On Sheep, Goats, and Feeding Tubes
Our Lord made no distinction between a plate and a tube
Over the last few years there have been a number of high-profile cases of patients in a vegetative state dying after they had their feeding and hydration tubes removed. The most recent case was in France, where a brain-damaged and crippled man named Vincent Lambert had his feeding tube removed by his family. One might be tempted to think that these cases are extraordinary, but in fact they are quite ordinary. The current “best practice” is to remove artificial hydration and nutrition so that patients actively dying can complete the dying process. But we should find this practice morally reprehensible. It is only because it is an already emotionally charged time and health-care professionals are earnest in their desire to make the patient comfortable that many people consent to an action that in all other situations they would find morally repulsive. In order to avoid being trapped in situations like this, it is better to understand the situation in principled terms beforehand.
The discussion ought to begin by challenging, or at least clarifying, the assertion that a patient is “actively dying.” The term “actively dying” contains some degree of arbitrariness. What is not arbitrary is whether a person is actively living, and if a person is living then it is a “best practice” to offer them food and water. We must not set aside the conviction that we are obliged to offer hydration and nutrition to persons as long as they live.
A second necessary distinction is between medical treatment and ordinary care. Medical treatment includes direct interventions like antibiotics, surgery, and chemotherapy — things that will aid in restoring the health of a patient. It may be determined that a particular treatment will not work or that its burdens on the patient outweigh the benefits. One may decide to forgo treatment in order to live one’s remaining days with a certain quality of life.
Medical treatment is different from ordinary care. Ordinary care is simple attention given to the patient’s well-being. This includes bathing, providing clean clothes and sheets, warmth, and providing food and water. Because each of these is essential to those who are actively living, especially for those who cannot provide them for themselves, it is cruel to withhold them. One would never consider leaving someone exposed to the elements outside as an act of beneficence; nor would we, in the name of compassion, allow someone to starve and become dehydrated.
St. John Paul II highlighted this difference between treatment and care in a papal allocution of 2004:
“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”).
In short, we can say that ordinary care is something we offer to everyone, regardless of whether death is imminent or not. To withhold it is to cause death, even if only indirectly. We might choose to do nothing to stop death, but we must never aid it. Deliberately starving and dehydrating someone makes us complicit in their death. Still, even the saintly pontiff pointed out that hydration and nutrition need not be given in all circumstances. Food and water should be given in all circumstances up until the time that they no longer can be processed or assimilated by the body. This must be “seen,” though. 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 this is true, it means they should be fed less rather than not at all. Often this argument is put forth as a reason for omitting food and water altogether. The only proper time for complete removal is when it is shown that the body no longer can make use of them.
We Christians are admonished to feed the hungry and give drink to the thirsty. These corporal works of mercy are what ultimately separate the sheep from the goats. Our Lord made no distinction between a plate and a tube, and neither should we. If there is a living person in front of us, then we should never cease practicing these works of mercy. Provided the person can still assimilate food and water, you should never remove a feeding tube or a hydration IV.
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