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  #1  
Old May 10, '11, 7:37 am
desales09 desales09 is offline
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Default Unable to swallow food/fluids

If a person in their nineties with dementia has been declining in health for some time - vomiting up all given through the mouth until very thin, weak, and looking near death's door, and finally losing the ability to swallow - anybody who knows, correct me if I'm wrong, but artificial administration of food and fluid is still considered "ordinary means" in the Church's moral teaching and should be given UNLESS the patient's body is unable to assimilate nutrients. Right? So what should a caregiver in a facility do if he/she sees that these ordinary means are being withheld in such a case?
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  #2  
Old May 10, '11, 8:14 am
dixieagle dixieagle is offline
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Default Re: Unable to swallow food/fluids

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Originally Posted by desales09 View Post
If a person in their nineties with dementia has been declining in health for some time - vomiting up all given through the mouth until very thin, weak, and looking near death's door, and finally losing the ability to swallow - anybody who knows, correct me if I'm wrong, but artificial administration of food and fluid is still considered "ordinary means" in the Church's moral teaching and should be given UNLESS the patient's body is unable to assimilate nutrients. Right? So what should a caregiver in a facility do if he/she sees that these ordinary means are being withheld in such a case?
We were in a similar situation several years ago with a close elderly relative who was in hospice care in a nursing home.

She was bedridden, her digestive processes had slowed, and it was clear she was slipping away. She had been only semi-conscious for a while, and had been fed through a feeding tube. IV fluids were administered as long as possible until her kidneys and other systems shut down. In other words, nutrition and/or hydration was given to the degree she was able to digest. The hospice personnel were very attuned to her needs, and were aware of our Catholic views on the sanctity of life and ordinary/extraordinary means.

The family member(s) who have the medical proxy for the patient should speak up, and perhaps contact hospice. Does the patient have a "Living Will" that expresses her wishes?

I think that, sadly, many elderly and terminal patients have even hydration withheld, and family members often think this is normal and "humane." Very sad and wrong.
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Old May 10, '11, 10:35 am
Spirithound Spirithound is offline
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Default Re: Unable to swallow food/fluids

Quote:
Originally Posted by desales09 View Post
If a person in their nineties with dementia has been declining in health for some time - vomiting up all given through the mouth until very thin, weak, and looking near death's door, and finally losing the ability to swallow - anybody who knows, correct me if I'm wrong, but artificial administration of food and fluid is still considered "ordinary means" in the Church's moral teaching and should be given UNLESS the patient's body is unable to assimilate nutrients. Right? So what should a caregiver in a facility do if he/she sees that these ordinary means are being withheld in such a case?
Please consult a knowledgeable priest or Catholic doctor.
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Old May 10, '11, 11:08 am
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Default Re: Unable to swallow food/fluids

The Vatican Congregation for the Doctrine of the Faith issued a statement in response to a question posed by the USCCB on artificial nutrition and hydration (a question that likely arose in regards to the Terri Schiavo case). Here is the statement:

Responses to Certain Questions of the United States Conference of Catholic Bishops Concerning Artificial Nutrition and Hydration

In addition to the brief Q&A, they issued a Commentary on the statement that spells out the general principles in greater detail. The last two paragraphs in particular speak about the types of situations that may give rise to exceptions.

Basically, nutrition and hydration (AKA "food and water") are always considered ordinary means of care, even when administered via artificial means. Food and water are not medicine. They are -- at the most basic level -- what we all need to survive. However, if a person can no longer assimilate food and water, giving it to the person can become useless.

Spirithound's advice to consult a knowledgeable priest or Catholic doctor (preferably both, if possible) is the best advice. I can point you to the general principles the Church has given, but you really need to talk to a priest and/or doctor to help you apply these general principles in your specific situation.
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Old May 10, '11, 11:20 am
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Default Re: Unable to swallow food/fluids

Giving food or water by artificial means can sometimes only be done by placing tubes via a surgical procedure such as a g tube or a PICC or central line. Many patients (including many Catholics ) do not wish to go through any additional painful procedures at the end of life.

This must be considered on a case by case basis. A Catholic Doctor would be a great resource.
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Old May 11, '11, 7:32 pm
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Default Re: Unable to swallow food/fluids

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Old May 11, '11, 8:03 pm
jomoco jomoco is offline
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Default Re: Unable to swallow food/fluids

They're called PEG tubes. It's a simple safe surgical procedure that extended my wife's life allowing her get the nutrition she needed to live without tubes through her nose.

If your patient's life expectancy is in excess of 30-60 days, and she is lucid enough to make the decision to live? It is an effective option that deserves serious consideration with consultation from a qualified doctor.

This is a good source on the legal and ethical aspects of PEG tube feeding.

http://www.thedoctorwillseeyounow.co...g/art2071.html

Good luck and best wishes for you and your patient.

jomoco
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Old May 11, '11, 8:31 pm
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foundmyfaith foundmyfaith is offline
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Question Re: Unable to swallow food/fluids

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Originally Posted by jomoco View Post
They're called PEG tubes. It's a simple safe surgical procedure that extended my wife's life allowing her get the nutrition she needed to live without tubes through her nose.

If your patient's life expectancy is in excess of 30-60 days, and she is lucid enough to make the decision to live? It is an effective option that deserves serious consideration with consultation from a qualified doctor
From your post, I assume that your wife has passed on. I extend my sympathy to you. I am also glad that the PEG was effective for her.

However, PEG placement is still abdominal surgery. Sure, it's minor compared to a bowel resection or something, but it can be painful and also comes with its own list of possible complications. Many People do not wish to go through such things as they near the end of their lives. If the patient has dementia, they may be extremely frightened by the procedure and attempt to remove the tube themselves. This can be painful, and the tube will have to be replaced. (though it is usually pretty easy to put back in)

I believe in following a patient's wishes. If their wish is to undergo these procedures, they should. If it would simply frighten them or they did not wish it, it should not be done. I am glad it worked for your wife, but we seem to agree that consultation with a qualified doc is the real answer here.
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  #9  
Old May 12, '11, 9:12 pm
Listener Listener is offline
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Default Re: Unable to swallow food/fluids

It seems to me that it doesn't make a lot of sense to give a feeding tube to a dying person with dementia. It seems like the person wouldn't know what it was for and would probably pull it out.

I should say that I'm not a doctor or a nurse, so maybe there's something I don't understand about feeding tubes.

I am puzzled as to why a the Church says that feeding tubes are ordinary but it is an extraordinary measure to be hooked up to oxygen.

People can go for quite awhile without food, but they will die right away if they are unhooked from oxygen (assuming they can't breathe on their own).

Anyway, a person with dementia would probably pull out the oxygen tube, too.

I guess each case is different, but sometimes you just have to use your common sense.
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