Last Updated on September 30, 2010 by Dave Farquhar
A longtime friend asked me (along with a couple of other friends) for an opinion on the ethics of using feeding tubes as life support.
I have a lot more problem with taking a tube away than I do with giving one in the first place, personally. If a person is, as my dad used to say, “that warm blob over there, which shows no brain activity and no response to stimulus,” then it’s a non-issue. Pull the tube, let go, and let the person go. To me, that’s not a gray area.
Whether you give the tube in the first place is another question. The answer, for me, if it’s me, is yes, but I’m a fighter. If something has a one in a million chance of working, I take it, so I don’t ever regret not having taken that chance. So in my case, give me what I need in order to be able to fight.
I have a lot less problem with not giving the tube in the first place than I do with giving the tube and then taking it away later. Unless the person stops being a viable life form.
But that’s just me.
She’s looking for other opinions. Anyone else have any?
Don’t argue amongst yourselves; if this turns into an all-out war, I close the thread and I post absolutely nothing to the site for the rest of the month. Just post your opinions. I hope I made that clear.
David Farquhar is a computer security professional, entrepreneur, and author. He started his career as a part-time computer technician in 1994, worked his way up to system administrator by 1997, and has specialized in vulnerability management since 2013. He invests in real estate on the side and his hobbies include O gauge trains, baseball cards, and retro computers and video games. A University of Missouri graduate, he holds CISSP and Security+ certifications. He lives in St. Louis with his family.
I come to this from 2 perspectives. First,while stationed in Guam I volunteered at an animal shelter, and part of my duties included euthanizing a large number of sick, injured as well as healthy abandoned animals. Second, my brother died of cancer 2 years ago in hospice care. The hospice care consisted of “aggressive” pain therapy which meant ever larger doses of morphine until until he basically OD’d. I don’t critisize this, considering the amount of pain my brother was in, it was the best possible answer. But it did, in my mind, amount to a form of euthanasia. Regards feeding tubes, I think it cruel to pull them once applied because it leaves the patient to basically starve and whither until the end. Unlike other supprt systems, like heart/lung machines where the end comes quite quickly once pulled. In all such cases, someone is essentially making the decision to end someone’s life, who can’t make that decision for themselves. It is never easy and demands both love and courage. But once made, I think the decision should be allowed to go forth in the quickest, most merciful means possible. Pulling the feeding tubes on someone who can’t possibly feed themselves, and letting nature take its course, seems to me a rather cowardly attempt to hide or lessen the impact of the real decision thats been made. I’m well aware of the “slippery slope” argument against euthanasia. But intent is everything. When the decision, whichever way it goes, is made out real love and concern then I personally believe there is no sin. My prayers for your friend, I hope she can find both mercy and consolation.
I thought I should amend part of my comment. I truly sympathize with those persons who had to make the painful decision to pull feeding tubes for a loved one, when that was the only option available to them. I apologize for being insensitive in making my point. What I really hope, is that people can be allowed to be more honest about difficult decsions like this, and have the option to take the steps that may in fact be the most compassionate.
I guess it comes down to three questions for me….
1) is the tube temporary or semi-permanent (we’re all just here temporarily, anyway… 😉
2) Is the tube going to improve the quality of life?
3) Does the person have a reasonable expectation of recovering enough to lead a meaningful life? As in – will they recover enough to know their surroundings, hold a conversation, recognize loved ones, etc.
If the answers to the first question is permanent/semi-permanent; if the answers to two and three are no, then I think your dad was right, Dave – it’s meat, it’s not a person.
All the usual disclaimers apply – I’m not a doctor, health professional, ethicist, moralist, etc. Just my $0.02.
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Dave,
As I understand the question: “When is it ethical to remove a feeding tube, knowing that this action will lead to death?”
As I see it, there are many cases. Dean and John Dominik cleared up the mostly clear cases.
I think the question your corespondent wanted answered was “When is it ethical to remove a feeding tube from a person who is not near death?”
The whole question leads us into the quagmire of “Situational Ethics.” To pull the tube or not? My gut says No. My mind says, if there is no hope of the patient returning to his (her) prior condition, let him go.
Then there is the part of me that says “let God sort it out”.
And I don’t really know the answer.
John
Read (that reads red) the accounts of people who’ve been in a coma for 20 years, then regained consciousness? Read the accounts of people who were supposedly in a coma for nine months, then regained consciousness? But in fact were simply unable to respond, and heard every word of what was said around thenm for the entire nine months? Including the discussions about whether to turn them off or not?
I’d be less concerned about something that fed them (food into stomach) than something that plugged them in (nutrients into bloodstream). And I’ve had saline-and-glucose drips myself.
In Australia we recently had a case where a women was only being kept alive by tube feeding and the hospital would not stop the feeding even though a: the family wished it and b: they conceeded she would never get any better.
