Decisions on Food and Fluids

It is crystal clear that food and fluids are required for life and that withholding them from a person will result in his death. 2 weeks is considered the maximum length of time a human can live without food and fluids, which is exactly how long it took for Terri Schiavo to die after withholding all food and fluids from her; which was mandated by a court ordered withholding of all food and fluids even by mouth (against most Hospice’s regulations!). As George Lundberg (former editor of JAMA, now editor of Medscape) has said in Severed Trust, “withholding all nutrition and fluids, orally and intravenously, is a very effective method of producing death. It may involve discomfort from thirst and hunger.”

It is a lie to try and present as the truth the argument that dehydration or starvation of an individual does not cause them anguish, pain, suffering, and eventually death. Those who argue this usually present a patient who has been drugged to unconsciousness and then “appears not to show any signs of discomfort.” How convenient. In reality, the medically verified results of dehydration and starvation are; an increasing dry mouth and cracked lips along with an increasingly uncomfortable sense of thirst, a heightened gnawing of the stomach with bowel churning and nausea, a concentrated-increasingly acidic and uncomfortable urine and urination, confusion and delirium from toxins built up in the body, sunken eyes and dry skin, and finally restlessness and irregular respirations prior to death.

It is medical fact and common sense that dehydration and starvation cause increasing physical and emotional discomfort until you are comatose and then dead. Yet, those arguing for the withholding of food and fluids claim it is not uncomfortable and say; that the lips can be moistened to relieve the feeling of dryness, that food at this stage can be more uncomfortable or nauseating than starvation (from the starved stomach finally digesting food again), that once the organ systems fail fluids will bloat the patient (resulting from the dehydration having killed the kidneys), and that the patient really “does not seem to be uncomfortable” when he is comatose. It is argued that feeding tubes do not improve nutrition, help maintain skin health, prevent aspiration pneumonia, minimize suffering, improve functional status, or extend life. However, the facts cut through the negative hype. In 1995 120,000 long-term care patients were using them, in 2003 344,000 U.S. residents used them in their homes, and “Once a feeding tube is removed, a person's systems gradually begin to shut down”, says Dr. Ronald Schonwetter, professor and director of geriatric medicine at the University of South Florida College of Medicine.[el20] It can not be disputed; feeding tubes (Peg tubes) maintain and support the nutrition of countless individuals and removing them would result in their death; would kill them.

There is an attempt continually being made by those arguing for dehydrating and starving patients to death to get any food and fluids supplied to patients in any manner other that by mouth termed a medical procedure, artificial, or termed ‘supplied by medical device’; as though that automatically qualifies them as being extraordinary and thus optional or forbidden. Feeding tubes have been around for over a century and despite attempts to paint them as complicated, expensive, deadly, and worthless; they are not. Dr. Cervo, Et Al in “To Peg or not to Peg”, “Peg tube placement…is a relatively “easy” procedure..requires only local anesthesia…takes between 10 and 30 minutes…may be performed at bedside…complications related to placement are generally minor”.[el100]

The vegetative state ( www) and coma require our attention as they are special conditions in which the withdrawal of food and fluids is often argued to be an ethical option. The person in the vegetative state shows no signs of self-awareness and seems unable to interact with others or to react to specific stimuli. The term ‘vegetative state’ is an unfortunate, generalized medical description coined by Drs. Plum and Jennett which, “describes behavior…presumes neither a particular physio-anatomical abnormality nor a specific pathological lesion”.[el30] Why has this grab-bag, undignified, vague term persisted for a condition(s) not “completely understood”[el30] in the field of medicine where more exacting descriptions of illness are forever sought. Studies are showing the dangers of applying this inexact diagnostic term, ‘vegetative state’, as it can result in a failure to further define the patient’s real diagnosis and thus treat him appropriately.[el31] [el32] [el33] [el34]

As Pope John Paul II said in his address “Life Sustaining Treatments and the Vegetative State”, “A man…is and always will be a man, and will never become a vegetable”…”The administration of water and food, even when provided by artificial means, always represents a natural means of preserving life”…”Its use”…”should be considered”…”ordinary and proportionate”…”and as such morally obligatory.”(www) In an attempt to change artificial nutrition from being considered an obligatory, ordinary aspect of patient care, which it was at that time, the American /academy of Neurology in 1989 reclassified artificial nutrition and hydration as “forms of medical treatment.”[el35] Approximately 10-25,000 adults and 6-10,000 children in the U.S in 2004 were diagnosed as being in the persistent vegetative state.[el35] The “prolonged survival” of such patients depends on “adequate nutrition by nasogastric or gastrostomy tyube.”[el36] When it is withdrawn “patients in a persistent vegetative state usually die within 10 to 14 days”.[el37](i.e. Terri Schiavo)

A Hasting Center Report in 1983 admitted that it wasn’t because of the burdens of tube feedings that a push for their withdrawal should be made but because, “a denial of nutrition may in the long run become the only effective way to make certain that a large number of biologically tenacious patients actually die.”[el18] If it is argued that it is really the patient’s medical condition that is killing him then it should not matter whether or not you continue to feed and hydrate him by whatever means necessary. The bottom line of food and fluids remains simple: they are the basic, ordinary sustenance of life. Refusing to give them to a human being by oral means or simple tube feeding kills that person by starvation and dehydration.

Note: See Reference Pages (Food and Fluid Problems) on this subject to view specific references cited above.