Are there any Freepers with a medical background who can weigh in on this?
Liberalism.
Although I am interested in the subject of science and medicine and at one time thought of going into the medical profession, I do not have a medical background, although some people think my screen name indicates I'm a doctor - I am not - the MD stands for Maryland.
But I can tell you what happened to my mother. On December 30th of 1995, mother was admitted to Johns Hopkins Hospital, to the Intensive Coronary Care Unit (ICCU), for what at first they thought was a mild heart attack as she was having chest pains and a blood test gave indications of such. But they were also running other tests because in addition, something else seemed to be going on with her but they were not sure at first what that was.
On New Year's Eve, I had been at her bedside and she was alert and talking to me, but obviously in some pain and discomfort, and as I was getting ready to leave at about 9:00 PM, she held my hand very tightly and her last spoken words to me was "please pray for me".
At around 11:30 I got a call l from the hospital saying that my mother was in acute respiratory distress and asked my permission to put her on ventilator which of course I said yes and rushed back to the hospital, and called the rest of the family. By now she was completely unconscious and unresponsive to us, to our voices and our holding her hands. In less than 3 hours she went from being alert and talking to unable to breathe on her own and unconscious.
The next day she was transferred from the coronary ICU to the medical ICU as they'd determined she had acute pancreatitis. The doctors at JHH asked us a lot of questions such as did she drink (she was a teetotaler), did she smoke heavily (no, never, not at all) and what sort of symptoms had she had prior (not much, although she had been complaining at Christmas of some stomach pain and lower back pain, some nausea but had chalked it up to a stomach bug), did she have any history of gall stones (no).
Over the next two weeks her condition continued to rapidly deteriorate. Her kidneys started shutting down and she was put on dialysis on day three. She became very bloated, her lungs continued to fill with fluids that required her to be suctioned every few hours, and by the end of the week her liver was also shutting down and she had no bowel signs, no urine output of her own without dialysis and she never regained consciousness. I will say however without any hesitation that the care she received at JHH was top notch and she had a team of doctors and ICU nurses working around the clock to save her life, including as I learned later, one of the top gastroenterologist at JHH and in the country.
But into the beginning of the 2nd week, the prognosis became very grim. The doctors requested a family meeting and told us that the toxins, the acids that her pancreas was still pumping out were basically liquefying her other internal organs and brain scans showed damage there as well as the toxins were now all through her blood stream - although she was not determined to be brain dead, she did have significant brain swelling.
The doctors further explained that despite all their efforts to stabilize and support her, there was nothing more they could do for her. They also said that while they could remove what was left of her pancreas and that a person could live without a pancreas, that requires massive amounts of medications and nearly round the clock care, but in her case, even if she survived any type of surgical intervention, which was unlikely, she'd also require dialysis for the rest of whatever was left of her life and perhaps even would need a liver transplant, although that would be unlikely given her overall condition, and very likely would never get off the ventilator because her lungs had become so badly damaged, not to mention the brain damage. In other words she'd never leave the hospital or an acute care facility at the very best and would never regain consciousness and not have any quality of life except to be kept alive on life support until her heart finally gave out, which might take days, weeks or months or up to a year in their medical opinion.
While they told us the decision was ours to make, they recommended removing her from life support. And FWIW, the gastroenterologist while very frank with us, was very compassionate and understanding and expressed deep remorse and his personal and professional frustration that he couldn't do more and offered his prayers for her and for us (I believe he was a religious Jew and his prayers were very welcomed).
And FWIW I after my mother died, I received a very nice personal letter from this doctor and a beautiful sympathy card from and signed by all the ICU nurses. I don't know if that is typical but I do think that they were all very impressed with our family, our care and concern for her (someone from our family was with my mother 24-7 and despite posted visiting hours, no one kept us from being with her - we were allowed unlimited access) and also our understanding of the situation and our appreciation and thanks for all they were trying to do for my mother and the thoughtful and intelligent questions we asked.
The family - me, and my father and brother and SIL who are traditional Catholics and very pro-life, all came to the conclusion that removing my mother from life support was the right thing to do. A traditionalist Catholic priest came and gave my mother Last Rites (and who BTW also agreed with taking her off of life support given the situation) and the next day she was removed from the ventilator and died peacefully and without any obvious signs of pain or struggle within about two minutes. We were thankful that she died peacefully and that her suffering was over.
The gastroenterologist and the team of other doctors had also asked us if we would give them permission for an autopsy. The reason was that they were perplexed why she, an otherwise healthy woman of 69 years old, developed such acute pancreatitis in such a short time and wanted to know if they could determine a cause as it might help them and other patients with pancreatitis, perhaps to save lives in the future and we agreed as we all thought and knowing my mother, the kind and giving and generous person she was, that this is what she would have wanted.
