End of life issues...


#1

**In caring for a terminally ill or dying individual, what medical care/treatments are we morally obligated to provide, and what medical care/treatments are considered optional?

Any opinions from a current/former nurse or doctor are especially welcome. :thumbsup:

Thanks to all who reply. God bless you and yours. :slight_smile:
**


#2

You are definitely required to provide nutrition and hydration. this is not considered medical intervention, but ordinary care.

Just about anything else will have to be a decision between family and doctors.

My mother wanted me to be the second on her durable power of attorney for health care, and I refused, because she did not want to be fed through a tube, or really have any other interventions (she had MS). I refused. I could NEVER starve someone to death.

She was lucid almost to the end and even consented to a trach tube. She died fewer than 24 hours after it was inserted.


#3

as a new catholic and an icu nurse, this was a big question for me. i found my catechism book and it had the answers. things like…morphine can be given to ease the pain or for comfort at the end. even knowing that it’s administration may stop breathing…as long as there is nothing we can do to change the fact the patient is going to die. fluids and nutrition will not keep a dying person alive, so giving them is ok. it’s even ok to turn the ventilator off if keeping it on would not change the outcome except to prolong the inevitable. medically we can keep a corpse alive for a very long time, but when God is calling this person home, what gives us the right? many times people prolong their loved one’s demise because they are selfish and cannot let go instead of allowing God to end the patients suffering and let them go to Heaven.


#4

Thanks everyone. :thumbsup:

I think my biggest struggles have been when doctors/nurses say that a patient will die, suffer intense pain if you try to provide fluids? :confused: Such as with heart or lung problems. Is hydration sometimes not possible?

Also, resuscitation? Is it required if the heart has stopped beating?

What is “brain dead”…when is the person really dead?

I would say to continue hydration and to resuscitate…but have always been confused on these matters, especially when I am not in charge of the situation.

I didn’t know exactly where the church stood on end of life matters save for letting person die naturally and providing hydration. Sorry this is grotesque. :o

Anymore opinions are most appreciated. :slight_smile:


#5

You’ve gotten very good advice so far. I am a nurse too, used to work on cancer floors and did a stint in neuro ICU. Nutrition and hydration are a must. Remember Terri Schiavo. She was murdered by starvation.

Beyond that, the best thing to do is get honest answers from the doctors. If there is no chance of recovery, you are not obligated to continue extraordinary measures, but you can if you choose to. That means things like ventilators, or surgery to insert any assistive devices like trachs or stents or anything is up to the family if the patient can not give their consent. You are not doing wrong by either refusing them, or choosing to use them. But if a feeding tube or central IV site is needed for nutrition/hydration, then that must be put in. At least, that is the way I have understood the Catechism. Think about JPII, he chose to have a feeding tube, but no other extraordinary measures.

Will be praying for your family.

ETA: With some types of heart failure, excessive hydration will actually worsen the problem, but nutrition still needs to be provided. In other words, no extra IV fluids, but some type of food, whether through the IV or a feeding tube in the stomach, should continue.


#6

actually, in the icu setting, hydration is not the problem. overhydration with horrible swelling is the problem since their kidneys have shut down by this point.
as for “brain dead”…that means that from the results of an eeg there are no brain waves. in other words, the brain which controls all body functions, will begin to swell to the point where the brain stem will push out the bottom of the skull and the heart and respirations will end. the patient dies in other words. there is no way to make the brain resume function. there is no such thing as a brain transplant.
lay people have no idea what torture it is to do cpr on a person. we often break their ribs while doing compressions because of the force needed to compress the heart. and you know how it feels to stick your finger in a light socket. imagine that times a hundred. it often leaves huge 3rd degree burns.


#7

Can a Dr., Nurse, or Nurse assistant provide ANY care for a person who chose to be off of any nutrition as long as we did not take out the tube or anything?


#8

I don’t understand the rules about hydration and nutrition for every terminally ill person. If someone has reached the stage where their organs are beginning to shut down and the body is beginning a natural progression toward death it seems that it would be wrong to force fluids and nutrition on them.

For example, my aunt recently died of pancreatic cancer. She stopped eating two weeks before her death. She continued to take small sips of water until several days before her death. The hospice nurses told us that at that point when she was obviously dying that it would be painful for her to receive fluids.


