Skip to comments.Commentary: When a feeding tube borders on the barbaric
Posted on 10/20/2003 9:08:00 PM PDT by Chancellor Palpatine
Just a few decades ago cases of brain death, vegetative state, and locked-in syndrome were rare. These days, medicine's "therapeutic triumphs" have made these neurologic conditions rather frequent. For all its power to restore life and health, we now realize, modern medicine also has great potential for prolonging a dehumanizing existence for the patient.
We realize this, and we're starting to deal with it. In landmark legal cases from Karen Quinlan to Nancy Cruzan, society has come to see that it's sometimes sensible to stop treatment in patients lingering in permanent vegetative states (PVS). That progress has been hard-won and welcome. But anybody who thought that the dilemmas of PVS were troublesome hasn't seen anything yet.
The United States has thousands or tens of thousands of patients in vegetative states; nobody knows for sure exactly how many. But before long, this country will have several million patients with Alzheimer's dementia. The challenges and costs of maintaining vegetative state patients will pale in comparison to the problems presented by Alzheimer's disease.
Since women now live much longer than men, and since Alzheimer's is a disease of the elderly, most of these patients will be female. Many will spend their last years largely unaware of themselves or their surroundings.
If people really understood the reality of this dementia, I doubt they'd find it an acceptable lifestyle. Being in a state of wakeful oblivion for five to 10 years or sometimes longer is a degrading experience. The degradation is borne not so much by the patient, who may be completely unaware of him- or herself, but by the patient's family. They must endure the agony of seeing a loved one lying there year after year, often sustained only by a feeding tube.
Just as we've tried to come to grips with appropriate care of PVS patients, we've got to confront the dilemma of dealing with the demented. Comfortable solutions aren't easy to find.
So much in medicine today is driving the public towards physician-assisted suicide. Many onlookers are dismayed by doctors' fear of giving families responsibility in these cases; our failure to appreciate that families suffer a great deal too in making decisions; our archaic responses to pain and suffering; our failure to accept death as a reality and an inevitable outcome of life; our inability to be realistic and humane in treating irreversibly ill people. All of this has shaken the public's confidence in the medical profession.
People fear becoming prisoners of medical technology, and their fears are largely justified. When medicine and society refuse to face up to tough questions of treatment and honor individual values, physician-assisted suicide and active euthanasia start to look like the only open exits.
Consider, for example, the case of Jamie Butcher -- a young Minnesota man of 34 who spent half his life in a vegetative state. After tending his inert body for 17 years, his parents finally made the heartbreaking choice to let him die. You couldn't find two more loving, caring, intelligent parents than Jim and Pattie Butcher. Their decision to remove Jamie's feeding tube should have been relatively simple -- and entirely private. But right-to-lifers and some disability groups fought the Butcher family every step of the way, assailing their legitimate choice to withhold futile treatment as an act of euthanasia.
This is just the sort of inflammatory talk that threatens to drive society down the path towards physician-assisted suicide. Medical organizations, courts and other groups generally agree that there are some important distinctions between stopping treatment and acting to cause a patient's death. By insisting that withdrawing a feeding tube is akin to euthanasia, these special interest groups are undermining their credibility.
And they're creating unnecessary confusion for the growing numbers of families losing a loved one to Alzheimer's. Vegetative state cases are not nearly as numerous as cases of Alzheimer's. But both kinds of cases force families to mull over the same question: When the human brain is so badly damaged that its owner can no longer think or even eat, what should be done?
This is a question families should feel free to answer for themselves -- without fearing intrusion from outsiders. And when you really think about it, the idea of placing a feeding tube in a patient with advanced Alzheimer's disease makes no sense at all, medically or morally. It borders on barbaric and cruel. It's just the kind of dehumanizing medical intervention that the public finds so distasteful. It's the sort of practice that undermines confidence that doctors have the best interests of patients and families at heart.
In Europe, feeding tubes are rarely seen in nursing homes. Once a patient is so severely brain-damaged that only artificial nutrition can sustain life, many doctors and families rightly ask, "What's the point?" In many civilized countries, the question wouldn't be asked -- because placing a feeding tube in someone with end-stage dementia wouldn't even be considered.
But here in the United States, many caregivers wouldn't consider not placing a feeding tube in the same patients.
It's hard to understand why. If we want our loved ones to live and die in dignity, we ought to think twice before suspending them in the last stage of irreversible dementia. At it is, it seems that we're not thinking at all.
-- Ronald Cranford, of Bloomington, is a neurologist at Hennepin County Medical Center and a faculty associate at the University of Minnesota's Center for Biomedical Ethics
Her husband "said" she wanted to die. Of course, he may have tried to kill her and that's how she got there in the first place, but hey. Would he lie just to save his own skin?
So Teri hears every damning word her husband says?
Pray for rehabilitation. All she has to know how to do is push a "yes" button to convict him.
Back when grandma and the kids had to decide to sell the farm or keep grampa alive, extreme life-suspending efforts after "the appointed time to die" was a rare exception.
I saw the parents interviewed on TV. He's beat her before.
He was Teri's husband. What could they do if she still stayed with him?
That's why they want the medical records exposed. She's SUPPOSE to be in her condition because of a heart attack, but she also had multiple broken bones and a wound to the neck.
He is not only a liar and a sadist but a killer.
You need to read some of the stuff he has written in medical journals, and the replies.
Anyway since when did you become such a utilitarianist?
And to clarify - I also don't agree with some of his euthanasia and alzheimer's mixing - but some of what he says does make sense.
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