Skip to comments.Wesley J. Smith: Should Dehydration Be the Default Decision for PVS
Posted on 03/17/2012 12:55:35 PM PDT by wagglebee
Bioethics exploded into the headlines over the last few weeks after the Journal of Medical Ethics published an article promoting after-birth abortion, that is, the right of parents to have infants killed if the childs presence in life did not serve their (or societys) interests.
But hidden by the sturm und drang over infanticide, Bioethics published another radical proposal that received virtually no attentionbut which, if adopted, could result in thousands of persistent vegetative state (PVS) patients being dehydrated to death.
The question concerns whether or not to provide such patients with food and water. Tube-supplied sustenancecalled artificial nutrition and hydration (ANH)is considered a form of medical treatment that can be withdrawn or withheld like any other medical care, such as antibiotics, chemotherapy, and indeed, aspirin. Of course, unlike withdrawing other treatments, ceasing to provide ANH results in the patients death in every caseusually over a 10-14 day period.
(Withdrawing such medically efficacious sustenance should not be confused with situations in which a patients body is actively shutting down during the dying process and the body cant assimilate food or water. In such cases, ANH is medically inappropriate. The patient dies of their disease, not dehydration.)
Currently, in the absence of an advance directive to the contrary, benefit is given to life in PVS and other catastrophic brain injury caseswith surrogate decision makers able to order that such treatment cease if they think it is in the patients best interests. But that would change if Catherine Constable, the author of the Bioethics article, gets her way.
She argues for a policy in which ANH must be withdrawn once a patient is diagnosed to be permanently unconscious unless the family orders otherwise. In other words, dehydration would become the default position for patients diagnosed in PVS.
How does she justify such a harsh measure? First, she denies PVS patients have an interest in living because (quoting Princeton bioethicist Peter Singer) life cannot benefit them. That being so, money rules:
We need not label these patients as already dead or claim that withdrawing care is not the same as taking life in order to find that it is difficult to apply any sort of right to life argument to a patient who would not now or ever choose to exercise that right. In view of this conclusion, other considerations, such as the cost to the health care system . . . would seem poised to be deciding factors.
Of course, such an argument could also be voiced in support of killing these helpless patients by harvesting their organs. Indeed, it already isas I have discussed previously.
But what about the people who unexpectedly wake up? Constable says most of these werent truly PVSeven though some had been so diagnosed. (In fact, studies show that PVS is misdiagnosed about 40% of the time.)
But that doesnt matter because the new life gained by the miracle patient is far less likely to resemble what he lost than to be some state of middle consciousness; a life quite possibly, worse than non-existence. Moreover, the potential benefit of living to be a miracle patient is not sufficient to trump the public interest in allocating resources to patients more likely to benefit.
In typical bioethics style, Constable then puts in a hedge, allowing that families of PVS patients should be given the last word. That would still put at immediate risk of dehydration the thousands of existing PVS patients without families.
But even Constables bow to family intimacy seems political and hollow. Thus even though she states that families should be encouraged to consider whatever factors they deem useful, families would be made to believe that dehydration is right:
We should discontinue the practice of putting families in the position of having to justify a decision to withdraw ANH by making assertions about what the patient would have wanted . . . To put the onus on a family to justify the decision to withdraw ANH is to effectively treat them as would-be executioners who need to be checked . . . In the case of PVS, when in doubt as to a patients wishes, it is better to discontinue life-sustaining treatment.
But if it is true that families now have to justify choosing to dehydrate, this radical shift would put families in the position of having to justify the continuance of food and fluids in the face of potentially hostile doctors, bioethicists, and the public policy of society.
Families often already face too many such pressures. Creating a default for death policy would not only make matters worse, it would establish the foundation for a veritable duty to die.
CBC special consultant Wesley J. Smith is a senior fellow at the Discovery Institutes Center on Human Exceptionalism and a consultant for the Patients Rights Council.
And this is EXACTLY what the culture of death intends to establish.
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If you are willing to kill them,, why not a strong dose of sedatives? I cannot understand how standing by impassively watching, sipping some cool water, as someone dies of thirst,, somehow means YOU didn’t kill them.
How does this charade make them less responsible for the death than administering an overdose of morphine, or pulling a trigger? If i did the same to someone perishing in the desert,,, i would justly be arrested under samaratan laws.
Same reasoning with DNX abortion. As long as a small percentage of the baby is still touching the mother, it's okay.
How do you distinguish that “state of middle consciousness”; from the state of consciousness of someone watching reality TV, or televised candidate debates?
Maybe they should be transported to the Mojave and left there, so that it would go quicker.
Thanks for posting that link.
Leave the medical "ethicists" there?
The Nazi Doctors is an excellent book. It’s scary how relevant it is today.
We hold these truths to be self-evident, that all men are endowed by their Creator with certain unalienable Rights, among these Life, Liberty, and the Pusruit of Happiness,...
Once, when I was younger, I thought I'd try to preserve some bit of the knowledge of mankind when, as often in history they have, the burning of the great libraries began.
Now, with only a backpack full of exceptions, I think I'd bask in the warmth and gleefully stand next to the conflagration and throw the books in. We have truly become too 'smart' for our own good.
Probably messes up the marketable spare parts--not that dehydration wouldn't.