Should a doctor in a hospital obey the request of the relative of a patient to stop a treatment that sustains life?

  • Thread starter Thread starter Alma
  • Start date Start date
Status
Not open for further replies.
St_Francis said:
Suppose a fairly healthy young man and his sister were in a terrible feud, and he had an accident from which he would probably recover, but he was currently unconscious and his only relative, the sister who hates him, said to the doctors to withdraw all treatment including food and water?

I don’t think that doctors *necessarily *have to follow the instructions but also use their good sense, no?
Click to expand...
Well that’s a legal issue. I’m talking about appointed proxies here, not just relatives who generally don’t have any moral authority in decision-making.
 
When said doctor gets his medical licence revoked for breaching medical ethics, how is he going to be able to continue to apply Catholic ethics to healthcare?
Click to expand...
If the medical ethics call you to kill an innocent person just because someone said to, I think it would be better to get a license revoked than to kill an innocent person, and when the person survived do you honestly think the license would actually get revoked? Once again, it’s the “would Jesus sin because someone asked him to?” question.
 
You mistake the thrust of my argument.
As a doctor, you are granted the privilege of treating individuals on the important basis that you don’t inappropriately interfere with the patients’ autonomy. The ethics of the situation must bear in mind the issue of the patients’ consent.
Clearly illegal acts would be unethical! Clearly there are limits to patient autonomy.
 
I think that the main area in which this would come up is in the area of nutrition and hydration, as many seem to consider that N&H as a medical procedure can be withdrawn like ventilation, and the Church does not agree?

Most of the other situations I have heard about are clearer.
 
Timbothefiveth said:
A well-formed conscience will not go against the church teaching, it won’t remove ordinary care.
Click to expand...
Quite right. However even with all of it’s wealth of “words” the Church cannot cover each and every contingeny of each and every case. That is why the Church in her wisdom has given us the “conscience” clause.

I will give you an example from my own life.
My father was diagnosed with Alzheimer’s disease. My mother kept him at home and cared for him till the end. By the end I mean he had reached the point where he could no longer eat or drink. He could not swallow. Our mother determine, with our concurrance and with the blessing of her parish priest, not to feed via tube. We did keep ice handy and would place small pieces of crushed ice on his lips. He lasted 5 days and then passed away.
Regardless of the specifics of Chruch teaching in this matter I know, and so did my mother and our priest, that this was the right thing to do. It fit perfectly with the Law of Love. Dad would never wish to be kept alive in this circumstance. His death was the natural progression of the disease and he can, free of his affliction, pray in heaven for the salvation of other souls.
This was a decision made by a “well formed conscience” that was not constricted by "the letter of the law’ so to speak.

I will face this same decision one day with my DW who also suffers from Alzheimer’s. I hope that I will be as brave and Loving as my mother was.

Peace
James
 
Alma said:
A 95 years old lady is in the hospital. She went in due to a severe infection caused by some unattended sores (probably because the woman who took care of her did not change her diaper as frequently as she should have).
She then got pneumonia. And became gravely ill.
Yesterday she had great trouble breathing. The doctors said she was in a terminal condition and would live at most 12 more hours.
The doctors removed the catheter on the lady’s hand, through which she received vital fluids that kept her well hydrated and fed.
They could not put another one because she is extremely thin and her veins are very damaged. They suggested opening a small hole on her throat to insert it.
Her grandaughter refused. She thought her grandmother would soon die. The thing is she did not die. She has survived the 12 hours prognosis and is still alive, though unresponsive. For more than 24 hours now.
But the lack of all liquid and nourishment will surely cause her to die of thirst and hunger.
And I was wondering, in a case like this, does a doctor have to acquiesce to what the person in charge of a patient tells him to do or not to do, no matter what? :eek:

Alma
Click to expand...
No, if the doctor is in disagreement the doctor does not have to do what the person in charge wants. You want a doctor to do what’s best for his/her patient. And if he/she feels that the request of the family member is unreasonable, the doctor doesn’t have to comply.

