Christian Medical Group Weighs In on Quality-of-Life Decision, Advance Directive

Center For Moral Clarity ^ | 4-1-05 | By Bill Fancher and Jody Brown

[hope]

Christian Medical Group Weighs In on Quality-of-Life Decision, Advance Directive By Bill Fancher and Jody Brown April 1, 2005 (AgapePress) - A Christian physician says when it comes to "quality-of-life" decisions, there is a huge difference of opinion between those making the decision and the patient. Dr. David Stevens is president of the Christian Medical & Dental Associations. Stevens says the quality-of-life debate was one of the big factors in the Terri Schiavo case and was weighed by the courts before they ordered her to be starved to death. According to the CMDA spokesman, quality-of-life evaluations often do not coincide with what the victims of the evaluations feel. "Studies of the health-care community have found that [those making the decision] always thought the quality of life was lower for the patient than the actual patient did," Stevens says. Such evaluations, he says, are not an exact science. "Any time you take someone's external judgment and impose it upon those who are vulnerable [or] those who are disabled, they always see a life not worth very much -- yet those who are in those conditions often have a very fulfilled life," he explains. Through its website, CMDA makes available a no-cost guide to end-of-life health care that includes an advance directive form for patients and their families. It was the absence of such documentation in the Terri Schiavo case that stirred much of the surrounding controversy, as her estranged husband, Michael, contended he had heard her tell him at one time she did not want to "live that way." Stevens acknowledges the media attention on the plight of the Florida woman, who died on March 31 -- almost two weeks after her feeding tube was removed by court order -- has highlighted the importance of a written documentation. He made these comments before Terri Schiavo's death. "One of the reasons [this] case has been so difficult to decide has been the absence not only of a written advance directive, but even more importantly, the absence of a designated proxy to protect her wishes in the event of incapacitation," he explains, adding that his group's guide is intended to help patients and their families -- and especially people of faith -- to decide these issues before a crisis arises. "While an advance directive and a proxy can protect patients from harm, they can also make clear what treatments the patient does not want when treatment would only prolong the dying process," Stevens notes. Stevens also addresses the ethical nature of the Schiavo decision. He says if a patient is dying, artificial nutrition -- such as that provided through a feeding tube -- can provide "comfort care" to a patient who can experience comfort, and "respect care" to one who cannot receive comfort. "The removal of a feeding tube should never be done with the intent to cause death," the CMDA leader says. The Florida woman's death this week, says CMDA, reflects a "failure of a medical system that failed to insist on a definitive diagnosis consensus, a legal system that failed to deliver due process, and a culture that failed to distinguish between artificially prolonging life and deliberately ending life." 2005 AgapePress all rights reserved.

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[hope]

Freepers finally an Evangelical Church has taken a stand on issues that are so important to us here. Please visit this site in the above link @ the Center for Moral Clarity.

[hope]

ping. Please pass this along. Great website to visit also.

[AmericanChef]

Lawyers ultimately decide everything we do. It's the Land of the Lawyers and the Home of the Cowering Citizens.

Poor Terri wouldn't know the difference between her previous "normal" existence and her then current one. She wouldn't remember her living will if she had one, and she certainly didn't want to be starved and dehydrated for 2 weeks because she signed a piece of paper.

[ThreePuttinDude]

Thanks for the post. I've sent this out to all my family, and friends. Since Terri's situation, this has been a main topic of conversation with my family. Now, with all family members aware of the thoughts and concerns, we can rest assured that this will not happen in our family.

Thanks, TPD

[facedown]

"The removal of a feeding tube should never be done with the intent to cause death," the CMDA leader says.

What other outcome could there be?

[DManA]

How about a respirator? Can we ever turn that off? Please someone in a principled way explain the difference between a respirator and mechanical feeding.

"The removal of a feeding tube should never be done with the intent to cause death," the CMDA leader says.

[jocon307]

"Please someone in a principled way explain the difference between a respirator and mechanical feeding."

If you cannot breath on your own, obviously you are going to die within minutes. However, there are many people who cannot eat or drink on their own and basic nutrition, to my mind, is not medical care. Terri Schiavo was no where near death's door, in fact she seems to have had a very good consitution. She might have lived for decades more. That's why they had to kill her, you see, it was her "husband's" right to chose.

