Comments on Secondhand Smoke: Your 24/7 Seminar on Bioethics and the Importance of Being Human: Janet Rivera: Case Overview

Just to clarify my earlier post...I do realize tha...

2008-07-31T09:55:00.000-07:00

Just to clarify my earlier post...I do realize that PVS (which may or may not be the case with Ms. Rivera) is not strictly speaking a terminal condition and the dysphagia associated with PVS is different than one's GI tract shutting down in the last days or weeks of, say, pancreatic cancer. Nevertheless, my point is that the mere invention of NG & peg tubes does not mandate their usage in all situations, and that dehydration as a proximate cause of death secondary to PVS is preferable to many other types of demise, I.e. infections, MI's, etc.
I also realize that some folks make a black & white distinction between ordinary and extraordinary means of life support and always consider food & fluids to be in the former category. Fair enough, but considering that dying in America is for most people more often a process than a moment, such a position begs the question: what then DO you want to die from? This is by no means a rhetorical question, and it is difficult for many people to reconcile intransigent ideological views with limited & bleak medical alternatives they encounter in situations like Ms. Rivera's or that of the Florida boy (Brad?) in another post.
The duty to care for the sick, vulnerable & disabled is a fundamental virtue for any moral individual or society, but the tricky task is to figure out how that care is meaningfully defined in specific cases and for specific conditions. Navigating this terrain by way of moral absolutes ("death by dehydration is always wrong!") is always tempting because it is easier than wading into the compicated and murky depths of extended life spans, evolving medical technologies, and limited health care systems. That said, I'll put my (guarded) trust with the waders.

Okakura: Well, I will let Lydia speak for herself....

2008-07-31T09:15:00.000-07:00

Okakura: Well, I will let Lydia speak for herself. But I have made that distinction in my books and speeches often.

It never hurts to bring it up again, though.

Quite the contrary; my take from Lydia's comments ...

2008-07-31T08:17:00.000-07:00

Quite the contrary; my take from Lydia's comments is that there exists a blanket moral imperative to prevent people from dying regardless of their condition, and that death by dehydration - even when it is secondary to an underlying disease or condition - is therefore also wrong. Not seeing any distinction made in this particular thread (which I was responding to). Perhaps I have missed something.

Okakura; You haven't been around here long, appare...

2008-07-30T22:12:00.000-07:00

Okakura; You haven't been around here long, apparently. We all know that distinction. It has been made frequently and often, by me, and by commentors.

Welcome to SHS, by the way.

Lydia: You don't work in a hospital, do you? In ma...

2008-07-30T21:04:00.000-07:00

Lydia: You don't work in a hospital, do you? In many end-stage conditions, the body's digestive system naturally shuts down. To 'force-feed' or 'force-hydrate' in those situations because of some technological imperative (that any and all medical means must be employed at all times regardless of circumstance) is not moral - it's irrational at best and cruel at worst. I take it you are NOT morally offended when a totally obtunded PVS patient with a feeding tube dies "naturally" of a massive infected bedsore or an anyerism? Please explain the moral logic of this, or better yet, volunteer at your local hospital ICU and explain this line of reasoning to a grieving family.

Nobody should be dehydrated to death, period. It m...

2008-07-29T09:06:00.000-07:00

Nobody should be dehydrated to death, period. It makes it no better to dehydrate a person while that person is lying in a hospice bed than to dehydrate the person to death lying on the street. The killing by dehydration is the same. It doesn't matter of the person is "irrevocably unconscious." It's still wrong to dehydrate the person to death.

I don't always understand very well why people can't stick to those simple moral truths.

As it stands now, American health care is already ...

2008-07-28T21:43:00.000-07:00

As it stands now, American health care is already effectively rationed by income, which greatly determines the type of regular preventative health care that you and your children can afford. The horrible effects of this income-based system is seen regularly in end-of-life care for these chronically underserved patients, many of whom die prematurely of largely preventable/manageable conditions. I don't see our present system providing any real protection against such discrepencies, even if it stops short of unilaterally 'pulling the plug' on such patients when they are either at death's door or irrevocably unconscious.

Okakura: Thanks for asking and for stopping by SHS...

2008-07-28T15:28:00.000-07:00

Okakura: Thanks for asking and for stopping by SHS.

The "Yeah right," wasn't aimed at him as an individual, but at the notion that we would be very careful once we decided to let bureaucrats, doctors, bioethicists, or anyone else decide that wanted care could be deprived based on resources/quality of life considerations. Once we let the wolf in the door, "careful" goes away and a new paradigm comes into place. And the victims end up being the powerless.

"The stewardship of scarce resources does require ...

2008-07-28T11:47:00.000-07:00

"The stewardship of scarce resources does require us to take resources into account," said Ben Rich, a University of California at Davis bioethics professor. "But it has to be done carefully.

WS: "Yeah right."

Do you know the context of Mr. Rich's remarks or are you just assuming that by merely answering a general question on the issue of resource allocation that Rich is advocating some sinister system of non-voluntary withdrawal of life support on the broad grounds of medical futility? Do you know Dr. Rich personally? If you don't, such a remark comes off as both snide and unprofessional.

Lydia: The family has not contacted me. But I thin...

2008-07-27T17:29:00.000-07:00

Lydia: The family has not contacted me. But I think what happened is the family was told she would expire very quickly after removing of the resperator. When that didn't happen, and now she was not receiving food and water, they realized that, perhaps, they had not been given accurate info, or perhaps, the expectations were wrong and so they thought the treatment issues should change accordingly.

Well, once it turned out she was breathing on her ...

2008-07-27T17:26:00.000-07:00

Well, once it turned out she was breathing on her own, it shouldn't have been so surprising that she lived for a while. I'm referring here to the one comment (by someone on the county's side) that she "lived longer than expected" and that that was why her feeding was reinstated. That cannot refer to her being able to breath unassisted, because they could have determined that within, what, a day? An hour? No, it means she lived for _12 days_ without food and water. What is this, an endurance test? If you can make it for twelve days without water, they say, "Oh, maybe we should give her water, now"? And the rationale there would be... I mean, the whole point of withdrawing hydration is that you're going to sit around and wait until the person dies, even if it takes two weeks. I can't figure out if the guy who made that comment was just ignorant or what.

Do I understand correctly, Wesley, that the family thought she would die immediately without the ventilator and that this was why they didn't make more of a fuss when everything was withdrawn? That was the impression I got from the earlier linked article. But then they were shocked when she breathed on her own and the food and fluids were still withheld?