When is it Euthanasia

[etspiri2sanctus]

I have been really confused about end of life procedures for quite awhile. I have read several articles and think I understand the Church’s teaching about euthanasia. However, I find, in my mind at least, so many grey areas regarding when to do what, or what not to do in end of life situations, I do stay confused. I would like (name removed by moderator)ut on the following instances please.

1. A patient has a terminal brain tumor. Is almost comotose, communication is minimal, almost non existent. She has been partially paralyzed for several months. (Not an excuse, just explaining why she could not communicate.) She seems to be in pain. The nurse is told this. The nurse gives the patient pain medication knowing it may bring about death earlier. Is this Euthanasia?
2. A patient is dying of ovarian cancer. The doctors tell her she has only a few weeks at best to live. She is taken to a hospice center. Hydration and food are omitted other than what she can take by mouth. Her system shuts down and she dies. Is this Euthanasia?
3. A man has a stroke. He is completely paralyzed and non communicative except being able to open his eyes occaisionaly. He has a tube (ventilation? food?) in his throat. His son upon being told he will need 24 hour care and seeing the condition of his Dad tells the doctor to remove the tube. Within a few hours of first having had the stroke, the man dies. Is this Euthanasia?

Please give an explanation of your vote. Thanks.

 

[vera_dicere]

One of the primary goals of pallaitive care is symptom management. It is absolutely cruel to refuse someone pain releif because “it may hasten death”.

A lot of people don’t seem to understand the process of dolling out meds. If someone is diagnosed with terminal cancer, they don’t just throw morphine at them for pain, they play around with a whole host of other meds until they can find something that works, morphine is the last resort. It also takes quite a bit of teh stuff to kill someone.

So if the nurse is giving morphine or whatever, that may hasten death if you will, it is not euthanasia. It is simply releiving someone’s pain. Death may happen, but their death is probably due to teh cancer et al. If you give morphine to a healthy person, it really takes a lot to dope them out.

So no, question one is NOT euthanasia, it is adequate pain releif.

1. IN this situation I have to ask why the woman is not being given food and water. If it is because she decided she didn’t want to eat because she wanted to starve herself, then well, honestly, the medical team should have gotten a psych review. If the staff refused to give her food and water, that is murder.

However, when one is dying from cancer, or even jus tdying, they very rarely want a good feed. The body shuts down all sorts of organs and systems near teh end, and the stomach and GI tract takes a lot of energy which the body is tryign to save for the brain and heart.

1. I think in this situation the son should get a good kick in the backside, along with the medical team. People who have CVAs can recover pretty well depending on where and how bad the CVA was. CVAs don’t tend to completely paralyse a person, they usually only damage one side of the body. Recovery from CVAs to some form of functionality is a lot more common then people think. The medical team should have intervened with CTs and MRIs to ascertain the level of stroke, and whether or not surgery and anti-coagulents could be helpful.

Now, the other question here is does the father have any kind of enduring power of attonry or living will to determine what is done in this situation? It could be argued that a ventalator is an extraodarinary means of keepign someone alive, and so it is fine for someone to remove that, and while he dies that’s jsut the outcome of nature.

I wouldn’t class it as euthanasia, a little on the immoral side, yeah, but really its just poor management and poor judgement by the son and medical team. But say teh man stroked out at home and wasn’t discovered until he was dead, the CVA simply killed him, and the son in this instance simply refused invasive treatment to prolong life.

Euthanasia is simply a direct action taken to end a person’s life. Removing a ventaliator or a NG or PEG tube may hasten death, but it doesn’t cause it. The underlying condition is what causes it. Euthanasia would be holding a pillow over someone’s face, or injecting a huge amount of morphine with teh direct intention of ending their life.

Euthanasia is murder. Removal of a ventilator or a PEG feed is simply accepting nature’s course of action. Of course, there are lots of variables in these situations which sometimes point out that someone is well aware that removing a PEG is going to cause death by starvation and that is their intention, like in the case of Terri Schiavo. She would have continued to live as she did with no other extreme mechanical interferance except for a PEG tube. What they did to her was not just a kind of cheeky euthanasia, but cold blooded murder.

