Removing Nutrition and Hydration

[WeakLucille]

Struggling with an email I just received from a friend who has a family member who has Parkinsons and now pneumonia. Death is near and the patient who cannot swallow has asked to have medication and nutriton/hydration removed which was done on Friday. I am very uncomfortable with this but not sure what to do. Thanks for your advice.

 

[valentino]

you shouldn’t be. If he feels God is calling Him now he doesn;t have an obligation to prolong his life.Just let him die in peace.

 

[Maturinus]

As far as I know (better informed people may correct me) it is not a sin to remove artificial life support and let nature take its course. Many people have advance directives to that effect. Is it incumbent upon people to cling to life by “heroic measures” when the end is inevitable? Must families bankrupt themselves to eke out a few more days or hours? This is not the same as euthanasia. I would think that if I wanted I could refuse treatment at any point.

And pardon me if I ask, but why is this of concern to you when it’s a friend’s family and not your own? I’m relatively new here, but it seems there are many, many threads about things that offend or upset people but which, viewed in perspective, would tend to fall under the heading of “that’s none of my business”.

 

[the_phoenix]

Praying for this person with Parkinsons / pneumonia:

Prayer to Saint Raphael

Glorious Archangel St. Raphael, great prince of the heavenly court, you are illustrious for your gifts of wisdom and grace. You are a guide of those who journey by land or sea or air, consoler of the afflicted, and refuge of sinners. I beg you, assist me in all my needs and in all the sufferings of this life, as once you helped the young Tobias on his travels. Because you are the “medicine of God,” I humbly pray you to heal the many infirmities of my soul and the ills that afflict my body. I especially ask of you the favor (name your request) and the great grace of purity to prepare me to be the temple of the Holy Ghost. Amen.

 

[markomalley]

Not so fast.

The Congregation for the Doctrine of the Faith addressed these specific issues a few years ago. Read it yourself here from the source.

First question: Is the administration of food and water (whether by natural or artificial means) to a patient in a “vegetative state” morally obligatory except when they cannot be assimilated by the patient’s body or cannot be administered to the patient without causing significant physical discomfort?
Response: Yes. ** The administration of food and water even by artificial means is, in principle, an ordinary and proportionate means of preserving life. It is therefore obligatory to the extent to which, and for as long as, it is shown to accomplish its proper finality, which is the hydration and nourishment of the patient.** In this way suffering and death by starvation and dehydration are prevented.
Second question: When nutrition and hydration are being supplied by artificial means to a patient in a “permanent vegetative state”, may they be discontinued when competent physicians judge with moral certainty that the patient will never recover consciousness?
**Response: **No. A patient in a “permanent vegetative state” is a person with fundamental human dignity and must, therefore, receive ordinary and proportionate care which includes, in principle, the administration of water and food even by artificial means.
Nutrition and hydration are not considered extraordinary means. A ventilator could be considered extraordinary. A heart lung machine could be considered extraordinary. But not food and drink.

 

[Maturinus]

Nutrition and hydration are not considered extraordinary means. A ventilator could be considered extraordinary. A heart lung machine could be considered extraordinary. But not food and drink.

Thank you. This is why I said I was no expert.

I do however still wonder why the poster is upset at the decision of another person’s family. Unless I were very, very close to that person and unless the family was Catholic and looking for my advice, I would hesitate to get involved.

 

[markomalley]

Thank you. This is why I said I was no expert.

I do however still wonder why the poster is upset at the decision of another person’s family. Unless I were very, very close to that person and unless the family was Catholic and looking for my advice, I would hesitate to get involved.

The other family made the OP involved.

I would not want to be put in that position, myself, either.

Perhaps this other family is Catholic. In which case the position of the CDF may be of use. (With far too many American Catholics, it wouldn’t…but there are still a few who value what the Church teaches)

 

[hazcompat]

Catholic Advance Directive

Page 1

This Declaration of Life and Death, made while I am of sound mind, is intended to convey my desires and directions regarding treatment or care for me in the event I become irreversibly and terminally ill or incapable of expressing my wishes for medical treatment.

Because of my Catholic belief in the dignity of the human person and my eternal destiny with God, I ask my family, physicians, lawyer, pastor, and friends to fully inform me of my condition and prognosis, if I should become irreversibly and terminally ill, so that I can prepare myself spiritually for death.

I have the right to make my own decisions concerning medical treatment beyond the limits dictated by any physician or hospital ethics committee’s judgment. This Declaration applies in the event that I have an incurable injury, disease or illness from which I will inevitably soon die, or should I become incapacitated and unable to express my wishes. As determined by two physicians who have examined me, one of whom shall be my attending physician, if this condition will directly cause my death even with appropriate medical care, and that the use of life sustaining procedures would serve only to artificially prolong the immediate dying process then I request and direct:

1. that my pain be alleviated,
2. that no excessively burdensome or disproportionate means be used to prolong my life, and
3. that nothing should be done with the intention of causing my death.

