Tuesday, September 25, 2007

Not Writiing About Vatican Food and Fluids Directive

I have been asked whether I will comment on the Vatican's directive regarding the application of tube-supplied food and fluids to those with a diagnosis of persistent vegetative state. I will not. That is a sectarian matter about which I am not qualified to comment.

That being noted, I believe it is wrong to deprive someone of food and fluids because they have a profound cognitive impairment. If people want to be dehydrated in such circumstances, it should be up to them to make that very clear in a written advance directive. Otherwise, the presumption should be for continued life, unless the provision of F and F is medically unwarranted, such as when the person is actively dying and the body is shutting down.

On a related note, I see that Michael Schiavo's little political PAC has failed and he is shutting it down. Why the man ever thought he could be an attractive leader is beyond me.

(Photo by WJS)



At September 25, 2007 , Blogger James said...

Thanks! You know that is going to come in a month at the antiethunasia cnvention in toronto.

At September 26, 2007 , Blogger Stephen Drake said...

While I didn't comment directly on the Vatican Directive, I figured there was pretty good fodder when it came to the reactions I was reading:


At September 26, 2007 , Blogger JacqueFromTexas said...

Oh, Wesley, my heart is breaking.

If people want to be dehydrated in such circumstances, it should be up to them to make that very clear in a written advance directive.

So you believe suicide by imposed medical neglect is acceptable? You believe forcing people to participate in someone's death by denying them food and water is perfectly okay? Say it ain't so. I don't want to have to rethink my crush on you. :)

I'm anti-suicide by any means and emphatically anti-advanced directives, but you're aware of that by now.

At September 26, 2007 , Blogger Wesley J. Smith said...

No, Jacque, I am recognizing that I am not the dictator. I am saying that if people want to refuse feeding tubes, it is incumbent on them to provide for that unequivocally, in writing. If they do, then it would not be "imposed medical neglect," as it would be in a futile care situation. I do not believe you can force someone to have unwanted surgery in such cases.

At September 26, 2007 , Blogger James said...

I agree Wesley. I believe a person should have the right to decline a feeding tube if they choose to by coming up with explicit instructions such a living will or advanced directive.

However, in cases where there no written instruction and just vague statments about feelings of life prolonging measures, then I believe is not right to remove a feeding tube.

This especially true in cases like Terri Schiavo.

Hopefully, the new Catholic position will help people to give further thought on starving and dehydrating loved ones to death.

In case similiar to Terri, these people are very vunerable.

They are allowed to live because the guardian has allowed them to live.

At September 26, 2007 , Blogger JacqueFromTexas said...

Hmmm- duly noted, but I think self-determination ends at harm to self or others. Someone who refused to drink and eat is the same in my mind as someone who self-mutilates or threatens suicide. This is because I don't view food and water as extraordinary medical treatment, regardless of how it is administered. When we conceded food and water as medical treatment, we accepted passive euthanasia (as well as people being starved in nursing homes because feeding was a time-consuming task.) Furthermore, I think too many people are all to quick to accept people's deathwishes for financial or ideological reasons.

Beyond that, I've done an exhaustive literature review on advanced directive research and even those that support the ideal behind them admit that they almost always fail at communicating the patient's wishes. I read of several studies with the proxy and the patient where the patient completed advanced directives (both types: scenario-based and values-based) and then the patient and proxy were given a scenario. The patient stated their wishes and the proxy was to guess their wishes based on both their knowledge of the patient and based on the advanced directive. A vast majority of the time when the proxy used the advanced directive, the proxy was wrong. In fact, the advanced directive led the proxy astray, when the proxy's guess was closer to the patient's wishes.

Another study compared the advanced directive to what the patient indicated were there wishes at a later time. The wishes almost always changed with time. Another study took the completed advanced directive of a patient and the patient's wishes in certain scenarios- most of the time the patient's wishes in those scenarios didn't match those they indicated on their advanced directive.

So I don't think advanced directives are reliable enough to starve/dehydrate someone based on them, since they been proven ineffective.

P.S. I can email a copy of my paper to anyone that is interested.

At September 27, 2007 , Blogger T E Fine said...

Jacque -


I'm interested!

At September 28, 2007 , Blogger JacqueFromTexas said...

t.e. fine-

I will find it and send it your way!


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