ON THE NATURE OF TUBE FEEDING: BASIC CARE OR MEDICAL TREATMENT? by ProQuest

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									Vol. 26:2 summer 2010                                                                               	




on the nature of tube feeding: basiC
Care or mediCal treatment?
E R I K M . C L A R Y, M D I V , M A


Abstract
Five	 years	 following	 the	 Terri	 Schiavo	 affair,	 and	 almost	 twenty	 since	 the	 issue	 of	
tube	 feeding	 first	 came	 to	 the	 national	 scene	 in	 the	 case	 of	 Nancy	 Cruzan,	 the	 debate	
over	 withdrawing	 this	 manner	 of	 care	 from	 patients	 with	 severe	 cognitive	 impairment	
continues.	One	question	that	frequently	arises	in	the	discussion	over	the	ethics	of	tube	
feeding	involves	the	matter	of	categorization—is	tube	feeding	basic	or	medical	care?	At	
its	most	fundamental	level,	this	question	requires	an	empirical	judgment	that	is	distinct	
from,	 though	 not	 irrelevant	 to,	 the	 ethical	 question	 (When,	 if	 at	 all,	 is	 it	 permissible	
to	 forego	 or	 withdraw	 tube	 feeding?).	 	 In	 this	 article,	 the	 nature	 of	 tube	 feeding	 is	
considered	in	light	of	the	evidence	that	has	accumulated	in	the	published	literature	since	
the	 procedure	 was	 first	 reported	 in	 1951.	 That	 evidence	 reveals	 tube	 feeding	 to	 bear	
several	hallmarks	of	medical	therapy,	including	its	direction	toward	the	sick	and	not	the	
healthy,	the	application	of	medical	knowledge	and	skills,	the	surgical	implantation	of	a	
foreign	body	intended	to	counter	the	effects	of	debilitating	disease,	and	the	exposure	of	
the	recipient	to	significant	risk	of	complications	directly	related	to	the	intervention.	It	is	
concluded	that	tube	feeding	is	properly	considered	medical	care.		Arguments	for	viewing	
tube	 feeding	 as	 basic	 care,	 which	 generally	 focus	 on	 the	 nature	 of	 the	 infusate	 or	 the	
personnel	required	to	administer	it,	are	addressed.		



With the rapid advance of medical technology in the past century, a host of ethical
challenges have arisen for which society has been ill-prepared. One of the more
controversial medico-ethical cases in recent memory is that of Terri Schiavo, a patient
diagnosed with severe brain damage who received nutritional support for fifteen years
up until her estranged husband finally prevailed in his effort to have her feeding tube
removed, prompting her death due to dehydration thirteen days later. Among the ranks
of those critical of the decision to remove Mrs. Schiavo’s feeding tube was Mary
Porta, who received national attention by carrying with her to rallies a giant, five-
foot Styrofoam spoon.1 Ms. Porta’s point was significant as it reflected a widely held
notion that the provision of nutrition and hydration through artificial means constitutes
“basic” (“ordinary” or “normal”) care. Pope John Paul II was certainly an advocate of
this approach to classifying artificial feeding, stating in 2004 that “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 . . .”2
      Are Pope John Paul II and Ms. Porta to be granted their presuppositions concerning
the nature of artificial feeding? If they are, then the question concerning tube feeding
really becomes one of when, if at all, is it morally permissible to deny a person basic care?
If, however, there is a cate
								
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