I first entered the health professions as a nurseâ€™s aid in 1986. We did things differently then. The nursing home, which later went out of business after an aid burned a patient to death in a hot tub (you may know the incident of which I speak), was ruled by a tyrannical nurse. Her favorite way of keeping the unit quiet was to tie up all the patients. â€œPosey that patient!â€? was her favorite expression.( A Posey is a restraint, made by the J.T. Posey company, which specializes in ways to tie people up.)
This was where I saw my first feeding tube. Like many other people, my reaction was — â€œLet me go quick so this never happens to meâ€?. Feeding tubes were common; Do Not Resuscitate orders were rare. In the absence of explicit instructions a tube would be inserted. If the patient was aware enough to try to rip it out you could always Posey them, and we did.
In the years that followed I saw many elderly people on feeding tubes. With proper care they can survive for a long time. Some fought and screamed wordlessly in their dementia, some seemed permanently asleep, some gazed at me with sad eyes.
A feeding tube is only a device. It can buy time for a person to recover. I have had the pleasure twice of removing a tube when the patient became able to eat normally. I met an elderly woman at a party who has to rely on a feeding tube. She is in decent health otherwise and accepts what she must. A feeding tube can relieve the pressure of having to eat a certain amount every day, which is a burden to some sick people. Like anything else, a feeding tube can be used or misused.
I think that our present system, which allows patients and their families to decide what treatment and how much is acceptable is the best we are going to get in an imperfect world. Iâ€™ve met patients who want to have everything medically possible and others who donâ€™t want any of it. Wishes are not always carried out in a crisis, but people have much more say in their medical care than they used to. I donâ€™t have any better idea than to let the patient and their designated people make the tough calls, along with their doctors and nurses.
Itâ€™s with firsthand knowledge of the care of dying people and deep alarm that I read the latest from Rome —
The Vatican, ruling on a debate that has divided Catholic hospitals, said on Friday it was wrong to stop administering food and water to patients in a vegetative state even if they would never regain consciousness. In a document approved by Pope Benedict, the Vatican’s doctrinal department said tube-feeding such patients presumed to be near death was “ordinary” care that should not be discontinued because the patients still had human dignity.
I guess it depends on how you define dignity. A feeding tube in a terminal patient can sometimes prolong the dying process, and the Church is very concerned with life at the very end and before birth. Mother Teresa is revered for her care of dying patients who lived in utter destitution. No feeding tubes for them, for sure. Also, none of the medical miracles we take for granted. The Vatican never came like the cavalry over the hill with troops of doctors and nurses bearing antibiotics and surgical tools. They will saint her, but with all their wealth they never turned her hospice into a hospital, rescuing poor people from preventable death.
Thereâ€™s a banner over Smith Street. Thereâ€™s going to be a Walk for Life. Maybe the Governor will be there. He has cut medical benefits to infants and children. He has cut support for orphans in foster care. The President has opposed legislation to extend health insurance to thousands of American children. And at the end of life, there is still coverage for the most extreme measures. There is triage going on, a triage that shows neither logic nor mercy.