 

[JRKH]

End of Life issues are perhaps the most difficult to get a handle on because of the many nuances. The best that any of us can hope for is to, like you, read up on it, pray about it and then be prepared to act in Love on our “well formed” conscience.
Even the answers below may not be correct in every case…they are simply my “best estimate” based on the info given.

By the way, I could not take the poll because it would not permit multiple answers.

In Scenerio 1: it is not euthenasia. Death is not intended, the intent is pain management.

In Scenerio 2: More difficult to judge, but I tend to agree with vera. 4 years ago my father lay dying from the late stages of Alzhiemer’s disease. We determined not to inster feeding tubes etc because his body was already shutting down and it would not be his wish to continue in that way. We had no concern for his soul as he was well fortified in the Sacraments of the Church. Therefore, we would give him whater he could take by mouth (which became only small bits of ice to wet his lips and tongue) and let him go to The Lord who was calling him.
So - depending on the overall situation and desires etc on those involved, I would say that this is not euthenasia

Scenerio 3: This is different. The feeding tube is already placed and the patient is stable. Without knowing any other details, Removal of the feeding tube at this point would not be acceptable.

Scenerio three points up a very good reason for making sure your end of life wishes are known and respected by family and doctors. My DW currently suffers from Alzheimer’s and I know her wishes and will honor them. Like my dad she is fortified in the sacraments and she has a living will and I have a DPOAHC.
We prayed over the matter and discussed it at length. God has told us that he is calling her home (no miraculous cures) and we will honor that call through Love, but without “extrodinary measures”, feeding tubes, rescusitation etc…

 

[Ron_Conte]

“I should like particularly to underline how the administration of water and food, even when provided by artificial means, always represents a natural means of preserving life, not a medical act. Its use, furthermore, should be considered, in principle, ordinary and proportionate, and as such morally obligatory, insofar as and until it is seen to have attained its proper finality, which in the present case consists in providing nourishment to the patient and alleviation of his suffering.”

“The obligation to provide the ‘normal care due to the sick in such cases’ (Congregation for the Doctrine of the Faith, Iura et Bona, p. IV) includes, in fact, the use of nutrition and hydration (cf. Pontifical Council ‘Cor Unum’, Dans le Cadre, 2, 4, 4; Pontifical Council for Pastoral Assistance to Health Care Workers, Charter of Health Care Workers, n. 120). The evaluation of probabilities, founded on waning hopes for recovery when the vegetative state is prolonged beyond a year, cannot ethically justify the cessation or interruption of minimal care for the patient, including nutrition and hydration. Death by starvation or dehydration is, in fact, the only possible outcome as a result of their withdrawal. In this sense it ends up becoming, if done knowingly and willingly, true and proper euthanasia by omission.”

Pope John Paul II, International Congress on Life-sustaining Treatments, n. 4.

 

[Newbie2]

I have been really confused about end of life procedures for quite awhile. I have read several articles and think I understand the Church’s teaching about euthanasia. However, I find, in my mind at least, so many grey areas regarding when to do what, or what not to do in end of life situations, I do stay confused. I would like (name removed by moderator)ut on the following instances please.

1. A patient has a terminal brain tumor. Is almost comotose, communication is minimal, almost non existent. She has been partially paralyzed for several months. (Not an excuse, just explaining why she could not communicate.) She seems to be in pain. The nurse is told this. The nurse gives the patient pain medication knowing it may bring about death earlier. Is this Euthanasia?

If the intent is to bring about death earlier, it is euthanasia, if the intent is to reduce or eliminate pain and a quicker death is a “side effect”, it is not euthanasia. Principle of double effect would hold here.

