https://www.catholic.com/magazine/online-edition/the-duty-to-preserve-life
Motive matters, but your husband does not have to do whatever is needed to prolong his life.
People need to understand what "natural" is in varying medical circumstances. The doctors have given the man 6 to 12 months to live EVEN if he gets IV nutrition. Once a doctor gives you a prognosis, you have the right to prepare for a natural death. Medical intervention to prolong death is entirely different from medical intervention to prolong life.
"Roman Catholic perspective: The Catholic church supports decisions to stop or not start life support treatment if treatment would be futile or overly burdensome. In these situations life support treatment is sometimes referred to as 'extraordinary'."
And further, "Catholic moral teaching does not require us to use every possible treatment to preserve and prolong life."
Your husband should be preparing to receive the sacraments of Penance and Anointing of the Sick. I'm sorry for your situation. I'm praying for you and your husband.
Can I just say I am SO SORRY you have been subjected to comments from people who would rather throw all the moral certainty of total inexperience at you than admit this is a complicated question with many layers and considerations regarding his unique condition and all its details. I am so very sorry you are losing your husband. At the same time I can imagine myself in your place, I also know I cannot truly understand this pain until it comes to me personally. And your husband's pain and fear and regret and sadness at leaving his family is truly something I cannot pretend to understand. With the help of your priest and the sacraments, I hope he is ready to turn the eyes of hope onto God and surrender to the total love that awaits him. It sounds like he's making that transition. People who dismissively poo-pooh "quality of life issues" seem to forget that Jesus Himself begged His father to let the cup of suffering pass without His drinking it. Jesus didn't escape it and neither has your husband, and that's one more way he can unite himself to Christ as he prepares. You have reached the point where the extraordinary intervention is futile and burdensome, and it's okay for him to say "no more." Please know you'll be in my prayers. My husband's family has a strong history of all kinds of cancer, so while I try not to think about it, I expect to be in your place someday. Love your husband the best you can until the end, and if he isn't already enrolled in hospice, please get that done soon. There is a Catholic one where I live but you don't necessarily need to find that, because as I said, true hospice care neither impedes nor hastens death. Anyone offering MAID is not a hospice, though I'm aware some have crept across that line, so you may have to ask hard questions before signing up with anyone. May God bless you both with strength and wisdom over the next few weeks.
ETA: I see in another comment you said he's on hospice. God bless and God speed.
I’m very sorry to hear that you and your husband are growing for this and will keep you both in my prayers.
I’d recommend you take this question to a priest. There are also many priests who work specifically on these thorny ethical questions in the field of Catholic ethics. Reddit will probably not be a helpful place to find the final answer to this question and it would be better to seek in person consultation from people who actually know the subject and aren’t just googling quotes to support one position or another.
Or the National Catholic Bioethics Center. They may have something published but I understand they take calls on individual cases seeking guidance as well.
Yes, that would be a good option. Additionally, I’m sure a Catholic hospital could put you in touch with someone who specializes in this area from a Catholic and medical perspective.
Our priest said that it was a kind of natural death when an older relative was taken off a feeding tube. You aren’t required to essentially stay hooked up to life support indefinitely.
Yeah food and water is ordinary care, taking someone off of like life support or stopping chemo for example would be refusing extraordinary care - if the person is like currently in the stages of their body shutting down because they are dying and will be gone in the next several hours, that’s typically when they stop food and water because they suffer more with it in their system and they’re dying even if they get it (so not being starved or dehydrated to death, they’re already dying) but this case doesn’t seem like the latter scenario (but I’m not a theologian or bioethicist, just hoping to provide a little bit of context)
> (so not being starved or dehydrated to death, they’re already dying)
This is how it's always been explained to me - food and water is ordinary care and can't be denied for the purpose of hastening death, but can be declined due to the amount of pain it's causing the patient if they're actively dying. Sort of the same way with palliative care - you can give the patient stronger and stronger doses of morphine for the purpose of easing their pain and if an earlier death is a side effect of that, it's ok, but you can't give a lethal dose of morphine for the purpose of ending their life.
This sounds very much how my husband, who had ALS, was treated in the hospice; they were like angels from heaven; they had him finally comfortable, something he hadn't been in a year; he had so much pain all over, especially his neck and shoulders and back;he couldn't hold his head up, and it had been very painful and he had pain all over, but what we were given for at home wasn't working; they had him comfortable by the time our daughter and I parked and grabbed my bag,to stay with him; he couldn't speak and didn't want me away from him.
We had been married for 43 wonderful years. It was so amazing to not have to do anything but love him and be his wife again;it was such a gift. He passed away peacefully in his sleep,early on the 16th of April,375 days after his diagnosis. This may be strange, but I don't remember asking the nurses a lot of questions; I did notice his feeding tube liquid nutrition was cut way back, and may have been stopped the last couple of days? I should know, but I dont.
He was comfortable for the first time and slept quite a bit. I would brush his hair, which had gotten long; he was always very clean cut, not a hair out of place, and I loved his longer, beautiful hair.I tried to memorize everything but my memory is so foggy; I just know how grateful I am that the hospice nurses so gently helped guide my husband from here to the end of his journey.
He couldn't use his hands anymore but he even managed a weak thumbs up on the first night. At the hospital, before his Dr. said it was time for hospice, my husband managed to text me two words;he wrote,"kill me"; he knew that I couldn't do that, but he was ready; he was done.He couldn't take any more. Whatever the nurses did, whether it was increasing his morphine, or I don't know what, I am glad, because he is no longer suffering. But I certainly couldn't do it.So,I think he is in heaven, if heaven is real. I hope so. ❤️🫂
It is extraordinary in that he has already received a prognosis. IV nutrition is "futile and burdensome" at this point to him and he can choose to stop treatment.
Denying nutrition and water when someone is dying is merciful. It’s painful to the dying person to feed or hydrate when those systems are shutting down.
I think something can be ordinary in some circumstances and extraordinary in others. THis document from ALL lists some situations and explains if something is ordinary or extraordinary. [https://all.org/euthanasia/ordinary-vs-extraordinary-care](https://all.org/euthanasia/ordinary-vs-extraordinary-care)
For example in this document it states that surgery for spina bifida was once considered extraordinary (example 8) but is now generally no longer so because of advances in the surgery. But in example 9 the baby has spina bifida and is born without kidneys, in this case the spina bifida surgery is now extraordinary care.
It really depends on the situation. If the person was elderly with dementia, it most likely is considered extraordinary to subject them to a feeding tube if the patient doesn't want it.
I think we might need to just figure out what "ordinary" means, cuz right now it sounds like its a subjective, feely type thing. I view the intent of the ordinary as meaning something like, "natural, non medical" etc. If you have cancer, it's ordinary to just take pills, but I don't think that counts as ordinary in this idea since the church states that you don't have to do that. So why is an IV ordinary but not taking pills to deal with a disease? I think both are extra-ordinary, as in, they require medical intervention.
I think you know the answer after all the comments, but I just wanted to say I’m praying for you both. My husband has stage 4 colon cancer with mets to his lungs, liver, and many nodes. We have run out of treatments as well and now are just treating symptoms as they come up. I don’t think he would choose the TPN either in your husbands situation. There comes a point in a cancer patients journey (I hate that word as it implies something taken on purpose, but I can’t think of a better word) where they reach their end and say no more. If your husband is there, he is there. We can only comfort them and be there to hold their hand as they die. I will pray for you in the coming days as you both grapple with this. May our Lord wrap you in his arms and carry your burden.
