essentially for the benefit of the baby, not the mother. As I understand it, after the baby’s birth, life support could be removed and the mother could be allowed to die ( while nutrition, hydration and other ordinary patient care would be continued until the mother did pass away.)

The way I am understanding it is this: if a family member of mine were seriously ill or injured, for instance in the case of a stroke or a car accident, if they were expected to die within a very short time, say 24 - 48 hours, I would want all measures taken to help them. If they survived that time period, I would want them to be given nutrition (and always given hydration), but I would not want them solely on a respirator indefinitely if other treatments were not helping them - that is, if only the respirator were keeping them alive indefinitely because they could not even breathe on their own.

I believe the Church has been clear about nutriton and hydration. Can someone point me to documents that would help me to understand the Church’s teaching on the prolonged use of a respirator? If someone could even help to clarify for me the proper use of a respirator in long-term patient care, I would also appreciate it.

 

[THurifer2]

Hi,

My dd and I have been trying to understand “brain death” and the Church’s teaching on the care of the ill. The discussion began when we read Peter Singer’s statements on the change in the standard used for the definition of death. Doctors used heart activity to determine death in the past, but they now use “brain death”. (Peter Singer argues that “brain death” should include anyone whose higher mental abilities are no longer working, so that if only the brain stem is functioning, the person would no longer be considered alive - which would mean, as he argues, that if necessary the brain stem should be forced to stop functioning - obviously, that is euthanasia. It is interesting reading because he is really arguing that the change to “brain death” basically was an ethical, not a medical decision, and if you apply the ethical reasoning that was stated by those who proposed this definition of death, then you would find his arguements carry the same weight.)

We keep getting confused on the use of a respirator. In a nutshell, it is my understanding that nutrition and hydration MUST be given to every patient unless the patient’s body is unable to use the food or the use of such treatment would actually harm the patient, that is, when the person’s body is truly shutting down and food of any kind can no longer be processed by the body. However, it has been my understanding that there is no directive that a respirator MUST be used. It is not the Church’s teaching that a person’s body MUST be kept alived by machinery alone, so that in particular cases the person would simply not be allowed to die. For instance, when a pregnant woman has experienced a severe illness or trauma that would have killed her, but she may be kept alive so that the baby can be brought to term; that treatment is essentially for the benefit of the baby, not the mother. As I understand it, after the baby’s birth, life support could be removed and the mother could be allowed to die ( while nutrition, hydration and other ordinary patient care would be continued until the mother did pass away.)

The way I am understanding it is this: if a family member of mine were seriously ill or injured, for instance in the case of a stroke or a car accident, if they were expected to die within a very short time, say 24 - 48 hours, I would want all measures taken to help them. If they survived that time period, I would want them to be given nutrition (and always given hydration), but I would not want them solely on a respirator indefinitely if other treatments were not helping them - that is, if only the respirator were keeping them alive indefinitely because they could not even breathe on their own.

I believe the Church has been clear about nutriton and hydration. Can someone point me to documents that would help me to understand the Church’s teaching on the prolonged use of a respirator? If someone could even help to clarify for me the proper use of a respirator in long-term patient care, I would also appreciate it.

Electing NOT to put a feeding tube can be an ethical decision. I work in Medicine and have been with hundreds at the end of their life. Disconnecting a respirator is not euthanasia…the church teaches that natural death is acceptable. I am not sure the churches teaching on nutrion and hydration. If a person relies on Intravenous fluids to maintain life and Intravenous nutrition and they had no chance for recovery then I would have to say that is artificial sustainment of life. I a person wants to have TPN or PVN then it is their wish. But if a person cannot live without outside support and the support is discontinued…their death would not be called euthanasia…it would be called natural death…However it could be neglect. But neglect and Euthanasia are two different things.

 

[manualman]

I don’t have any documents for you, but I wanted to comment on your summary of Mr. Singer’s argument. Frankly, its nutty. The entire reason the medical community switched to brain criteria for death is because we have the technology to relatively easily restart and sustain heart function. Clearly, this can no longer be the standard for death since a heart in a clearly dead person can forced to continue beating.

The brain, on the other hand, cannot be ‘jump-started’ and cannot be forced to carry on after death. Thus, it is the advance in physical medicine that forced the criteria change, not a decision to move from physical to ethical standards. The brain death criteria are still entirely physically based.

 

[Seatuck]

See if this helps. I’ll see what else I can find.

ncbcenter.org/FAQ_BrainDeath.asp

What you want to find is a good discussion on “ordinary means” and “extraordinary means”.

 

[rpp]

Catholics are not obliged to use extraordinary means to extend life.

While I may be stating this incorrectly, or rather misapplying it, life-support machines, like respirators, are considered extraordinary care. I think this is true mainly because of the invasive and artificial nature of the machines. Supplying supplemental oxygen would not be considered extraordinary, I presume. I am not sure where kidney dialysis or receiving an organ transplant fall, but I suspect it could also be considered extraordinary.

Food and water, that is nutrition and hydration, are **never **considered extraordinary, even if they have to be given intravenously, an nasal-gastric tube or a surgically places stomach tube. There are times, however, when food and/water may be withheld, but these are usually in those cases where death by some other means is immediately imminent or the food cannot be assimilated.

These are issues with which I have recently struggled and continue to struggle with. I care for my elderly parents in my home. In October, my father became quite ill and we had a feeding tube inserted. The day before he passed away, the doctors wanted to put him on a respirator. He declined. Instead, they used a very tight fitting, and rather uncomfortable, positive-pressure mask to force 100% oxygen into his degenerated lungs. My father was 83.

