I find it hard to believe that we’re still debating the removal of feeding tubes. Then I found this article in the Dallas Morning News about the passing of Ruth Graham. Apparently, toward the end of her days, she asked that her artificial feedings be stopped. The same author, Jeffrey Weiss, wrote this on the Dallas News Religion Blog. It highlights the differences Judeo-Christian religions have about this one, end of life, decision. Mrs. Graham was a presbyterian, which allows for the removal of feeding tubes. Mr. Billy Graham is a Southern Baptist, whose denomination does not specify what to do in that situation. Even within a religion, there are contradictions. Pope John Paul II had his feeding tube removed in the days before his death. Yet on March 20, 2004, at the International Congress on “Life Sustaining Treatments and Vegetative State:Scientific Advances and Ethical Dilemmas” Pope John Paul said this:

I should like particularly to underline how the administration of water and food, even when provided by artificial means, always represents a natural means of preserving life, not a medical act. Its use, furthermore, should be considered, in principle, ordinary and proportionate, and as such morally obligatory, insofar as and until it is seen to have attained its proper finality, which in the present case consists in providing nourishment to the patient and alleviation of his suffering.

Add to this the empirical and scientific data on end of life care. One of the popular misconceptions from lay people is that denying artificial nutrition and hydration to the dying is akin to starving them. I have heard and read this again and again about how cruel it is to withhold feedings. Yet research shows that feedings may actually cause discomfort and prolong dying. WebMD had this to say:

For patients at the end of life, providing artificial nutrition and hydration may prolong the dying process without contributing to the patient’s comfort. In fact, because of side effects, artificial nutrition and hydration may actually contribute to the dying patient’s discomfort.

With terminally ill patients, death is more of a process than an event, a single moment in time. As the body shuts down, peristalsis slows and feedings can cause nausea, vomiting and bloating. Hospice workers have noted that patients without artificial feedings appear more comfortable. The difference between Ruth Graham and say, Terri Schiavo, is the difference between someone whose death was imminent and someone who was being maintained with nursing care and nutrition. It’s also the difference between those who can and have expressed their wishes and those who don’t or can’t. For patients who haven’t written an advanced directive or talked with their family about their wishes, it can leave their families and caregivers in a legal and moral quagmire. The majority of us will die in a hospital or nursing home, most likely unable to communicate our wishes. The image of an elderly person lying on their death bed at home, surrounded by loved ones, is a rarity. As nurses we’re in a unique position to talk to patients about their wishes and encourage them to write an advance directive. It should be a part of every admission assessment. If we learn anything from Karen Ann Quinlan and Terri Schiavo it should be that it’s never to soon to have this discussion. Religion can provide the moral teaching, but patients need us to provide the facts. To help them make a decision they can live, and die, with.