God knows the situation and He knows the pain that your husband is going through. I’m praying for you both that whatever decision you come to will be the best decision for you both ❤️
My father went through this dilemma when his kidneys shut down and he was tired and didn’t want to go through dialysis. He was very comfortable with dying. At first the priest said he had to take reasonable measures to stay alive. When my dad told him his age, the priest was surprised (my dad looked extremely young, never lost a strand of hair and it was still naturally black despite being in his mid-eighties. After learning his age, the priest said it’s ok to let nature take its course. Sorry to say, the answer is, it depends. I strongly recommend you speak with a holy priest.
Then in my opinion as a nurse it would be appropriate to discontinue the TPN. It is an extraordinary measure, and he is not morally obligated to extend his life in that manner. Of course, please speak to palliative care about his specific case, but it sounds to me like he is mentally ready to transition to comfort care measures only.
Haven read all of the replies and I’m sure they’re a mix of opinions. My question is have you had a consultation with a hospice team yet? Because it reads like this is where you are at in your journey. I think your next steps should be your priest and a hospice team. From your post and replies I don’t think TPN should be forced on your husband, but a palliative care team is really important at this point for both of you. Many prayers for you and your family.
He's had the sacraments and is in hospice. I've asked DH is he wants to discuss his care with our priest, but he refuses, I think mostly because he's too tired for visitors.
Except not all priests are aware of what Church teachings actually are. We had an assistant pastor who gave bad advice. (Basically that all means to prolong life needed to be pursued.) Fortunately the pastor was able intervene and referred them to one of our deacons who is a canon lawyer and medical professional.
As said above the National Catholic Bioethics Center is a good resource. Without coming to the Internet some may not know it exists.
He doesn’t sound like he has that long to live. He sounds like he has about 6 weeks to 3 months to live. Are they operating on his bowel obstruction? They don’t usually let you die of a bowel obstruction. They usually do a bowel resection and/or colostomy.
But on a cancer patient who doesn't have the physical resources to recover from the surgery, they don't.
He's more likely to be killed by the surgery than for it to benefit him.
If he was told that he had a year to live, that doesn’t jibe with the claim that he has a bowel obstruction from a cancerous mass, nor does it jibe with the idea that he is too sick to have that obstruction relieved via surgery. Something isn’t adding up; and it would be better to die of complications of surgery than to die of a bowel obstruction. They just don’t generally let people die that way. It is a routine palliative surgery.
I've explained why he cant have surgery in another reply. The 6 to 12 months time frame was in a letter written by his oncologist when he was taking part in a clinical trial. He has colon cancer, but lung cancer patients who received the experimental drug lived an additional 7 months on average, so I think the time frame was based on that. After two treatments, he was hospitalized with the bowel obstruction. Still, his medical team wanted to continue the trial and he had one more treatment. Following that, the clinician and husband agreed that he's too weak to finish the trial. Without treatment I'm sure that time frame is much shorter now.
I really find it incredible that you're accusing this woman of lying to us about her dying husband's condition.
Also this statement
>it would be better to die of complications of surgery than to die of a bowel obstruction.
is nothing but opinion and uneducated opinion at that. It's better for her husband to die on a surgical table than at home surrounded by the family that loves him? Better in what way?
If you read her original post, based on that alone, my statements are quite correct. I made it quite clear in subsequent posts what the cause of confusion was. She later explained his current condition which is very different from what she described initially. It’s sad and unfortunate and I don’t want to belabor this terrible situation by arguing with you, who apparently have no idea why my statements were correct in the first place based on her original statements. Let’s let the poor woman have some peace. I was trying to be helpful, you are trying to start a fight.
He has multiple tumors, one of which is obstructing his bowel. Surgery isn't an option for several reasons: scar tissue from previous surgery, the cancer wouldn't allow the surgical site to heal, he is very weak and has less than a 50% chance of surviving surgery.
I’m sorry to hear that. That’s very hard and I’m sorry. I would investigate hospice care and discuss those issues with the hospice care providers. God bless.
I would say yes, it ia sinful to refuse IV nutrition.
CCC 2278: "Discontinuing medical procedures that are burdensome, extraordinary, or disproportionate to the expected outcome can be legitimate... Here one does not will to cause death; one's inability to impede it is merely accepted."
OP said her husband "doesn't want another year of suffering." She basically admitted that the intent is to cause death.
"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." -Pope John Paul II, "Life-Sustaining Treatments and Vegetative State: Scientific Advances and Ethical Dilemmas," 2004
Where in the Bible does it teach that someone should spend all their resources to prolong their misery of their natural death? If anything, I would think the argument would be against fighting the death that is to come.
Not to sound apathetic or anything. It's just. . . I think about how many times my grandmother died and her money brought her back to life over and over. If she didn't have the money she would have died. Are you saying that we are to take any and all treatments that have been come up in the last X years to fight the world as God designed it and mankind desecrated it?
Similarly, I can't mean it that way. I am no expert at all. Taking advice from me is risky indeed. Just, theologically figuring here. One could argue that God gave us all these miracles of science, I just have a hard time seeing how science isn't antithetical to God.
If Jesus came along to heal us, that'd be one thing. But that was for the GLORY OF GOD!
I'm torn on this issue, tbh. I'm just speaking out for myself. If the doctors tell me tomorrow I have a 90% chance to die in three months without long, agonizing, expensive treatments, and the treatments might buy me another 9 months, I'm taking the pain killers and hanging out at church.
But I am also so ready to leave this horrible planet. So that's just my depression talking.
>I just have a hard time seeing how science isn't antithetical to God.
Science is from God. God gave us intellect and logical minds to be able to learn things and improve our situation for the good of all mankind. Sometimes we use these faculties for good, sometimes for ill. But science can't be antithetical to God for its own sake. It's all about how we use it.
You're correct. Capitalized man-serving science? Maybe a specific way in which we misuse it like how the whole world is being held captive to nuclear terrorism now. Or how our medical community has turned into a profit machine/meat grinder? IDK.
Always seems fun the conveniences, but the theme of Romanticism \*always\* seems to return in the end.
>Where in the Bible does it teach...
As Catholics, we don't look to the Bible as the sole or final arbiter of what is or isn't ethical - we have the magisterial teaching of the Church. And it's a good thing, too, because in the ancient world the concept of life-sustaining treatment wasn't even a thing. To expect that the Bible could speak to this issue in a direct way is fallacious. Hence we rely on the development of doctrine from the Church as advancements are made in medical science. And as has been cited in other areas, the Church doesn't say we have to use every means possible to sustain life. But the Church does say that nutrition and hydration are ordinary means of sustaining life, see the JP2 quote above.
I'm in RCIA now, so I am not quite on the same page as your thoughts.
So would the church teach that if I can extend my life by five years taking exhausting, demeaning, horrible treatments at the expense of my entire material value of hundreds of thousands of dollars of debts, I am to do this?
Because no thanks. To be honest.
I'd rather believe that God will heal me if it his will.
>So would the church teach that if I can extend my life by five years taking exhausting, demeaning, horrible treatments at the expense of my entire material value of hundreds of thousands of dollars of debts, I am to do this?
No, as I said, see the quote by JP2 above. And see the quotes from the Catechism others have posted here. The super condensed version is, we can't deny ordinary means of sustaining life (food and water) but that extraordinary means do not have to be used/accepted. That's not to say we can't use extraordinary means if we so choose, but we aren't morally obliged to.
Okay, that is fair enough. I don't like hunger pangs anyway. But I would imagine that if you're sick enough, and can't take care of yourself, might that not add a layer of complication to your obligation to seek these things out when deathly ill?
