Father Tadeusz Pacholczyk
What about ventilators?
The use of ventilators can pose particularly challenging problems during end of life situations for families. When should we place a loved one on a ventilator? If somebody is on a ventilator, can we ever "pull the plug"? Understanding our moral duty depends upon whether the use of a ventilator in a particular case can be considered "ordinary" or "extraordinary."
Ordinary interventions can be understood as those medicines, operations and treatments that offer a reasonable hope of benefit for the patient and that can be obtained and used without excessive pain, expense, or other significant burden. Use of a ventilator will sometimes satisfy these criteria, and other times it will not, depending on the specifics of the patient's situation.
Consider a young woman with serious pneumonia who is having difficulty breathing and is placed on a ventilator. The physicians treating her believe the pneumonia eventually can be controlled so that she can be weaned off the ventilator and breathe on her own in a few days or a week. They believe the device will be needed mostly as a temporary "bridge to healing," that it will be effective while in use, and that it will not impose much burden on her. In such circumstances, the use of the ventilator could reasonably be considered "ordinary" and thus morally obligatory.
Whenever there is a considerable hope of recovery from the illness by making use of a particular means (a ventilator, in this case), and when the patient can employ the means without much difficulty or burden, it is likely to be "ordinary" treatment. Thus, in the experienced hands of a well-trained physician, in a developed country with access to proper medication and equipment, intubation and ventilation of a patient can be a low-burden intervention.
The difficulties associated with using a ventilator, however, can become notable depending on the details of a patient's situation. Dr. Stephen Hannan, a pulmonary and critical care specialist in Fort Myers, Florida recently summarized some of the burdens associated with ventilation, noting particularly
"...the physical discomfort of the endotracheal tube going from the mouth, traversing the oropharynx, crossing the larynx, and reaching the trachea. Sedation, analgesics, and physical restraints are often necessary. The patient cannot talk while ventilator support is in use. The ventilator exposes the patient to greater risks of infection and barotrauma [damage to the lung tissue from the pressure of ventilation]. Even an untrained observer will recognize that the burden imposed by a ventilator with a standard endotracheal tube is much greater than the burden of a feeding tube."
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