- Conflicting Beliefs
Vijay is a forty-eight-year-old man with profound mental retardation and cerebral palsy. He uses a wheelchair, cannot speak or eat by mouth, and requires constant care. He lived in a group home for twenty-eight years.
During the last year, Vijay has required two visits to the emergency room on average per month and has been hospitalized for two hundred days in total. These hospitalizations are the result of a number of painful and dangerous complications related to the gastrostomy tube that provides his nutrition. The last time he was in the hospital, doctors had to give him a peripherally inserted central catheter, or PICC line, to provide nutrition because the gastrostomy tube was no longer effective and Vijay was losing weight. But the PICC line has had its own problems. Shortly after insertion, it became infected, requiring a prolonged course of antibiotics and Vijay’s transfer to a nursing home for care, since the group home does not have the manpower to care for and maintain a PICC line. Vijay’s stay at the nursing home lasted two months, and many attempts during this time to return to feeding him through the gastrostomy tube failed.
Vijay has just been rushed to the ER yet again because the PICC line is not flowing. The ER physician wants to change it, but his parents refuse to consent. They consider his care futile at this point and believe he will never resume enteral feeding through the gastrostomy tube. They also consider his care a burden, both to him and to themselves. They tell doctors that the constant surgeries and procedures—along with the pain and suffering they may be causing Vijay—violate his dignity. They also say that dealing with his chronic problems has made it impossible to pay attention to their own lives and the rest of their family. And finally, his parents are Hindus. They believe that Vijay’s body is now trapping his spirit, keeping it from its onward journey. They say Hinduism prohibits unwholesome efforts to prolong life like the repeated surgeries that Vijay has undergone. They tell the ER physician that they will not allow another surgical procedure to adjust or replace Vijay’s PICC line, even if doing so means he will starve to death.
Faced with this decision, the ER physician proposes returning Vijay to the nursing home, but the medical director there will not accept him back without a PICC line. He tells the physician that while Vijay’s parents may believe his care is futile, he does not think that Vijay meets the usual criteria for withholding life-sustaining treatment—he is not terminal or permanently unconscious, and his recent failure to thrive is not conclusively irreversible. The medical director also believes that the PICC line will probably be a temporary measure, despite a lack of success so far in restoring enteral feeding. And he admits he is afraid that letting Vijay die will make both him and the nursing home vulnerable to accusations of euthanasia and possibly a lawsuit.
How can Vijay’s situation be resolved in a way that all parties concerned can accept?
by Vidya Bhushan Gupta
The primary question here is whether we may consider quality of life when deciding about extraordinary measures to prolong life for individuals with developmental disabilities. And in the absence of a clear definition of—or objective measure for—quality of life, can the value of a life be assessed subjectively through the meaning it has for family members? And are the family’s religious beliefs relevant?
Vijay’s family has indicated that their family priest has advised them that withholding artificial nutrition is morally appropriate in Vijay’s case. Hindus believe that a person’s true self is his soul, which is eternal and transmigrates to another body when its prior one is worn out. Although the body is the vehicle for discharging karmic obligations, only the spirit unites with God. A Hindu might argue that a body that does not allow the spirit to discharge its karmic duties through desire, ability to reason, ability to feel aversion, pain...