1. Issues in Care for the Seriously Ill and Dying Part 2
4/15/13
Russ Rentler, MD, CMD
Geriatrics/Internal Medicine

3. Percutaneous Endoscopically-placed Gastrostomy Tube

4. Case Study 1 (Artificial Hydration and Nutrition)
A patient comes to the nursing home for rehabilitation after sustaining a severe stroke leaving him with the inability to swallow or speak. He is cognitively intact and can answer yes and no questions by shaking his head. A feeding tube was placed in the hospital and the family was told by the physician that it could be pulled out and feedings could be stopped in a few weeks if he did not regain his speech and swallowing functions. After two weeks he has not improved and the daughter is requesting the feeding tube be discontinued so her father can die "with dignity." The physician who is a practicing Catholic asks you whether he can comply with the daughter's request.

5. Case Study 2 Palliative Care
A 68 year-old woman with stage 4 (end stage advanced) ovarian cancer comes to a nursing and rehab center to get strong enough to receive further chemotherapy treatments because the oncologist suggests there is a chance that the cancer may respond to more aggressive treatment. In the meantime the patient has massive fluid accumulations in her abdomen requiring trips from the nursing center to the hospital every other day to have several liters of fluid tapped off. This allows her to breath easier and relieves the abdominal distention temporarily. She is also on artificial nutrition called hyper-alimentation that places large amounts of calories/protein and nutrients into a major blood vessel in her upper chest. The side effect of this is that it worsens the fluid accumulation in her abdomen. The plan is to continue the nutrition and frequent abdominal taps, and push her to get physical therapy until she is strong enough to get further chemotherapy. The husband comes to you and asks if he is obligated by his Catholic faith to continue this course of treatment. He would like to discontinue chemo and therapy and take her home but the patient insists that she has to follow doctor's plan of treatment in order to get well.

6. Artificial Nutrition and Hydration
Blessed JP2’s Statement on ANH
Not a “medical act”
Always indicated in those not imminently dying (with exceptions)
ERD. 57 and 58
“For I was hungry and you gave me food, I was thirsty and you gave me drink…” Matt. 25

8. When to Recommend a Peg Tube:

9. Determination of Death
Church does not decide the criteria but leaves it to the scientists to decide
The Church concurs with the current definition, “brain death”
“ an irreversible cessation of all brain functions”
Exceptions, rare.

10. Organ Transplantation
Genuine act of love
Strict separation of donor team and transplant team
Free will and Informed Consent
For living donor transplantation, a proportionate good must be anticipated
JP2: Nurtures the “Culture of Life”
ERD 62-65