What We Are Becoming: Time to Dehydrate Debilitated Stroke Patient

A disturbing column in today’s LA Times has a woman wanting to “let” her Dad go by removing his feeding tube—which would really be to make him go, since there could only be one outcome from such a decision.

Dad isn’t unconscious. He is debilitated and disabled by a stroke. He apparently had an advance directive eschewing “extraordinary” care, which the family—rightly in my view—did not see as applying to a feeding tube. And yet, we are told that even so, he should be “let go,” e.g., be dehydrated to death, because his life isn’t worth living. From the column, byline Diana Wagman:

But what kind of life? Since that morning, he has been in a deep sleep, rousing rarely and unpredictably and only enough to say a word or two. He’s paralyzed on his right side. His eyes are closed, and the nurses, the doctors and his family cannot wake him. The rehab doctor literally knocks on his chest and shouts “Wake up, Arthur!” and he does not respond. He is not in a coma, he is not in pain, he is breathing on his own, his heart is strong, but he has basically checked out. The doctor said it’s not uncommon to be lethargic after a stroke, although my father’s response is unusually severe. The scans of his brain show that the bleeding and swelling have stopped, but he is not getting better. A feeding tube is keeping him alive.

Money is part of the issue, and no doubt, it is a big problem:

Now the hospital wants to move him. It is not a long-term care facility, and he does not need acute care. He needs what they call sub-acute care, daily maintenance and monitoring, some rehab therapy to keep blood circulating. We have begun the depressing, complicated process of looking for a home. The nicest place we found is $10,000 a month once his insurance and Medicaid run out. We have no idea how long he’ll be there. My stepmother would have to sell the income property whose rent supports them. Then she would have to figure out another way to live.

But do we really want to be a society that dehydrates people to death because they are debilitated elderly or have serious disabilities? Probably not—if these attitudes spread throughout the society we will be a society that wants to lethally inject them to death because we are, after all, humane.

I have great empathy for Wagman and her family. I certainly support their refusal of antibiotics or CPR in such a case. But depriving Dad of food and water—as she really does understand in this piece—is a huge thing, both medically and symbolically.

Being in anguish at one’s father’s real difficulties is natural. Wishing he would die for his own good is understandable. But I don’t think Wagman or her family should feel guilty for doing the right thing. Nor do I think it is a good idea to move society—as this piece seems intended to do—toward the time when people like her father are can be comfortably deemed too much of a burden on themselves, their families, or society to have their lives maintained.

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