I believe nutrition and hydration are not excessively burdensome or disproportionate, whether being administered orally or artificially. Therefore they are not to be withheld or withdrawn from me unless there is clear and convincing evidence that they would cause me harm, cannot effectively sustain my life or are excessively burdensome to me.

Excessively burdensome means that the administration of nutrition and hydration for me would worsen my condition, cause excessive pain, suffering or death and would in no way benefit my existence.

I ask my family, friends and the Catholic community to join me in prayer and sacrifice as I prepare for death and request that my rights as a Catholic to receive the Holy Sacraments according to my faith be respected and provided. Finally, I seek prayers after my death, that I may enjoy eternal life.

Signed this _____ day of ____________ , 20 ___.

____________________________ (Signature) _________________________ (Address)

cogforlife.org/Catholiclivingwill.htm

peace

 

[gardenswithkids]

Struggling with an email I just received from a friend who has a family member who has Parkinsons and now pneumonia. Death is near and the patient who cannot swallow has asked to have medication and nutriton/hydration removed which was done on Friday. I am very uncomfortable with this but not sure what to do. Thanks for your advice.

Prayers for your friend’s family member and everyone involved. If this hasn’t already been done, I suggest someone call a priest to administer Last Rites.

 

[Maturinus]

I apologize if I sounded overly critical of the person who posted this. It is very valuable to have the Catholic advance directive on hand, too.

 

[cathoichelp]

Not so fast.

The Congregation for the Doctrine of the Faith addressed these specific issues a few years ago. Read it yourself here from the source.

First question: Is the administration of food and water (whether by natural or artificial means) to a patient in a “vegetative state” morally obligatory except when they cannot be assimilated by the patient’s body or cannot be administered to the patient without causing significant physical discomfort?
Response: Yes. ** The administration of food and water even by artificial means is, in principle, an ordinary and proportionate means of preserving life. It is therefore obligatory to the extent to which, and for as long as, it is shown to accomplish its proper finality, which is the hydration and nourishment of the patient.** In this way suffering and death by starvation and dehydration are prevented.
Second question: When nutrition and hydration are being supplied by artificial means to a patient in a “permanent vegetative state”, may they be discontinued when competent physicians judge with moral certainty that the patient will never recover consciousness?
**Response: **No. A patient in a “permanent vegetative state” is a person with fundamental human dignity and must, therefore, receive ordinary and proportionate care which includes, in principle, the administration of water and food even by artificial means.
Nutrition and hydration are not considered extraordinary means. A ventilator could be considered extraordinary. A heart lung machine could be considered extraordinary. But not food and drink.

At the end of life continuing hydration will actually prolong dying not prolong living-

Nutrition and Hydration given ORAL are not considered extraordinary means -
IV hydration can prevent someone who IS dying of natural causes to pass … it is making the dying process take longer not extending the life of the person.

also the presence of pneumonia is a clear sign his body systems are now failing - this person is dying.

I am very sorry for your loss.

 

[gardenswithkids]

Not so fast.

The Congregation for the Doctrine of the Faith addressed these specific issues a few years ago. Read it yourself here from the source.

First question: Is the administration of food and water (whether by natural or artificial means) to a patient in a “vegetative state” morally obligatory except when they cannot be assimilated by the patient’s body or cannot be administered to the patient without causing significant physical discomfort?
Response: Yes. The administration of food and water even by artificial means is, in principle, an ordinary and proportionate means of preserving life. It is therefore obligatory to the extent to which, and for as long as, it is shown to accomplish its proper finality, which is the hydration and nourishment of the patient. In this way suffering and death by starvation and dehydration are prevented.
Second question: When nutrition and hydration are being supplied by artificial means to a patient in a “permanent vegetative state”, may they be discontinued when competent physicians judge with moral certainty that the patient will never recover consciousness?
**Response: **No. A patient in a “permanent vegetative state” is a person with fundamental human dignity and must, therefore, receive ordinary and proportionate care which includes, in principle, the administration of water and food even by artificial means.

Nutrition and hydration are not considered extraordinary means. A ventilator could be considered extraordinary. A heart lung machine could be considered extraordinary. But not food and drink.

