Ventilator as extraordinary means?

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I’m sure the end-of-life issues have been discussed extensively on these forums, but I have a very specific question, and my searches didn’t find anything on this point.

I know most of the Church’s teachings on the morality of removing feeding tubes, etc. We are not obligated to keep someone going with extraordinary measures. And food and water are NOT extraordinary measures. (This was brought to the world’s attention with the Terri Schiavo case several years ago; she was essentially murdered.)

My question: Is a ventilator considered extraordinary? I was told that it is, since it’s not in the food/water category. But why is it necessary to use an artificial delivery method for food (a feeding tube) but not necessary to use an artificial delivery method of oxygen to the bloodstream?

In the case of a feeding tube, we are helping to get around a physical impediment – the inability to swallow. In the case of a ventilator, we are helping to get around a physical impediment of lungs that cannot operate on their own. But why must we keep the feeding tube in, yet a ventilator is optional? I must be missing something…
 
Just my opinion, but the body is still able to absorb food, so feeding it is necessary, the lungs being incapable of breathing air on their own is another I guess, the organ has essentially died, so the body is dependant upon a machine to keep going, of which that list can go on and on to the point the human being is essentially being turned into a cyborg.
 
When someone is artificially ventilated, we are keeping them alive. Without this extraordinary measure, the person would quickly die. However, feeding tubes are not an extraordinary means to keep someone alive who is in the immediate danger of death. Feeding tubes are placed after the patient is stabilized. Permanent feeding tubes are placed when the patient is no longer being mechanically ventilated or is projected to soon be off the ventilator–that is to say, rehab-able. They will eventually be breathing on their own.
Intubation and mechanical ventilation are what people mean when they talk about “life support.” People are not required to be on long term mechanical ventilation if it looks like they will never recover. However, providing nutrition and hydration to a patient who will be unable to eat or drink on his own is considered a humane act–given that it is cruel to starve or dehydrate someone to death.
I’m sort of rambling a little. If I’m not making any coherent sense, please let me know.
 
Well it makes sense, but I still see a fuzzy area.

A ventilator is a mechanical means – one that is considered extraordinary because it replaces the action of the lungs. My point is that some might argue that a feeding tube is also a mechanical replacement for the action of the throat. So why is one optional but the other required?

FYI – I agree with you both, but I’m in discussion with a relative about this.
 
I know this won’t completely answer your question, but I thought I’d observe that even in antiquity people commonly needed aid to eat when ill to survive, even going so far as to pour food and water into an ill persons mouth and aid them in swallowing. This was not considered “extraordinary” in most senses of the word that I can tell. People cared for their loved ones in this manner before modern medicine. A feeding tube of course is more convenient (and effective.)

Not a very scholarly approach, but I figured it might be worth considering.
 
The EWTN article helped, but my brother still isn’t budging. Here’s the problem, rephrased:

Exhibit 1: A body needs food. The normal way to get the nutrition into the bloodstream is to chew the food, swallow it, the stomach digests it, etc. If a person can’t chew or swallow on his own, then a feeding tube is used as a mechanical work-around in order to provide nutrition.

Exhibit 2: A body needs oxygen. The normal way to get oxygen into the bloodstream is to breathe air into the lungs, which filter the oxygen and pass it into the bloodstream. If a person can’t breathe on his own, then a ventilator is used as a mechanical work-around in order to provide oxygen.

Here’s the sticking point – Exhibits 1 and 2 are exactly the same, with different substances being provided to the body. Assuming we’re talking about someone who’s not terminally ill, why is Exhibit 1 not extraordinary measures (meaning it’s mandatory) but Exhibit 2 is extraordinary (meaning it’s optional)?
 
I think one needs to look at it on a case by case basis.

My son was born 11 weeks early, and became very ill with a sepsis infection. He was on a ventilator for a few days, because he was to weak to breathe on his own. The hospital was not required to ask for our written permission, they just ventilated him because he needed it.
 
surritter said:
The EWTN article helped, but my brother still isn’t budging. Here’s the problem, rephrased:

Exhibit 1: A body needs food. The normal way to get the nutrition into the bloodstream is to chew the food, swallow it, the stomach digests it, etc. If a person can’t chew or swallow on his own, then a feeding tube is used as a mechanical work-around in order to provide nutrition.

