When to sustain life.

Author:Huddle, Thomas S.
Position:Correspondence - Letter to the Editor

Wesley J. Smith identifies some worrisome developments in contemporary bioethics, including proposed changes in the legal definition of death ("Waking from the Dead," October 2003). He rightly points out that patients such as Terry Wallis may wake up even after long periods in a persistent vegetative state, although most such patients do not. The persistent vegetative state poses difficult decisions for physicians and families. Many physicians, including many of us who are Christian, feel no such difficulty in generally opposing the use of feeding tubes and intravenous fluids in patients who are terminally ill. It might be unethical to withhold these interventions from terminal patients if they were effective in prolonging life; but they are not effective. Nutrition provided by medical intervention (as opposed to patients eating and drinking what's offered to them) has not been shown to prolong the life of patients in the terminal conditions in which it has been studied, such as end-stage cancer and dementia. And patients in whom we refrain from inserting tubes and needles for food and fluids do not "endure agony."

I would expect a Christian medical ethic to recognize that our life on earth is limited and that at the end of our natural span there might be a time beyond which attempts at further prolongation of life by medical means are likely to increase rather than limit suffering. It is not given to us to take our own lives before their natural end; but what warrant from religion does Mr. Smith have for seeking to delay that end to the uttermost extremity at a time when it must be soon upon us, come what may?

Feeding tubes and IV needles have their uses, but subjecting patients at the end of life to them is simply wrong, except in carefully chosen situations where the chance (no more than a chance) of gaining a short period of time by their use is worth their associated discomforts and possible complications. Physicians who practice among patients with terminal conditions have the experience and perhaps the wisdom to decide when feeding tubes and intravenous fluids ought to be used; just as they make decisions about any other medical intervention. Virtuous physicians who are sensitive to patients and families will make such decisions together with them and will usually do so in harmony. Mr. Smith contrasts the unconditional love of Terry Wallis' family with the sterile intellectualism of bioethics. Medical decisions at the end of life...

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