I am my mother’s health care representative. She is also 83. She filled out her advanced directive in line with what we understood Catholic teachings to be.

Here are some related Church documents.

From the Congregation of the Doctrine of the Faith at the Vatican this past September 14.

The USCCB’s response.

A guidebook from the Indiana Catholic Conference (PDF).

 

[rwoehmke]

Electing NOT to put a feeding tube can be an ethical decision. I work in Medicine and have been with hundreds at the end of their life. Disconnecting a respirator is not euthanasia…the church teaches that natural death is acceptable. I am not sure the churches teaching on nutrion and hydration. If a person relies on Intravenous fluids to maintain life and Intravenous nutrition and they had no chance for recovery then I would have to say that is artificial sustainment of life. I a person wants to have TPN or PVN then it is their wish. But if a person cannot live without outside support and the support is discontinued…their death would not be called euthanasia…it would be called natural death…However it could be neglect. But neglect and Euthanasia are two different things.

I have a woman friend who had her small intestine removed due to cancer. She has now been on intravenious feeding for about twenty years. Every thing else works and she is truly a happy productive woman. Be careful in deciding what is optional life support and what is not. Totally brain dead is in my opinion dead. Anything short of that could be questionable. Would one disconnect the respirator on someone who’s brain is active and functioning but who is quadraplegic because of a spinal injury and unable to breath on their own?

 

[1ke]

American Life League has some brochures on this topic:

Life, Life Support, and Death
Life Support: The Ventilator
Understanding “Brain Death”
Finis Vitae: Is Brain Death Still Life?

 

[thomasf]

Catholics are not obliged to use extraordinary means to extend life.

While I may be stating this incorrectly, or rather misapplying it, life-support machines, like respirators, are considered extraordinary care. I think this is true mainly because of the invasive and artificial nature of the machines. Supplying supplemental oxygen would not be considered extraordinary, I presume. I am not sure where kidney dialysis or receiving an organ transplant fall, but I suspect it could also be considered extraordinary.

Food and water, that is nutrition and hydration, are **never **considered extraordinary, even if they have to be given intravenously, an nasal-gastric tube or a surgically places stomach tube. There are times, however, when food and/water may be withheld, but these are usually in those cases where death by some other means is immediately imminent or the food cannot be assimilated.

These are issues with which I have recently struggled and continue to struggle with. I care for my elderly parents in my home. In October, my father became quite ill and we had a feeding tube inserted. The day before he passed away, the doctors wanted to put him on a respirator. He declined. Instead, they used a very tight fitting, and rather uncomfortable, positive-pressure mask to force 100% oxygen into his degenerated lungs. My father was 83.

I am my mother’s health care representative. She is also 83. She filled out her advanced directive in line with what we understood Catholic teachings to be.

Here are some related Church documents.

From the Congregation of the Doctrine of the Faith at the Vatican this past September 14.

The USCCB’s response.

A guidebook from the Indiana Catholic Conference (PDF).

According to my understanding of the situation, this is right on point.

 

[momof8]

Thank you so much for all of the replies. I will research the suggested links and documents. I’ll also send a link to JPII’s statement that nutrition and hydration, even by artificial means, must always be considered ordinary care (with the exceptions noted by thomasf, that is, when the food cannot be assimilated or when death is imminent, although I would like to see “imminent” clarified because if a person survives longer than expected, there should be a standard time when artifical nutrition should begin or there is the risk that it is the starvation, and not the illness, that would be the cause of death).

Thanks again for your help. I will most likely be back with more questions!

 

[momof8]

Food and water, that is nutrition and hydration, are **never **considered extraordinary, even if they have to be given intravenously, an nasal-gastric tube or a surgically places stomach tube. There are times, however, when food and/water may be withheld, but these are usually in those cases where death by some other means is immediately imminent or the food cannot be assimilated.

These are issues with which I have recently struggled and continue to struggle with. I care for my elderly parents in my home. In October, my father became quite ill and we had a feeding tube inserted. The day before he passed away, the doctors wanted to put him on a respirator. He declined. Instead, they used a very tight fitting, and rather uncomfortable, positive-pressure mask to force 100% oxygen into his degenerated lungs. My father was 83.

I am my mother’s health care representative. She is also 83. She filled out her advanced directive in line with what we understood Catholic teachings to be.

Here are some related Church documents.

From the Congregation of the Doctrine of the Faith at the Vatican this past September 14.

The USCCB’s response.

A guidebook from the Indiana Catholic Conference (PDF).

Thank you, rpp. These are very helpful, especially the first which is directly from the Vatican on the quesiton of nutrition and hydration. God bless you for taking care of your ill parents. I saw my sister go through these difficulties after her mother-in-law’s strokes. Thank God we have these teachings of the Church which can offer some peace of mind in spite of the suffering your parents have experienced and that you have experienced with them.

 

[Wolseley]

When my mother was dying, she was on a ventilator. She wasn’t “brain-dead”, but she had suffered major brain deterioration. We checked with my pastor, and baiscally what it boiled down to was this: we would take her off the ventilator, and…

a) If she was meant to stay alive, then God would enable her to breathe on her own.

b) If she was not meant to stay alive, then she would stop breathing, and she would expire.

Having a machine do your breathing for you is extraordinary means. If you’re breathing on your own, that’s another matter entirely…then, you must be provided with food and water. If you’re not breathing on your own, food and water is a moot point.

So we took her off the ventilator, and she slipped peacefully away. It was hard, but better than having her hooked up to a machine for who knows how long.

As for Peter Singer, I wouldn’t believe anything that came out of that man’s mouth, even if it was “Good morning”. Do not pay any attention to anything that man has to say.