Artificial feeding-Terri Schiavo

angieRN · Mar 19, 2005

My mom died under hospice and so I have some involvement in it. The above link is my understanding also - that is when a person is dying and the system is shutting down, hydration can actually increase suffering.
However, in the conxted of schivao case, is she dying? If she is dying, then forcing hydration is not doing any good. If she is not dying, however, withholding hydration can be a cruel way to die (if I am understanding it correctly). When people quote hospice literature about hydration, we have to agree that Terri is dying and not just severly disabled before the hospice literature can be used in its proper context.
-Dan

I realize that she is not currently dying. I only wanted to point out that it is not a painful death to die from dehydration as some people believe.

Angie

webblarsk · Mar 19, 2005

http://www.cnsnews.com/pdf/2003/aff2.pdf

I have been browsing the internet, very interested in this case. I came across this avadavidt from a nurse that cared for Terri. What do ya'all think? The more I read about this case the more wrong I think it is. It really bothers me!

tiggerforhim · Mar 19, 2005

Contrary to popular belief, if the feeding tube was removed she would not starve to death but die of dehydration. Dehydration is a peaceful and painless death.I did a hugh research paper on this subject and people are misinformed.

Really? When was the last time you went 12 hours or 24 hours without a drink? How did they get input on this topic, ask comatose patients how they are feeling about drying to death? Or did a research project in a hospice where they cut off the feeding/fluids of people and then asked them if it was a painless and peaceful way to go? Now I know that I haven't researched the topic, but doctors are also of the opinion that babies don't feel pain as much as we do.... I work with them all the time (peds nurse), and they sure do.

VeryPlainJane · Mar 19, 2005

None of the experts addresses the implications of Terri's cerebral cortex having been destroyed and replaced by fluid. Nor does anyone attempt to defuse the observation that Terri's movements can be explained by non-conscious processes but not by higher brain activity because she doesn't actually have those higher brain centers anymore.

Moreover, most of the "experts" are quite upfront about having viewed only heavily-edited videos, whereas the trial judge and the doctors who saw the uncut footage saw no evidence of consciousness. Several of the affidavit filers state explicitly that their opinions are based on video clips from Terri's parents' website!

Not a single one of the so-called experts has even examined Terri. Generally speaking it is considered unethical for a physician to diagnose a patient without examining her. Only a handful of the "experts" even claimed to have reviewed her medical records. Most filed from outside the state of Florida.

Two of the experts identified by the Schiavo Foundation website as "Dr." hold no doctoral degree of any kind (speech and language pathologists Hyikn and and Lakas), and a third claims to have a doctorate in "neuroscience" but admits under oath that his PhD is in clinical psychology (Dr. Hooper).

Dr. Ralph Ankenman is a psychiatrist who wants to treat Terri with Namenda (memantine) a drug indicated only for Alzheimer's disease. Ankenman hypothesizes that Schiavo's speech is "blocked" because she is in a dissociative state akin to that of some patients with severe postraumatic stress disorder. He admits that neither his blocking theory nor his as yet untested proposal to treat massive cortical brain damage with Namenda is what you'd call a "standard concept." As he puts it, "Unfortunately there is as yet no published literature validating these assertions." His recommendations are especially unorthodox, given that Terri Schiavo is neither catatonic nor comatose.

Dr. Beatrice Engstrand believes Terri is conscious based on "a television show that [she] watched" and her experience caring for the Central Park Jogger in 1989. It is difficult to see how Dr. Engstrand's experiences with the Central Park Jogger afford any insight in to Schiavo's case. The CPJ was never in a persistent vegetative state, in fact the patient was only comatose for 12 days.

Dr. Richard Neubaeur wants to treat Terri with hyperbaric therapy, herbs, and acupuncture. It should also be noted that Dr. Neubaeur is also the owner of the largest neurological hyperbaric clinic in Florida and that his affidavit reads like an infomercial.

