No easy answers with end-of-life care

  • April 3, 2009
{mosimage}TORONTO - There are no easy and pat answers on the difficult question of artificial nutrition and hydration for patients with little brain function and less hope of recovery, bioethicist Moira McQueen told a packed lecture hall at the University of St. Michael’s College March 25.

“Moral theology is quite humble about its findings. It demands moral certainty but not absolute certainty,” McQueen said in delivering her half of the fifth annual Cardinal Ambrozic Lecture in Bioethics for the Canadian Catholic Bioethics Institute. McQueen is executive director of the institute.

This year’s lecture paired McQueen with Dr. Rory Fisher, who practises geriatric medicine at Toronto’s Sunnybrook Health Sciences Centre.

McQueen summed up nine centuries of Catholic thinking on moral questions in medical care from St. Thomas Aquinas to the bitterly controversial Terry Schiavo case in 2004. Looking at the tradition, McQueen concludes that in the difficult case of people in persistent vegetative states with no hope of recovery families and physicians need to make hard decisions in the context of prayer and spiritual discernment based on the medical facts, but there are no easy answers.

“These are not just matters for philosophical analysis,” she said. “Moral theology is not an abstract discipline.”

Pope John Paul II’s 2004 address to an international congress on “Life-Sustaining Treatments and Vegetative State: Scientific Advances and Ethical Dilemmas” and the Congregation for the Doctrine of the Faith’s 2007 answers to questions on this topic from the United States Conference of Catholic Bishops should be part of the discernment, but neither statement can be interpreted to mean artificial hydration and nutrition are obligatory in all cases all the time, said McQueen.

Fisher expanded the question beyond the rare cases of persistent vegetative states to the more common circumstance of patients in the end stages of Alzheimer’s disease.

In Alzheimer’s patients food and water administered by a tube have not been shown to prolong the patient’s life, however, it can result in diminishing the dignity of a dying patient, Fisher said. Alzheimer’s patients don’t understand why a plastic tube has been inserted into them and will frequently become agitated, pulling out the tubing. In cases where food and water are administered artificially it frequently results in greater isolation for the patient. The only human contact left to the patient will be occasional visits from nursing staff to change and maintain the intravenous feeding system, he said.

“You are more concerned about comfort than calories for these patients,” said Fisher.

More and better palliative care would put the debates over end-of-life decisions into a proper context, said Fisher. Fisher also urged better education for doctors and nurses on geriatric and end-of-life issues.

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