Daily Archives: April 1, 2020

Reader unimpressed with HSUs previous leaders

Sundays article from Rollin Richmond on the evils of drink was interesting (What research says about alcohol and you, the Times-Standard, March 29, Page A4). Carrie Nation of the Womens Christian Temperance Union would have been proud. I wish that he had exercised that same intellectual and academic prowess while leading Humboldt State University. During his tenure he hired many administrative staff while letting the number of tenured professors dwindle.He helped recruit many students from Californias urban centers while doing very little to help them adapt to a rural setting.

He was responsible for scuttling the nursing program at HSU as being too costly; you know all those labs and things.

His successor didnt fare much better. Although she did help resurrect the nursing program in partnership with College of the Redwoods, something Rolland didnt do. She was successful in eliminating the football program after allowing the coaches to recruit student-athletes in the expectation of being able to play during their academic stay at HSU. Also she pulled the plug on KHSU, the universitys popular radio station weeks after conducting one of their periodic fundraising drives. Of course no notice, no appeals to the public, just the pulling of the plug.

In education parlance I would give Rollin and Lisa A+ for their personal retirement enrichment (you know, five years and out) and an Incomplete in their leadership.

John Kulstad, McKinleyville

Most medical experts agree it will take a number of months of limited social interaction to gain control over the COVID-19 virus. But President Trump sees this cure as more of a curse. For the sake of the U.S. economy, hed like to loosen things up in several weeks just in time for Easter.

The Republican Lt. Gov. Dan Patrick of Texas also wants the country to get back to business in weeks, not months. He says vulnerable seniors should understand we cant afford to sacrifice the countrys future because of the virus. In other words, if more seniors die its OK because the economy may not otherwise be strong enough to survive for younger generations.

I find his an interesting concept. In a sense Patrick is implying that seniors should agree to euthanasia to relieve pain, but not their own pain. Rather the pain that the economy is going through. In the U.S. today, in most states euthanasia is either illegal, or if legal, requires difficult steps to achieve. Here the Lt. Governor is approving euthanasia for all seniors a priori because he says it will benefit Americas future.

When I examine the two arguments above I find them both quite flawed. They both place the economy ahead of the health of U.S. citizens which I think is immoral by its very nature. And I also think both are examples of fake logic, which is sadly par for the course in the age of Trump.

Sherman Schapiro, Eureka

More:

Letters to the editor (March 31, 2020) - Eureka Times-Standard

People are doing what they can to stay healthy, but what about their pets?

Dr. Phyllis Sill is a veterinarian at Roscoe Veterinary Clinic. She says if you want to keep your dogs safe, there are certain things you shouldn't do:

"Dont let your dog suddenly go on a long run or a long walk if it hasntbeen conditioned to do so," she said. "They are probably going to end up with lameness issues or injuries." She continued, "Dont get a group of dogs together, they might fight."

Sill said it is important to think about things your dog can eat or swallow, like chocolate or the sugar substitute xylitol. "Try to keep them up and away," she warned, "because if dogs get into sugar-free gum, it can kill them."

The Roscoe Veterinary Clinic is considered an essential business; therefore it remains open amid Governor J.B. Pritzker's "stay-at-home" order. But, Sill said, even though they are open, they are only admitting patients with serious conditions.

"We are looking at patients who have growths or tumors that need to be removed," she said. "We are doing dentistries where our patients have uncomfortable mouths and maybe have teeth that need to be removed in order for them to eat better and do better," she added. "We are continuing to take X-rays and diagnose things that are going on orthopedically."

Sill gave examples of services they are not providing right now:

"We're trying to not have patients come in for things like a toenail trim," she said, "or vaccines that are maybe just coming due. We're trying not to have grooming type appointments except if the dog has a history of anal gland issues and we know the dog is going to be uncomfortable."

Sill said the practice now only allows one animal at a time in the building and staff are practicing curbside service with strict social distance guidelines. "We get as much of a history over the phone as we can," she said, "before we have a technician go out to the car. Then the technician brings the animal into the building."

Sill said clients aren't allowed inside the clinic unless it's for euthanasia. "Euthanasia is an extremely, extremely important part of [our] practice," she said. "People need to know that their animals went peacefully and the animals need to know that they were loved all the way until the end."

But other than that, clients may not enter the clinic. Sill said this act of social distancing helps keep the staff, public, and animals healthy. "It's nothing personal," she said. "We can't make an exception. If one person gets sick on our staff, we have to close our clinic."

Sill said most people understand why they are not allowed inside with their pets, but some do not. "They think we are being ridiculous," she said. "And that's just the one thing people have to understand -- that we want this to go away. We want to be done with it. This is not the way we want to process long term."