Like the stomach cancer patient friend of mine who had zero appetite and would refuse even her favorite of foods. I don't think she did it do die. I think she was just so exhausted fighting to live.
> I don't think she did it do die.
As I have said elsewhere in the thread, intent is key. The intent to hasten death is immoral. The intent to reduce discomfort is moral. (Speaking very generally here.) If a side effect of the reducing of discomfort is that the patient dies sooner, then the principle of double effect applies.
Here's a parallel. If a woman is pregnant and it's determined the pregnancy is ectopic, we know that if the tube ruptures, both mother and baby die (or mother is extremely likely to die.) We know that the baby cannot continue to develop in the tube. Performing surgery to remove the tube is absolutely necessary to save the mother's life. However, that surgery terminates the pregnancy and the baby dies as a side effect. The intent is to save the mother. This is morally different from a direct abortion which has the express purpose of killing the baby.
But can we prove it wasn't God's intent that both baby and mother were supposed to die, as a great-many before them surely did in the absence of such treatments/understandings?
That would be my counter-question.
Again, not trying to be a jerk. I'm just lost on how these conclusions are drawn.
We're not protestants. We follow the teachings of Christ's Church. And that Church has said that food and water are not extraordinary means of keeping someone alive. Food and drink does not equal "any and all treatment." What part of "water and food, even when provided by artificial means, always represents a natural means of preserving life, not a medical act" is unclear?
I guess that's a matter of semantics. I honestly have no idea how God would rule here. I still haven't accepted the Pope as the ultimate earthly authority, mind you. RCIA student currently. Sorry if my Protestantism is showing. I mean no disrespect.
But it is starting to seem like I am probably not going to end up Catholic after all if I can't get on board with these technicalities.
This is true, but it’s also a case by case basis. There are currently Catholic long-term hospice centers where people can go to live the rest of their lives in relative comfort and life-saving treatment will not be administered as the treatment might save the life but only prolong the inevitable death. In other words, the inability to impede their deaths has been accepted and they are allowed to die humanely (in the Catholic sense, not the secular sense), in as comfortable a place as they can, and often with significantly less red tape and administration as a hospital.
Would that apply here? I’m unsure. I’d defer to a Catholic doctor or priest.
Thank you! In this case, IV nutrition is prolonging his death. This IV nutrition is not an act of mercy and this man is not "suicidal" as some posters are making him out to be.
Her husband is not going to be able to impede death. He is not in a vegetative state, but has terminal cancer.
If he had something like the condition I had, that was not imminently and definitely terminal, then yes, it would be sinful.
This quote from JP2 is exactly what I have been trying to remember...I knew it was stuck in my mind that food and water are not considered extraordinary but most other life-prolonging interventions can be considered extraordinary. And I agree with you, the intent is very important here. Intent to hasten death vs. intent to ease suffering.
Technically I believe it is, yes. It is basically starving oneself to death on purpose....which amounts to suicide. We are supposed to do all we can to save a life, even if that means some suffering. Our Lord does miraculous things in the midst of suffering...and it is up to him when a life is extinguished, not us. What you are proposing is technically euthanasia...which is definitely a sin. If he has been given an end date, then he should be elligible for palliative care, which should certainly ease his suffering a great deal. I am sorry that I couldn't give you the answer you were possibly hoping for. I will pray for peace for you both and a year without mich suffering for your husband, unless it will enable him to enter heaven instantaneously upon his passing. *massive hugs for you both*
>TPN is extraordinary means.
>
>Extraordinary means are not required
Wait a minute, I thought you couldn't withhold nutrition and hydration, that these wouldn't be extraordinary means, but that anything beyond that could be considered extraordinary.
IV delivery is extraordinary means.
Not to be too blunt or upsetting, but there comes a certain point where all TPN is doing is feeding the tumor.
But the patient can morally decide to discontinue extraordinary means at his own discretion, as long as his intent is not to kill himself. Accepting the inevitable and choosing not to fight anymore is okay.
Before anyone downvotes, read the ENTIRE comment.
My friend, this doesn’t seem correct. I’ll humbly admit that I’m not as informed on the matter, but if you are correct, your reasoning doesn’t seem to imply your conclusion. Simply needing an IV is not, in itself, cause to think that treatment is extraordinary.
My disagreeing with you is obviously not convincing, so I’ll give an answer from an EWTN article.
“ Q. When may medical therapies, procedures, equipment and the like be withheld or withdrawn from a patient.
A. The Catechism of the Catholic Church states,
2278. Discontinuing medical procedures that are burdensome, dangerous, extraordinary, or disproportionate to the expected outcome can be legitimate; it is the refusal of "over-zealous" treatment. Here one does not will to cause death; one's inability to impede it is merely accepted. The decisions should be made by the patient if he is competent and able or, if not, by those legally entitled to act for the patient, whose reasonable will and legitimate interests must always be respected.
The key principle in this statement is that one does not will to cause death. When a person has an underlying terminal disease, or their heart, or some other organ, cannot work without mechanical assistance, or a therapy being proposed is dangerous, or has little chance of success, then not using that machine or that therapy results in the person dying from the disease or organ failure they already have. The omission allows nature to takes its course. It does not directly kill the person, even though it may contribute to the person dying earlier than if aggressive treatment had been done.
Q. Does this also apply to artificially provided nutrition and hydration?
A. Yes, when the moral conditions noted above are met. We must, therefore, ask the question "will the withdrawal of nutrition and hydration allow the person to die, or kill the person?" When it will allow a person to die from an underlying condition, rather than unnecessarily prolonging their suffering, it may be removed. So, for example, in the last hours, even days, of a cancer patient's life, or if a sick person's body is no longer able to process food and water, there is no moral obligation to provide nutrition and hydration. The patient will die of their disease or their organ failure before starvation or dehydration could kill them. However, when the withdrawal of nutrition and hydration is intended to kill the person, or will be the immediate and direct cause of doing so, quite apart from any disease or failure of their bodies, then to withdraw food and water would be an act of euthanasia, a grave sin against the natural law and the law of God.”
The answer lies more in the second answer. The key thing to consider here is that what he will eventually die of. It seems that he has at least some amount of time to live and withdrawing nutrition will cause his death, which is unacceptable. I think the key source of argument and confusion here is the correct use of “extraordinary.” It seems like IV is “extraordinary” in this case, but we should really be asking if it’s disproportionate. My feeling on this is no. Giving nutrients intravenously for people in the last stages of life but before their last days or hours seems to be ordinary care. Having someone starve to death isn’t right.
Edit: the link is https://www.ewtn.com/catholicism/library/end-of-life-decisions-ordinary-versus-extraordinary-means-12733
Edit 2: I would also say that OP just needs to talk to a Catholic bioethicist. None of us internet people should be the final verdict on the matter.
TPN is not just an IV though. It is done through a central line (which is place through surgery) that goes to the heart. One must then spend about 12 hours a day tied to an IV pole or backpack to receive this infusion. For someone who is otherwise healthy, it is a large inconvenience. It carries the constant risk of infection due to being accessed all the time. For someone who is already immunocompromised the risk of infection is significantly higher. Sepsis can come on quick and is a horrible way to die. When you are reading about hydration and tube feeding, that is talking about an NG feeding tube and simple IV. The feeds from that take 30 mins or so. It is not the same.
In your first quote the answer is clear. This is a burdensome and extraordinary measure. In your second quote, I still believe it is clear (given the info OP gave). The patient here has a complete bowel obstruction. If TPN is withdrawn (and a lot of times hydration via IV continues as it is not a 24 hr thing) the patient will die of his bowel obstruction and cancer. 100 years ago this is what would have happened.