1. A patient is dying of ovarian cancer. The doctors tell her she has only a few weeks at best to live. She is taken to a hospice center. Hydration and food are omitted other than what she can take by mouth. Her system shuts down and she dies. Is this Euthanasia?

No. If **all **hydration and food were omitted, it would be passive euthanasia, but euthanasia nonetheless.

1. A man has a stroke. He is completely paralyzed and non communicative except being able to open his eyes occaisionaly. He has a tube (ventilation? food?) in his throat. His son upon being told he will need 24 hour care and seeing the condition of his Dad tells the doctor to remove the tube. Within a few hours of first having had the stroke, the man dies. Is this Euthanasia?

Could be, but without knowing more it sounds like it is. If the tube is for nutrition and the man dies within a few hours after having it removed, it wasn’t keeping him alive in all liklihood. If it was for ventilation, removing it probably caused his death. The question about the man’s condition is “is/was he dying from the stroke?” If so, then it might not be considered euthanasia. But it sounds like as you described it he was not, and so it probably would be considered euthanasia. Need more information on the case to really make a better judgment.

Please give an explanation of your vote. Thanks.

 

[JRKH]

Ron,
Thank you for this. I’d like to “highlight” one other item in it though by extending the bolds on morally obligatory.

“I should like particularly to underline how the administration of water and food, even when provided by artificial means, always represents a natural means of preserving life, not a medical act. Its use, furthermore, should be considered, in principle, ordinary and proportionate, and as such morally obligatory, insofar as and until it is seen to have attained its proper finality, which in the present case consists in providing nourishment to the patient and alleviation of his suffering.”
(Snip)
Pope John Paul II, International Congress on Life-sustaining Treatments, n. 4.

The reason that I wished to extend this is because it is important to recognize that, at the end of life, the body will begin to shut down and attempts to “feed” will actually cause pain and distress while doing nothing extend that life. I don’t point this out to undercut in any way what the Holy Father (and you) are communicating, only to clarify that there are appropriate times when feeding is actually contra-indicated and this is what the Holy Father is indicating in the underlined passage.

Note here that I am speaking only from the narrow view and experience of my own father’s death from Alzheimer’s. I do not pretend to any knowledge or insight into other diseases or conditions.

Peace
James

 

[Sailor_Kenshin]

I have been really confused about end of life procedures for quite awhile. I have read several articles and think I understand the Church’s teaching about euthanasia. However, I find, in my mind at least, so many grey areas regarding when to do what, or what not to do in end of life situations, I do stay confused. I would like (name removed by moderator)ut on the following instances please.

1. A patient has a terminal brain tumor. Is almost comotose, communication is minimal, almost non existent. She has been partially paralyzed for several months. (Not an excuse, just explaining why she could not communicate.) She seems to be in pain. The nurse is told this. The nurse gives the patient pain medication knowing it may bring about death earlier. Is this Euthanasia?
2. A patient is dying of ovarian cancer. The doctors tell her she has only a few weeks at best to live. She is taken to a hospice center. Hydration and food are omitted other than what she can take by mouth. Her system shuts down and she dies. Is this Euthanasia?
3. A man has a stroke. He is completely paralyzed and non communicative except being able to open his eyes occaisionaly. He has a tube (ventilation? food?) in his throat. His son upon being told he will need 24 hour care and seeing the condition of his Dad tells the doctor to remove the tube. Within a few hours of first having had the stroke, the man dies. Is this Euthanasia?

Please give an explanation of your vote. Thanks.

I did not vote because I am horrified that people are not only accepting, but welcoming, the slippery slope to Hell.

It’s ‘euthanasia’ when you decide to end the life of a suffering ANIMAL. In the case of a human, it’s always murder.

Why do certain people want us to accept the lies that it’s not our souls that need saving, but ‘the planet?’ Or the heinous lie of ‘mercy killing?’

Once you cross that line, you are on Hell’s borderlands.

(And yes, I’m aware the CCC teaches we may refuse certain treatments----but when WE are in our right minds—not for the convenience of others).

