Thursday, March 15, 2012

Dehydration and PVS

Over at The Center for Bioethics and Culture Network Wesley Smith has an excellent update on withdrawing hydration from those patients diagnosed as to be in a persistent vegetative state (PVS).  Here are the first few paragraphs but be sure to go and see the whole story.
Bioethics exploded into the headlines over the last few weeks after the Journal of Medical Ethicspublished an article promoting “after-birth abortion,” that is, the right of parents to have infants killed if the child’s presence in life did not serve their (or society’s) interests.
But hidden by the sturm und drang over infanticide, Bioethics published another radical proposal that received virtually no attention—but which, if adopted, could result in thousands of persistent vegetative state (PVS) patients being dehydrated to death.
The question concerns whether or not to provide such patients with food and water. Tube-supplied sustenance—called artificial nutrition and hydration (ANH)—is considered a form of medical treatment that can be withdrawn or withheld like any other medical care, such as antibiotics, chemotherapy, and indeed, aspirin. Of course, unlike withdrawing other treatments, ceasing to provide ANH results in the patient’s death in every case—usually over a 10-14 day period.
(Withdrawing such medically efficacious sustenance should not be confused with situations in which a patient’s body is actively shutting down during the dying process and the body can’t assimilate food or water. In such cases, ANH is medically inappropriate. The patient dies of their disease, not dehydration.)
Currently, in the absence of an advance directive to the contrary, benefit is given to life in PVS and other catastrophic brain injury cases—with surrogate decision makers able to order that such treatment cease if they think it is in the patient’s best interests. But that would change if Catherine Constable, the author of the Bioethics article, gets her way.
She argues for a policy in which ANH must be withdrawn once a patient is diagnosed to be permanently unconscious unless the family orders otherwise. In other words, dehydration would become the default position for patients diagnosed in PVS.
Christians need to be aware of what is being put forward in today's ethical journals.  This is not mere ivory tower reasoning.  The proposals put forward today become the policies of tomorrow.