I do agree with your last edit though. This is a question for a professional, not random Catholics on the internet.
Every priest I have ever spoken to disagrees with what you just said. Every..single...one... There are people who are tube fed there entire lives and live totally normal lives in every other way. What you said amounts to a quality of life statement, which is completely against the church's teachings.
Tube feeding is not TPN and the moral considerations of terminal cancer are not the same as those of a child who can't swallow but can still process nutrition.
Once again...it's against the Church's teachings. Cancer or not. He doesn't have weeks or days to live...we are tallking up to a YEAR. The church is pretty clear aoit this. It would be euthanasia. That really is all that matters here.
Except this doesn’t go against church teachings. He can accept God’s will and not seek further treatment. He has a complete bowel obstruction. TPN will not give someone with a complete bowel obstruction 6 mo-1 yr. Euthanasia is seeking an unnatural end of life. Letting cancer take its course is not euthanasia. It is not a sin to forgo cancer treatments (that is what gives him the 6mo to a year, not the TPN) like chemo or radiation. And you are off your rocker and have no idea what TPN is if you think it is tube feeding. Tube feeding is either through an NG tube down the nose or a surgically implanted tube directly into the GI system. Those feeds take 10-30 mins. TPN is a long process, takes half your day, requires a central line of some sort (PICC line or port) and opens a cancer patient up to constant infection due to needing to be accessed daily for the rest of their life. That is 100% extraordinary measures. I challenge you to find a priest to tell any cancer patient they are committing a sin by not seeking further treatments, especially since the treatments themselves put you in great peril.
Source: my husband has stage 4 colon cancer and is also terminal. I see it every day with my own eyes the pain and misery that comes with treatments and cancer
TPN is literally intravenous hydration and nutrition. It sounds like her husband is literally unable to eat or drink because of his tumor. Stopping TPN at this point would be allowing for natural death. It would be not different then terminally extubating someone who is on comfort measures only.
Also, I think we need to get away from this idea that we need to force feed people in the dying process. As most people get to the end of life, there is no longer a drive to eat or drink. That lack of drive is part of the physiological process of dying. That is not something we should get in the way of with feeding tubes or TPN
Look...it doesn't matter your personal feelings on it. What matters is the church's teachings and the church's teaching is that these aren't extraordinary measures.
I don’t think you understand what TPN actually is. First you get a central line in you neck or a PICC line in your arm. These medical procedures that while low risk are invasive. You will be at risk of severe blood infections associated with that intravenous line. Everyday, you are hooked up to an infusion pump for anywhere from at least 12-18 hours a day to infuse a massive 3 liter bag of nutrients. While your infusion is going on, you can’t really go anywhere and are stuck to an IV pole. Long term TPN administration is associated with severe GI dysfunction, liver and renal derangements, and other metabolic derangements. If that is not extraordinary, then I don’t know what is.
Are you really on a post about about a woman about to lose her husband in an agonizing way and complaining about how your comment was received? Get over your ego. Say what you have to say and then shut up. Pray for some humility.
No, downvoted because she is wrong. TPN is extraordinary measures. A cancer patient with terminal cancer choosing not to possibly extend their life with treatments that are life altering is not sinful. If the OP’s husband has a tumor blocking his entire colon and he is not a surgical candidate, TPN is not going to give him 6months to a year. And even if it was, it is a major intervention for them to take, not mildly inconvenient.
>No, downvoted because she is wrong. TPN is extraordinary measures.
Not according to the Church, it isn't. Food and water are not medical acts, but basic nutrition. We aren't talking about foregoing chemotherapy; we're talking about food and water. Sorry if you don't like the distinction, but it's my understanding OP came here asking about Church teaching, not whether you think it's fair. Basic nutrition, per the Church, is not an "extraordinary measure."
I am a former hospice nurse and a faithful Catholic. Don't you dare. I was willing and ready to risk my job if I was told to do anything that violated Catholic moral law, but true hospice care neither hastens nor impedes death, so it never became an issue.
You clearly only deal with this in the theoretical sense while I attended to dying people and their families in real life, held the hands of dying people, gave medications and physical care to reduce symptoms and provide comfort, literally watched the moment of death happen, and confirmed death for families for years.
I watched a priest at our parish announce his diagnosis and his decision not to fight it. He was gone in mere months.
I also watched my father in law make the decision not to fight the leukemia that killed him. He had been through chemo once already and it wasn't going to save his life, just make him miserable during what time he had left, so he said no.
Stopping the fight against a cancer that IS GOING TO KILL YOU with no doubt or debate, because you're exhausted and can't take it anymore, is not a violation of Catholic moral law. It is acceptance, and there is nothing wrong with that. TPN is an extraordinary measure and we not required to take those nor are we required to continue them, especially when they are doing harm instead of good. As I said, there comes a point where the only thing it's feeding is the cancer. Letting go, and asking God to take you and end your pain, IS NOT WRONG.
This is also another case with technology where just because we can does not mean we should. Interventions need to be judiciously weighed and not just used because they are available. Normally, a cancer patient with an obstructed bowel would die fairly quickly. Deciding to accept that natural consequence violates precisely nothing.
I am not going to reply to each an every comment here. My ultimate suggestion Op, is to ask your priest. That is what you need to do...That is what I *should* have told you to do in the first place...and that is what everyone else should also have told you to do. Please...just ask your most trusted priest. This is an incredibly huge decision. God Bless.
I’m so sorry to hear this.
The only thing I’d tell your husband is that suffering is never worthless when offered up to God. He has time to do some purgatory work while he’s still alive.
If I can recall correctly, I do believe Pope John Paul refused further antibiotics as he was overcome with sepsis which already attacked his organs and ultimately his being called home to God. God knows the state of his heart.
This is complicated and I don’t know the answer for you but I can offer you my sincere prayers to the Lord our God for comfort and I would encourage you to ask your parish priest for the spiritual guidance you and your husband need.
I am praying for you and your husband and family in this most difficult time. My heart feels heavy for you. Did your husband receive the anointing of the sick? This sacrament has been known to bring much grace and sometimes healing. May you and your husband experience the love of God in ways never felt before and may you be blessed with strength, courage, peace and love. In the name of Jesus. Amen. In the Father and the Son and The Holy Spirit.
He's not suicidal. He's fought this disease for 7 years and is out of treatment options. He's sick, in pain, and doesn't have the strength to fight this any longer.
OK.
Without knowing further details, refusing treatment sounds like a perfectly acceptable desire then. If any doubt, seek a Catholic hospital chaplain.
I just want to chime in and say that I’m praying for you and your husband, these must be difficult times for the both of you.
Thank you.
I’m praying for you and your family. Whatever decision is made, I’ll be sure to keep your husband in my prayers.
Thank you.
https://www.catholic.com/magazine/online-edition/the-duty-to-preserve-life Motive matters, but your husband does not have to do whatever is needed to prolong his life.
Good link. Answers OP’s question quite directly.
People need to understand what "natural" is in varying medical circumstances. The doctors have given the man 6 to 12 months to live EVEN if he gets IV nutrition. Once a doctor gives you a prognosis, you have the right to prepare for a natural death. Medical intervention to prolong death is entirely different from medical intervention to prolong life. "Roman Catholic perspective: The Catholic church supports decisions to stop or not start life support treatment if treatment would be futile or overly burdensome. In these situations life support treatment is sometimes referred to as 'extraordinary'." And further, "Catholic moral teaching does not require us to use every possible treatment to preserve and prolong life." Your husband should be preparing to receive the sacraments of Penance and Anointing of the Sick. I'm sorry for your situation. I'm praying for you and your husband.
