"No Tubes For Me"

March 2006. When discussions about end of life treatments come up, people will often say something like this: "I don't want to be a burden to anyone. No tubes for me. I just want to go quickly and peacefully." People are attracted by technology and what it offers when they are sick, but they also have fears about it when they are in a weakened or vulnerable state. They imagine becoming trapped in a situation where they aren't allowed to die but are held in a kind of suspended animation by machines. They also worry that their pain may not be managed well. Sometimes they may feel pressure from family members that they shouldn't "stick around" too long. These kinds of fears and concerns, however, need to be scrutinized carefully, because they can prompt us to act rashly and think unclearly when it comes to making concrete treatment decisions.
In making end of life decisions, the important question is whether a proposed treatment is likely to be ordinary or extraordinary. Ordinary treatments are required as part of our duty to take care of our health. Extraordinary treatments, on the other hand, are optional. The process of weighing whether a treatment is ordinary or extraordinary was concisely summarized back in 1980 in a passage from the Vatican's Declaration on Euthanasia:

In any case, it will be possible to make a correct judgment as to the means by studying the type of treatment to be used, its degree of complexity or risk, its cost and the possibilities of using it, and comparing these elements with the result that can be expected, taking into account the state of the sick person and his or her physical and moral resources.

Thus ordinary treatments will offer a reasonable hope of benefit to the patient, are not excessively costly and are not unduly burdensome. Taking antibiotics to fight an infection would generally be an ordinary treatment, since it would be effective in combating the infection, would not be unduly burdensome or expensive, and would be a low-risk procedure.
In order to decide whether a treatment is ordinary, we must also look at the particulars of the patient's condition, and not merely focus on the treatment, the medical device, or the medicine itself. So if a person were imminently dying from cancer, with but a few hours of life remaining, and the physician discovered that he had an infection in his lungs, the use of antibiotic medications would generally be extraordinary and optional in these circumstances, since their use would be largely ineffective to the patient's real-life situation.
Weighing and determining whether a treatment is ordinary or extraordinary is not always a simple and straightforward task. It often requires some struggle and searching. I recall once helping a woman whose 82 year old mother was in a nursing home with Alzheimer's. We spoke by phone every few weeks as the condition of her mother would change. She would ask, "Do I have to put Mom into an ambulance and take her to the hospital every time something goes wrong? It causes such stress and anxiety at her age." One time when her mother got a urinary tract infection, she ended up sending her to the hospital for treatment. After some discussion, it had become clear that making that ambulance trip would mean providing a bridge to healing for her mother, bringing her to another plateau in her condition, and hence would be ordinary treatment. When the urinary tract infection came back again a few months later, she had her taken to the hospital a second time. But after several more months passed, her mother's condition suddenly deteriorated further. She had several small strokes, in addition to a serious bowel obstruction and kidney problems. I remember how at a certain moment during one of our phone conversations, as we were reviewing her mother's condition, it became clear to both of us that we had crossed a line into new territory. We saw that it was becoming an extraordinary intervention to put her elderly and demented mother into the ambulance again and try to treat her more recent and more serious maladies. Whenever we would discuss her mother's health on the phone, she would say, "I want Jesus to take her at the time HE chooses, and I want to be a good daughter to my Mom up to the end." It was becoming clear that her mother was in fact reaching the end of the line, and further interventions would no longer be obligatory, that Jesus was indeed ready to take her. She felt able to let her go at the proper moment. The whole process of figuring out when her mother had reached the point where further interventions and hospital visits were extraordinary had been nested in a lot of prayer, consultation and struggle on the part of her daughter. Precisely because of that prayer and effort, as the end approached, she knew she had taken the appropriate steps along the way and had no regrets after her mother passed on.
At the end of our own lives, each of us should have the liberty of spirit to be a "burden" to our loved ones and our family. That's what love means. When each of us was born, we were a "burden" to our parents for many years. Our parents and grandparents should feel no pressure about "quick exits." They should know that their family and friends will be there for them, loving them and journeying with them into the mystery of death. Our parents and grandparents should never feel constrained to decline ordinary treatments. When tubes will serve as an ordinary bridge to healing for them, they shouldn't feel pressured to declare: "no tubes for me." Tubes can sometimes be required as part of our duty to take care of the health and life which we have received as a gift from God.
Each of us would like to have an easy, peaceful death. Each of us is entitled to good health care and pain management as we die. But giving in to an undue fear and concern about tubes, suffering, and pain can cause us to fail to appreciate the graces that come at the end of life. Above all we must be willing to accept, to surrender and to turn ourselves over to the Lord's plan, knowing that He will grace us in our final days and hours through any sufferings we may have to endure before our journey comes to its completion in Him.
Rev. Tadeusz Pacholczyk, Ph.D. earned his doctorate in neuroscience from Yale and did post-doctoral work at Harvard. He is a priest of the diocese of Fall River, MA, and serves as the Director of Education at The National Catholic Bioethics Center in Philadelphia. See www.ncbcenter.org