Wednesday, May 30, 2018

How dare they point out it is wrong to starve grandma to death

The Orthodox Jewish group being banned from a NYC hospital.

Long story here.

Deep in the article you find out why: no, not that they are opposing expensive, futile extraordinary care, but because they oppose starving people with dementia.

“Our technology has advanced to the point where it is getting harder to die in the ICU,” said Dr. Kenneth Prager, a pulmonologist and head of medical ethics at Columbia University Medical Center, also in Manhattan.
except it is not about people on repirators in ICUs.

 “A common example is inserting a feeding tube into a patient with end-stage dementia who has lost the ability to swallow. Will this patient ever recover? He won’t. But is it starving a patient to death by denying him a feeding tube [the Orthodox Jewish perspective] or causing the patient additional suffering by prolonging his death — which is a more conventional modern perspective? Medical ethics consultations are often sought in cases like this,” Prager said...
and it's not just those stubborn Jews causing problems:
The conflict in values isn’t limited to Orthodox Jews, but comes up for African-American, Hispanic and Asian patients too, he said.
I should note: Often these patients do not have swallowing difficulties and can be fed slowly and lovingly by hand. But nursing homes are undestaffed, and often we see things like what my mom ran into when she visited her sister in a nursing home: the tray was put beyond her reach so she didn't feed herself, but would take food when my mom helped her eat.

Madeline L'Engle wrote about this in her elderly grandmother who often did not want to eat, but was able to eat: They did not force her to eat, but they didn't withhold her food either.

So it's not a "starve vs feed" problem. 

Truly terminal patients don't have to get IVs or feeding tubes because they are dying, but there are financial reasons one might not want to prolong the life of someone after a stroke or with dementia, that is, patients who are disabled and elderly but not "dying".

Follow the money.

when there is indeed a "dysphagia" problem, often the person dies within six months from aspiration pneumonia, so feeding tubes might not help.

Remember this when you read about the Schiavos who lived for years on feeding tubes....maybe the diagnosis is wrong, the staff is too overworked to feed them, or they are on medications that cause sedation so they don't want to eat.

and when the decision is made not to put in a feeding tube, often all food is withheld (i.e. they stop trying to persuade grandmom to eat). Because it is not about feeding her, it is about trying to make her dead. sigh.

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