Dr. Carolyn Heron's affidavit contains at least two elementary errors about the neuropathology of PVS. She argues that the fact that Terri's swallowing reflex is partially preserved indicates that she is not in a PVS. In fact, the reflexive component of swallowing is often preserved to various degrees in patients with PVS (cf. Cole G, Cowie VA. Clin Neuropathol. 1987;6:104-9.) Dr. Heron also claims that the fact that Terri doesn't choke on her own saliva is evidence that she is not in a PVS, again, saliva-handling is a brainstem reflex that is preserved in PVS.*

Dr. Lawrence Huntoon's assessment is based on video clips from "Terri Schiavo's web site."

Perhaps the most bizarre contribution comes from Dr. Richard Weidman, the head physician at the US Department of Engraving and Printing.

He has not examined Terri Schiavo, instead he bases his opinions on his experiences with his mother, who had Alzheimer's disease. He states:

"I am willing to compare test results done on my mother's brain to those done on Ms. Schiavo's brain and then testify as to the behavior displayed by my mother and how that would be important to Ms. Schiavo."

The Terri Schiavo Foundation promises more affidavits soon.

* Some of the "experts" claim that Terri could be taught to swallow again. If this were feasible, it might be a relevant consideration because the issue is that Terri didn't want to be kept alive artificially. In fact, it is completely unrealistic to think that Terri could survive without a feeding tube.

To put it bluntly, Terri has to be fed by tube is because she is unconscious--it's just not safe to feed unconscious people by mouth, no matter how robust their swallowing reflexes may be. Think drunks and vomit--people who have passed out can easily choke to death even though they retain a much higher level of consciousness than Terri. Ronald Reagan's doctors believe that, like many Alzheimer's patients, the former President died of pneumonia caused by aspirating food while conscious but demented.

No one who cares about Terri's welfare or dignity would ever endorse this doomed swallowing experiment. Death by aspiration pneumonia would be much uglier and more protracted than death by dehydration.

Terri's husband is a Nurse RN in fact!

tiggerforhim · Mar 19, 2005

Artificial feeding can be a heroic measure under some circumstances - unfortunately in too many cases. If Terri is being tube fed can we not assume that she has no or an insufficient gag reflex. Being able to swallow a sip of water and being fed by mouth are not the same thing. How much are the taxpayers paying for her care? If her parents want to control her prolonged death, they should take her home. There are so many other patients that could use the money that is spent on her care - including prevention.

They should take her home? Excuse me? Ahem... the HUSBAND has all the legal rights in this case and has been denying care for Terri for 14 years. Don't you think the parents would have taken her home if it was at all possible?

drdan · Mar 19, 2005

If it was me in her situation, I would still want to live. Even if it meant not really having a "life" but at least I would be alive.

I would like to see her live.

UnewmeB4 · Mar 19, 2005

Until this past year, the Catholic Church considered feeding tubes "an extraordinary measure". My problem with the whole thing is the Governments attempts to get involved. People make these decisions all the time. My friend had a cousin with ALS. He was home on the vent, alert and oriented. He CHOSE to be taken off. He was able to say goodbye to everyone. The priest came to give him the Sacrament, and the church harpist played. Doesn't get much better than that.

kaykay · Mar 19, 2005

I realize that she is not currently dying. I only wanted to point out that it is not a painful death to die from dehydration as some people believe.
Angie

Ever had a U.T.I.? Was it painful? Ever had ulcers inside your mouth? Read on to find out just how "painless" Terri's death will be...

If all food and fluids (nutrition and hydration) are removed from a person -- whether that person is a healthy Olympic athlete who takes food and fluids by mouth or a frail, disabled person who receives them by a feeding tube -- death is inevitable. That death will occur because of dehydration.

As a person dies from lack of food and fluids, his or her

Mouth would dry out and become caked or coated with thick material.

Lips would become parched and cracked.

Tongue would swell, and might crack.

Eyes would recede back into their orbits.

Cheeks would become hollow.

Lining of the nose might crack and cause the nose to bleed.

Skin would hang loose on the body and become dry and scaly.

Urine would become highly concentrated, leading to burning of the bladder.

Lining of the stomach would dry out and he or she would experience dry heaves and vomiting.

Body temperature would become very high.

Brain cells would dry out, causing convulsions.

Respiratory tract would dry out, and the thick secretions that would result could plug the lungs and cause death.

At some point within five days to three weeks, the person's major organs, including the lungs, heart, and brain, would give out and death would occur.

