HEALTH: by Richard EganNews Weekly
Stopping feeding and hydration is true euthanasia
, May 17, 2003
Dr John Billings urges us (News Weekly May 3, 2003) to read carefully the Reasons for Decisions delivered in the Victorian Civil and Administrative Tribunal case of Mrs BWV by Judge Duggan, Associate Professor J. Davis and Dr Billings' own son, Mr J. Billings.
Dr Billings endorses the view that the Tribunal's discussion on removing the stomach tube by which Mrs BWV received food and liquids "were in no way a consideration of euthanasia."
This view is at odds with that of the Catholic Church as expressed in the authoritative Charter for Health Care Workers issued in 1995 by the Pontifical Council for Pastoral Assistance to Health Care Workers with the approval and confirmation of the Congregation for the Doctrine of the Faith. Paragraph 120 of that Charter reads in full:
"Aware that he is 'neither the lord of life nor the conqueror of death', the health care worker, in evaluating means, 'should make appropriate choices, that is, relate to the patient and be guided by his real condition'."
Here he will apply the principle - already stated - of "appropriate medical treatment," which can be specified thus: "When inevitable death is imminent, despite the means used, it is lawful in conscience to decide to refuse treatment that would only secure a precarious and painful prolongation of life, but without interrupting the normal treatment due to the patient in similar cases. Hence the doctor need have no concern; it is not as if he had failed to assist the person in danger."
The administration of food and liquids, even artificially, is part of the normal treatment always due to the patient when this is not burdensome for him: their undue suspension could be real and properly so called euthanasia.
The Charter's reasoning is based on natural law principles rather than specific religious revelation and, while authoritative for Catholics, may also be persuasive for anyone giving serious consideration to this question.
The Charter is in direct opposition to the view adopted by the Tribunal that the provision of food and water is somehow mysteriously transmuted into "medical treatment" merely by being delivered through a tube rather than by spoon. Rather it is "part of the normal treatment always due to the patient". In other words, it is part of basic human solidarity to feed those who can't feed themselves, just as we ought to keep them warm and comfortable.
Both the Tribunal and Dr Billings go to some lengths to persuade us that somehow the stomach tube is so burdensome that its removal is justified. But this tube has been in place now for eight years. For five of those years, Mrs BWV was cared for at home and fed through the tube by her husband. He even replaced the tube several times when it became disconnected. This is not some horrible mechanical and artificial device imposed cruelly on Mrs BWV. It is not causing Mrs BWV pain. Neither is it making her ill. In fact the only burden it seems to impose is that of keeping Mrs BWV alive
The Tribunal is also extraordinarily cavalier about the relevance of whether or not Mrs BWV is imminently dying. We are told she was only expected to survive about three months when she went into the nursing home three years ago. If the provision of food and liquids is allowed to continue she "was likely to develop pneumonia or 'another terminal event' in the next months to years". (Dr Billings curiously refers to Mrs BWV as having "now reached the terminal stage").
It is quite disingenuous then for Dr Billings and the Tribunal to make out that ceasing the provision of food and water is just "allowing her to die". All of us could be allowed to die by withdrawing our access to food and water. Neither in this case, where Mrs BWV has Pick's disease, a form of progressive dementia, nor in the case of Tony Bland (who was in the so-called "persistent vegetative state") decided by the House of Lords is the person actually dying. In fact it is precisely their inconvenient tardiness in dying that has led others to seek to bring about their death by the cessation of food and liquids.
Despite frequent denials by the Tribunal that they are making "quality of life" decisions they are plainly doing just that. There is no point in feeding Mrs BWV because she has no prospect of recovery and all she can do is lie in bed, probably ("It was very difficult to assess if she had any awareness") without any cognitive capacity, but following people about the room with her eyes.
There is nothing in the Tribunal's decision to set any barrier to the progressive application of this decision - that some people are not worth feeding - to ever widening categories of people. This has been happening in England after the Bland decision, with stroke patients, the elderly and disabled children all at risk of being denied food and liquids under controversial new British Medical Association Guidelines.