Thank you for providing that link. I highlighted in red something from that quote that you did not highlight. “**In this way suffering and death by starvation and dehydration are prevented.” **

I highlighted in blue something that qualifies another part of the statement "to the extent to which, and for as long as, it is shown to accomplish its proper finality,"

If death is eminent (meaning very, very near) and providing food and hydration by means of iv’s and feeding tubes causes discomfort and even cause undesirable physical complications, then food and water may sometime no longer “accomplishing their proper finality”. IVs and feeding tubes do not neccesarily prevent a person who is already very near death from dying from starvation or dehydration. It takes a few days to die from dehydration and even longer than that to die of starvation. The tubes can be uncomfortable to a dying patient, and sometimes they no longer accomplish their intended purpose. I am not comfortable with removing feeding tubes and IV’s from dying patients, but I recognize that sometimes they no longer accomplish the goal of providing food and nutrition. In such cases when death is already very near and the tubes no longer serve their intended purpose, removal may be morally licit.

If anything I wrote is against the Church teachings, then I gladly submit to the Church.

 

[Beth_Cecilia]

Thank you for providing that link. I highlighted in red something from that quote that you did not highlight. “**In this way suffering and death by starvation and dehydration are prevented.” **

I highlighted in blue something that qualifies another part of the statement "to the extent to which, and for as long as, it is shown to accomplish its proper finality,"

If death is eminent (meaning very, very near) and providing food and hydration by means of iv’s and feeding tubes causes discomfort and even cause undesirable physical complications, then food and water may sometime no longer “accomplishing their proper finality”. IVs and feeding tubes do not neccesarily prevent a person who is already very near death from dying from starvation or dehydration. It takes a few days to die from dehydration and even longer than that to die of starvation. The tubes can be uncomfortable to a dying patient, and sometimes they no longer accomplish their intended purpose. I am not comfortable with removing feeding tubes and IV’s from dying patients, but I recognize that sometimes they no longer accomplish the goal of providing food and nutrition. In such cases when death is already very near and the tubes no longer serve their intended purpose, removal may be morally licit.

If anything I wrote is against the Church teachings, then I gladly submit to the Church.

I am pretty sure you are right. Also, the directive from the Church is specifically about patients in a “vegetative state.” It is another question altogether. Can I kill someone who is not dying, because I do not know if they will ever be a contributing member of society again? No. That is the question which this teaching speaks to.

I am not saying that the Church would allow that we starve someone to death- even someone who wanted to die. WeakLucille can rest easy. The patient is not dying of starvation or dehydration. The patient is not committing suicide. The patient is dying as naturally and peacefully as the disease which is killing him will allow.

 

[WeakLucille]

I am grateful to all who responded to my inquiry. It has given me more clarity in a situation of a non Catholic family/patient who likely would not feel the same convictions we do about several life issues. However, when informed by email of the situation it caused grave concern on my part, thanks to the guidance I have received over the years regarding the moment of conception to natural death. I am sure that this family did not take the decision lightly, and I, being un schooled regarding the physiological processes, worried that I may have a moral obligation to forgo “minding my own business” even though to do so seems so harsh.
Thank you for reaching out to me. May God bless you all !

 

[foundmyfaith]

Just want to throw this out there…

When a person is nearing the end of life, the organs begin to shut down. One of the things that stops is bowel motility, meaning that a tube feeding might stay in the stomach until it becomes full. This puts the patient in danger of aspirating ‘formula’ into their lungs. This will cause discomfort and a choking sensation, as the patient tries to cough fluid from their lungs. It will also interfere with the lungs transferring oxygen to the bloodstream.

Intravenous fluids are used to keep the patient hydrated. IV sites have to be changed every 3-4 days. Also, people who are sick enough to die rarely have an abundance of great veins to place IV catheters. The procedure to place a central venous catheter or PICC line can be very stressful for the patient and the family. Patients can be ‘fed’ via a regular IV catheter with a substance called PPN. It contains nutrients and glucose.

When we look at an advance directive, let us remember that the procedures to feed and hydrate a patient while they are dying may actually violate the FIRST priority. We want people to die in a dignified manner, and to be free of pain.

I have closed many eyes, and bid many patients goodbye. While I would never be a party to starving someone to death, I also know that delivering nutrition and hydration is not always possible to accomplish in a dignified and humane manner. I do intensive care for a living, and I was often the girl that they called when 7 other people have tried to get an IV line in Granny. I have gone home sobbing after sticking that needle in that frail, bruised and bloody arm while she cried out in pain.

Sometimes, there is no easy answer. I just trust that God will guide my practice.

 

[valentino]

Not so fast.

The Congregation for the Doctrine of the Faith addressed these specific issues a few years ago. Read it yourself here from the source.

