In the past few months our family has been confronted with end of life medical care for two close members. In both cases, we had to fight to continue providing nutrition and hydration. After hitting so close to home twice, I began to wonder about other’s experiences and found that nearly everyone who has had to walk this journey with a loved one did not know what to do and eventually deferred to “the experts” in the medical profession. Already emotionally overwhelmed and lacking confidence in their medical knowledge, they trusted that the medical professionals would guide them to do the right thing. If our experience has taught us anything, it is two things. First, the culture of death is so deeply imbedded that even those medical professionals who are genuinely compassionate and of good will can succumb to it and that we were glad that we did not wait until the situation came up to learn about the importance of nutrition and hydration at this most vulnerable stage of life.
This is not meant to be a condemnation of those caregivers who devote their lives to walking with families through this. This is meant to raise awareness that the current “best practice” in dealing with those who are actively dying is morally repugnant. By arming yourself now with a proper understanding, you can protect yourself later when your thinking may be clouded because of the stress of the situation.
Medical Treatment and Ordinary Care
First, there is an important distinction to be made between medical treatment and ordinary care. In general treatment would include those interventions that may cure a disease or aid one in returning to health. Medical treatment would include things like antibiotics, dialysis, surgery, chemotherapy, and the like. One may look at these treatments and decide that their burdens outweigh their benefits and decide to forgo them in order to live the remaining days of his life with a certain quality of life.
Medical treatment is different than ordinary care however. Ordinary care is simply routine attention given to the patient. This would include bathing, providing clean clothes and sheet, keeping them warm, and providing food and water. Each of these is essential to life and to withhold any of these, especially to those who cannot provide them for themselves, and assuming you have the means to do so, is considered cruel. No amount of misguided compassion would say that we should leave a sick person outside in December exposed to the elements. Likewise, no amount of misguided compassion would say that we should allow someone to starve and become dehydrated.
It was this important distinction between medical treatment and care that Pope St. John Paul II brought attention to when in a papal allocution in 2004 he said,
“I should like particularly to underline how the administration of water and food, even when provided by artificial means, always represents a natural means of preserving life, not a medical act. Its use, furthermore, should be considered, in principle, ordinary and proportionate, and as such morally obligatory, insofar as and until it is seen to have attained its proper finality, which in the present case consists in providing nourishment to the patient and alleviation of his suffering” (Address of John Paul II To the Participants in the International Congress on “Life Sustaining Treatments and Vegetative State: Scientific Advances and Ethical Dilemmas”).
Notice as well that John Paul II did not say nutrition and hydration must be given in all circumstances. He said that they are only to be given for as long as they are “seen to have attained its proper finality.” What he means is that they should be given in all circumstances until it can be definitively shown that they no longer can be processed or assimilated by the body. It must be “seen.” There cannot be mere medical conjecture or blanket statements like “we see that as the patient is dying their nutritional and hydrational needs are greatly diminished.” Even if their needs are greatly diminished, this is an argument for giving less, not cutting them out altogether. All too often this argument is put forth as a reason for omitting them altogether. The only time they should be completely removed is when it is shown that the body no longer can make use of them.
Other Arguments against Nutrition and Hydration
The “diminished need” argument is not the only one that is commonly put forth. There are two others. The first is what I like to call the “argument from technology.” This argument essentially says something like “75 years ago we didn’t have the ability to use feeding tubes or IV’s and we can now keep people alive longer because of these technologies.”
What makes the flaw in this argument hard to see initially is that it is true. We did not have the ability to use feeding tubes and IV’s for nutrition and hydration in the past. The problem with this argument is that we have a lot of things because of technological advances that we did not have in the past. The refrigerator that allows us to feed sick people (even those who can still feed themselves) in a relatively recent invention. Indoor plumbing, another technological advance, keeps the sick who can still hold their own cups (another technological advance) hydrated. But we also did not have the pain killers we have now. Should we remove those as well? Certainly, we are prolonging their lives by controlling their pain. In the past they would have gone into shock and died.
One can easily see how absurd this line of reasoning can actually become. Where do we draw the line? If we have the ability and the technology to provide care for someone and it is care that they have the capacity to receive, then we ought to provide it. The fact that nutrition and hydration extends one’s life is true for all of us. Remove those things from even the healthiest person and they will die. More accurately, removing those things from the person would be to kill them. Allowing someone to die is different than causing someone to die, even if you do so by an act of omission such as withholding care from them when you have the means to do so.
The second argument is that by providing nutrition and hydration, even when the patient is still able to tolerate it, we are “postponing the inevitable.” Again the difficulty in seeing where this thinking goes wrong is that it is true. We are postponing the inevitable. Although again, by me eating lunch today, I also have postponed the inevitable.
What those who use this line of reasoning surely mean is that when death is imminent we should do nothing to stop it. But doing nothing to stop it, is not the same thing as aiding it. Why not, as my son with Autism suggested when we told him his grandmother was going to die, push them off the roof then? The fact that death is imminent does not mean we should kill the person, even if it is by omission.
The fact is that human life, even when the person is suffering, even when the person is close to death is a good that ought to be protected. Life is a gift, one that none of us earned. Therefore we are never free to give the gift back or decide that we do not want it any longer. We must wait on the decision of the One Who bestowed the gift. Until such time, we should see the person before us and care for them. Feed the hungry, give drink to the thirsty, clothe the naked, and visit the sick—all corporal works of mercy that should never cease as long as a person is present before us. Don’t allow anyone to take those acts of charity away from you. Provided the person can still assimilate the food and water, you should never remove a feeding tube or a hydration IV.