I am doing my clinical in an ICU right now and just last week the doctor denied signing a DNR for a patient’s wife because he thought it was too soon to tell and wanted to make sure the patient had a chance to improve without something like choking to death on sputum happening.
 
St_Francis said:
Suppose a fairly healthy young man and his sister were in a terrible feud, and he had an accident from which he would probably recover, but he was currently unconscious and his only relative, the sister who hates him, said to the doctors to withdraw all treatment including food and water?

I don’t think that doctors *necessarily *have to follow the instructions but also use their good sense, no?
Click to expand...
Yes. They don’t have to follow instructions that contradict their good sense.
 
How so? Actually you are contradicting the Church position. The withdrawal of fluids is not mean to be intended to result in death.

Nope not contradicting the church. We are not required to continue life when death is already happening under certain circumstances such as in a body ravaged by end stage cancer… You can’t withdraw the fluid unless the organs are shutting down which is a sign that death is imminent. So removing the hydration isn’t causing the death but instead not prolonging the suffering.

It seems this person is not able to take food by mouth. What tubes do you mean?

IV or an NG tube . Yes , there was some difficulty putting in an IV that was alluded to but we aren’t sure of the full situation there.

Meaning?

You are having problems with the church forbidding use of Methotrexate in the case of ectopic pregnancy aren’t you ?
 
Doc_Keele said:
You mistake the thrust of my argument.
As a doctor, you are granted the privilege of treating individuals on the important basis that **you don’t inappropriately interfere with the patients’ autonomy. **The ethics of the situation must bear in mind the issue of the patients’ consent.
Clearly illegal acts would be unethical! Clearly there are limits to patient autonomy.
Click to expand...
Seems like the bolded part is the answer to the original question: doctors can, within limits, decide to go against the appropriate person’s wishes.
 
Nope not contradicting the church. We are not required to continue life when death is already happening under certain circumstances such as in a body ravaged by end stage cancer… You can’t withdraw the fluid unless the organs are shutting down which is a sign that death is imminent **So removing the hydration isn’t causing the death **but instead not prolonging the suffering.
Click to expand...
Exactly my point!
IV or an NG tube .Yes , there was some difficulty putting in an IV that was alluded to but we aren’t sure of the full situation there
Click to expand...
Give IV nutrition to someone who’s septic and probably with poor cardiac reserve?
Give NG feeding to someone with pneumonia who’s probably not protecting their airway?
You are having problems with the church forbidding use of Methotrexate in the case of ectopic pregnancy aren’t you ?
Click to expand...
I’m having problems with the incoherence of the Church’s position, not just about methotrexate actually.
 
Doc_Keele said:
I see you know better than a qualified doctor. OK:thumbsup:
Click to expand...
I am a doctor of Veterinary Medicine, and I’ll bet I’ve directly attended to the end of more of my patients lives than most physicians have with their patients, hospice physicians and some others excluded.

In any case, I’m guessing I’m qualified enough to correct your statement of “fact”.
 
JRKH said:
I will give you an example from my own life.
My father was diagnosed with Alzheimer’s disease. My mother kept him at home and cared for him till the end. By the end I mean he had reached the point where he could no longer eat or drink. He could not swallow. Our mother determine, with our concurrance and with the blessing of her parish priest, not to feed via tube. We did keep ice handy and would place small pieces of crushed ice on his lips. He lasted 5 days and then passed away.
Regardless of the specifics of Chruch teaching in this matter I know, and so did my mother and our priest, that this was the right thing to do. It fit perfectly with the Law of Love. Dad would never wish to be kept alive in this circumstance. His death was the natural progression of the disease and he can, free of his affliction, pray in heaven for the salvation of other souls.
This was a decision made by a “well formed conscience” that was not constricted by "the letter of the law’ so to speak.
Click to expand...
What an inspirational story of sacrifice and love. I bet your mother and father were both remarkable people.
I will face this same decision one day with my DW who also suffers from Alzheimer’s. I hope that I will be as brave and Loving as my mother was.
Click to expand...
I have no doubt that you will.
 
