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

[Alma]

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?

Alma

 

[Jermosh]

I am a little leery on the term of removing a catheter, this can fall in the realm of extraordinary measures for life sustaining. Food is usually not given intravenously, other then simple nutrients I am at a loss of sustaining someone on IV nutrients. It sounds like she was not able to ingest food through her system, if so that another flag.

Sometimes the quest to preserve life goes above and beyond what is moral, human dignity is just as paramount as anything else IMHO. In the end I do not see enough factual information to state if the Drs were correct or not, but I am going to state that I think its perfectly moral at that stage of life and condition to refuse further medical help, she could have spoke of this with her family at sometime before.

 

[Doc_Keele]

IV fluids make death more uncomfortable, rather than less.
People have this erroneous notion that you can’t survive more than 3 days without fluids - not true except in extreme environmental conditions.

 

[Seatuck]

We can only remove hydration if death is imminent and it’s administration is causing discomfort . Organs would already have to be shutting down. Providing hydration via tubes is considered ordinary care by the Catholic Church. Although it is difficult to know without more details it seems this poor woman is being starved/dehydrated to death.

“The administration of food and water even by artificial means is, in principle, an ordinary and proportionate means of preserving life,” according to the Congregation’s response. “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.”

A Vatican commentary noted some possible exceptions.

“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,” it said.

“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.”

“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,” it added.

vatican.va/roman_curia/congregations/cfaith/documents/rc_con_cfaith_doc_20070801_risposte-usa_en.html

vatican.va/holy_father/john_paul_ii/speeches/2004/march/documents/hf_jp-ii_spe_20040320_congress-fiamc_en.html

 

[Doc_Keele]

We can only remove hydration if death is imminent and it’s administration is causing discomfort

which it appears to be in this case

Although it is difficult to know without more details it seems this poor woman is being starved/dehydrated to death

try impossible to know without more details?
starved to death? you think? how do you think feeding should be provided?

 

[JRKH]

** try impossible to know without more details?**

Here is the rub. We really are not intimately involved in this case and so cannot really make a properly informed judgement. For instance, we know the woman was in diapers, but we don’t know what her congnative state was before this infection. We don’t know if this woman has a “Living will”. Heck we don’t even know if this woman or her granddaughter are Catholics or Atheist or something else??

As to the specific question of whether the Doctor is, or should be, required to acquiesce, it depends on how the laws are written but I would say yes he should. He can council and advise and provide options but he should not go against the wishes and decisions of the family.

:twocents: duly depositied

Peace
James

 

[St_Francis]

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?

Alma

Not knowing the exact circumstances on this particular case, I will reply in general, which is that no, a doctor does not have to do what a relative requests.

When a patient is in the process of dying, his or her body may be unable to properly deal with nutrients or liquids of any type. At this point, they can be removed, and the patient does not die *as a result of *their removal, the patient would have died anyway, having been unable to assimilate them.

Doctors have different ethics, but ideally they would go by Catholic principles, sometimes needing to go against a relative’s wishes.

 

[Doc_Keele]

Professional ethics would mandate complying with the competent patient’s wishes in the vast majority of circumstances, and with the wishes expressed in an advance directive or by their appointed proxy depending on the jurisdiction. Autonomy has to be respected.
If the healthcare provider feels constrained from complying with the request, they are obliged to arrange transfer to another facility.

 

[Seatuck]

which it appears to be in this case
try impossible to know without more details?
starved to death? you think? how do you think feeding should be provided?

I haven’t seen her labs, or other tests for organ function. Have you? We do not know this woman’s full condition. In any case , the proper application of withdrawing the fluids would result in death within a few hours , no longer.

Feeding /hydration via tubes , baby bottles to people who cannot provide it for themselves is normal means for Catholics.

“The administration of food and water even by artificial means is, in principle, an ordinary and proportionate means of preserving life,” according to the Congregation’s response. “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.”

You aren’t surprised to see yourself at odds with the church on yet another position of medical ethics are you ?

 

[Doc_Keele]

I haven’t seen her labs, or other tests for organ function. Have you? We do not know this woman’s full condition

Exactly my point

In any case , the proper application of withdrawing the fluids would result in death within a few hours , no longer

How so? Actually you are contradicting the Church position. The withdrawal of fluids is not mean to be intended to result in death.