The autopsy however showed no sign of pancreatic cancer and no sign of gall stones and it was determined to be idiopathic, meaning there was no cause that could be determined. But I do hope that the doctors learned something that might save lives in the future.
In this man's case, I can't say the situation is at all similar to that of my mother's. In the case he is conscious and able to respond and is asking for continued treatment and life support and should be granted, if not extreme measures, at least continued ventilation and basic palliative care.
But in answer to your question, yes, "a digestive tract malady" especially one in which the pancreas is involved and also where the liver and kidneys and intestines are also affected could very well require a breathing tube and morphine for pain and FWIW morphine is also used on patients on a vent to relax them so that a ventilator can work - often patients on a vent become very distressed and try to remove it unless heavily sedated.
He has been in the hospital for eight weeks since a noncancerous mass was found where his small intestine connects to the pancreas. Ms. Kelly says the mass is squeezing off the small intestine and is affecting his liver and kidneys.
However this article says "Doctors found spots on his liver and pancreas. He has been on a breathing tube and is frequently put under heavy sedation."
http://www.churchmilitant.com/news/article/Texas-Hospital-Still-Fighting-to-Let-Patient-Die
That in my non-medical opinion even if the mass is non-cancerous, the "spots" could very well indicate late stage pancreatic cancer that has spread to his liver, and if so, is very likely beyond any further medical treatment and intervention and sadly is likely terminal. Pancreatic cancer is only treatable if at all if caught very early but overall, even if detected early, often has a very poor prognosis.
http://www.mayoclinic.org/diseases-conditions/pancreatic-cancer/basics/definition/con-20028153
With that being said, if he does have late stage pancreatic cancer that has metastasized, that has now spread to his liver, while he is still conscious and aware, IMO he should not be removed from the ventilator but I can also see the hospital, his doctors deciding that any further treatment or extreme measures would be both futile and perhaps even cruel. If this is the case, he should be made as comfortable as possible, given palliative care and support until such time that either he dies or looses all consciousness at which point the family might very well decide to remove him from life support. Or maybe not.
Then again, some family members flatly refuse to believe that their loved one is actually terminal and that no amount of modern medicine will not be able save their loved one. They sometimes expect a miracle from the doctors who aren't able to perform one.
His tumor may have grown to an inoperable size so that even with insurance, no surgeon wants to touch him. The tumor is said to be ‘squeezing off his small intestine and pancreas’ A tumor that size would put pressure on his diaphragm so he couldn’t breath properly,thus pneumonia and the need for high pressure vent support to help what lung capacity was left to exchange gases. The morphine would be for pain as it would be excruciating but it would also reduce his respiratory drive, hence another reason for the vent. The small intestine is being crushed to a point that the intestinal wall will become necrotic and soon perforate causing massive infection and hemorrhage. The crushing of the pancreatic ducts causes the pancreas to become inflamed with leakage of the pancreatic enzymes into the abdominal space causing peritonitis and autodigestion syndrome. The patient’s insulin production would be affected causing either extreme highs or lows in his glucose levels. His blood protein stores and his albumin will fall because he is not receiving much nourishment unless fed intravenously but that can stress his liver over time. Then there is the case of cytokines and release of dangerous levels of myoglobin which are strands of degraded muscle fibers cause by the ongoing damage by the tumor which eventually clog the kidneys and destroy them.
He probably needed venting and airway support because of he may have gone into respiratory failure related to the above. They probably ran tests and cat scans and concluded he was too far gone medically to attempt to do anything with him. Emergency Medicaid can be gotten for such cases if they are treatable. Making him comfortable and withdrawing treatment might be the only kindness left, but that is usually done once a patient has slipped past sentient consciousness.(it will happen anyway, vented or not, just isn’t happening as quickly as the hospital administrators are wishing for.) Hence the real horror of this case...to actively attempt to end a sentient life when that person has not consented to it!
The man is screwed...but I don’t have any info about whether the tumor is operable but they won’t operate because he can’t pay or if they wouldn’t operate(able to pay or not) because the tumor is so big and the damage is just too extensive. Sometimes comfort care is the only option but the hospital is just being too hamfisted in it’s approach. I know that as an RN, relatives have pleaded with us to try to get mom or sweetheart past the Christmas season...no one wants to remember their relative as having died every time Christmas comes along! Hospital systems need to make adjustments and to realize that it may make fiscal sense in the long run in how they help their patients and patients’ families to accept their impending deaths instead of just brutally setting a fiscal “dead”line(sarcasm intended) and enforcing it as though it were a guillotine!
A hospital may have been given legislatively some “legal and arbitrary” right to override family concerns over the cessation of treatment, but a pubic health market may also note how that hospital system treats a given family and decide to go to other hospitals elsewhere...politicians may also lose votes as well!