[source: Brophy v. New England Sinai Hosp., 398 Mass. 417, 444 n.2,

:chair:

michelleicu · Mar 19, 2005

i think terri is like stuck in the middle of this, poor lady doesn't even know what's going on she's brain dead.they should make a law in every state,that says if I am put in to a life threatning situation let me die don't keep me alive for sake of loved ones.everyone should sign one when they turn 18.then the hospital will know what to do.cause I know if i was in her situation i'd wanna die right away,you know let me go.let her rest in peace now GOD wants to give her angel wings now in heaven.

UnewmeB4 · Mar 19, 2005

I've expressed my opinion on the subject in the current event boards many times. I support the husband in his desires to carry out his wife's wishes and I'll leave it at that.
To the original question, as it pertains to my nursing practice, I support spouses and families with nonjudgement no matter what they do in cases like this. I taken care of patients on both sides of this issue, those in a permanent vegetative state that are kept alive with all kinds of heroics and those who have been allowed to finish the process of dying that their initial illness/injury started, which I think of a tremendous act of love and courage, not murder. This included the case of a 19 year old head injured boy who would have lived for 40 years on a tube feeding, but his parents cut it off and he died of dehydration.
I think any "Terri's Laws" that would present this option for families is dangerous territory.
Off topic. Terri's husband was on the radio the other day saying he got offered lots of money to keep her alive and drop his efforts. I wonder if this is true.

I do NOT want Uncle Sam telling me if I can or cannot die. The SAME people who are attempting to prevent her death, are the very same people who are cutting back Medicare and Medicaid payments to nursing homes! These are also the same people passing laws about the sanctity of marriage. Someone needs to make me understand this concept.

NONE of these people making these laws have taken the time to care for those in the nursing homes. They have no idea what is involved in caring for someone in a PVS. Yes, their eyes open, and perhaps they move some. BUT, for the most part...you are turning them q2hr, 1 can or 2 of whatever tube feeding q4hr. Mouth care qshift(hopefully). That is their life...24/7. It ain't even pretty. And for how many years??? For what purpose?