Sill said there are things people can do to eliminate human contact. Rather than hand a credit card to a technician, make the payment over the phone. "Think of all the times a technician has to either glove, de-glove, or just scrub in between each transaction," she said. "I promise you there is no identity theft whatsoever. We are just trying to do a transaction without touching cash or checks." She said over-the-phone payments will also speed up the process because it means less before and after santitizing.

Another thing people can do is not engage in a conversation during curbside pickup. "I don't want my technician talking through a rolled down window," she said. "It offers no protection whatsoever. So please, please, please, talk to us on the phone."

Looking ahead, Sill said, "I think this will be an unusual summer. I don't think this is going to easily and quickly go away. I think we're going to be dealing with this for months on end."

Even so, she said there isn't any need to panic. "We're going to get through this. I think everybody is trying to do what they're supposed to do."

And, Sill said, the main goal for animals remains the same as it is for other family members: Stay out of the emergency room.

The rest is here:

Veterinary Clinic Keeps Pets (& Their Humans) Safe Amid COVID-19 - WNIJ and WNIU

Reading Time: 8 minutesCaring for our elderly and terminally ill is expensive. But it is also a non-negotiable, fundamental duty of government.

It can be unethical to withdraw artificial hydration and nutrition and doing so can constitute a form of euthanasia that is, when its withdrawn with a primary intention to cause death. But withdrawal is not always unethical. Just as there are situations where it is justified to turn off a ventilator, so too there can be situations where it is justified to withdraw artificial hydration and nutrition.

Australias ABC networkrecently reported a storyof an elderly South Australian woman with dementia and breast cancer, who was not mentally competent and was being given hydration and nutrition through a nasogastric tube.

The tube fell out and the Public Advocate, who was the legal guardian of the patient and decision maker for her, determined that it should not be replaced. The reasons given included that the tube was burdensome, that it was prolonging suffering, and that replacing it would be contrary to the presumed wishes of the patient which is to say, if she were able to decide for herself, she would refuse replacement.

Two of the patients daughters, a Catholic bishop and the patients Catholic priest all disagreed with the Public Advocates decision and sought to change it. The daughters argued that the patient would want to live as long as possible and that replacing the tube was consistent with her Catholic faith.

The tube was not replaced, and the patient died five weeks later.

Now, despite being a truism, a very important principle in applied ethics is that good facts are essential for good ethics. The story as reported does not provide sufficient facts to judge whether or not the cessation of artificial feeding by means of a nasogastric tube was an ethically acceptable decision.

Its worth noting that hydration wasnotwithdrawn, but was delivered by intravenous line. So a pertinent question is: what justification was there for withdrawing nutrition, but not hydration? Either both hydration and nutrition were ethically appropriate life-prolonging treatment, or neither were.

One reason for the different approach to hydration as compared with nutrition could be that delivering total parenteral nutrition is a far more invasive procedure and more burdensome for the patient than, as occurred in this case, delivering hydration by way of an intravenous drip. The hydration might also have been continued as comfort care rather than life-prolonging treatment.

I was once consulted on a comparable case.

A young woman, who was diabetic and on haemodialysis for kidney failure, had a sudden cardiac arrest. She was revived and placed on a ventilator, but several days later, when she was due for dialysis, was diagnosed as being in a deep and irreversible coma.

Her parents decided that she should not receive dialysis, but they did not want the ventilator to be removed. We complied with their wishes in order to avoid further sufferingto them, not because we believed it was necessary treatment for the young woman. We explained in the case notes that was the reason the ventilator was continued. The young woman died a natural death from renal failure, at which time the ventilator was stopped.

What often causes great emotional trauma for a patients family, as was true in the South Australian case, is the thought of starving and dehydrating the patient to death in withdrawing artificial hydration and nutrition. There is, however, research that shows the hunger and thirst mechanisms in our brains shut down when we are dying.

The reflections of the Catholic Church on medical ethics are a frequently used reference point for bioethicists around the world. Even if they reject them, bioethicists respond to its concerns. This is especially true in a case such as the one we are considering, in which the patient and her carers are of that faith.

The Catholic Church teaches that food and fluids must always be offered and supplied if the person can take these orally. Pope John Paul II (now Saint Pope John Paul II) declared in a 2004 address that the same requirement of mandatory provision applies to artificial hydration and nutrition for people in a permanent vegetative state that is, hydration and nutrition not taken orally but delivered by other means.

With great respect, I believe that this statement needs to be nuanced. In that particular document its clear that the Pope wanted to protect vulnerable patients receiving artificial hydration and nutrition who are in a stable medical condition.

There are thousands of such patients in nursing homes and they have a right to humane basic care, as the Pope says. But the Pope might not have been thinking of the acceptability of withdrawal of artificial hydration and nutrition fromallpatients in a permanent vegetative state.

