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End of Life Care: Are food and water ‘medicine’?

We can’t live without food and water. Our bodies rely on these basic essentials of life for survival. Think for a moment about a time you were extremely hungry or thirsty. Remember the hunger pains, the light-headed feelings, the dry mouth and throat, the loss of energy? Now imagine going without food and water for as many as 14 days!

Food and water are necessities for life on earth to continue. They don’t directly heal diseases. So why are food and water considered medicine for some people needing health care?

While it may seem simple to many of us that food and water are not “medical treatment,” there is an alarming trend in withholding or withdrawing food and water (also called “nutrition and hydration”) from certain vulnerable persons. As a matter of fact, courts have repeatedly allowed health care workers, at the family’s request, to stop feeding their patients.

The “quality-of-life” mentality

We’ve probably heard it before: “I wouldn’t want to live like THAT.” Or, “I know she/he wouldn’t want to live like THAT.” “His/her condition won’t improve, and his/her ‘quality of life’ is not worth living.”

Such statements can refer to persons who, because of disability or disease, need assisted feeding. Sometimes this is done through a straw or with a spoon. For others, food andfluids are provided via an IV (a small needle inserted into the vein), an NG-tube (a small tube inserted through the nose), or a G-tube (a small tube inserted through the skin into the stomach). Through these tubes, people are nourished with real food and water. While some may consider such tubes “artificial,” they are really no more artificial than a spoon or a baby bottle–devices used to help a person receive the nutrition and hydration necessary for survival. In fact, it’s very natural to allow technology of all kinds to help us and those we care for.

Too often, persons needing this assisted feeding are viewed as less-than-human–“burdens” or “vegetables.” Some of these persons are conscious and aware; some are not. However, all are living human beings equally deserving of treatment and care. To deny them food and water because of the so-called “low quality” of their lives is nothing less than lethal discrimination.

What is your intent: To avoid an extraordinary or ineffective means? Or to end a person’s life?

Sometimes patients decide that a specific medical intervention is “extraordinary means”–that is, it is gravely burdensome for the patient to bear or otherwise requires heroic virtue. For instance, a patient who is already significantly weakened by a life-threatening disease might decide that another major surgery which requires travel to a distant location is extraordinary means for him or her. Other times, a determination is made that some particular measure is not effective to prolong the patient’s life, to preserve or restore functioning, or to relieve symptoms the patient is experiencing. For example, in the final hours of a patient’s life, the provision of food and water might not be effective. In these cases, although death may follow when extraordinary or ineffective means are not administered, death is not intended. Rather, the patient simply accepts the reasonable limitations on his/her ability to stop death.

Today though, proposals to withhold or withdraw food and water can involve neither ineffective nor extraordinary means. Many chronically ill or disabled persons, including those said to be in a so-called “persistent vegetative state,” can live for years with assisted feeding devices that are easily tolerated, medically simple (low-tech), and not excessively expensive. When such assistance is stopped, there is only one desired result–death, and this amounts to killing–euthanasia–by starvation and dehydration.

Everyone seeking to make the right medical treatment and care decisions must, therefore, honestly assess his or her intent. A means considered ordinary for others must not be considered extraordinary or ineffective for severely impaired persons because of a judgment that the so-called “low quality” of their lives makes them not worth living.

Starving and dehydrating to death

While some who advocate withdrawing or withholding food and water may speak of “ending a patient’s suffering,” few people are aware of just what can happen once food and water are withdrawn.

These are possible effects:
-mouth will dry out and become caked with a thick material
-tongue will become swollen and may crack
-lips will become parched and cracked
-eyes will sink back into the orbits and cheeks will hollow
-the lining of the nose may crack and lead to nose bleeds
-skin will hang loose on the body and become dry and scaly
-urine will become highly concentrated, decrease in volume and may stop altogether
-stomach lining will dry out and cause dry heaves and vomiting
-brain cells will dry out causing convulsions
-respiratory tract will dry out, giving rise to thick secretions that could plug the airways and lungs, leading to death
-eventually all major organs will fail–including lungs, heart, and brain

Does this sound like “alleviating a patient’s suffering” or inflicting more suffering on the patient? Just because a patient may have lost the ability to express hunger and thirst doesn’t mean he/she doesn’t feel it. Indeed, sedation has been recommended when food and water are withdrawn from those in so-called “persistent vegetative state,” and other medication or disease can mask the symptoms of starvation and dehydration. Death by starvation and dehydration may take up to 14 days.

The answer: true compassion

The dictionary definition of compassion means to “suffer with” another person. People needing assistance in living are not “useless burdens.” Instead, these vulnerable human beings deserve extra care, extra attention, and extra love. Withholding nutrition and hydration from a patient, then, may really mean starving and dehydrating a human being to death.