First question: Is the administration of food and water (whether by natural or artificial means) to a patient in a “vegetative state” morally obligatory except when they cannot be assimilated by the patient’s body or cannot be administered to the patient without causing significant physical discomfort?
Response: Yes. ** The administration of food and water even by artificial means is, in principle, an ordinary and proportionate means of preserving life. It is therefore obligatory to the extent to which, and for as long as, it is shown to accomplish its proper finality, which is the hydration and nourishment of the patient.** In this way suffering and death by starvation and dehydration are prevented.
Second question: When nutrition and hydration are being supplied by artificial means to a patient in a “permanent vegetative state”, may they be discontinued when competent physicians judge with moral certainty that the patient will never recover consciousness?
**Response: **No. A patient in a “permanent vegetative state” is a person with fundamental human dignity and must, therefore, receive ordinary and proportionate care which includes, in principle, the administration of water and food even by artificial means.
Nutrition and hydration are not considered extraordinary means. A ventilator could be considered extraordinary. A heart lung machine could be considered extraordinary. But not food and drink.

what is money becomes an issue.Insurance ran out and there is no viable way to pay for the care?what’s one to do?(remember he’s going to die in the near future )

 

[markomalley]

what is money becomes an issue.Insurance ran out and there is no viable way to pay for the care?what’s one to do?(remember he’s going to die in the near future )

Are you saying that a lack of money is a justification for starving and dehydrating somebody to death?

Granted, the hospital may say “His insurance ran out and unless you can demonstrate that you have the means to pay his hospital bill, we are going to get him dressed and wheel him onto the street” (not that this would be morally acceptable on the part of the hospital). That’s one thing. Then the family would need to do what they need to do. That may be simply keeping him comfortable.

When insurance makes a decision that they are no longer going to cover a hospital stay (whether the “insurance runs out” or if the individual incident reaches the number of days that the insurance will cover), in my experience the hospital will make arrangements with the family so that the patient can be cared for at home or whatever. I have not seen in recent memory a situation where a hospital has literally kicked a patient out on the street. (I know of situations where they may not admit such a patient due to lack of fiances, but I’m talking about somebody who is already admitted)

So consequently, what the scenario is likely to really be (stated in a whole lot more cold-blooded fashion) is:

“Dad’s going to die in 2 weeks. Then his will is going to be probated. We don’t want the hospital to present a big bill to the probate court to screw up our inheritance.”

I can say this in that cold-blooded fashion because I know we are talking about a hypothetical family in a hypothetical situation here and not about the family of any particular CAF poster.

 

[foundmyfaith]

Are you saying that a lack of money is a justification for starving and dehydrating somebody to death?

Granted, the hospital may say “His insurance ran out and unless you can demonstrate that you have the means to pay his hospital bill, we are going to get him dressed and wheel him onto the street” (not that this would be morally acceptable on the part of the hospital). That’s one thing. .

I have seen people stay in an ICU at a minimum cost of 8000 a day with no insurance and no hope of recovery. Hospitals are simply not allowed to do this. Even if they were allowed, they would not do it. Any hospital would rather eat a bill totalling hundreds of thousands of dollars than do something like that.

 

[markomalley]

I have seen people stay in an ICU at a minimum cost of 8000 a day with no insurance and no hope of recovery. Hospitals are simply not allowed to do this. Even if they were allowed, they would not do it. Any hospital would rather eat a bill totalling hundreds of thousands of dollars than do something like that.

Exactly and that is the point. What I’m getting at is that a hospital “could” do such a thing.

And in this hypothetical, the family’s culpability would be different.

But I was, in no way, implying that a hospital would do such a thing.

 

[PilgrimToChrist]

Struggling with an email I just received from a friend who has a family member who has Parkinsons and now pneumonia. Death is near and the patient who cannot swallow has asked to have medication and nutriton/hydration removed which was done on Friday. I am very uncomfortable with this but not sure what to do. Thanks for your advice.

You should be uncomfortable with this, it is suicide even though it is passive, and as such it is a mortal sin. Medication is not necessary (it is extraordinary means) but nutrition and hydration (even if through a tube) are necessary. For a person to stop eating in order to kill themselves is suicide, for a person to stop feeding someone in order to kill them is murder, these things are clearly sinful.

I’m sure the person in question is very depressed because of their situation, this is why they are trying to kill themselves. You should find a priest (preferably traditional or at least a good conservative) to talk to them, hopefully to convince them to allow food and water to be given to them, and to administer the Last Rites.

A month or even a year worth of suffering in a hospital bed is a million times better than suffering even a minute in Purgatory (and, of course, infinitely better than an eternity in Hell). It is also meritorious if done in a state of grace and for the right reasons, uniting their suffering with Christ’s for some good end. If you have difficulty explaining this to them, talk to the hospital Catholic chaplain about it so he can talk to this person (and if he is not orthodox, go find one who is, like a traditional priest).

Pray much for this person that they may have a conversion of heart before their suicide succeeds.