Food and Hydration

This is a phrase which frequently occurred in the popular media associated with reports of the legal proceedings in 2004-5 regarding Terri Schiavo and whether or not she should be deprived of food and hydration.  It is not our intent to examine that specific case, but rather to take that issue and others often associated with it and discuss them as they so often affect others.

The administration of food and liquid usually becomes an issue when a person is in a state of unconsciousness, i.e., they are unaware of almost all sensory stimuli and their surroundings.  The National Institute of Neurological Disorders and Stroke defines coma as a “…profound or deep state of unconsciousness…unable to move or respond to…environment.  Coma may occur as a complication of an underlying illness or as a result of injuries, such as head trauma.  A persistent vegetative state…sometimes follows a coma.  Individuals in such a state have lost their thinking abilities and awareness of their surroundings, but retain non-cognitive function and normal sleep patterns.  Other key functions such as breathing and circulation remain relatively intact.  Although…[they] may appear somewhat normal, they do not speak and they are unable to respond to commands.”

When persons are unconscious, but able to swallow, food, usually pureed, and liquids can be fed orally.  If they are not able to swallow, other means of introducing nutrients must be used to maintain adequate physiologic functionality, unless there are overriding circumstances (see below and in later articles).  (1) A nasogastric tube can be passed through the nostril, down the throat and into the stomach.  (2) A PEG (percutaneous endoscopic gastrostomy) tube can be inserted surgically directly through the abdominal wall into the stomach.  (3) Indwelling catheters can be inserted into peripheral veins and deliver the nutrients directly into the venous blood.  These three methods are commonplace in health care today, although they can be associated with sometimes serious medical complications; and the optimal choice depends on the circumstances of each case.  Does the patient have a compromised immune system?  Is the patient subject to seizures or other involuntary movements?  Is one method particularly uncomfortable or burdensome for a particular individual?

Food and liquids are the most basic needs of life, and all human beings have a right to these basic needs.  Such necessities should be available to all persons unless there are some serious overriding considerations.  If a person has a terminal illness and death is imminent, it would be proper to stop or forego such treatment because it would prolong the normal dying process and could possibly be burdensome to the patient.  The proper choice would be to forego the nutrition, keep the patient as comfortable as possible and let nature take its course, much as Pope John Paul passed into eternity.  In discussing such overriding circumstances, we will soon deal with the concepts of “self-determination” and of “futility”.  The proper course of action is frequently difficult because of the uncertainties associated with prognoses and the emotional stress of making a decision for a loved one.  “…Thy will be done…”

Peter Moore, PhD    George A. Sprecace, M.D., J.D.