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brain injury some 14 years ago and is still in a persistent vegetative state. The despondent mother reportedly now wants to stop artificial hydration and let him die a natural death. This dilemma brings up several ethical questions.
• Would stopping fluid feedings be more merciful than keeping him alive for years in a vegetative state?
• The paradox of fluid replacement meant to sustain life is that it can also prolong pain and suffering. In this case, there is a significant burden of suffering from severe muscle spasms not to mention the consequences of total bed rest and complete dependency.
• Would stopping fluid feedings cause him to suffer?
• Scientific experience shows us that during the dying process, if dehydration occurs, the brain produces natural endorphins that reduce pain, and provide comfort. This allowed, a human being will slip away gently over an 8 to 12 day period of time, just like nature has done it for as long as humans have walked this earth… that is until we interrupted the natural process less than a century ago with artificial hydration.
• Is there a difference between not starting fluid feedings in the first place, and stopping them at any time?
• The AMA Code of Medical Ethics, and the law of the land, both state that there is no ethical or legal difference between not starting treatment and stopping. Any treatment, started to enhance health and diminish suffering can be stopped, especially if the situation changes and treatment is no longer helping or is causing harm.
• Do I, as an individual, or someone acting on my behalf, have the right to ask for the tube to be removed?
• Yes, especially where sustaining life might cause suffering. Further, the physician should either honor those wishes, or, if the physician believes this is not consistent with her or his personal ethics, then the physician should transfer the patient to the care of another doctor.
• What is the most important lesson from this story?
• We should all talk to our family in advance about our wishes regarding vegetative states and feeding tubes. It might prevent a lot of suffering.
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• Dr. Rick Holm wrote this Prairie Doc Perspective for "On Call®," a weekly program where medical professionals discuss health concerns for the general public.  "On Call®" is produced by the Healing Words Foundation in association with the South Dakota State University Journalism Department. "On Call®" airs Thursdays on South Dakota Public Broadcasting-Television at 7 p.m. Central, 6 p.m. Mountain. Visit us at OnCallTelevision.com.