Exhibit 2: A body needs oxygen. The normal way to get oxygen into the bloodstream is to breathe air into the lungs, which filter the oxygen and pass it into the bloodstream. If a person can’t breathe on his own, then a ventilator is used as a mechanical work-around in order to provide oxygen.

Here’s the sticking point – Exhibits 1 and 2 are exactly the same, with different substances being provided to the body. Assuming we’re talking about someone who’s not terminally ill, why is Exhibit 1 not extraordinary measures (meaning it’s mandatory) but Exhibit 2 is extraordinary (meaning it’s optional)?
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No, Exhibit 1 & 2 are not exactly the same. Interrupt the treatment in each case for 2 hours, and the difference is clear and obvious. People can, and do, routinely go 2 hours without eating with no discomfort. People cannot, and do not, go 2 hours without breathing. So, in a person who is not terminally ill, providing nutrition and hydration does not prevent that person’s immediate death (although, if you deprive a person of nutrition and hydration for long enough, you will cause death). But respiration and heartbeat are essential to life, and if a person’s body does not do these two things, the person will die as a result of whatever condition brought them to that point.
 
Melissa said:
Respiration and heartbeat are essential to life, and if a person’s body does not do these two things, the person will die as a result of whatever condition brought them to that point.
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Sorry to be difficult, but this doesn’t seem to fly. Food and water are also essential to life! Just because it takes longer to die from lack of food and water doesn’t make it less essential, at least in terms of moral theology.

So I still see a conflict.
 
There is no conflict, unless the party is being deliberately obtuse.

Withholding food and hydration for a long enough period will cause death in a person who would not have otherwise died.

In the case of artificial ventilation and circulation, it is the underlying condition which would cause the person’s death.

You can tell the difference because by interrupting the treatment for a short period (2 hours), the underlying conditions are what are in effect. In the case of the person who cannot eat/drink in the normal manner, the underlying conditions *will not *cause his death. In the case of the person who cannot respire/circulate blood without mechanical assistance, the underlying condition will cause death.
 
Hmmm – how about this…

Suppose someone has a stroke, and their lungs may not be able to function properly, so they can’t get the oxygen they need. If a ventilator is used, they will continue to live (perhaps not a quality of life many would want, but it is not a terminal condition if the ventilator keeps going).

Now suppose another person has a stroke such that they can breathe, but they are unable to swallow. If a feeding tube is used, they will continue to live.

Neither person will die if we merely assist the body in processing the essentials of food–water–air. But you are saying that lungs that cannot function are a cause of death. OK. But then isn’t the inability to swallow also an automatic cause of death?
 
It was a little more than two years ago that I had to confront this situation directly. My father was is a very grave condition. I did much searching and spoke with some very faithful priests and nuns. I also saw some of the same articles linked to on this thread. In the end is became clear that a ventilator is considered extraordinary care but a feeding tube is not.

Anyone who has ever seen how a feeding tube is inserted and works and sees how intubation and a ventalator works would clearly see that these are nowhere near equivalent treatment modes. In fact, even medical practitioners do not equate these. For example, a person can have a normal conversation, get up and move around with a feeding tube. A patient cannot do this on a ventilator.

In the end, with the unanimous moral guidance of priests and the other religious I spoke with, my father chose not to be intubated. Instead he chose another medical alternative which was to use a high-pressure positive pressure mask. (My father had COPD). In the end, my father died after his kidneys failed.

But he was able to do something that was impossible to do if he was on a ventilator, he expressed his love for us as his last words.
 
rpp said:
It was a little more than two years ago that I had to confront this situation directly. My father was is a very grave condition. I did much searching and spoke with some very faithful priests and nuns. I also saw some of the same articles linked to on this thread. In the end is became clear that a ventilator is considered extraordinary care but a feeding tube is not.

Anyone who has ever seen how a feeding tube is inserted and works and sees how intubation and a ventalator works would clearly see that these are nowhere near equivalent treatment modes. In fact, even medical practitioners do not equate these. For example, a person can have a normal conversation, get up and move around with a feeding tube. A patient cannot do this on a ventilator.