One problem is that if we apply this criterion to all such patients, it actually supports the euthanasia movement, as I shall explain below. But let me first attempt to make some distinctions that could help us to decide when withdrawal of artificial hydration and nutrition is ethical and when it is not.

It depends, first, on how we classify artificial hydration and nutrition: as simply food and water, or as medical treatment for a failed alimentary system (just as a ventilator is medical treatment for a failed respiratory system). If its just food and water and basic care, then ethically itmustbe provided. If it is medical treatment, that is not always the case.

I propose that, just as there are situations where it is justified to turn off a ventilator, so too there can be situations where it is justified to withdraw artificial hydration and nutrition. Both are forms of medical life-support treatment. And what if, for instance, a PEG feeding tube is painful or has become infected? What should doctors do then?

One distinction that is sometimes made in order to determine whether a given medical treatment must be offered is whether the intervention is ordinary or extraordinary medical treatment. The Catholic moral teaching is that the former must be provided, whereas the latter need not be.

Bishop Gregory OKellyis quotedas saying in his letter to the Office of the Public Advocate that, To deny food or drink, no matter how it is delivered, to such a person is to deny themordinary[emphasis added] means for sustaining life.

But this distinction betweenordinaryandextraordinarymedical treatment is not always clear cut. It can be that the patients quality of life is being judged and not the treatment. When a patient is in very fragile health in ICU, a certain treatment can be judged as extraordinary; but when the patient improves and is living in a nursing home, thesame treatmentfor the same personcan be characterised as ordinary.

In short, circumstances need to be taken into account. Moreover, whether a treatment is judged ordinary or extraordinary can be a very subjective and discretionary decision, which can leave it open to abuse.

Justifications for withdrawing life support treatment include that withdrawal is required to respect a patients right to refuse medical treatment, including through an advance directive that is, withdrawing treatment is required in order to respect a patients rights to inviolability (the right not to be touched without ones informed consent) and competent patients rights to autonomy.

Artificial hydration and nutrition would not be forcibly imposed on such a patient. Justifications also include: that the treatment is medically futile; that the burdens of continuing treatment outweigh any benefits; and that the treatment is prolonging dying, not living.

The Public Advocatedescribed the patient in questionas pre-terminal, which might or might not mean that she was dying, although her daughters denied that she was. With respect to the burden of the nasogastric tube, they are admittedly very uncomfortable, but its at least an open question whether the suffering involved for the patient could have justified not replacing it. Further questions include how the tube fell out (did the patient pull it out?) and whether, if the tube had not fallen out, its removal would have been justified?

To repeat, these decisions about providing or withdrawing artificial hydration and nutrition can be very difficult ones in relation to determining the right ethical path to take. Every case (and person) is different; assessments must be made on that basis and, importantly, in the light of all the relevant facts.

As I said, advocates of legalising euthanasia use cases such as the one describedin the ABC reportto promote their cause. They argue that withholding artificial hydration and nutritionis euthanasia often called slow euthanasia or passive euthanasia; therefore, we are already practising euthanasia and, if we are to be consistent, should recognise the legal right to do so by means of lethal injection.

Consequently, people who oppose the withdrawal of artificial hydration and nutrition when this withdrawal could be justified, and object to such a withdrawal on the grounds that it would be euthanasia, sadly help the pro-euthanasia cause.

Moreover, when members of the public think euthanasia isanyfailure to useallpossible means to prolong life and believe thatallrefusals of medical treatment that could prolong life are euthanasia, they respond positively to survey questions that ask, Do you agree with legalising euthanasia? because they want to have the right to refuse treatment. The publics responses are even more compromised when asked, If someone is in terrible pain and suffering should they be able to consent to euthanasia?

The option of saying yes to fully adequate pain and suffering management and no to euthanasia adopting a position that we must kill the pain and suffering, but not the personwiththe pain and suffering is often not possible in surveys. They tend to pose conjunctive questions (rather than two disjunctive ones)that is, do you agree with fully adequate pain and suffering managementandas a separate question, do you agree with euthanasia?.

It bears always keeping clearly in mind when discussing withdrawal of artificial hydration and nutrition that it can be employed unethically, when it does become a form of euthanasia that is, when its used with a primary intention to cause death.

This is most likely to occur when it is paired with an unwarranted use of palliative sedation, where the patient is unjustifiably deeply sedated until they die. Such a use is better called terminal sedation to differentiate it from the ethical use of palliative sedation, that is, when sedation is necessary and used appropriately to relieve a patients pain and suffering and not to hasten their death.

Margaret Somervilleis Professor of Bioethics in theSchool of Medicine and the Institute for Society and Ethics at the University of Notre Dame Australia.

This article was originally published at Mercatornet.com.

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Originally posted here:

Margaret Somerville: Withdrawing artificial hydration and nutrition - The Catholic Weekly