Newbie2 said:
I am a doctor of Veterinary Medicine, and I’ll bet I’ve directly attended to the end of more of my patients lives than most physicians have with their patients, hospice physicians and some others excluded.

In any case, I’m guessing I’m qualified enough to correct your statement of “fact”.
Click to expand...
No, you’re not (qualified enough). You’re also contradicting the practice and experience of palliatice care specialists around the world. You don’t know what you’re talking about.
A human isn’t a dog or a cat.
 
Doc_Keele said:
No, you’re not (qualified enough). You’re also contradicting the practice and experience of palliatice care specialists around the world. You don’t know what you’re talking about.
A human isn’t a dog or a cat.
Click to expand...
Wow, “Doc”, thanks. I feel enlightened somehow. I must have slept through that part of comparative physiology. And one of my clients, who is a hospice care physician, must be a complete idiot or a sadist.

:rolleyes:

Now if you’re saying that IF giving IV fluids is **unnecessarily prolonging life **in a certain case, and I think we all agree that there exist certain situations where that may be so i.e. where a patient is gasping out his or her last couple hours of life…and IF that patient is in agonizing discomfort that cannot be alleviated with pain relief medication, one could make the case that the IV fluids are contributing to a patient’s suffering " mak(ing) death more uncomfortable, rather than less.", as you wrote.

However, IF that is what you’re saying, I’d agree fully, with the caveat that such could be said about other medications as well i.e.that such is not limited to IV fluids e.g. a terminal patient is on an antiarrhythymic, preventing them from going into ventricular fibrillation and dying. The case could be made, in certain circumstances, that the antiarrythymic is contributing to a patient’s suffering.

I still contend that unless medically unnecessary or contraindicated i.e. CHF, pleural or abdominal effusion, certain types of renal failure, etc. that replacing a physiological substance, in this case water and electrolytes (IV fluids) by themselves, " make death more uncomfortable, rather than less." as you claim, unless I misunderstood your meaning, i.e. by unnecessarily prolonging life they " make death more uncomfortable, rather than less."
 
Well if this client of yours doesn’t know that hydration often makes dying more uncomfortable then I guess he may be an idiot or a sadist - it’s well recognized.

Don’t take my word for it, do your own research. The UK is the originator of the hospice movement after all.

Why IV fluids would make a pleural effusion worse (unless you put the central line through the pleura or it’s due to CCF) beats me.
You’re not qualified to treat humans, and there’s a reason for that.
 
Doc_Keele said:
Well if this client of yours doesn’t know that hydration often makes dying more uncomfortable then I guess he may be an idiot or a sadist - it’s well recognized.

Don’t take my word for it, do your own research. The UK is the originator of the hospice movement after all.

Why IV fluids would make a pleural effusion worse (unless you put the central line through the pleura or it’s due to CCF) beats me.
You’re not qualified to treat humans, and there’s a reason for that.
Click to expand...
No need to be insulting or judgmental, “Doc”.

Looks like you changed your your claim from IV fluids “make death more uncomfortable, rather than less.” to * “hydration often makes dying more uncomfortable”.*
These are two quite different statements. “Often”, yes, perhaps…on that I could agree with you. Perhaps you meant “often” in your original claim, if so, that was not clear to me.
 
I wasn’t insulting.
Yes, I needed to qualify my statement to make it more accurate, but the effect is not as dramatic as you make out.
 
Apology accepted. 👍

Sometimes the internet forum medium doesn’t translate well across the pond.
 
I might have been slightly terse, but I didn’t mean to be insulting:)
I couldn’t treat animals. Some of the knowledge might cross over I’m sure but the biggest factor would be missing - experience.
Re the hydration issue - this is the policy and practice of the MacMillan nurses in the UK, and this is what happens to my mother when she had bladder cancer in her last week.
 
Status
Not open for further replies.
Back
Top