Starving someone to death is not “end of life care”

I’m sick of the lying.  Yesterday, Barack Obama, in a conference call to sympathetic religious leaders, accused his enemies of “bearing false witness” against his socialist health care plan.  The Democrat shills at Yahoo and the AP keep trying to “debunk” the “myths” about “Health Care Reform.” 

He calls the discussion of abortion coverage a “fabrication,” but the point is that, as a priest recently pointed out on Facebook, if abortion is not specifically *not* covered, it is implicitly covered by Obamacare because it is a legal medical procedure.

And then there’s Sarah Palin’s “Death Panels” comment. 

Now, there are two issues at stake here:

1.  Obama and his supporters are conveniently skipping over the question of “rationing”: that in any government-run healthcare system, there is rationing of services.  This is expressed in minimal practice by the waiting lists in Canada and the UK.  I’ll do a separate post on that later.

However, it needs to be said that, when people talk about “death panels,” they’re talking in part about panels that will at least establish triage rules if not the very overt elimination of “inferior people” advocated by Peter Singer, Tom Daschle, and several of Obama’s closest advisors.

2.  The question of “end of life care.” Obama’s supporters, including some Republicans, say the issue is just whether Medicare/Medicaid and the hypothetical “government option” should pay doctors to give “end of life” counseling to elderly and terminally ill patients–things like living wills and such.  They claim it’s not about the government or doctors dictating the end of life decisions, and that provisions specifically forbid euthanasia or assisted suicide counseling.

That’s all a matter of your definition of terms.  Because the Obama Apologists point to the Terri Schiavo case as the example of what they’re talking about.  In *their* view, an individual has the right to decide *not* to receive basic care such as nutrition and hydration.

I’m the first to admit that a patient should be allowed to refuse measures which can be classified as “extraordinary” according to the criteria laid out in the Catechism, and that any one of the conditions listed in the Catechism can be sufficient to refuse a medical treatment.

For example, I don’t get the flu vaccine, even though I’m in the category that “ought to”.  In my experience , every year I got the flu vaccine, I ended up getting a horrible bout of bronchitis or pneumonia .

Or when a particular medication has side effects that are too severe for the particular user, that’s an extraordinary measure in that person’s case.

But basic survival is a moral obligation.  Even if one believes a feeding tube as such is “extraordinary,” one is still obligated to provide *some* sustenance.  It wasn’t just that they removed Terri Schiavo’s feeding tube–that was bad enough-but after they did that, they tortured her by not even trying to give her ice cubes or small amounts of food by mouth.  They brutally starved her to death.

A feeding tube is not the same thing as a respirator or other “life support.”  On a respirator or heart-lung machine, one could theoretically go on for years in a physiological limbo.  But one can also die on such a machine, in spite of artificial survival.  There is no natural cognate to the machine in that case: but for a feeding tube, the natural cognate is just eating or drinking. 

My mother in law lived off a feeding tube for a year.  In terms of basic life functions, there was nothing else wrong with her.  Certainly, there were times she felt like “giving up”–quite frequently, in fact–but she kept going.  Seven years later, she’s living a fairly normal, active senior life. 

Now, when she was at the worst of her situation, she’d had several surgeries, infections, etc., and it was pretty dire.  It would have been one thing to say, “I don’t want any more surgeries.”   Had she made that decision, it would have been sad and tragic and ironic (given that the last one was the one that worked), but that would have made sense.

However, to say, “Take out the feeding tube” would *not* be a morally acceptable decision, because, while it’s a very nuanced difference, that would have been to actively kill her. 

Certainly, these matters are complex.  We are not, as Obama has claimed, “God’s partners in matters of life and death”–at least not in the way that he means.  Indeed, we should be God’s “partners’ in these matters, if he means prayerfully deciding what action is most in keeping with moral law.  But when we force God’s hand, whether it’s by contracepting, or using IVF, or by denying basic life sustenance to a seriously disabled or terminally ill person , we are not “partnering”–we’re controlling.

Recently, some friends’ former son-in-law passed away.  Their grandson was faced with the troubling decision of whether to “pull the plug” on his own father.  God was merciful, and his father passed away that night on the life support, anyway.

On the other hand, there was a family member who, after multiple bouts with cancer, signed a living will with a blanket refusal of life sustaining measures, which was phrased so broadly that, when the time came, she was starved to death.

And then there was a family friend who was in a horrible traffic accident like a year and a half ago.  When it first happened, he was on lifesupport and not responding, and there was a big debate about “pulling the plug.”  Before a decision was made, he woke up.  Then they said he was completely paralyzed.  Then he wasn’t.  Now he’s walking again and, while not 100%, mostly back to his old life.

As I have read many stories of middle aged Marfans who coughed too hard, thus dissecting their aortas, and then went into comas for several months only to die of respiratory failure when their lungs filled up with blood, I wonder how I want such a situation handled.  I don’t want to be arbitrarily denied care or taken off the machines.  I don’t want to die *only* because a living will was improperly written or whatever, too vaguely.  

Or my wife’s cousin, who was the center of a national Botox scandal, whose father almost “pulled the plug” when things were most dire (they brougth the family together and used the minimal communication they were able to get from her–as they do with people with “locked in” syndrome–to get her response on which family member she wanted as her representative), but she’s since recovered.

I’ve never been comfortable with the idea of shutting down “life support,” nor with the idea of “brain death.”  

So much of it depends on the exact circumstances ,an

Should people have living wills?  Yes, if only to protect themselves from the  Michael Schiavos of the world. 

Should people carefully consider these issues?  Yes. 

Should doctors or the government or the insurance be the ones to “counsel” people?  No.  This decision should be made with detached parties who have the expertise in the moral rules, with a thorough understanding of the medical situation and possibilities, not with those who have a vested interest in the situation.

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