Wednesday, August 09, 2006

Part Three: The Nebraska Humane Care Amendment FAQ

In recent days I have posted here on Vital Signs Blog some of the answers to Frequently Asked Questions about the Humane Care Amendment that will be on Nebraska's ballot this November. If you've missed Parts One or Two of those posts, follow the links to catch up. Here is the next set...

What if I personally wish to decline food or fluids, especially nourishment by tube or IV, under certain circumstances?

The Nebraska Humane Care Amendment does NOT prevent anyone from declining care. The text expressly provides for “honoring the will of any person who, by means of a valid advance directive record, has fully, expressly, and personally either authorized the withholding of food or water from himself or herself under specific conditions, or delegated that decision, under specific conditions, to one or more relatives or to another person unrelated to the entity with a legal duty of care.” HCA preserves your right of self-determination by barring any unauthorized person from acting to dehydrate/starve you to death.

What about a situation where heirs with conflicting financial interests, perhaps in line for an inheritance, want to withdraw food and water from me while I am institutionalized?

If you authorize them to do so in writing by means of an advance directive (e.g., a living will or a durable power of attorney for health care) the Nebraska Humane Care Amendment would not protect you. If you never so authorize them, or if you ever withdraw such authorization, your right to the humane basics of hydration and nourishment would be constitutionally protected. The Nebraska Humane Care Amendment leaves YOU and your authorized loved ones in control -- not strangers, not greedy corporations, and not people you don’t trust to uphold your best interests.

Someone in the newspaper said Humane Care imposes all sorts of burdens and is inflexible. True?

Not true! Humane Care requires hydration/nutrition ONLY if its absence could reasonably kill or cause grave harm to the person at risk – and ONLY if the person can metabolize, and ONLY if there is no advance directive expressly authorizing otherwise. Conversely, Humane Care does NOT require water/food for a time if failure to hydrate/nourish would NOT reasonably cause death or grave harm. A less “burdensome” and more “flexible” policy would require that Nebraskans allow for involuntary dehydration/starvation to the point of death or grave harm.

But, could hydration and nutrition cause pain for the recipient?

Again, Humane Care allows for absence of water and food for a time if this would NOT reasonably kill or gravely harm the person at risk. On the other hand, because water and nourishment are ALWAYS necessary to sustain human life over an extended period of time, and because an individual may have a condition that causes pain (such as cancer), the caregiving institution should do everything it can to help the individual and loved ones in their desire manage any pain – but without acting unethically; without discriminating based on disability, age, etc.; and without acting against the Hippocratic Oath to expedite death. For an extended discussion of pain management, see for example, Power Over Pain: How to Get the Pain Control You Need (Eric M. Chevlen and Wesley J. Smith, 2002).

I'll post the next installment in a day or two.