Nutrition and hydration, whether a person is fed with a spoon or through a tube, is basic care, not medical treatment. Insertion or surgical implantation of a feeding tube takes medical expertise, but it is an ordinary life-preserving procedure for a person who has a working digestive system, but is unable to eat by mouth.
Is it right or wrong to withhold or withdraw food and water from patients?
It is important to distinguish between appropriate medical decisions and discriminatory decisions based on value judgments.
During the natural dying process, when a person’s organs are shutting down or when a person is unable to receive food and fluids without harm, they are discontinued and the person is kept as comfortable as possible until death occurs naturally. This course of action is both medically and morally appropriate. In these circumstances, the direct cause of death is the disease or injury.
On the other hand, when a person is not dying—or not dying quickly enough to suit someone—food and fluids are often withheld to intentionally hasten death. In order to rationalize depriving a person of such basic, life-sustaining care, the person is first dehumanized, that is, described as having an unacceptably low quality of life and/or as a wasteful use of limited health care resources. In such a case, death is caused by starvation and dehydration, not by the underlying disease or injury. This is simply inhumane.
Dr. William Burke, a St. Louis neurologist, describes what happens to patients as they die an unnatural death from dehydration:They will go into seizures. Their skin cracks, their tongue cracks, their lips crack. They may have nosebleeds because of the drying out of the mucus membranes, and heaving and vomiting might ensue because of the drying out of the stomach lining. They feel the pangs of hunger and thirst. Imagine going one day without a glass of water! Death by dehydration takes 10 to 14 days. It is an extremely agonizing death.1
Tube-feeding and the Law
Tube-feeding is often simpler, less costly and safer than spoon-feeding a patient who is a slow eater or chokes on food. It may be necessary for comfort, to ensure adequate nutrition and hydration, or to sustain life when a person is unable to swallow.
Real food and water are delivered through a feeding tube, though often they are inaccurately referred to as “artificial nutrition and hydration.” It is the feeding tube that is artificial, much as a baby bottle is an artificial means of delivering real nourishment to an infant who is not breastfed.
Food and fluids do not become “treatment” simply because they are taken by tube any more than penicillin and Pepto-Bismol become “food” when taken by mouth. Those who claim otherwise do so to advance their own agenda. For instance, in 1984, at a World Federation of Right to Die Societies conference, bioethicist Dr. Helga Kuhse explained the strategy of euthanasia advocates:
If we can get people to accept the removal of all treatment and care, especially the removal of food and fluids, they will see what a painful way this is to die, and then, in the patient’s best interest, they will accept the lethal injection.
Deliberately causing human beings to painfully die of hunger and thirst is beneath the dignity of both patients and medical professionals. Nonetheless, in every state, advance directive laws permit imposed death by withholding or withdrawal of nutrition and hydration. These laws are the foot in the door for acceptance of medical murder by lethal injection.