Niet starten om staken te voorkomen?

Abstract

The research question of this study is based on a practical problem in nursinghomes. When a patient develops dysphagia, caused by a cerebrovascular accident (CVA or stroke), tubefeeding-treatment (TFT) is an option. There is a great chance the patient does not recover and will be depending on this tretment. From this situation arises the next question. Is it morally justified - when the prognosis is bad or unclear - to withhold TFT to a CVA-patient with dysphagia, in order to prevent that the patient will be dependent on TFT for the rest of his life, and to prevent the problems of withdrawing TFT.

For the justification of this TFT two grounds can be distinguished: (a) justification on the effects of the treatment and (b) justification based on moral principles. This study is founded on the Christian conviction, and the associated moral principles: respect for life, doing well (or beneficence) and (respect for) responsibility. In general, starting TFT is effective when this treatment results in the recovery of the patient. It is justified to withhold TFT when the treatment doesn’t bring the patient any good. In this case beneficence is the guiding principle. When a doctor starts TFT and - after few weeks - the patient does not recover, the treatment is ineffective. Still the treatment shows one minimal result: it is a life-sustaining treatment. In principle, the doctor can justify the action to withdraw TFT. But as soon as a doctor wants to remove the tube, the risk increases that this decision is not only grounded on the lack of effectiveness of the treatment, but also on the low quality of patient’s life. This justification conflicts with the protection of human life. This vision confirms the hypothesis that when TFT is given for longer time, the moral justification shifts from beneficence to respect for life. It is caused by the differences of both decision-moments: (a) the stability of the patient, (b) TFT shows to be a life-sustaining treatment, and (c) a different judgment about the low quality of patient’s life. Therefore a doctor should be very careful to withdraw TFT without the intention of life-shortening. The view that the doctor should be very careful to withdraw TFT (given the ‘increased risk’ of wrong intentions) implies for the central question of this study that it is not justified to withhold TFT in order to prevent the moral problems of withdrawing TFT. When a doctor judges the problem of ‘withdrawing TFT’ at the moment of ‘withholding TFT’, he can not avoid the ‘increased risk’. In this way the central question of this study is answered.