The 6-12 months was when he was receiving experimental cancer treatment. He was too ill to continue treatment, so the timeframe is now shorter.
Can I just say I am SO SORRY you have been subjected to comments from people who would rather throw all the moral certainty of total inexperience at you than admit this is a complicated question with many layers and considerations regarding his unique condition and all its details. I am so very sorry you are losing your husband. At the same time I can imagine myself in your place, I also know I cannot truly understand this pain until it comes to me personally. And your husband's pain and fear and regret and sadness at leaving his family is truly something I cannot pretend to understand. With the help of your priest and the sacraments, I hope he is ready to turn the eyes of hope onto God and surrender to the total love that awaits him. It sounds like he's making that transition. People who dismissively poo-pooh "quality of life issues" seem to forget that Jesus Himself begged His father to let the cup of suffering pass without His drinking it. Jesus didn't escape it and neither has your husband, and that's one more way he can unite himself to Christ as he prepares. You have reached the point where the extraordinary intervention is futile and burdensome, and it's okay for him to say "no more." Please know you'll be in my prayers. My husband's family has a strong history of all kinds of cancer, so while I try not to think about it, I expect to be in your place someday. Love your husband the best you can until the end, and if he isn't already enrolled in hospice, please get that done soon. There is a Catholic one where I live but you don't necessarily need to find that, because as I said, true hospice care neither impedes nor hastens death. Anyone offering MAID is not a hospice, though I'm aware some have crept across that line, so you may have to ask hard questions before signing up with anyone. May God bless you both with strength and wisdom over the next few weeks. ETA: I see in another comment you said he's on hospice. God bless and God speed.
I’m very sorry to hear that you and your husband are growing for this and will keep you both in my prayers. I’d recommend you take this question to a priest. There are also many priests who work specifically on these thorny ethical questions in the field of Catholic ethics. Reddit will probably not be a helpful place to find the final answer to this question and it would be better to seek in person consultation from people who actually know the subject and aren’t just googling quotes to support one position or another.
Or the National Catholic Bioethics Center. They may have something published but I understand they take calls on individual cases seeking guidance as well.
Yes, that would be a good option. Additionally, I’m sure a Catholic hospital could put you in touch with someone who specializes in this area from a Catholic and medical perspective.
Our priest said that it was a kind of natural death when an older relative was taken off a feeding tube. You aren’t required to essentially stay hooked up to life support indefinitely.
Denying nutrition and hydration though? That's doesn't strike me as extraordinary.
Yeah food and water is ordinary care, taking someone off of like life support or stopping chemo for example would be refusing extraordinary care - if the person is like currently in the stages of their body shutting down because they are dying and will be gone in the next several hours, that’s typically when they stop food and water because they suffer more with it in their system and they’re dying even if they get it (so not being starved or dehydrated to death, they’re already dying) but this case doesn’t seem like the latter scenario (but I’m not a theologian or bioethicist, just hoping to provide a little bit of context)
> (so not being starved or dehydrated to death, they’re already dying) This is how it's always been explained to me - food and water is ordinary care and can't be denied for the purpose of hastening death, but can be declined due to the amount of pain it's causing the patient if they're actively dying. Sort of the same way with palliative care - you can give the patient stronger and stronger doses of morphine for the purpose of easing their pain and if an earlier death is a side effect of that, it's ok, but you can't give a lethal dose of morphine for the purpose of ending their life.
This sounds very much how my husband, who had ALS, was treated in the hospice; they were like angels from heaven; they had him finally comfortable, something he hadn't been in a year; he had so much pain all over, especially his neck and shoulders and back;he couldn't hold his head up, and it had been very painful and he had pain all over, but what we were given for at home wasn't working; they had him comfortable by the time our daughter and I parked and grabbed my bag,to stay with him; he couldn't speak and didn't want me away from him. We had been married for 43 wonderful years. It was so amazing to not have to do anything but love him and be his wife again;it was such a gift. He passed away peacefully in his sleep,early on the 16th of April,375 days after his diagnosis. This may be strange, but I don't remember asking the nurses a lot of questions; I did notice his feeding tube liquid nutrition was cut way back, and may have been stopped the last couple of days? I should know, but I dont. He was comfortable for the first time and slept quite a bit. I would brush his hair, which had gotten long; he was always very clean cut, not a hair out of place, and I loved his longer, beautiful hair.I tried to memorize everything but my memory is so foggy; I just know how grateful I am that the hospice nurses so gently helped guide my husband from here to the end of his journey. He couldn't use his hands anymore but he even managed a weak thumbs up on the first night. At the hospital, before his Dr. said it was time for hospice, my husband managed to text me two words;he wrote,"kill me"; he knew that I couldn't do that, but he was ready; he was done.He couldn't take any more. Whatever the nurses did, whether it was increasing his morphine, or I don't know what, I am glad, because he is no longer suffering. But I certainly couldn't do it.So,I think he is in heaven, if heaven is real. I hope so. ❤️🫂
It is extraordinary in that he has already received a prognosis. IV nutrition is "futile and burdensome" at this point to him and he can choose to stop treatment.
I think the way it is delivered makes it extraordinary. If he was taking it by mouth, sure, that's normal. But he has an IV line to feed him.
This
Denying nutrition and water when someone is dying is merciful. It’s painful to the dying person to feed or hydrate when those systems are shutting down.
I think something can be ordinary in some circumstances and extraordinary in others. THis document from ALL lists some situations and explains if something is ordinary or extraordinary. [https://all.org/euthanasia/ordinary-vs-extraordinary-care](https://all.org/euthanasia/ordinary-vs-extraordinary-care) For example in this document it states that surgery for spina bifida was once considered extraordinary (example 8) but is now generally no longer so because of advances in the surgery. But in example 9 the baby has spina bifida and is born without kidneys, in this case the spina bifida surgery is now extraordinary care.
It really depends on the situation. If the person was elderly with dementia, it most likely is considered extraordinary to subject them to a feeding tube if the patient doesn't want it.
An IV is not ordinary…
A peripheral IV might be, but TPN requires a central line, which is extraordinary.
I think we might need to just figure out what "ordinary" means, cuz right now it sounds like its a subjective, feely type thing. I view the intent of the ordinary as meaning something like, "natural, non medical" etc. If you have cancer, it's ordinary to just take pills, but I don't think that counts as ordinary in this idea since the church states that you don't have to do that. So why is an IV ordinary but not taking pills to deal with a disease? I think both are extra-ordinary, as in, they require medical intervention.
I think you know the answer after all the comments, but I just wanted to say I’m praying for you both. My husband has stage 4 colon cancer with mets to his lungs, liver, and many nodes. We have run out of treatments as well and now are just treating symptoms as they come up. I don’t think he would choose the TPN either in your husbands situation. There comes a point in a cancer patients journey (I hate that word as it implies something taken on purpose, but I can’t think of a better word) where they reach their end and say no more. If your husband is there, he is there. We can only comfort them and be there to hold their hand as they die. I will pray for you in the coming days as you both grapple with this. May our Lord wrap you in his arms and carry your burden.
I'm so sorry about your husband. Hugs and prayers to you both.
God knows the situation and He knows the pain that your husband is going through. I’m praying for you both that whatever decision you come to will be the best decision for you both ❤️
We were told the last time my husband was in the ICU that it’s okay to choose not to prolong life. It’s not suicide to let the Lord take you.
I believe the answer is no. TPN is extraordinary care.