Feeding /hydration via tubes , baby bottles to people who cannot provide it for themselves is normal means for Catholics

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

You aren’t surprised to see yourself at odds with the church on yet another position of medical ethics are you ?

Meaning?

 

[JRKH]

This is an area that is simply not “cut and dry” it is, in fact, an area that calls for the “freedom of the well fomred conscience” as stated in the Catholic Catachism.

1782 **Man has the right to act in conscience and in freedom so as personally to make moral decisions. “He must not be forced to act contrary to his conscience. Nor must he be prevented from acting according to his conscience, especially in religious matters.”

1783 Conscience must be informed and moral judgment enlightened. A well-formed conscience is upright and truthful. It formulates its judgments according to reason, in conformity with the true good willed by the wisdom of the Creator.** The education of conscience is indispensable for human beings who are subjected to negative influences and tempted by sin to prefer their own judgment and to reject authoritative teachings.

There is much more written in the section on conscience, but it boils down to this. Each of us is required to learn and to try and understand the teachings of the Church and to discern prayerfully what the Will of God is in a given situation.
We then must apply what we have learned to situations as they come up. The more complex the situation, the more necessary it is to have a “well formed” conscience.

What is the proper or improper decision in these sorts of medical cases cannot be resolved to set of “rules” but must be carefully and prayerfully discerned by the full “caregiving team” which includes both the Doctor(s) AND the family. The Doctor, whether Catholic or not, should act in the role outlined by his expertise, explaining options, and possible/probable outcomes. The Church, likewise acting in it’s realm of expertise, explains options and circumstances and possible outcomes.
It is then up to the patient/family to decide, based on their understandings of these teachings and medical options, their knowledge of the patient and their prayerful discernment of what is “best” to make a decision. The Doctor should then comply with the decision of the family as communicated by the properly appointed family member.

After that we must trust God to sort it out.

Peace
James

 

[Doc_Keele]

Well said
We all have the right and indeed the obligation to make moral decisions, rather than defer to someone or something else.

 

[JRKH]

Well said
We all have the right and indeed the obligation to make moral decisions, rather than defer to someone or something else.

So long as we don’t use it as a “cop-out”!!!
We must always remember the “Well Formed” conscience part of this.
We should also seek out counel as appropriate.
For instance.
Say you are a “Family Doctor”. You have no problem in diagnosing and treating many common ailments from infections to flu to baybe even tonsils. But when it comes to “brain surgery” you might know the principles and the basics, but you would seek the advise can counsel of another rather than try to diagnose and treat on your own.
That is because your Knowledge is not “well formed” in this area. You need to either "study more on your own, or seek the advise of another and be guided by them.

Peace
James

 

[Doc_Keele]

Yes, agreed.

 

[Timbothefiveth]

A well-formed conscience will not go against the church teaching, it won’t remove ordinary care.

As for the original question, I don’t think the doctor would have to do what the family requests if the family requests something immoral. Would Jesus do something immoral because someone asks him? I think not. I also think that even though doctors may have a code of ethics, not even that can be followed when it interferes with the Lord’s code of ethics.

 

[Newbie2]

IV fluids make death more uncomfortable, rather than less.
.

False, unless there is accumulation of fluid in the pleural space (chest cavity) making breathing more difficult, in the abdomen (same reason) or that they are exacerbating congestive heart failure.

 

[Doc_Keele]

False, unless there is accumulation of fluid in the pleural space (chest cavity) making breathing more difficult, in the abdomen (same reason) or that they are exacerbating congestive heart failure.

I see you know better than a qualified doctor. OK:thumbsup:

 

[Doc_Keele]

A well-formed conscience will not go against the church teaching, it won’t remove ordinary care.

As for the original question, I don’t think the doctor would have to do what the family requests if the family requests something immoral. Would Jesus do something immoral because someone asks him? I think not. I also think that even though doctors may have a code of ethics, not even that can be followed when it interferes with the Lord’s code of ethics.

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?

 

[St_Francis]

Professional ethics would mandate complying with the competent patient’s wishes in the vast majority of circumstances, and with the wishes expressed in an advance directive or by their appointed proxy depending on the jurisdiction. Autonomy has to be respected.
If the healthcare provider feels constrained from complying with the request, they are obliged to arrange transfer to another facility.

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?

 

[St_Francis]

When said doctor gets his medical licence revoked for breaching medical ethics, how is he going to be able to continue to apply Catholic etyhics to healthcare?

This is why we need a conscience clause.