Futile Care Dehydration Stopped in Alaska
The Alliance Defense Fund, which helped save Jesse Ramirez's life, has won another one, at least for now. From its press release: On May 16, the patient's husband filed the suit P.C. v. K. against the hospital and a doctor in order to keep the medical staff from removing his wife's life support, which would have terminated her life. [ADF lawyer Kenneth] Kirk subsequently filed a motion for stay on the husband's behalf to keep the hospital from doing so.
I am stunned at the energy that goes into forcing people off life support. Good for the ADF and the patient's husband.
The motion was granted, and the Alaska Supreme Court issued a temporary restraining order on May 30 prohibiting the hospital from discontinuing life support pending appeal and further order of the court (www.telladf.org/news/story.aspx?cid=4544). The hospital then determined that it would remove her feeding tube instead, which would have caused the woman to starve to death.
Following additional proceedings and efforts by Kirk, the hospital changed positions and will now allow continuation of the patient's nutrition, hydration, and pain treatment.
posted by Wesley J. Smith @ 12:24 PM
11 Comments
11 Comments:
Wesley: Do you have a news link other than the ADF release?
Never mind; found the court ruling...
http://www.state.ak.us/courts/ops/sp-ord61.pdf
By the way, the husband was stripped of his surrogacy rights by the court "several years ago" after Mari was injured in an auto accident. There also are reports that the Chamberlain's minor children were also removed from his home at that time.
Which makes it okay to dehydrate her to death how, exactly? And is relevant how, exactly?
WS: "Good for the ADF and the patient's husband."
Just responding to the last part of Wesley's statement above The husband's motives in this case are unclear, as happens sometimes in these cases. There can be less-than-noble reasons that family members have for demanding aggressive end-of-life treatments - often financial motivated.
Lydia: You have made it clear that since the invention of the feeding tube, it has been our collective moral obligation to never let someone die of dehydration or starvation. I have previously expressed my view that there exist several medical circumstances wherein forced feeding is both inhumane and only serves to extend the dying process.
We should probably just agree to disagree on this; we're talking past each other at this point.
Yes, and again, this isn't apparently about a case where the woman's body cannot absorb nutrition and hydration. It's about dehydrating her to death. So the "patient's body cannot absorb" is a red herring. I say this because that is the situation you refer to, Oka, in other threads, yet your actual response to actual situations where people are going to be dehydrated to death shows that that isn't really all it's all about for you.
And again, Lydia, your obliteration of any distinction between proximate and underlying causes of death, making me wonder whether you give a care about the actual suffering of actual patients in actual situations like this. And since you brought it up, what facts DO you possess about Mari Chamberlain's medical situation? Please share them. (I have found very little data to date on this case, thus I made no comment on what was or was not medically appropriate.)
Again, it appears you are primarily concerned with an ideolgical agenda and have no qualms with ignoring any facts or individual cases that would challenge its legitimacy.
I sincerely hope you are not a health care provider.
The very fact that this patient has lived since efforts back at the end of May to terminate her nutrition and hydration, which is how I interpret the timeline given in the story, shows that she was not dying of an underlying condition that was going to kill her prior to death by dehydration, which takes approximately 10 days to 14 days. By my count, the end of May was over three months ago. If they had stopped nutrition and hydration then, she would be dead long ago. If she were literally unable to process nutrition and hydration, period, she would be dead long ago. The fact that she has survived with the feeding tube this long shows that the feeding tube is, in fact, effectively providing nutrition and hydration. That is the relevant point from my perspective. As for suffering, suffering can be relieved in far better ways--from every perspective--than by taking people in nursing homes (as this patient presently is, where she is receiving care) who *are processing food and hydration*, removing their nutrition and hydration, and dehydrating them to death. One only thinks of dehydrating people to death as a legitimate way of treating their suffering if one is seriously confused on a very important point.
We're clearly not going to agree on the 'proximate' vs. 'underlying' distinction. Dying slower is preferable to some terminally ill patients, families and advocates and not others. In some cases, force-feeding can be seen as more noxious than allowing nature to take its course. Clearly not for you or yours, regardless of circumstance - fair enough.
"In some cases, force-feeding..."
As for dying slower vs. dying faster, we are all "dying slower," Oka. Every last one of us. You and me both.
I take it that you regard it as "force feeding" to give this woman nutrition and hydration. On what basis? If it is a matter of consent in your opinion, at a minimum it would seem to me that you would need some reason to believe that she does not, did not, or would not wish to receive effective (for nourishing and hydrating) food and water at this time in order to use the phrase "force feeding." Otherwise, it's just an invidious phrase. We could argue about force feeding where some such argument could be given if we wanted to, I suppose (e.g., if a person has signed a statement saying that he doesn't want a feeding tube), but in this case the description does not even seem to apply, unless you know something about the case that I have simply missed--i.e., that this woman has said she does not wish to receive food and water under these conditions or that she is right now attempting to refuse food and water.
LMc: "...it would seem to me that you would need some reason to believe that she does not, did not, or would not wish to receive effective (for nourishing and hydrating) food and water at this time in order to use the phrase "force feeding."
Precisely; this is why doctors routinely look to the family for guidance. As to your use of "effective," that depends entirely on whether you mean the ability to merely sustain physiologic life a few more weeks or months, or whether you mean "effective" as a means to help the person restore meaningful function? And who defines "meaningful?" Also the patient or her appropriate surrogate.
~80% of adult Americans don't have a living will or similar directive to guide such clinical decisions. Of those remaining 20%, the research indicates that most of them would grant at least partial permission for their surrogate to override their written wishes if there were medically specific reasons for doing so. Living wills are in most instances overly generic (and in some instances slightly dangerous) 'pre'-informed consent documents that do not readily conform to often-fluid medical situations or inform many intermediate medical decisions.
The sobering point remains that most of us will ultimately be at the mercy of our loved ones, regardless of any directive.
"Forced feeding" was a commonly used term in the old days prior to the more neutral "artifical nutrition and hydration" (ANH). "Forced" was meant literally to describe & contrast the process to "voluntary" and/or " by mouth" -- not descriptively as to whether the patient was a willing recipient of the intervention.
Yes we're all dying, Lydia. You know that wasn't what I was referring to. Rather, prognosis and the immanence of death.
Like I've said multiple times, we seem to keep talking past one another. You really want to understand my perspective? Go volunteer to sit on your local hospital's ethics committee as a community representative. Better yet, volunteer at a nursing home and befriend a PVS patient. Then report back after a year or two about your opinion on the immutable & intrinsic value of feeding tubes. Or dialysis. Or ventilators. Or multiple visits to the ED that bankrupt a person's estate and his caregivers. At least then you'll be able to talk about specific cases that you've seen with your own eyes and have been privvy to all the details. I will read that post with great interest.
Until then, may I suggest that for the benefit of SHS that you respond to other posters than myself for a while? We both seem to share a desire to get the last word and are perhaps stifling participation by others.
To this end, I will help you out. I am taking a extended hiatus from SHS, at least from posting though I will visit regularly. I said I was here to learn so I'm going to shut up and read until '09.
Oka
Oka
This is good, I think. Passive euthanasia is disgusting, unless combined with a substantial dosage of painkillers.
Active/aggressive euthanasia, or none at all, in my opinion.
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