So we let the courts decide (something about whether forced feeding was paliative or medical care, one can be withdrawn the other can’t) , she will die of old age before this plays out.
So, nobody wins… and my taxes are paying to keep her ‘alive’
And no, she is NOT in a coma, nor likely to get any better.
Jimbo
This is one of those issues that didn’t exist 100 years ago because the medical technology didn’t exist to make it an issue. In the States, the debate pretty much started with the case of Karen Ann Quinlan (1975), a young woman who suffered irreversable brain damage after massively abusing drugs and alcohol. After concluding she would not recover, her parents requested she be taken off her respirator, with the assumption she would soon die. The hospital fearing criminal repercussions refused and the case was taken to court, which decided in favor of the parents. However, Karen Quinlan did not die but breathed on her own and lived another 9 years in a “persistant vegetative state” Her eventual cause of death was pneumonia; I found no articles stating whether her eventual death involved any denial of care. The court case which addressed the specific issue of withdrawing feeding tubes, which would definitely lead to death if a patient could not fend for themselves, came when the parents of Nancy Cruzan, an auto accident victim identified as brain dead, requested her feeding tubes be withdrawn. Part of the case centered around the legal standard which would prove that the legal surrogates of the patient were in fact acting in accordance with the stated desires of the patient. The court initially denied the parent’s request but on appeal the standard was lessened and the feeding tubes removed. Nancy Cruzan’s accident occured in 1983, the tubes were withdrawn in December 1990, and she died later that month. In both cases, the argument allowing the actions was based not on any right to die, but rather the right of the patient (or their legal surrogates) to refuse specific treatments. Even though death may be the likely result of that refusal, the patient is still viewed as succumbing to the underlying pathology and not the active efforts of someone to help them die. There is a lot of legal effort to distiguish between allowable medical actions which may result in death and the state’s recognizing a specific right to die and allowing individuals to actively initiate death. Though at times they may seem to be distinctions without a difference. The arguments quickly become incredibly complex regarding the state’s or society’s interests in protecting life, which may supercede the individual’s,in acknowledging any form of a right to die. As an aside, you could legitimately wonder about many seemingly conflicting arguments which are applied to any rights to abortion, which is a subject well outside the scope of this thread. The legal and ethical repercussions from the simple desire to end an individual’s struggle is quite significant. The current status of things may not be much help those facing this sort of issue directly. As for the rest of us, it is probably best to make our personal views and desires clearly known to our friends and family. It would also be good to remember that death comes to us all and we know not the hour of its arrival, be prepared.
I’m sure recent news regards the case of the Florida woman, Terri Schiavo, has brought back people’s thoughts on this matter. From what I’ve seen, there seems to be a lot of conflicting details; and enough reasonable doubt that I personally would choose life until the facts become clearer. That said, from this woman’s example I am certain about one thing, Pulling the feeding tubes and leaving the body too a slow withering death is cruel, for everyone. The legal niceties and necessities that say the “body” must rely on it’s own resources to live – The notion that the “body” could still live if it can somehow wake itself up and make its way to the nursing station and ask for a sandwhich and a glass of water is absurd inhumanity. Convicted murderers aren’t executed this badly. I realize that in this case, if there had been a “quick” option this woman might already be dead – perhaps wrongly. That speaks to the need for clear procedural guidelines. But when the decision is made honestly to end life, the patient, family and friends deserve a better option than just pulling the feeding tubes. A bullet would be more merciful.
If I ever need one, I hope my wife won’t apply funds awarded for my care toward legal fees to get it removed, after promising under oath during the malpractice trial to care for me the rest of my life, as Michael Schiavo did.
I hope my bones and neck will be thoroughly examined for evidence of any strangulation or evidence of beating–as Terri’s weren’t, although such trauma damage was noted by her attending physician in 1990.
I also hope my wife doesn’t start shacking with another man and have a kid or two by him, while ordering antibiotics for infections withheld from me while refusing to relinquish guardianship to my parents–as Michael Schiavo did.
And I hope my wife’s attorney isn’t on the board of directors of the hospice where I’m being thirsted to death–as Michael Schiavo’s is.
But if she and her attorney do all that monstrous stuff, and as a result I further deteriorate, then I sure hope my wife doesn’t somehow stand to collect a million dollars in trust funds and life insurance upon my death, while retaining legal standing to order that death–as Michael Schiavo does–or did, until Governor Bush and the Florida legislature acted to deny him his fervent wish to finish her off.
If Terri Schiavo’s feeding tube is pulled, then there is no chance she can ever recover enough to tell society exactly what or whom brought about her disabled condition–is there.
My opinion is, keep Terri’s in. On the other hand, if Michael Schiavo ever needs one, my wife and I both would like to be appointed his guardian.