Of all the hard choices in the hush of the intensive-care unit, the toughest must be the decision to withdraw an unconscious patient's food and water.
Just the idea makes us shudder.It's nearly 20 years since Karen Ann Quinlan's parents won for most of us the right not to have our dying prolonged by machines. We've come to realize that it isn't necessary to use every possible technological gadget on a dying patient, just because we know how.
But food and water? That's not a new idea. That's basic.
And for most doctors and nurses, as well as for the relatives at the bedside, it seems pretty obvious: food and water are part of the basic care.
Yet there's a growing belief that sometimes it's morally OK not to feed a patient. That there are times when kindness and common sense make it proper to withdraw the tubes that are keeping a patient alive.
- Father Kevin O'Rourke, a Dominican priest and director of the Center for Health Care Ethics at St. Louis University Medical Center, discussed this recently with the St. Louis Post-Dispatch. He spoke of Christine Busalacchi, kept alive five years in a vegetative state:
"Those who maintain that there is an ethical responsibility to continue food and water for patients in persistent vegetative states contend that doing so is the same as feeding a baby. It would be cruel and inhumane to starve a baby to death. . . . But we feed a baby because it has the potential for cognitive-affective function. is a beneficent and ethically mandated action.
"There is a clear and discernible difference between helping a person regain or maintain human function, and merely supporting the physiological function of a person with no potential for cognitive-affective function."
- The American Dietetic Association last summer agreed that it is sometimes "ethically defensible to discontinue hydration and nutrition support."
- The Supreme Court of the United States ruled in June 1990, in the Nancy Cruzan case, that artificial feeding is a medical procedure, not a basic comfort.
What are those conditions? Many of us are going to face the unthinkable question for somebody we love. So what's the basis for decision?
1. If the treatment is not doing the patient any good, and there's no hope of reopening communication, we're not obligated to continue artificial feeding.
2. If the patient has left an advance directive rejecting artificial support we're not required to continue artificial feeding. The principle is autonomy - the patient's right to refuse any and all treatment.