#9

No, you don’t have to force it on someone who is obviously at the very end of life, if doing so would cause them discomfort. But it would be unethical to deliberately withhold nutrition from someone to cause their death, like happened to Terri Schiavo. She was not dying, but was starved to death. Cancer patients especially will usually stop eating in the last couple weeks, and that is a natural part of the disease process. If it makes them feel worse to eat, and they are at the point where they will die anyway with or without food, it is not necessary.
This is the problem–it is so hard to define what is OK, when every situation is different. I just try to think about what would be best for each patient. If a treatment would make them uncomfortable and would have no reasonable chance of preventing their death, and they are very near death, don’t do it, choose comfort at that time. If, on the other hand, someone is not near death, just very ill, it is necessary to try to provide at least basic care for them, which includes nutrition/hydration. I hope I am wording this so it makes sense. These are very good questions that more of us need to think about before we are faced with it in one of our family members.


#10

Thank you, this is reassuring. I’ve had doubts about this.

What about despair vs. knowing you’re about to die and wanting a dignified death? My mother went through a series of operations when no one knew what was actually wrong with her and every operation was sure to solve it. She said at one point “Please, just let me die.” We thought she was just discouraged and despairing, we wouldn’t let her talk about it, but she did die, during the sixth or seventh operation. Should we have obeyed her wish and taken her home to die in peace? This is more of a rhetorical question, no one needs to feel pressured to answer this one for me, although I wouldn’t mind hearing your opinions.:o


#11

Thanks. That makes sense.


#12

Well, my thoughts as a nurse who has worked with a lot of cancer patients is, if the person knows they are going to die, and they are in their right mind, it is their choice to refuse further treatment or not. After you’ve been through some of the surgeries, and the chemotherapy, and all that it entails, you gain a different perspective. The patient usually knows when it is time to say, "Enough."
But from the perspective of a family member who has lost several relatives, it is harder to say when to stop treatment. You want to do the best you can for them. From outside, it isn’t usually until the very very end that we can say enough. The ill person themselves usually knows sooner than we do.

Again, it is different for each person. Some patients will fight until their very last breath. Others, seeing that death is inevitable, choose to not undergo painful procedures, they would rather have a higher quality of life for a shorter time, than a longer life full of more suffering. There is no right or wrong in that choice. Both are valid choices. Either way is hard for us as family to watch.


#13

i am no expert and am not currently working in a health field, however i just wanted to comment that if you are in the situation where you have to make these decisions for someone ( a family member, or you being a medical personnel),i think you just know. as long as you give it to God and ask him to guide you to make the right decision i think you just know in your heart. there have been cases where people have had family members in a coma for months or years and kept them alive and they eventually came out of it against the odds and opinions of the doctors and i think those people just knew it wasnt time to let their loved ones go yet. it will always be a hard decision if it’s someone you love because you have to be selfless, just as God was when he gave up his only son so that we could be free of sin.


#14

teakafrog…i think you said it very well. people just have no clue until they have been sick themselves or have to watch a family member die.i learned alot going thru chemo and radiation myself.

i think if more people would listen to God, he will tell you when enough is enough. all good nurses know to go with that gut feeling.


#15

I’m a critical care nurse, and I’ve seen many of these situations unfold.
Extraordinary measures and artificial feedings are not required to maintain life, according to church teachings.
However, as the Terry Shiavo case demonstrates, it’s much more unethical to to stop care, rather than chose not to insert a feeding tube to begin with. Just because the technology exists does not mean we are mandated to use it…
I do not believe the church would require artificial feedings to be started to maintain life. (Correct me if I’m wrong on this)

Legally, you cannot treat anyone without consent; that would be battery. Treatments are withheld and refused all the time.
This is not the same as euthanasia. There are several Catholic Hospices out there providing comfort care only.

Anytime I’ve taken care of a patient who’s been removed from life support (artificial ventilation, or medications used to maintain blood pressure and heart rate) I’ve never felt any guilt in participating in their care, because, I beleive that if God wants that patient to live off of life support, they will. I’ve seen patient’s withdrawn from care that we expect to die that don’t.
Life is in God’s hands.

I advocate for everyone to have advance directives in place (living wills and health care proxy designations) and have discussions with your family members about your end of life wishes.


closed #16

DISCLAIMER: The views and opinions expressed in these forums do not necessarily reflect those of Catholic Answers. For official apologetics resources please visit www.catholic.com.