Medicine: To Feed Or Not to Feed?

John Jobes vividly remembers the day in 1971 when he first met his future wife Nancy. Both were high school students in Parsippany, N.J. "She was a very independent, headstrong, loving person," he recalls. They married a few years after graduation, when John was working as a machinist and Nancy as a lab technician. Then six years ago, while she was pregnant with their first child, Nancy was injured in a traffic accident; several bones were broken, and the baby was lost. "She was a real tiger and a real fighter," John recalls, but her struggle to recover ended abruptly during surgery to remove the fetus. Oxygen was inadvertently cut off, causing irreversible brain damage. Nancy Jobes has been in a coma ever since, sustained by a feeding tube in a New Jersey nursing home. John, together with Nancy's parents and siblings, wants to have the feeding tube removed, but faces a battery of legal and medical obstacles. "There is no quality of life," he insists. "Nancy would not want to be in this state."

There are about 10,000 other Americans in Nancy Jobes' predicament, a hopeless twilight known to doctors as a "permanent vegetative state." For their families, they are a constant source of anguish, and there is a tremendous financial burden (as much as $100,000 a year, usually paid by insurance). These patients pose a knotty ethical dilemma for doctors as well --a conflict between the duty to sustain life and the obligation to relieve suffering. With few professional guidelines to help them resolve the conflict, doctors have frequently decided to continue treatment because of their moral qualms or fear of legal consequences.

Now a bold new ruling by the American Medical Association's Council on Ethical and Judicial Affairs ought to make it easier for doctors to go along with a family's request to end treatment. After two years of deliberation, the seven-member panel affirmed that patients' wishes, as best as can be determined, should be respected and their "dignity" maintained. It is "not unethical," said the council, for doctors to discontinue all life support for patients who are in irreversible comas, "even if death is not imminent." In its most controversial provision, the council included food and water on the list of treatments that could be withheld. The council's decision reflects a growing concern in the medical community and society at large that death in America is too often controlled by machines rather than nature. In a sharp departure from the past, when most Americans died at home, an estimated 80% now die in hospitals or nursing homes, often surrounded by a thicket of tubes and life-extending apparatus. Public opinion surveys suggest that most Americans fear and oppose this invasion of one of life's most private moments. Last year a Louis Harris poll of 1,254 adults found that 85% thought a terminally ill patient "ought to be able to tell his doctor to let him die"; 82% supported the idea of withdrawing feeding tubes, if that was the patient's wish.