Termination Of Nutrition And Hydration

Terminating Nutrition and Hydration: Controversial Issues

Nurses deal with moral and ethical issues daily. As health care advances with changes in legal and social issues, medical technology, and patient's rights, more ethical concerns will arise. Nurses must learn how to respect their patients by recognizing an individual's preference; therefore, granting them autonomy. According to Blais, Hayes, Kozier and Erb (2006), "Autonomy refers to the self-determination and the right to make one's own decisions." By applying this principle of autonomy, patient's decision must be respected even though their choices may not seem to be in the patient's best interest. The Patient Self Determination Act of 1991 mandates all healthcare institutions to complete an advanced directive such as a living will or a durable power of attorney upon the patient's request. What will happen if a patient without an advance directive is unable to express his or her own wishes due to cognitive function loss or persistent vegetative state (PVS)? The lack of legal documentation will eventually lead to an ethical dilemma. An ethical dilemma is a situation that often involves an apparent conflict between moral imperatives, in which to obey one would result in transgressing another (Longman, 1987). Termination of nutrition and hydration from patients that are in a persistent vegetative state is an example of an ethical dilemma, which will be discussed. Ethical issue has raised questions regarding quality of life, appropriate use of resources, the wishes of the family, and professional responsibilities. Before we decide whether terminating nutrition and fluids is right or wrong, we must understand its guidelines.

In Favor of Terminating Nutrition and Hydration

The Federal courts have defined artificial nutrition and hydration (ANH) as medical treatments; a conscious patient can refuse to eat and drink. Nowadays, tube feeding or PEG (percutaneous endoscopic gastrostomy) provides nourishment and hydration for those patients who have diseases or conditions that make it difficult to swallow or eat such as elderly demented patients, patients who are near the end of life or those who are comatose. People lived and died just fine 30 years ago when feeding tubes were not around, so it is possible to die comfortably without a feeding tube. However, if we have a comatose patient who does not have a living will, who will precedes her decision?

In the case of Terri Schiavo, according to Economist (2005),

First, under American law it is Mrs. Schiavo's husband, not her parents, who is now responsible for her. Second, despite the heart-rending video, court-appointed doctors who have looked at her concur that she is indeed in a "persistent vegetative state". When she opens her eyes and smiles these are, alas, just reflex actions, they say. She is not aware, she cannot communicate and she will not recover (p. 6).

Another major benefit will be reducing the financial burden on the family. By terminating ANH, it is believed that families will be relieved from the financial burden and stress. According to Lovvorn (1998), "The cost of enteral feeding range from fifteen dollars to twenty dollars per can (approx. six cans a day) where TPN (total parenteral nutrition) will cost even more (Average $428 to $857 a day)."

Against Terminating Nutrition and Hydration

There are many people who are against terminating nutrition and hydration for PVS patients due to ones religious beliefs, morals, and values. According to Wesley J. Smith (2004), "Advocates for dehydrating the neurologically disabled assert that it is a painless end." Yet, according to one case presented by Wesley J. Smith, 33 years old Kate Adamson suffered a stroke. She was diagnosed as likely to develop a persistent vegetative state (PVS) but was actually completely awake and aware but unable to communicate. Even after the doctors realized that Adamson was entirely conscious, the doctors urged her husband to let her go. Mr. Adamson refused. When Kate Adamson developed a bowel obstruction, her husband authorized a corrective surgery. In order to correct the problem, they had to clean her bowel for eight days by stopping the feeding. Adamson later regained the ability to communicate and was able to write Kate's Journey: Triumph over Adversity. In the book, Adamson described the agonizing hunger pain she went through. In Adamson's book, she stated, "Your whole body cries out, feed me. I am alive and a person, don't let me die, for God's sake! Somebody feed me."

In Terri Schiavo's case, her tube feeding was withheld which left her to die from starvation and dehydration. Mrs. Schiavo eventually died 13 days later. While she was in a persistent vegetative state, food and fluids were used to sustain her body. Milkes (2003) states, "Some people, perhaps based on religious beliefs, regard all life as valuable and worth preserving." In the case with Terri Schiavo, her parents as Roman Catholic strongly believed that removing the feeding tube would be a sin.

In conclusion, life and death have been part of our lives from the beginning of time. As health care providers, difficult circumstances like Terri Schiavo's cases exist. As patient advocates, nurses have to take in consideration patients' value, culture, belief and moral ethic before taking sides. Also, nurses have to take into consideration of the emotional and physical burden Mr. Schiavo went through. The hope that Terri will wake up someday became distant, and Mr. Schiavo's need of affection is remotely impossible. Many debates in his head were entertained whether or not to go on with his life or die along with her. Either way, a negative impact is expected in his life. The patient is always the key source of authority in these decisions. What's critical is to try to ascertain what the patient thinks about their quality-of-life values before surrogate decisions