 

[ElizabethPH]

It is one of the most difficult questions. And understand your confusion. Even after reading all I have about it including this thread I’m still confused. I would go by if they are extraordinary means in which to keep them alive.

Here’s another scenario a man had a stomach aneurysm (sp) resulting in kidney failure, several heart attacks and other medical issues, he was on a vent and feeding tube and kidney machine he could not eat or even have water or ice. Although his kidneys started showing improvement he became dehydrated and at that time it was found he had terminal cancer in his lungs. Within half an hour of removing the vent he passed.

When I took the poll I think I pressed the yes button by mistake on the first one. Or some such. And I could only vote on one scenario.
#3 could be. As the man may not have been given enough time to see improvement.

 

[Joe_5859]

I would recommend reading the Holy See’s Congregation for the Doctrine of the Faith’s document Responses to Certain Questions of the USCCB Concerning Artificial Nutrition and Hydration and especially the accompanying Commentary which spells out the reasoning behind the document.

As Ron alluded to with his quotes, nutrition and hydration (AKA food and water) are considered ordinary means of care, even when administered via artificial means (i.e. a feeding tube). But, as James pointed out, there are exceptions, particularly when it is evident that one is close to death.

I think the last two paragraphs of the CDF Commentary spell this out quite well (underlining added for emphasis):

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, and then ad impossibilia nemo tenetur. However, the obligation to offer the minimal treatments that are available remains in place, as well as that of obtaining, if possible, the means necessary for an adequate support of life. 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.

Note, they list three scenarios where it may be licit to no longer provide food and water. These principles really need to be taken to heart and applied as best we can with the consult of our priest and medical professionals to make the best decision on a case-by-case basis.

I really don’t think I have enough info to make the judgment call for the situations you have described. As others have said, for #1, the intent appears to be pain relief with the hastening of death an unintended consequence. This is permissible, but again, if it were me making the decision, I would want to know that there were no other better alternatives that wouldn’t have this side effect. If we presume that there are no alternatives, then this would seem to me to be morally permissible.

In Scenario #2, I would want to know why food and water are being ommited except for what can be taken by mouth. I would also want to know if she is able to take by mouth a sufficient amount where she does not die of starvation or dehydration. If we presume she is able to take in enough food and water the natural way (which I don’t think needs to be that much food), then it would seem to be morally permissible to refrain from using artificial means.

For Scenario #3, I would say that, if the man died within hours of having the stroke, it was certainly not the lack of food and water that killed him. No one starves to death or dies of dehydration in mere hours (to my knowledge). Thus, I would say that it does not seem to be euthanasia. However, it appears that the son had euthanasia as a possible motive for removing the tubes if his decision was based on the prospect of 24 hour care rather than on the fact that death seemed imminent.

In Scenario #3, you also mention a ventilator, though. A ventilator is different that a feeding tube in that it can be considered extraordinary care. Again, one would have to consult a priest and a doctor to really ascertain the moral implications of removing the patient from a ventilator in any given situation. In addition, removing the patient from the ventilator is different from never putting them on in the first place.

 

[Ron_Conte]

The reason that I wished to extend this is because it is important to recognize that, at the end of life, the body will begin to shut down and attempts to “feed” will actually cause pain and distress while doing nothing extend that life. I don’t point this out to undercut in any way what the Holy Father (and you) are communicating, only to clarify that there are appropriate times when feeding is actually contra-indicated and this is what the Holy Father is indicating in the underlined passage.

If the administration of food cannot benefit the patient, for example because the GI tract cannot absorb the food, then food need not be given. But water or IV fluids can benefit the patient and so must be given. Hydration by IV is useful to the health of the patient, even if he is terminally ill and not far from death.

Pain and distress do not cause food or water to become extraordinary or contraindicated.

Euthanasia is always an intrinsically evil act, regardless of intentions and circumstances.

