Targeting the Vulnerable

by PJ King, RN

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Not long ago I arrived at work to hear that one of the residents I care for on my night shift had a critically high blood level of sodium. I brushed up on hypernatremia and found that she was more likely to die than to live. I called her doctor to inform him of her sodium level. His initial response was, "I don’t want to bother with her tonight. Let it go till morning." Actually his response was longer than that but I refuse to fill your ears with the language with which he filled mine.

I then called the woman’s son. My position was difficult. I couldn’t cast the doctor in a bad light but I needed to communicate both the doctor’s decision and the urgency of his mother’s condition. I did so carefully and dispassionately. He asked me if there were any alternatives. "She could be given intravenous fluids to correct the sodium level," I said. "My mother has lived a long and full life," he replied, "and I think extraordinary measures would not be appropriate. But I couldn’t live with myself if I failed to urge her doctor to provide basic treatment. I’d like her to have an IV."

And so I called the doctor again. When I told him the son’s decision, he swore. "How old is this woman?" he asked. I told him she was 79. "How long has she been in a nursing home?" I checked and found she’d been there six years. "Any treatment for someone that old and living in a nursing home is extraordinary treatment," he shouted. "I’ll see her in the morning!"

I instructed the two nursing assistants who, with me, made up the team that night, to push fluids at every opportunity. This was not easy, as our patient was all but unconscious as a result of her electrolyte imbalance. The aides seemed not to be very ambitious in following my instruction. I felt the burden of preserving this woman’s life was mine alone for eight hours that night. I probably spent two of those hours with her, dribbling straws-full of water into her mouth and watching that she swallowed without choking. She made it through the night and was still there the next. Over the next two or three weeks she gradually improved.

I could tell you other such stories. But this one should suffice to illustrate the attitudes of many health care personnel toward the infirm elderly today. The sanctity-of-life principle, a heritage from our Christian roots, has largely been replaced by the relativistic quality-of-life standard whereby we judge the merit of continuing existence on the basis of our estimate of what constitutes a good life.

Abortion has been legal for more than twenty years now. Not long after the Roe v Wade decision, Dr. James Dobson predicted that infanticide would follow naturally, and then euthanasia. In 1982 "Baby Doe" was born in Indiana with Down syndrome and a problem of the esophagus easily correctable by surgery. But they elected against surgery and asked the physician to order that their baby not be given food or water. And so the little girl’s lungs were slowly digested by gastric juices while she starved to death. The decision was upheld by the Indiana Supreme Court on the basis of the parents’ right to privacy. Other infants judged doomed to a life not worth living have also been "allowed" to die. Is assisted suicide and euthanasia for adults "burdened" with unworthy life just around the corner?

What you may not be aware of, as I was not as recently as a year ago, is that killing life judged unworthy of life is already happening quietly in this country.

A year ago last January, 83-year-old Marjorie Nighbert suffered a stroke. She was left with severe physical disability, including difficulty swallowing, not uncommon in stroke victims. A feeding tube was inserted so that she could receive nourishment.

In 1992 Marjorie had designated that her brother be given power of attorney for health care for her. He directed that the tube feeding be discontinued. The tube was removed.

Marjorie, of course, became hungry. She repeatedly asked those caring for her in the nursing home for food. But the order was clear, and legal. Marjorie was to be starved to death. She would have died unnoticed behind closed doors had it not been for the conscience of one staff member who saw Marjorie touch a nurse’s arm and ask for food. He told a priest, who contacted the local chapter of Right to Life, who reported Marjorie’s situation to Florida’s Health and Rehabilitation Services. The case went to court. Ultimately the judge ruled that Marjorie not be fed on the basis of her not being competent to ask for food. The employee who reported the incident was fired. Marjorie died on April 6, 1995.

This is not an isolated incident. A study published in the March 27, 1996, issue of the Journal of the American Medical Aassociation reports a survey of physicians in the state of Washington. Twelve percent of the respondents had in the previous year been asked by one or more patients for help in ending their lives. Of these, 24% had complied by prescribing a lethal dose of oral medication and 24% had administered a lethal injection on request. Although Washington is the only state in which a formal study of the incidence of assisted suicide and euthanasia has been done thus far, it is not the only state in which these practices are occurring. Bioethicists and other knowledgeable persons on both sides of the issue take it as established fact. Respected journals confirm its existence. Although not yet legal, death for the marginalized is already here.

Posted 6 Sep 2000.

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Copyright 1996 by PJ King
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