kaykay · Mar 19, 2005

None of the experts addresses the implications of Terri's cerebral cortex having been destroyed and replaced by fluid. Nor does anyone attempt to defuse the observation that Terri's movements can be explained by non-conscious processes but not by higher brain activity because she doesn't actually have those higher brain centers anymore.
Moreover, most of the "experts" are quite upfront about having viewed only heavily-edited videos, whereas the trial judge and the doctors who saw the uncut footage saw no evidence of consciousness. Several of the affidavit filers state explicitly that their opinions are based on video clips from Terri's parents' website!
Not a single one of the so-called experts has even examined Terri. Generally speaking it is considered unethical for a physician to diagnose a patient without examining her. Only a handful of the "experts" even claimed to have reviewed her medical records. Most filed from outside the state of Florida.
Two of the experts identified by the Schiavo Foundation website as "Dr." hold no doctoral degree of any kind (speech and language pathologists Hyikn and and Lakas), and a third claims to have a doctorate in "neuroscience" but admits under oath that his PhD is in clinical psychology (Dr. Hooper).
Dr. Ralph Ankenman is a psychiatrist who wants to treat Terri with Namenda (memantine) a drug indicated only for Alzheimer's disease. Ankenman hypothesizes that Schiavo's speech is "blocked" because she is in a dissociative state akin to that of some patients with severe postraumatic stress disorder. He admits that neither his blocking theory nor his as yet untested proposal to treat massive cortical brain damage with Namenda is what you'd call a "standard concept." As he puts it, "Unfortunately there is as yet no published literature validating these assertions." His recommendations are especially unorthodox, given that Terri Schiavo is neither catatonic nor comatose.
Dr. Beatrice Engstrand believes Terri is conscious based on "a television show that [she] watched" and her experience caring for the Central Park Jogger in 1989. It is difficult to see how Dr. Engstrand's experiences with the Central Park Jogger afford any insight in to Schiavo's case. The CPJ was never in a persistent vegetative state, in fact the patient was only comatose for 12 days.
Dr. Richard Neubaeur wants to treat Terri with hyperbaric therapy, herbs, and acupuncture. It should also be noted that Dr. Neubaeur is also the owner of the largest neurological hyperbaric clinic in Florida and that his affidavit reads like an infomercial.
Dr. Carolyn Heron's affidavit contains at least two elementary errors about the neuropathology of PVS. She argues that the fact that Terri's swallowing reflex is partially preserved indicates that she is not in a PVS. In fact, the reflexive component of swallowing is often preserved to various degrees in patients with PVS (cf. Cole G, Cowie VA. Clin Neuropathol. 1987;6:104-9.) Dr. Heron also claims that the fact that Terri doesn't choke on her own saliva is evidence that she is not in a PVS, again, saliva-handling is a brainstem reflex that is preserved in PVS.*
Dr. Lawrence Huntoon's assessment is based on video clips from "Terri Schiavo's web site."
Perhaps the most bizarre contribution comes from Dr. Richard Weidman, the head physician at the US Department of Engraving and Printing.
He has not examined Terri Schiavo, instead he bases his opinions on his experiences with his mother, who had Alzheimer's disease. He states:
"I am willing to compare test results done on my mother's brain to those done on Ms. Schiavo's brain and then testify as to the behavior displayed by my mother and how that would be important to Ms. Schiavo."
The Terri Schiavo Foundation promises more affidavits soon.
* Some of the "experts" claim that Terri could be taught to swallow again. If this were feasible, it might be a relevant consideration because the issue is that Terri didn't want to be kept alive artificially. In fact, it is completely unrealistic to think that Terri could survive without a feeding tube.
To put it bluntly, Terri has to be fed by tube is because she is unconscious--it's just not safe to feed unconscious people by mouth, no matter how robust their swallowing reflexes may be. Think drunks and vomit--people who have passed out can easily choke to death even though they retain a much higher level of consciousness than Terri. Ronald Reagan's doctors believe that, like many Alzheimer's patients, the former President died of pneumonia caused by aspirating food while conscious but demented.
No one who cares about Terri's welfare or dignity would ever endorse this doomed swallowing experiment. Death by aspiration pneumonia would be much uglier and more protracted than death by dehydration Terri's husband is a Nurse RN in fact!

AND WHO BETTER to know how to kill her? I have more than 25 years of experience with who is concious, unconcious, in a coma or semi coma (now called a persistent vegetative state) and I can tell you that Terri is none of those.. she is simply brain damaged. If we allow this to happen to her, why not do it for MD patients in the same condition, for the profoundly retarded, for the depressed who refuse to eat? Hey, why not? They aren't "really" alive, are they? To presume, based on the heresay of her estranged husband and his brother and sister, that Terri would want to die, to go against the religion she was so devout in, is ludicris! If you really believe this, why then has a former RN caregiver given an affadavit stating that Terri's blood sugar wouldn't even read after Michael's vists? This same caregiver states in the same affadavit that Michael would call and harass the nurses with questions like "Is she dead yet?"... Wow, we ALL really need to be careful here...

kaykay · Mar 19, 2005

I do NOT want Uncle Sam telling me if I can or cannot die. The SAME people who are attempting to prevent her death, are the very same people who are cutting back Medicare and Medicaid payments to nursing homes! These are also the same people passing laws about the sanctity of marriage. Someone needs to make me understand this concept.
NONE of these people making these laws have taken the time to care for those in the nursing homes. They have no idea what is involved in caring for someone in a PVS. Yes, their eyes open, and perhaps they move some. BUT, for the most part...you are turning them q2hr, 1 can or 2 of whatever tube feeding q4hr. Mouth care qshift(hopefully). That is their life...24/7. It ain't even pretty. And for how many years??? For what purpose?

And for what purpose are you alive? What gives you the right to determine a persons purpose for life? I have worked for many, many years in nursing homes and home health care...AND my own mother went through these same issues... Terri is NOT in PVS. Anyone who has experience with this situation can clearly see that and even if she were, why should we determine its time to stop feeding her... with that logic, all tube feeders would be discontined. So, is a walkie-talkie only worth keeping alive? We kept my Mom on a vent and she had a feeding tube, UNTIL she died... and thats when her heart stopped beating... and yes, we would do it all over again....