In the end, with the unanimous moral guidance of priests and the other religious I spoke with, my father chose not to be intubated. Instead he chose another medical alternative which was to use a high-pressure positive pressure mask. (My father had COPD). In the end, my father died after his kidneys failed.

But he was able to do something that was impossible to do if he was on a ventilator, he expressed his love for us as his last words.
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Thank you for this story, rpp. It’s the stories of the patients and their families that truly make it all come together, make it all make sense.
 
surritter said:
Neither person will die if we merely assist the body in processing the essentials of food–water–air. But you are saying that lungs that cannot function are a cause of death. OK. But then isn’t the inability to swallow also an automatic cause of death?
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No, it is not an immediate cause of death. It is possible to deliver nutrition and hydration to an otherwise functional digestive system.

The ventilator doesn’t merely deliver air to an otherwise functional respiratory system.
 
Melissa said:
No, it is not an immediate cause of death. It is possible to deliver nutrition and hydration to an otherwise functional digestive system.

The ventilator doesn’t merely deliver air to an otherwise functional respiratory system.
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Exactly. A patient needing artificial ventilatory support, by definition, does not have a functional respiratory system. Oxygen is not the only thing delivered. Breaths, pressure, positive-end expiratory pressure, tidal volumes…basically, things that keep the oxygen flowing and in the proper pressures to keep airways open in order to deliver said oxygen. A patient needing this would immediately die if it were removed.

Look at it this way. A COPD patient needs 2 liters/min of oxygen at all times (through a nasal cannula). If he does not have this, he will die within a couple days of something known as respiratory acidosis–a condition that basically causes everything to get messed up to the point where a person is not breathing effectively and their hearts can go into deadly rhythms leading to total cardiac arrest. The oxygen is keeping him alive, but he wouldn’t die IMMEDIATELY if it was removed. He doesn’t have a fully functioning respiratory system, but it functions pretty well as long as it is supported. The oxygen is supporting him, but not completely like a vented patient is.

Same with the feeding tube. The patient just can’t swallow without food and liquids going into his lungs, but he is otherwise able to stay alive. If he isn’t fed, he will starve to death eventually. The feedings support him, but not totally.

It boils down to partial support, versus complete and total support. Sometimes, ventilation is needed when the condition is temporary–like pneumonia.
 
Melissa said:
The ventilator doesn’t merely deliver air to an otherwise functional respiratory system.
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Thanks, Melissa! And also Lumenorientale! That’s the key that helps me understand this! Obviously I’m not knowledgeable about medical stuff, so I knew there was something that I was missing. I’ll pass this idea on to my brother, who actually started this debate (at Thanksgiving dinner, no less…)

Thanks also to rpp
 
rpp said:
It was a little more than two years ago that I had to confront this situation directly. My father was is a very grave condition. I did much searching and spoke with some very faithful priests and nuns. I also saw some of the same articles linked to on this thread. In the end is became clear that a ventilator is considered extraordinary care but a feeding tube is not.

Anyone who has ever seen how a feeding tube is inserted and works and sees how intubation and a ventilator works would clearly see that these are nowhere near equivalent treatment modes. In fact, even medical practitioners do not equate these. For example, a person can have a normal conversation, get up and move around with a feeding tube. A patient cannot do this on a ventilator.

In the end, with the unanimous moral guidance of priests and the other religious I spoke with, my father chose not to be intubated. Instead he chose another medical alternative which was to use a high-pressure positive pressure mask. (My father had COPD). In the end, my father died after his kidneys failed.

But he was able to do something that was impossible to do if he was on a ventilator, he expressed his love for us as his last words.
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My father was on a ventilator for eleven years 1996-2007, after a tragic fall from a rickety latter in the bell tower in our home parish. He spent fourteen months in a Neuro-Intensive Care-Unit before my family was able to refit our split level home into a Mini-Hospital complete with Nursing Office. This would not have been possible had it not been covered by the Provincial Work-mans Compensation Insurance Board which was a real blessing by God. With the gracious tender love of Nurses and Respiratory technicians 24/7, 365 days a year he lived the remainder of his life with the love of his family always at his side. My father was also on a feeding tube.
He died peacefully of heart failure a few days before Christmas in 2007.

