Twenty hours before my father died, the doctor came to us and recommended that his feeding tube be removed.
He was dying. He could no longer digest anything. All his organs were shutting down.
I did not hesitate to agree that the tube should be removed. There is no sense in pumping fluid into someone who can no longer benefit from it.
My dad did not starve to death on his hospital bed. He died a beautiful death and departed for the heavenly country in peace. I wish he could have stuck around a little bit longer, but that is another matter…
Five years ago, our whole country watched Terri Schiavo slowly starve to death after the court ordered that her feeding tube be removed. She was NOT dying. She just needed someone to feed her.
We can hope that Mrs. Schiavo died in the friendship of God. But her death was not peaceful for everyone else. There has yet to be a full reckoning of what happened. In Italy right now, there is a similar case.
After Terri Schiavo’s death, our family had an argument about medical “advance directives.” A couple of my relatives insisted that they would draw up directives to the effect that, if they became incapacitated, they did not want feeding tubes for an indefinite period of time.
“Do not keep me alive with a tube!” these relatives insisted.
My response: I don’t care what your advance directive says. If you are not dying, I will see to it that you are fed. I am not about to get myself sent to hell for starving you to death. You will remain on this earth as long as God wills.
I bring all this up because last month’s issue of Ethics and Medics includes a debate over the following question:
Must we respect a patient’s advance directive refusing tube feeding, or should we provide food and water until death?
Pope John Paul II said that nutrition and water must be given for as long as they can do any good.
In his Ethics and Medics article, Stephen Napier argues that patients’ advance directives refusing tube-feeding should be honored. He claims that ignoring patient wishes inflicts spiritual, “theological” suffering. Under such circumstances, nutrition and water does NOT do the patient any good, he claims, but rather harms the patient.
Napier also claims that Pope John Paul’s declaration regarding food and water is aimed at doctors and nurses only, so patients are free to ignore it.
Both of these claims are nonsense. Dr. William E. May rebuts Napier in Ethics and Medics. In my humble opinion, however, Dr. May’s response is not adequately precise.
First to Napier’s claim regarding inflicting “spiritual, theological suffering” by feeding someone: It does not seem possible for one human being to inflict “theological” suffering on another (unless you are talking about a really tedious seminary class!) I have never even heard of “theological suffering.” Perhaps the phrase could be used to refer to eternal damnation at the divine Tribunal. When it comes to the question at hand, “theological suffering” is nothing but a fiction, cooked up to justify a foregone conclusion.
Tube-feeding may not be pleasant for the person being fed. A nice juicy Italian coldcut sub would certainly be better. But if you’re looking for suffering, try watching someone starve to death. Nat Hentoff has described it.
Secondly, the moral question at hand, namely whether we are allowed to starve helpless people to death, does not pertain to the moral life of the helpless person. It is a matter for the people who take care of the helpless. For a caregiver the principle at work would be: Nobody can in good conscience preside over the starvation of a helpless person.
This resolves the question, but there is more in Napier’s article to rebut. He makes another spurious distinction. He claims that there are different motivations for a patient to order that he or she not be fed through a tube for a long period of time.
On the one hand, Napier claims, it would be wrong for me to insist that I be starved to death if what I am aiming at is my own death. That would be suicide.
On the other hand, it is fine for me to order that I should be starved if I primarily intend to spare my family and the community the burden of taking care of me, and accept my death as a consequence of this. This, Napier claims, is charity, not suicide.
The irony of Napier’s making this pointless distinction is that he makes it in the service of an attempt at “spiritual” violence, the likes of which he earlier lamented.
Where is the charity if I try to make someone do something that no one in good conscience can do?
If I become incapacitated to the point where someone else would have to feed me to keep me from starving, I have no right to try to force anyone’s hand. If I tried to oblige my loved ones to neglect to feed me, it would not be charity on my part. The charitable thing would be for me to submit gratefully to the loving care I would be given. I have no right to demand that someone else commit a sin just because I don’t like the idea of being helpless.
Napier’s writes with stunning creativity. But moral problems cannot be resolved by created fictions used to camoflauge foregone conclusions. Moral problems can be resolved only by humble submission to clear principles and the exercise of sober reason.
Sober reason concludes that the admirable desire to respect patients’ wishes cannot justify starving a helpless person to death. This is not really a clash of principles at all.
Respecting patients’ wishes is a good thing to do whenever possible, a matter of courtesy.
Feeding helpless people so that they do not starve to death is something we HAVE to do. This is a principle.