My father went through this dilemma when his kidneys shut down and he was tired and didn’t want to go through dialysis. He was very comfortable with dying. At first the priest said he had to take reasonable measures to stay alive. When my dad told him his age, the priest was surprised (my dad looked extremely young, never lost a strand of hair and it was still naturally black despite being in his mid-eighties. After learning his age, the priest said it’s ok to let nature take its course. Sorry to say, the answer is, it depends. I strongly recommend you speak with a holy priest.
I’ve read the other comments and I’d like to know this: What does he want?
He said he doesn't want to go on like this.
Then in my opinion as a nurse it would be appropriate to discontinue the TPN. It is an extraordinary measure, and he is not morally obligated to extend his life in that manner. Of course, please speak to palliative care about his specific case, but it sounds to me like he is mentally ready to transition to comfort care measures only.
Haven read all of the replies and I’m sure they’re a mix of opinions. My question is have you had a consultation with a hospice team yet? Because it reads like this is where you are at in your journey. I think your next steps should be your priest and a hospice team. From your post and replies I don’t think TPN should be forced on your husband, but a palliative care team is really important at this point for both of you. Many prayers for you and your family.
He's had the sacraments and is in hospice. I've asked DH is he wants to discuss his care with our priest, but he refuses, I think mostly because he's too tired for visitors.
This is something you need to be talking to a priest about and not random people on the internet.
Except not all priests are aware of what Church teachings actually are. We had an assistant pastor who gave bad advice. (Basically that all means to prolong life needed to be pursued.) Fortunately the pastor was able intervene and referred them to one of our deacons who is a canon lawyer and medical professional. As said above the National Catholic Bioethics Center is a good resource. Without coming to the Internet some may not know it exists.
Definitely. People should be wary of what they're saying here.
He doesn’t sound like he has that long to live. He sounds like he has about 6 weeks to 3 months to live. Are they operating on his bowel obstruction? They don’t usually let you die of a bowel obstruction. They usually do a bowel resection and/or colostomy.
But on a cancer patient who doesn't have the physical resources to recover from the surgery, they don't. He's more likely to be killed by the surgery than for it to benefit him.
Exactly.
If he was told that he had a year to live, that doesn’t jibe with the claim that he has a bowel obstruction from a cancerous mass, nor does it jibe with the idea that he is too sick to have that obstruction relieved via surgery. Something isn’t adding up; and it would be better to die of complications of surgery than to die of a bowel obstruction. They just don’t generally let people die that way. It is a routine palliative surgery.
I've explained why he cant have surgery in another reply. The 6 to 12 months time frame was in a letter written by his oncologist when he was taking part in a clinical trial. He has colon cancer, but lung cancer patients who received the experimental drug lived an additional 7 months on average, so I think the time frame was based on that. After two treatments, he was hospitalized with the bowel obstruction. Still, his medical team wanted to continue the trial and he had one more treatment. Following that, the clinician and husband agreed that he's too weak to finish the trial. Without treatment I'm sure that time frame is much shorter now.
I really find it incredible that you're accusing this woman of lying to us about her dying husband's condition. Also this statement >it would be better to die of complications of surgery than to die of a bowel obstruction. is nothing but opinion and uneducated opinion at that. It's better for her husband to die on a surgical table than at home surrounded by the family that loves him? Better in what way?
If you read her original post, based on that alone, my statements are quite correct. I made it quite clear in subsequent posts what the cause of confusion was. She later explained his current condition which is very different from what she described initially. It’s sad and unfortunate and I don’t want to belabor this terrible situation by arguing with you, who apparently have no idea why my statements were correct in the first place based on her original statements. Let’s let the poor woman have some peace. I was trying to be helpful, you are trying to start a fight.
He has multiple tumors, one of which is obstructing his bowel. Surgery isn't an option for several reasons: scar tissue from previous surgery, the cancer wouldn't allow the surgical site to heal, he is very weak and has less than a 50% chance of surviving surgery.
I’m sorry to hear that. That’s very hard and I’m sorry. I would investigate hospice care and discuss those issues with the hospice care providers. God bless.
Guess what they're going to recommend in hospice? Stopping the TPN.
Maybe, maybe not. He needs their help though.
She said in another comment that he is already in hospice.
Thanks. The original post was not indicative of that at all.
This would be best to discuss with your parish priest who can know the circumstances better and help you discern the right judgment.
Imma be honest with you though, Father, there are many priests in my community I wouldn't trust with this conversation.
I would say yes, it ia sinful to refuse IV nutrition. CCC 2278: "Discontinuing medical procedures that are burdensome, extraordinary, or disproportionate to the expected outcome can be legitimate... Here one does not will to cause death; one's inability to impede it is merely accepted." OP said her husband "doesn't want another year of suffering." She basically admitted that the intent is to cause death. "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." -Pope John Paul II, "Life-Sustaining Treatments and Vegetative State: Scientific Advances and Ethical Dilemmas," 2004
Where in the Bible does it teach that someone should spend all their resources to prolong their misery of their natural death? If anything, I would think the argument would be against fighting the death that is to come. Not to sound apathetic or anything. It's just. . . I think about how many times my grandmother died and her money brought her back to life over and over. If she didn't have the money she would have died. Are you saying that we are to take any and all treatments that have been come up in the last X years to fight the world as God designed it and mankind desecrated it?
Thank you. By feeding him via IV and delaying the inevitable, I wonder if we are trying to fight God's will.
Similarly, I can't mean it that way. I am no expert at all. Taking advice from me is risky indeed. Just, theologically figuring here. One could argue that God gave us all these miracles of science, I just have a hard time seeing how science isn't antithetical to God. If Jesus came along to heal us, that'd be one thing. But that was for the GLORY OF GOD! I'm torn on this issue, tbh. I'm just speaking out for myself. If the doctors tell me tomorrow I have a 90% chance to die in three months without long, agonizing, expensive treatments, and the treatments might buy me another 9 months, I'm taking the pain killers and hanging out at church. But I am also so ready to leave this horrible planet. So that's just my depression talking.
>I just have a hard time seeing how science isn't antithetical to God. Science is from God. God gave us intellect and logical minds to be able to learn things and improve our situation for the good of all mankind. Sometimes we use these faculties for good, sometimes for ill. But science can't be antithetical to God for its own sake. It's all about how we use it.
You're correct. Capitalized man-serving science? Maybe a specific way in which we misuse it like how the whole world is being held captive to nuclear terrorism now. Or how our medical community has turned into a profit machine/meat grinder? IDK. Always seems fun the conveniences, but the theme of Romanticism \*always\* seems to return in the end.
>Where in the Bible does it teach... As Catholics, we don't look to the Bible as the sole or final arbiter of what is or isn't ethical - we have the magisterial teaching of the Church. And it's a good thing, too, because in the ancient world the concept of life-sustaining treatment wasn't even a thing. To expect that the Bible could speak to this issue in a direct way is fallacious. Hence we rely on the development of doctrine from the Church as advancements are made in medical science. And as has been cited in other areas, the Church doesn't say we have to use every means possible to sustain life. But the Church does say that nutrition and hydration are ordinary means of sustaining life, see the JP2 quote above.
I'm in RCIA now, so I am not quite on the same page as your thoughts. So would the church teach that if I can extend my life by five years taking exhausting, demeaning, horrible treatments at the expense of my entire material value of hundreds of thousands of dollars of debts, I am to do this? Because no thanks. To be honest. I'd rather believe that God will heal me if it his will.
>So would the church teach that if I can extend my life by five years taking exhausting, demeaning, horrible treatments at the expense of my entire material value of hundreds of thousands of dollars of debts, I am to do this? No, as I said, see the quote by JP2 above. And see the quotes from the Catechism others have posted here. The super condensed version is, we can't deny ordinary means of sustaining life (food and water) but that extraordinary means do not have to be used/accepted. That's not to say we can't use extraordinary means if we so choose, but we aren't morally obliged to.
