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PubMed1985

Feeding policy protects patients' rights, decisions.

In adopting a policy to guide patients and care givers in treatment decisions, the Carmelite Sisters for the Aged and Infirm, Davenport, IA, have taken an important step toward resolving issues related to force-feeding. The policy enables residents of Kahl Home for the Aged and Infirm to discuss their future health care with relatives and physicians while they are competent. It also establishes guidelines concerning the insertion of feeding tubes and provides for periodic evaluation of residents' feeding needs. Formulating such a policy, of course, requires consideration of the ethical assumptions underlying decisions to withdraw or withhold life-sustaining therapy. It requires an understanding of the difference between a diminished capacity to pursue life's ends and the complete inability to do so when a person is permanently comatose. this difference affects the decision as to whether it is time to allow one to die--a decision that should precede the medical decision to withhold or withdraw treatment. For example, to present as an option the removal of feeding tubes and intravenous equipment when a patient is brain dead is poor medicine and bad ethics. The patient is dead; thus no choice exists whether to end treatment. Despite objections to decision making based on quality-of-life criteria, this concept--when related to a person's ability to pursue life's temporal goals--is critical to good decision making and allows decision makers to avoid arbitrary judgments in determining when it is time to let a person die.

Aged↗
PubMed1986

Catholic positions on withholding sustenance for the terminally ill.

Legislators and others are amending "life-prolonging procedure" acts to include artificial sustenance as an intervention that may be withheld or withdrawn when it serves only to prolong the dying process. Catholic teaching on this issue is summarized in this article. In the Catholic tradition, life is not an absolute value, and it need not be prolonged at all costs and in every case. The morality of withholding or withdrawing artificial sustenance hinges on the patient's perception of the burdensomeness of the treatment. Standards of a treatment's reasonableness and proportionality must govern treatment decisions, and each patient must determine the application of these standards to his or her own case. Persons should communicate their wishes and values verbally or through such documents as a "living will" so that if they become unconscious or incompetent, others may make informed decisions for them.

Catholicism↗
PubMed1984

Legal, moral concerns in life-support treatment decisions.

Catholic health care facilities' responsibility to ensure that treatment decisions are based on the patient's best interests and sound medical practice rather than on the person's disability poses difficult legal and moral questions in cases involving terminally ill patients and handicapped newborns. For example, hospitals and physicians, to avoid undertreatment, may be induced to use all available life-sustaining technology. Such extraordinary measures, however, may not be in the patient's best interests if they place undue burden on the patient and family. Ordinary care, which usually means nourishment and hydration, also may be deemed morally optional. Some health care professionals, in light of new information about hydration's effects on terminal patients, suggest that no moral obligation to give ordinary care exists in certain "hopeless" cases. The prohibition in many facilities of written "do not resuscitate" orders also is a source of controversy. Appropriate guidelines, however, can help to reduce decision makers' uncertainty and ease the work of hospital personnel. The overriding concern, though, is who should make the decision to withhold or terminate treatment. In most cases the courts have assumed this responsibility themselves or have delegated it to others. Little consensus, however, has formed concerning whether family members, physicians, or hospital ethics committees are better able to make such decisions. Since few court rulings are available to guide those who must make treatment decisions, Catholic health professionals must stay abreast of the developing law and resist efforts to promote philosophies that measure life according to "quality" or productivity potential.

Catholicism↗
PubMed1989

Playing God in the NICU. Ethical guidelines focus on what seems best for the handicapped infant--Saint Vincent Health Center, Erie, PA.

Physicians, nurses, and administrators of Saint Vincent Health Center, Erie, PA, embarked on a project to refine ethical standards regarding the treatment of severely handicapped infants to meet current government regulations and to express the hospital's Catholic ethical ideals. The guidelines they developed do not lead to precise conclusions; rather, they direct the search for right decisions. Complicating the development of guidelines are psychological considerations, medical ambiguities, and economics. One reaction to the attempt to establish guidelines for decision making for very ill and handicapped infants is predictable: What right does anyone have to decide who will live and who will die? Who can play God? But healthcare providers must all play God because they have no alternative. If playing God means making life-and-death decisions, then being stewards of human life involves just such a responsibility. Medical professionals working with severely handicapped infants know they cannot avoid this responsibility. Caring human beings simply have to decide for helpless others. The guidelines developed by the Pediatrics Ethics Committee at Saint Vincent Health Center focus on what seems to be best for the dependent and helpless infant, who rightly has a claim on our support, care, love, and concern.

Congenital Abnormalities↗
PubMedDate not supplied

In God's garden. Creation and cloning in Jewish thought.

The possibility of cloning-human beings challenges Western beliefs about creation and our relationship to God. If we understand God as the Creator and creation as a completed act, cloning will be a transgression. If, however, we understand God as the Power of Creation and creation as a transformative process, we may find a role for human participation, sharing that power as beings created in the image of God.

Attitude to Death↗