During my fathers life in that state he had a standing “Do Not Resuscitate Medical Order” which my family checked with our priest to see if it was supported with Church Law, which it was, given his quality state of life. I have heard people ask me if it was morally right to let my father live in the invalid state he was for over a decade. Granted he would not have lived as long as he did if we had left him to rot in a hospital bed. He survived mostly on love and wanted to be sure his loving wife and children would be OK. It’s difficult to see any family faced with such a cross. But as my mother said; it was for the betterment of his soul and just as much for the individual members of his family. He is truly missed.
 
centurionguard said:
My father was on a ventilator for eleven years 1996-2007, after a tragic fall from a rickety latter in the bell tower in our home parish. He spent fourteen months in a Neuro-Intensive Care-Unit before my family was able to refit our split level home into a Mini-Hospital complete with Nursing Office. This would not have been possible had it not been covered by the Provincial Work-mans Compensation Insurance Board which was a real blessing by God. With the gracious tender love of Nurses and Respiratory technicians 24/7, 365 days a year he lived the remainder of his life with the love of his family always at his side. My father was also on a feeding tube.
He died peacefully of heart failure a few days before Christmas in 2007.

During my fathers life in that state he had a standing “Do Not Resuscitate Medical Order” which my family checked with our priest to see if it was supported with Church Law, which it was, given his quality state of life. I have heard people ask me if it was morally right to let my father live in the invalid state he was for over a decade. Granted he would not have lived as long as he did if we had left him to rot in a hospital bed. He survived mostly on love and wanted to be sure his loving wife and children would be OK. It’s difficult to see any family faced with such a cross. But as my mother said; it was for the betterment of his soul and just as much for the individual members of his family. He is truly missed.
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Thank you for this.

I should have added that my father was 83 at the time of his passing and in very poor health. A ventilator would have only delayed the inevitable. The doctors at the time said that once he was on it, he would never be able to be extubated and that he would still pass. As it was, in his situation, it did not seen to make sense.

Either way, this is up to the choice of the individual. Either choice is a morally justifiable.

This is in stark contrast to denying food and water.
 
rpp said:
Thank you for this.

I should have added that my father was 83 at the time of his passing and in very poor health. A ventilator would have only delayed the inevitable. The doctors at the time said that once he was on it, he would never be able to be extubated and that he would still pass. As it was, in his situation, it did not seen to make sense.

Either way, this is up to the choice of the individual. Either choice is a morally justifiable.

This is in stark contrast to denying food and water.
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My apologies for the belated reply from your last post. Three months after my fathers terminal life altering accident on November 25th, 1996, I remember doctors confronting my mother and asking her if she wanted to have them remove all life support from my father who was on a ventilator and feeding tube. Two catholic nurses happened to be present beside my mother when this conversation took place in the Neuro Intensive Care Unit where my father was hospitalized for fourteen months.

It had always bothered me that doctors would suggest such a form of euthanasia.
When the doctors had left my mother who was visibly upset, the two Catholic nurses comforted her and told her that it would be murder if the doctors performed this course of action.

**In that course of 14 months I took it my family responsibility to go to the hospital to visit and pray with my beloved father every day in the evening hours. I remember one night when my father was having a very difficult time in with his phantom limbs and breathing difficulties.
He had his full mental faculty but couldn’t speak because of the tracheal breathing tube.
He motioned me with his head and eyes towards the ventilator. I knew he wanted me to shut the ventilator off. Yet; because I respected the dignity of life, I had to leave the room overwhelmed with great sadness because I felt like a coward for not doing what I myself would have wanted in the same situation. **

You said;
**Either way, this is up to the choice of the individual. Either choice is a morally justifiable.
**
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It’s certainly a difficult choice for any family to make especially when a loved one is in this terminal situation.

As a result though my family chose to convert our split level home into a mini-hospital with 24/7 nursing care where my father lived another 10 years with the love of his family always at his side.

Such memories are fond in my mind this time of year. My father passed away peacefully on December 20th, 2007. We prayerfully honored his Requiem Mass on (“Christmas Eve”) December 24th that same year.
 
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