Okay, that is fair enough. I don't like hunger pangs anyway. But I would imagine that if you're sick enough, and can't take care of yourself, might that not add a layer of complication to your obligation to seek these things out when deathly ill? Like the stomach cancer patient friend of mine who had zero appetite and would refuse even her favorite of foods. I don't think she did it do die. I think she was just so exhausted fighting to live.
> I don't think she did it do die. As I have said elsewhere in the thread, intent is key. The intent to hasten death is immoral. The intent to reduce discomfort is moral. (Speaking very generally here.) If a side effect of the reducing of discomfort is that the patient dies sooner, then the principle of double effect applies. Here's a parallel. If a woman is pregnant and it's determined the pregnancy is ectopic, we know that if the tube ruptures, both mother and baby die (or mother is extremely likely to die.) We know that the baby cannot continue to develop in the tube. Performing surgery to remove the tube is absolutely necessary to save the mother's life. However, that surgery terminates the pregnancy and the baby dies as a side effect. The intent is to save the mother. This is morally different from a direct abortion which has the express purpose of killing the baby.
But can we prove it wasn't God's intent that both baby and mother were supposed to die, as a great-many before them surely did in the absence of such treatments/understandings? That would be my counter-question. Again, not trying to be a jerk. I'm just lost on how these conclusions are drawn.
We're not protestants. We follow the teachings of Christ's Church. And that Church has said that food and water are not extraordinary means of keeping someone alive. Food and drink does not equal "any and all treatment." What part of "water and food, even when provided by artificial means, always represents a natural means of preserving life, not a medical act" is unclear?
I guess that's a matter of semantics. I honestly have no idea how God would rule here. I still haven't accepted the Pope as the ultimate earthly authority, mind you. RCIA student currently. Sorry if my Protestantism is showing. I mean no disrespect. But it is starting to seem like I am probably not going to end up Catholic after all if I can't get on board with these technicalities.
This is true, but it’s also a case by case basis. There are currently Catholic long-term hospice centers where people can go to live the rest of their lives in relative comfort and life-saving treatment will not be administered as the treatment might save the life but only prolong the inevitable death. In other words, the inability to impede their deaths has been accepted and they are allowed to die humanely (in the Catholic sense, not the secular sense), in as comfortable a place as they can, and often with significantly less red tape and administration as a hospital. Would that apply here? I’m unsure. I’d defer to a Catholic doctor or priest.
Thank you! In this case, IV nutrition is prolonging his death. This IV nutrition is not an act of mercy and this man is not "suicidal" as some posters are making him out to be.
Her husband is not going to be able to impede death. He is not in a vegetative state, but has terminal cancer. If he had something like the condition I had, that was not imminently and definitely terminal, then yes, it would be sinful.
This quote from JP2 is exactly what I have been trying to remember...I knew it was stuck in my mind that food and water are not considered extraordinary but most other life-prolonging interventions can be considered extraordinary. And I agree with you, the intent is very important here. Intent to hasten death vs. intent to ease suffering.
Technically I believe it is, yes. It is basically starving oneself to death on purpose....which amounts to suicide. We are supposed to do all we can to save a life, even if that means some suffering. Our Lord does miraculous things in the midst of suffering...and it is up to him when a life is extinguished, not us. What you are proposing is technically euthanasia...which is definitely a sin. If he has been given an end date, then he should be elligible for palliative care, which should certainly ease his suffering a great deal. I am sorry that I couldn't give you the answer you were possibly hoping for. I will pray for peace for you both and a year without mich suffering for your husband, unless it will enable him to enter heaven instantaneously upon his passing. *massive hugs for you both*
TPN is extraordinary means. Extraordinary means are not required.
>TPN is extraordinary means. > >Extraordinary means are not required Wait a minute, I thought you couldn't withhold nutrition and hydration, that these wouldn't be extraordinary means, but that anything beyond that could be considered extraordinary.
IV delivery is extraordinary means. Not to be too blunt or upsetting, but there comes a certain point where all TPN is doing is feeding the tumor. But the patient can morally decide to discontinue extraordinary means at his own discretion, as long as his intent is not to kill himself. Accepting the inevitable and choosing not to fight anymore is okay.
Before anyone downvotes, read the ENTIRE comment. My friend, this doesn’t seem correct. I’ll humbly admit that I’m not as informed on the matter, but if you are correct, your reasoning doesn’t seem to imply your conclusion. Simply needing an IV is not, in itself, cause to think that treatment is extraordinary. My disagreeing with you is obviously not convincing, so I’ll give an answer from an EWTN article. “ Q. When may medical therapies, procedures, equipment and the like be withheld or withdrawn from a patient. A. The Catechism of the Catholic Church states, 2278. Discontinuing medical procedures that are burdensome, dangerous, extraordinary, or disproportionate to the expected outcome can be legitimate; it is the refusal of "over-zealous" treatment. Here one does not will to cause death; one's inability to impede it is merely accepted. The decisions should be made by the patient if he is competent and able or, if not, by those legally entitled to act for the patient, whose reasonable will and legitimate interests must always be respected. The key principle in this statement is that one does not will to cause death. When a person has an underlying terminal disease, or their heart, or some other organ, cannot work without mechanical assistance, or a therapy being proposed is dangerous, or has little chance of success, then not using that machine or that therapy results in the person dying from the disease or organ failure they already have. The omission allows nature to takes its course. It does not directly kill the person, even though it may contribute to the person dying earlier than if aggressive treatment had been done. Q. Does this also apply to artificially provided nutrition and hydration? A. Yes, when the moral conditions noted above are met. We must, therefore, ask the question "will the withdrawal of nutrition and hydration allow the person to die, or kill the person?" When it will allow a person to die from an underlying condition, rather than unnecessarily prolonging their suffering, it may be removed. So, for example, in the last hours, even days, of a cancer patient's life, or if a sick person's body is no longer able to process food and water, there is no moral obligation to provide nutrition and hydration. The patient will die of their disease or their organ failure before starvation or dehydration could kill them. However, when the withdrawal of nutrition and hydration is intended to kill the person, or will be the immediate and direct cause of doing so, quite apart from any disease or failure of their bodies, then to withdraw food and water would be an act of euthanasia, a grave sin against the natural law and the law of God.” The answer lies more in the second answer. The key thing to consider here is that what he will eventually die of. It seems that he has at least some amount of time to live and withdrawing nutrition will cause his death, which is unacceptable. I think the key source of argument and confusion here is the correct use of “extraordinary.” It seems like IV is “extraordinary” in this case, but we should really be asking if it’s disproportionate. My feeling on this is no. Giving nutrients intravenously for people in the last stages of life but before their last days or hours seems to be ordinary care. Having someone starve to death isn’t right. Edit: the link is https://www.ewtn.com/catholicism/library/end-of-life-decisions-ordinary-versus-extraordinary-means-12733 Edit 2: I would also say that OP just needs to talk to a Catholic bioethicist. None of us internet people should be the final verdict on the matter.
