By Tim Drake
Catholic Online

Dr. Chris Kahlenborn is an internist in Altoona, Pennsylvania. He serves as president of the Polycarp Research Institute (www.polycarp.org). He spoke with Tim Drake about the dynamics and ethics of denying a person nutrition and hydration.

Q: What happens to a person when he or she is denied food and water?

A: The first thing is that after 2-3 days you get extremely dehydrated. That results in a lot of changes in the body. Your mucous membranes and your skin get very dry. Your mouth cracks. It’s very uncomfortable. Your urine becomes very concentrated and acidic, making it uncomfortable to urinate.

Then your heart rate increases, your blood pressure decreases, and after about the third day, your kidneys start to develop problems. When the kidneys are damaged enough, they cannot get rid of the poison in the body. Blood urea nitrogen (BUN) builds up. The effect that this has on the body is to give you a type of lethargy, and has an almost anesthetic effect. It can also result in seizures. The poison builds up and drives the person towards unconsciousness after a period of days. The cause of death is usually seizures or cardiac arrhythmia because of an electrolyte imbalance.

That sounds painful.

The initial part of the process is pretty painful. Imagine playing a tennis match and not grabbing your Gatorade. Try not drinking anything for a day or two and you would get a sense of what it would feel like. You could say that the person eventually gets comfort, but it’s after a lot of pain.

Q: Is the denial of nutrition and hydration a standard practice in health care?

A: It’s happening daily in hospitals, in hospices, in homes. It happens most often with patients who have Alzheimer’s or who have suffered bad strokes. It’s happening, yet no one is doing anything about it. Patients are often being denied stomach tubes per the family’s request.

Medical professionals are using the term “artificial nutrition and hydration” to say it’s not natural. They are arbitrarily calling it artificial partly because the means of getting food into you require assistance. Yet, if you use that definition, babies should be starving too, because every baby needs our help in order to be fed.

Q: Are Catholic medical professionals condoning this?

A: They are split. The Catholic Medical Association (www.cathmed.org) has an excellent statement currently on their web site: it reads:

In March 2004, Pope John Paul II addressed an international congress of health care professionals convened in Rome to discuss the scientific advances and ethical dilemmas in the vegetative state. In the statement by the Vicar of Christ, “Life Sustaining Treatments and Vegetative State,” he declares clearly and unequivocally that “the sick person in a vegetative state still has the right to basic health care…the administration of water and food, even when provided by artificial means, always represents a natural means of preserving life, not a medical act…Its use furthermore, should be considered in principle, ordinary and proportionate, and as such morally obligatory…Death by starvation or dehydration is, in fact, the only possible outcome as a result of their withdrawal. In this sense it ends up becoming, if done knowingly and willingly, true and proper euthanasia by omission.”

This papal statement makes it absolutely clear that the withdrawal of food and water from Mrs. Schindler-Schiavo constitutes euthanasia, a gravely immoral act. We would add furthermore, that it represents a violation of her constitutionally protected right to life and a violation of her religious freedom as a Catholic.

They would argue rather strongly that food and hydration should be provided unless it’s harmful or death is imminent. Some physicians have a pretty loose definition of imminent. For some that’s an hour or two; for others it’s six months. Death is imminent for all of us.

Q: Are there times when the denial of nutrition or fluids is permissible?

A: The way I see it, there should always be some form of hydration. There may be a time in medicine when you don’t have to place a stomach tube, but fluids should be continued to keep a person comfortable and to assist in hydration. If someone has metastatic cancer and has only a few hours or days to live, you wouldn’t have to put in a stomach tube, but the person should be kept comfortable with I.V. fluids.

About the only case I can see where you might withhold fluids for a certain time would be congestive heart failure, but that’s only temporary. It would be pretty hard to find a case where you wouldn’t give a person fluids. In almost every case, nutrition should be ...