“During times of universal deceit, telling the truth becomes a revolutionary act.” George Orwell

Friday, April 14, 2006

Removing the feeding tube

I just heard that a lifetime friend of mine who had fallen into Alzheimers disease has possibly had her feeding tube removed. Both she and her family are absolutely wonderful people. They have been a model for me of love and caring in an extremely difficult situation. But apparently the disease has progressed to the point that the decision to remove the feeding tube has been made.

I must admit that I am very conflicted on this whole issue. Knowing these friends the way I do, only adds to my conflicted feelings.

On the one hand this is the active taking of a life. There is no way to remove food from a person without having the effect of taking his life. So this is a conscious decision to take a life, to kill someone to put it bluntly. When I state it in this manner it seems obvious that to remove the feeding tube is wrong.

Yet, if a person is at the end of her life as my friend is, is it humane to deliberately take her life? The fact that I would even entertain such a question makes me wonder about the degree to which I have bought a secular, liberal society's understanding of the value of life in its various forms and its various stages. Clearly my friend is not suffering by any measure that can be made. So the suffering that is being alleviated is not hers. Who knows where her mind is at this point in time? Is she better off dead? The death process will be made "easier" through the delivery of pain medication. The apostle Paul when confronted with the choice between life and death says that he doesn't know what he should choose. He says to die is gain. Should I usher others into death because I believe to die is gain? I hardly think so.

For myself, I would of course hate to be a burden to my family. Particulary me as a large person would be difficult to care for, to move around. However, I also would not want the taking of my life to be at the hands of my family. Because society would allow my wife to remove the feeding tube from my body, does not mean that I would want my wife to have my death on her hands no matter how humanitarian she might think she was being. You see it is one thing to remove various life supports from me such as medicines or other dramatic measures to keep me alive. It is quite another thing to stop feeding me. If food is keeping me alive than I am no different than anyone else. I am no different from children with severe disabilities. Your decision to stop feeding me now becomes based upon your judgement of the value of my life.

What criteria might you use to make a determination of the value of my life? Perhaps you might use a return on investment criteria, or my potential contribution, or something of that sort. The question is why would you enter into this discussion in the first place? Why would you enter into a discussion of how to determine whether someone's life is worth living? Particularly when you cannot get the perception of the person themselves who are living under that set of conditions. Additionally, as soon as we enter into the discussion, we affirm that there are some lives worth living and some which are not and those who would take life win the point. Perhaps a better position would be to simply say that I will not have this discussion because I know where it leads. Are we unwilling to say that all life is valuable and precious, or can we be brought to a point where we will say that a particular life no longer has value, based on a set of criteria which we would probably not be willing to see more broadly applied?

I have mentioned before that I am reading a book called "By trust betrayed" which is about the taking of the lives of persons with various disabilties during the time of the Nazis in Germany. Yes there was great evil involved in the practices which led to the deaths of hundreds of thousands of persons with disabilties. But there were also many who felt they were providing humanitarian aid to people they perceived as suffering. So there were those who honestly felt they were humanitarians of the highest order (the difficuly of their decisions only adding to there love for the people they chose to euthanize) when they sent people with epilepsy or schizophrenia or mental retardation to their deaths. It seems that there was also the proverbial "slippery slope" where the killing of the most severely disabled led to the killing of less disabled and less disabled, etc.

Are people better off dead? Would we be willing to have the process we moved through to make decisions to stop feeding someone be broadly applied? Are we willing to have death on our hands, independent of absolute love and desire for the best for a person that went into such a decision? Is it really heroic on our part to make a decision for death for a loved one who we perceive is living a life not worth living? Should I put such a decision on a loved one?

These are the questions that swirl through my mind as I think about such situations.



Mark said...

Dr. J.
I also am very conflicted about this issue. What criteria is it appropriate to use when making decisions about "quality of life" issues for others,or for ourselves, for that matter?

Paul's question revolved around his desire to see Jesus and return to paradise (he had been afforded a brief glimpse that faded from memory, remember) and his duty to keep to his called work until relieved of duty.

I don't know. Talk about it Wednesday, maybe?

impossibleape said...

life is hard

some questions have no good answers
(at least none that our minds can comprehend)

but it still is worthwhile asking them

Anonymous said...

I don’t feel that it is inhumane to remove a feeding tube, if a person is dying and it is voluntary death. No one can really understand the pain that person is enduring. It is inhumane not to do anything at all. I don’t think however, what the Nazi’s did was correct. As I mentioned before, if the patient is dying and it is there wish to die, one should respect there decision. Nevertheless, there should be guidelines to follow. There should be a psychiatric evaluation of the patient to make sure they are capable of making such a decision, and also a doctor’s note, assuring there is no medical indication that the patient’s health will improve, such as your friend’s prognosis.
I feel that life is a precious, when you’re not suffering. So, if a person is dying an incurable disease that is difficult to sustain, than we as compassionate people should understand that sometimes, “removing the tube” is the only solution to end someone’s suffering.