[DManA]

So the difference to you is that you die in seconds when you turn the ventilator off and days when you turn off the feeding machines? Not convincing. Where's the principle?

[exDemMom]

So the difference to you is that you die in seconds when you turn the ventilator off and days when you turn off the feeding machines? Not convincing. Where's the principle?

Actually, the standard should be that death must be imminent. Even so, I think I'd want the ventilator on until my heart stops beating and my EEG goes flat.

I've heard that there are former polio victims who are still on respirators after decades. There's no reason to deny them the right to breathe, is there?

[TexasTaysor]

So the difference to you is that you die in seconds when you turn the ventilator off and days when you turn off the feeding machines? Not convincing. Where's the principle?

You can't see the difference???

[DManA]

No. I said as much.

[DManA]

I don't agree with you but at least you are consistent.

[LaineyDee]

Not convincing. Where's the principle?

You are kidding....right??

[jocon307]

DManA, as if per your request, here is a thread that discusses the topic of feeding tubes vs. repirators at lenght. I didn't read the whole thing myself, I probably will later, but I wanted to ping you ASAP

http://www.freerepublic.com/focus/f-news/1376552/posts

[MainFrame65]

" How about a respirator? Can we ever turn that off? Please someone in a principled way explain the difference between a respirator and mechanical feeding. "

Consider a healthy newborn child. Breathing is a natural act, and interference with that breathing would also be criminal. Failure to provide nutrition and hydration (food and water) also would be criminal, even though the baby is incapable of feeding himself. After all, isn't baby formula from a bottle a form of artificial life support?

Now suppose that baby has a problem that prevents sucking on a nipple - a failure of the sucking reflex, or a physical problem like a cleft palate. But the baby breathes, cries, and responds normally otherwise. Do you withhold nutrition? Of course not. This is a temporary and correctable problem, and "artificial feeding" is simply a bridge to a full, normal life.

But what if the baby were several weeks premature, and did not breathe on its own due to underdeveloped lungs? Do you provide breathing support? Again yes, because it is once again a bridge to a full, normal life.

On the other side, a very few babies are born with a rare (and always fatal) condition called anencephaly, in which most of the brain fails to form. A baby born with anencephaly is usually blind, deaf, unconscious, and unable to feel pain. Although some individuals with anencephaly may be born with a rudimentary brain stem, the lack of a functioning cerebrum permanently rules out the possibility of ever gaining consciousness. Simple reflex actions such as breathing and responses to sound or touch may occur. But they do not possess - and will never develop - human interaction at ane perceptible level. Would you even attach such an infant to a respirator? Probably not, because this would only prolong dying. And what about nutrition? It would have the same effect, but if the infant can suckle, it provides comfort at a primitive level, and I could not refuse it. But I would not install a feeding tube.

Some couples do carry these babies to term, and love and care for them for the very few weeks or months of their lives, if they survive birth. Those who do seldom regret their decision.

Breathing is not merely a natural act - it is one that our bodies perform naturally, even in the absence of conscious control. We breathe when asleep, or even when unconscious due to trauma. And even when awake and aware, when we can control our breathing, we often withdraw our attention from this vital act, and give it no thought at all.

But eating is always an act of volition - we cannot turn eating and drinking over to a subconscious automaton that runs without our attention. Instead we are equipped with the sensations of hunger and thirst, to prod our conscious mind to seek and secure sustenance. Denying these to one who cannot act to secure them is an act of torture, and our society is the worse for having committed it.

[the invisib1e hand]

judging quality of life is not the business of the law.

[Mrs Zip]

ping

[DJ MacWoW]

"The removal of a feeding tube should never be done with the intent to cause death," the CMDA leader says.

What other outcome could there be?

There are some terminally ill patients who can no longer tolerate food. Some cancer patients for example. Removing their feeding tube when the body can no longer process food doesn't cause their death. Usually the cancer is so advanced that they die from that and not dehydration/starvation. Besides they usually are given an IV to prevent dehydration/starvation.

[TASMANIANRED]

Number one. Assess the reason for the ventilator.

If it is a brain injury severe enough to destroy the breathing center then the patient is not concious. Remove the ventilator and death in under 5-6 minutes.


Tube feeding death prolongued over 2 or more weeks. Cruel and unusual by any definition.