In "Living Life's End" (May), Gilbert Meilaender maintains "that if a possible treatment seems useless or quite burdensome for the patient, we are not under obligation to try it or continue it." Yet he later states, "it is hard to believe that we could withhold feeding while simultaneously withholding the intention that the patient die." In clinical situations, I have been with many families who withdrew feeding because it was useless, and did not have the direct intention of causing their loved one to die.
Kevin O'Rourke, O.P.
Neiswanger Institute for
Bioethics and Public Policy
In an otherwise excellent article, Gilbert Meilaender makes an unconvincing distinction between respiratory and nutritional support. Withdrawing respiratory support is distinguished from intending the patient's death on the grounds that "one does not know for certain that a patient will be unable to breathe on his own." In normal practice, patients are "weaned" from a ventilator as their arterial blood chemistry is monitored; unfavorable results preclude further weaning. In certain patients with severe respiratory acidosis, it is morally certain that complete removal of respiratory support will cause coma and death. That such a patient may have spontaneous, but shallow and inadequate, respiration during this process would not seem to be morally significant.
Mechanical ventilation--with the painful blood-gas monitoring that it entails--is certainly burdensome, and withdrawal may be justified on these grounds. But this justification is not strengthened by feigning ignorance of the sure course of untreated acidotic respiratory failure.
Jon Edwards, MD
I appreciated Gilbert Meilaender's article very much, but I object to his use of the example of implanting a pacemaker for an Alzheimer's patient who has suffered a Stokes-Adams episode. I think the illustration, admittedly borrowed from Leon Kass, is an unfortunate choice in support of an important principle. As a Christian clinical cardiologist who has walked with families and patients through this circumstance more times than I can remember, I would like to offer an alternative.
The term "Stokes-Adams attack" has traditionally described a transient, sudden, and complete loss of consciousness caused by a high-grade atrioventricular heart block. The patient usually collapses with no opportunity to protect him or her self. As Meilaender points out, death from cardiac...