 

[ElizabethPH]

If the administration of food cannot benefit the patient, for example because the GI tract cannot absorb the food, then food need not be given. But water or IV fluids can benefit the patient and so must be given. Hydration by IV is useful to the health of the patient, even if he is terminally ill and not far from death.

Pain and distress do not cause food or water to become extraordinary or contraindicated.

Euthanasia is always an intrinsically evil act, regardless of intentions and circumstances.

So pulling the plug (vent) no matter what is euthanasia. I understand about feeding and water. I think.

 

[JRKH]

If the administration of food cannot benefit the patient, for example because the GI tract cannot absorb the food, then food need not be given. But water or IV fluids can benefit the patient and so must be given. Hydration by IV is useful to the health of the patient, even if he is terminally ill and not far from death.

Pain and distress do not cause food or water to become extraordinary or contraindicated.

Euthanasia is always an intrinsically evil act, regardless of intentions and circumstances.

Thank you for your counterpoint to my post.

I don’t think that anyone here is disputing that Euthanasia is always an intrinsic evil I certianly am not. The question that troubles the OP, as it does many who have faced, are facing, or anticipate facing such situations is just what constitutes “Euthanasia”.

While I don’t know that I entirely agree, it is only because of the fact that every circumstance is unique. The Church provides much guidance on these matters, all to the good. It is up to us to study on it and to pray on it and, if and when, we are called upon to make decisions for our loved ones, we will make proper decisions based upon a “well formed conscience”.

One thing that I would like to mention here for ANYONE faced with these types of situations and decisions. Talk to your and/or the patient’s parish priest. Ask him to pray with you for guidance. In many/most cases your priest will know the people involved and the particulars of a given situation better than any of us could hope to. Be guided by his advice.

Peace
James

 

[ElizabethPH]

I think that many of us will be faced with this in our lives. I pray for each of us to have the wisdom and proper guidance when the time comes.

 

[Ron_Conte]

So pulling the plug (vent) no matter what is euthanasia

Medical interventions such as a ventilator cannot be withdrawn, unless the person is certainly brain-dead, so that continuing to keep the body alive artificially has no benefit to the person. In such a case, the ventilator is not ordinary and necessary care, and so its withdrawal is not euthanasia.

 

[Ron_Conte]

Euthanasia is any act of comission or omission that is intrinsically ordered toward the deprivation of life from an innocent human person. The intentional choice of such an intrinsically disordered act is always a grave sin.

The intentional choice of an intrinsically evil act is distinct from the intention (purpose) for which the act was chosen. No intention, no circumstance, can justify the intentional choice of an intrinsically evil act.

 

[ElizabethPH]

Medical interventions such as a ventilator cannot be withdrawn, unless the person is certainly brain-dead, so that continuing to keep the body alive artificially has no benefit to the person. In such a case, the ventilator is not ordinary and necessary care, and so its withdrawal is not euthanasia.

So they have to be brain dead. I think I indeed killed my husband. Tough thing to face. I thought everything they had him attached too was extraordinary means contrary to what I read in here. oh dear. this is awful. You know sometimes these forums drives me nuts.

 

[Marie682]

Medical interventions such as a ventilator cannot be withdrawn, unless the person is certainly brain-dead, so that continuing to keep the body alive artificially has no benefit to the person. In such a case, the ventilator is not ordinary and necessary care, and so its withdrawal is not euthanasia.

This is not necessarily true. Being brain-dead is not the only instance in which a ventilator could be considered “extraordinary”. The context of an individual’s medical condition needs to be considered, and a ventilator can be considered ordinary or extraordinary, depending on the circumstances.

 

[Joe_5859]

So they have to be brain dead. I think I indeed killed my husband. Tough thing to face. I thought everything they had him attached too was extraordinary means contrary to what I read in here. oh dear. this is awful. You know sometimes these forums drives me nuts.

Ron tends to oversimplify moral issues (no offense, Ron ). I would like to see Ron’s basis for saying that being brain dead is the necessary and only condition in which someone may licitly be removed from a ventilator. A source from the documents of the Magisterium would be nice.

