Saturday, August 8, 2009

Killing Hospital Patients By a 2nd Disease

In my previous post I spoke about the immoral policy of the American Academy of Pediatrics to approve of withholding nutrition and hydration (or, antibiotics or insulin) from a very sick, injured, or disabled--but not dying--child for the express purpose of ending that child's life.

Now I would like to consider an example where such a policy would make it possible for medical personnel to approve of killing a hospitalized patient (child or adult; young or elderly) by means of a secondary (typically non-lethal) infection or otherwise usually treatable disease. This would not be considered killing by the AAP. However, in a Catholic moral analysis a person can indeed be guilty of killing--here, euthanasia by omission--by deliberately not treating a second disease process which, due to a primary pre-existing disease condition, would be too much for the patient's body to handle on its own in combination with the primary disease and so would be likely to cause death.

Secondary infections can occur which are a different (and not-necessarily lethal) disease process added on to the condition of an already present primary disease. With sound medical care, these can be treated and resolved or at least minimized while the more serious (lethal) primary disease condition remains.

For example, many patients in the hospital with advanced cancer have some sort of "central line" in place (a surgically installed intravenous line that permits intravenous access to the patient without needing to use peripheral IV lines in the arms that only last a few days and thus need frequent changing--not good for prolonged IV therapy, such as is needed for chemotherapy). Any IV line, including central lines, can become infected. In fairly rare circumstances, an IV infection can take hold in the patient's blood in a potentially lethal condition called "sepsis." A person already weakened by cancer, chemotherapy, and/or age, is very vulnerable to sepsis. In the case of a new IV site infection, skilled nursing staff should notice the early signs of infection appearing around any IV access line (whether central or peripheral). A typical medical response would be to remove the IV line at the infected site, and, if needed treat the patient with antibiotics to clear the infection. A new IV line could be established at a different location free from infection while antibiotic treatment is clearing up the old site. An infection from an IV that might spread to the blood is a different disease (treatable with antibiotics) than cancer.

Now, if a patient with cancer develops an infection and the medical staff makes a deliberate choice not to treat the infection (and the patient's body does not heal the infection on its own), that patient would die from infection--not from cancer--an infection which itself very well might not have been lethal if treated properly and quickly. In such a scenario the infection would have progressed to the point of becoming lethal because of the decision to omit antibiotics. In this way (e.g. not treating a secondary infection), physicians may actually choose to bring about the death of a patient by omission. Death, in such situations, would not have been caused by the original lethal disease but by a secondary (treatable) disease. By not treating the secondary disease doctors have a (convenient?) means of making death come sooner--perhaps much sooner--than it otherwise would have come. Is this morally much different from just shooting the person, like a farmer might do with an old sick dog?

This is a crude analogy, but it applies. If I walk up to a dying man who has sustained a lethal snake bite delivering ten times the amount of poison needed to kill a human and shoot him in the head, I have killed an innocent person (murder) and committed a grave offense against God, that person, all of human society, as well as my own dignity. Christians do not do this. This is never permissible under any circumstances. The time involved would be longer, but killing a man by withholding antibiotic treatment for a curable infection is not, morally speaking, very much different from putting a bullet in his head. One is faster, more gruesome, and more direct--but they both produce a dead body. Both cases would involve making a free choice with one's will to end the life of another human being using means known to be lethal in the given circumstances. For a Christian, such acts of commission or omission ought never be considered proper medical treatment. It makes a mockery of the medical arts. Healers are gradually turned into killers, convinced by leaders in their profession that they are doing a great service. Horrible.

The same might apply to insulin. Antibiotics and insulin are routine, ordinary care used to handle conditions which are manageable or curable when treated according to standard medical practices. If antibiotics or insulin (diabetic shock can progress to death without insulin) are deliberately withheld for the purpose of causing death, when giving them would prevent death, it is killing, not medical treatment, not benign care. It is taking life into our own hands and making ourselves God, deciding when life should end.

Please note, this does not mean there is never a situation in which antibiotics or insulin (or nutrition and hydration) could be withheld in a way that would be morally upright. I simply want to stress that we may not do something (or omit something) for the reason of ending someone's life. By listing antibiotics and insulin (as well as food and hydration) in the LSMT category the AAP makes euthanasia by omission (of these treatments) a more likely scenario, for it gives such actions the official stamp of approval of a respected medical organization.

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