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Questions About Medically Assisted Nutrition And Hydration

5. What role should "quality of life" play in our decisions?

Financiai and emotional burdens are willingly endured by most families to raise their children or to care for mentally aware but weak and elderiy family members. It is sometimes argued that we need not endure comparable burdens to feed and care for persons with severe mental and physical disabilities, because their low "quality of life" makes it unnecessary or pointless to preserve their lives. [29]

But this argument—even when it seems motivated by a humanitarian concern to reduce suffering and hardship—ignores the equal dignity and sanctity of all human life. Its key assumption—that people with disabilities necessarily enjoy life Jess than others or lack the potential to lead meaningful lives—is also mistaken.30 Where suffering does exist, society's response shouid not be to neglect or eliminate the lives of peopie with disabilities, but to help correct their inadequate living conditions.[31] Very often the worst threat to a good "quality of Jife" for these people is not the disability itself, but the prejudicial attitudes of others—attitudes based on the idea that a life with serious disabilities is not worth living.[32]

This being said, our moral tradition allows for three ways in which the "quality of life" of a seriously ill patient is relevant to treatment decisions.

1. Consistent with respect for the inherent sanctity of life, we should relieve needless suffering and support morally acceptable ways of improving each patient's quality of life.[33]

2. One may legitimately refuse a treatment because it would itself create an impairment imposing new serious burdens or risks on the patient. This decision to avoid the new burdens or risks created by a treatment is not the same as directly intending to end life in order to avoid the burden of living in a disabied state.[34]

3. Sometimes a disabling condition may directly influence the benefits and burdens of a specific treatment for a particular patient. For example, a confused or demented patient may find medically assisted nutrition and hydration more frightening and burdensome than other patients do because he or she cannot understand what it is. The patient may even repeatediy pull out feeding tubes, requiring burdensome physical restraints if this form of feeding is to be continued. In such cases, ways of alleviating such special burdens should be explored before concluding that they justify withholding all food and fluids needed to sustain life.