It would be better to look to your priest for guidance on these issues.

 

[Ron_Conte]

Medical interventions such as a ventilator cannot be withdrawn, unless, for instance, the person is certainly brain-dead, so that continuing to keep the body alive artificially has no benefit to the person. In such a case, the ventilator is not ordinary and necessary care, and so its withdrawal is not euthanasia.

I did not mean to imply that brain-death is the only instance when ventilators can be withdrawn. It was an example. I’ve **modified **my post, as quoted above

Another instance would be if the lungs are so injured by disease that the ventilator does is not effective. This is analogous the the instance when food is withdrawn because the GI tract cannot absorb the food.

 

[etspiri2sanctus]

One of the primary goals of pallaitive care is symptom management. It is absolutely cruel to refuse someone pain releif because “it may hasten death”.

A lot of people don’t seem to understand the process of dolling out meds. If someone is diagnosed with terminal cancer, they don’t just throw morphine at them for pain, they play around with a whole host of other meds until they can find something that works, morphine is the last resort. It also takes quite a bit of teh stuff to kill someone.

So if the nurse is giving morphine or whatever, that may hasten death if you will, it is not euthanasia. It is simply releiving someone’s pain. Death may happen, but their death is probably due to teh cancer et al. If you give morphine to a healthy person, it really takes a lot to dope them out.

So no, question one is NOT euthanasia, it is adequate pain releif.

1. IN this situation I have to ask why the woman is not being given food and water. If it is because she decided she didn’t want to eat because she wanted to starve herself, then well, honestly, the medical team should have gotten a psych review. If the staff refused to give her food and water, that is murder. She received any food or water by mouth that she wanted to take. She had little appetite, but I have always wondered why artificial hydration (IV) was not given.

However, when one is dying from cancer, or even jus tdying, they very rarely want a good feed. The body shuts down all sorts of organs and systems near teh end, and the stomach and GI tract takes a lot of energy which the body is tryign to save for the brain and heart.

1. I think in this situation the son should get a good kick in the backside, along with the medical team. People who have CVAs can recover pretty well depending on where and how bad the CVA was. CVAs don’t tend to completely paralyse a person, they usually only damage one side of the body. Recovery from CVAs to some form of functionality is a lot more common then people think. The medical team should have intervened with CTs and MRIs to ascertain the level of stroke, and whether or not surgery and anti-coagulents could be helpful.

Now, the other question here is does the father have any kind of enduring power of attonry or living will to determine what is done in this situation? It could be argued that a ventalator is an extraodarinary means of keepign someone alive, and so it is fine for someone to remove that, and while he dies that’s jsut the outcome of nature.

I wouldn’t class it as euthanasia, a little on the immoral side, yeah, but really its just poor management and poor judgement by the son and medical team. But say teh man stroked out at home and wasn’t discovered until he was dead, the CVA simply killed him, and the son in this instance simply refused invasive treatment to prolong life.

Euthanasia is simply a direct action taken to end a person’s life. Removing a ventaliator or a NG or PEG tube may hasten death, but it doesn’t cause it. The underlying condition is what causes it. Euthanasia would be holding a pillow over someone’s face, or injecting a huge amount of morphine with teh direct intention of ending their life.

Euthanasia is murder. Removal of a ventilator or a PEG feed is simply accepting nature’s course of action. Of course, there are lots of variables in these situations which sometimes point out that someone is well aware that removing a PEG is going to cause death by starvation and that is their intention, like in the case of Terri Schiavo. She would have continued to live as she did with no other extreme mechanical interferance except for a PEG tube. What they did to her was not just a kind of cheeky euthanasia, but cold blooded murder.

Removal of a PEG? feed? I don’t know what was used, or the purpose. I do know that Terry Schiavo’s feeding tube was removed and she starved to death. That was Murder.

Thanks for you (name removed by moderator)ut. It was very informative.