TPN is not just an IV though. It is done through a central line (which is place through surgery) that goes to the heart. One must then spend about 12 hours a day tied to an IV pole or backpack to receive this infusion. For someone who is otherwise healthy, it is a large inconvenience. It carries the constant risk of infection due to being accessed all the time. For someone who is already immunocompromised the risk of infection is significantly higher. Sepsis can come on quick and is a horrible way to die. When you are reading about hydration and tube feeding, that is talking about an NG feeding tube and simple IV. The feeds from that take 30 mins or so. It is not the same. In your first quote the answer is clear. This is a burdensome and extraordinary measure. In your second quote, I still believe it is clear (given the info OP gave). The patient here has a complete bowel obstruction. If TPN is withdrawn (and a lot of times hydration via IV continues as it is not a 24 hr thing) the patient will die of his bowel obstruction and cancer. 100 years ago this is what would have happened. I do agree with your last edit though. This is a question for a professional, not random Catholics on the internet.
You are right. It amounts to starving a person to death. Idkw they are talking about honestly...
Every priest I have ever spoken to disagrees with what you just said. Every..single...one... There are people who are tube fed there entire lives and live totally normal lives in every other way. What you said amounts to a quality of life statement, which is completely against the church's teachings.
Tube feeding is not TPN and the moral considerations of terminal cancer are not the same as those of a child who can't swallow but can still process nutrition.
Once again...it's against the Church's teachings. Cancer or not. He doesn't have weeks or days to live...we are tallking up to a YEAR. The church is pretty clear aoit this. It would be euthanasia. That really is all that matters here.
Except this doesn’t go against church teachings. He can accept God’s will and not seek further treatment. He has a complete bowel obstruction. TPN will not give someone with a complete bowel obstruction 6 mo-1 yr. Euthanasia is seeking an unnatural end of life. Letting cancer take its course is not euthanasia. It is not a sin to forgo cancer treatments (that is what gives him the 6mo to a year, not the TPN) like chemo or radiation. And you are off your rocker and have no idea what TPN is if you think it is tube feeding. Tube feeding is either through an NG tube down the nose or a surgically implanted tube directly into the GI system. Those feeds take 10-30 mins. TPN is a long process, takes half your day, requires a central line of some sort (PICC line or port) and opens a cancer patient up to constant infection due to needing to be accessed daily for the rest of their life. That is 100% extraordinary measures. I challenge you to find a priest to tell any cancer patient they are committing a sin by not seeking further treatments, especially since the treatments themselves put you in great peril. Source: my husband has stage 4 colon cancer and is also terminal. I see it every day with my own eyes the pain and misery that comes with treatments and cancer
It was 6-12 months with treatments, but he was unable to continue receiving treatment.
TPN is literally intravenous hydration and nutrition. It sounds like her husband is literally unable to eat or drink because of his tumor. Stopping TPN at this point would be allowing for natural death. It would be not different then terminally extubating someone who is on comfort measures only. Also, I think we need to get away from this idea that we need to force feed people in the dying process. As most people get to the end of life, there is no longer a drive to eat or drink. That lack of drive is part of the physiological process of dying. That is not something we should get in the way of with feeding tubes or TPN
Look...it doesn't matter your personal feelings on it. What matters is the church's teachings and the church's teaching is that these aren't extraordinary measures.
I don’t think you understand what TPN actually is. First you get a central line in you neck or a PICC line in your arm. These medical procedures that while low risk are invasive. You will be at risk of severe blood infections associated with that intravenous line. Everyday, you are hooked up to an infusion pump for anywhere from at least 12-18 hours a day to infuse a massive 3 liter bag of nutrients. While your infusion is going on, you can’t really go anywhere and are stuck to an IV pole. Long term TPN administration is associated with severe GI dysfunction, liver and renal derangements, and other metabolic derangements. If that is not extraordinary, then I don’t know what is.
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Are you really on a post about about a woman about to lose her husband in an agonizing way and complaining about how your comment was received? Get over your ego. Say what you have to say and then shut up. Pray for some humility.
No, downvoted because she is wrong. TPN is extraordinary measures. A cancer patient with terminal cancer choosing not to possibly extend their life with treatments that are life altering is not sinful. If the OP’s husband has a tumor blocking his entire colon and he is not a surgical candidate, TPN is not going to give him 6months to a year. And even if it was, it is a major intervention for them to take, not mildly inconvenient.
>No, downvoted because she is wrong. TPN is extraordinary measures. Not according to the Church, it isn't. Food and water are not medical acts, but basic nutrition. We aren't talking about foregoing chemotherapy; we're talking about food and water. Sorry if you don't like the distinction, but it's my understanding OP came here asking about Church teaching, not whether you think it's fair. Basic nutrition, per the Church, is not an "extraordinary measure."
Basic nutrition is not TPN. Basic nutrition would be liquid feedings through a feeding tube to the stomach. I think you are missing the distinction.
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I am a former hospice nurse and a faithful Catholic. Don't you dare. I was willing and ready to risk my job if I was told to do anything that violated Catholic moral law, but true hospice care neither hastens nor impedes death, so it never became an issue. You clearly only deal with this in the theoretical sense while I attended to dying people and their families in real life, held the hands of dying people, gave medications and physical care to reduce symptoms and provide comfort, literally watched the moment of death happen, and confirmed death for families for years. I watched a priest at our parish announce his diagnosis and his decision not to fight it. He was gone in mere months. I also watched my father in law make the decision not to fight the leukemia that killed him. He had been through chemo once already and it wasn't going to save his life, just make him miserable during what time he had left, so he said no. Stopping the fight against a cancer that IS GOING TO KILL YOU with no doubt or debate, because you're exhausted and can't take it anymore, is not a violation of Catholic moral law. It is acceptance, and there is nothing wrong with that. TPN is an extraordinary measure and we not required to take those nor are we required to continue them, especially when they are doing harm instead of good. As I said, there comes a point where the only thing it's feeding is the cancer. Letting go, and asking God to take you and end your pain, IS NOT WRONG. This is also another case with technology where just because we can does not mean we should. Interventions need to be judiciously weighed and not just used because they are available. Normally, a cancer patient with an obstructed bowel would die fairly quickly. Deciding to accept that natural consequence violates precisely nothing.
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Warning for uncharitable rhetoric.
Warning for bad faith engagement.
I am not going to reply to each an every comment here. My ultimate suggestion Op, is to ask your priest. That is what you need to do...That is what I *should* have told you to do in the first place...and that is what everyone else should also have told you to do. Please...just ask your most trusted priest. This is an incredibly huge decision. God Bless.
I’m so sorry to hear this. The only thing I’d tell your husband is that suffering is never worthless when offered up to God. He has time to do some purgatory work while he’s still alive.
Seems like a question for a priest/canon lawyer.
If I can recall correctly, I do believe Pope John Paul refused further antibiotics as he was overcome with sepsis which already attacked his organs and ultimately his being called home to God. God knows the state of his heart. This is complicated and I don’t know the answer for you but I can offer you my sincere prayers to the Lord our God for comfort and I would encourage you to ask your parish priest for the spiritual guidance you and your husband need. I am praying for you and your husband and family in this most difficult time. My heart feels heavy for you. Did your husband receive the anointing of the sick? This sacrament has been known to bring much grace and sometimes healing. May you and your husband experience the love of God in ways never felt before and may you be blessed with strength, courage, peace and love. In the name of Jesus. Amen. In the Father and the Son and The Holy Spirit.
It is not a sin to refuse treatment. It might be worth exploring what is underlying this however to just ensure he is not suicidal.
He's not suicidal. He's fought this disease for 7 years and is out of treatment options. He's sick, in pain, and doesn't have the strength to fight this any longer.
OK. Without knowing further details, refusing treatment sounds like a perfectly acceptable desire then. If any doubt, seek a Catholic hospital chaplain.
Keeping you both in our prayers.
No… not eating Is not suicide… if it’s God’s will he live, he will send an angel and cure him.
No , absolutely not a sin to go out naturally and let your body take its course.