Today on that site I read an essay written by a woman who is worried that her elderly mother’s living will would not be honored at a Catholic hospital because of the new directive on health care issued by the Catholic bishops. The directive basically says that they will not participate in the withholding of artificial hydration and nutrition in cases of persistent vegetative state or other cases in which the patient may live many years and is not actively dying. The woman’s mother’s living will “specifies that no extraordinary medical measures — including artificial feeding — be used to prolong her life if there is no hope of recovery.” I feel that the confusion over what constitutes “no hope of recovery” and “extraordinary measures” is largely at play in the controversy over artificial hydration and nutrition. To that end I wrote what turned out to be a rather long comment to that essay. I decided to reproduce it here. I am more than happy to discuss the ins and outs of this subject regardless of your place in the debate, but I will ask that we keep it civil in the comments.
[My background includes 13 years of nursing, the last three of those dealing with gynecologic oncology patients. I’ve had one grandmother die from Alzheimer’s and one grandfather die from leukemia. In neither case were they given artificial hydration or nutrition.]
“I think that the public in general is not very well educated when it comes to terms like “persistent vegetative state” and “terminally ill”. This has serious repercussions when talking about high-charged issues like compassionate care versus starving someone to death.
If a patient is dying, toward the end of the dying process the body is no longer effectively capable of processing fluids. The kidneys begin shutting down and a lot of the fluid is no longer eliminated in urine. This causes among other things: edema including weeping of the skin, heart overload (trying to pump way too much blood), pulmonary edema (fluid “backs up” in the lungs causing the patient to ultimately drown) and altered consciousness caused by uremia (waste products not being removed from the blood and hence the body). You can imagine how uncomfortable these might be. There is a natural instinct on the part of the patent to refuse or severely limit fluid intake. If the patient is given intravenous fluids or nutrition at this point, their sufferings are only intensified but not necessarily prolonged. The behaviour of the kidneys when dying is only one mechanism that is affected by artificial hydration.
Persistent vegetative state, however is not synonymous with impending death. In this situation the body is quite capable of surviving without artificial ventilation and circulation. It is capable of normal digestion and elimination (although, I suppose, a catheter might be placed for comfort). It can maintain a normal temperature. This is not a dying body. If a person is “brain dead”, then the body is dead as well. The brain controls all of the above mentioned functions. The only thing the person in this state is not capable of (that is needed to maintain life) is chewing and swallowing purposefully.
Nutrition and hydration are provided via short-cuts to the stomach, either with a PEG tube (inserted through abdominal wall) or an NG tube (nasogastric). For long-term use, an NG tube is unadvised because of eventual erosion of the tissue it is in contact with. Therefore a PEG tube is generally inserted. This is not connected to feeding 24 hours a day, but is used for bolus feedings three to five times a day…like a meal.
Deciding to starve a patient in persistent vegetative state, or one who has been paralyzed by a stroke (such that swallowing is unsafe), etc., is in essence deciding that the patient is not worthy of life because he cannot swallow.
On whatever side of the argument you find yourself, these facts must be acknowledged.”