artificial feeding-Terri Schiavo - page 21

I posted this here becaue I think this subject is something that we as nurses deal with on a regular basis.....Many many people state that they have a big problem with the feeding being stopped... Read More

  1. by   SmilingBluEyes
    Quote from decoopa
    Well, In an effort to answer your question #1 IT IS NOT DIFFRENT from any other case. The public is being drawn into a family feud with money via the gracious black journalism we have come to know and love. It is ignorance to think that this is the first time this scenario has been played out. It was just before; there wasn't the money to be had by the players to take it into the public stage. And now congress is getting involved, OH God please help us when we the public need the government to TELL get involved even more than they are in our personal lives. This is not about Terri but about a struggle over WHO has control over her.
    #2 How to handle this type of situation with family members? I have to admit it is a gray area with a potential slippery slope; but given REAL information with data from MD's with the backbone to state "the EEG is Flat! " etc. Allows the family permission to let go and come together and grieve together.
    The general public cannot understand the personal motivations of her husband or her family. I can say he's standing his ground against pushy and unrealistic in-laws. But what does it matter except now the government is getting way to involved into the private matters of personal lives; to answer the basic underlying question "Who IS the POA " the husband or can someone else cause enough stir and confusion in the name of "HUMANITY" to take it away.
    AS long as there have been medical advances that change and alter the disease process alleviating death, this scenario will continually repeat itself.
    I agree. Thank you for saying a lot of how I feel on this. I am sickened here....and sick of the government sticking its nose in. And I sick of the media treatment of this case. It's a circus, not a humanitarian case any longer. I am beyond fed up and disgusted.
  2. by   Spidey's mom
    Quote from underwatergirl
    I have been following this forum for a while...I don't deny that what Terri may experience isn't going to be pretty...the thing is I don't know and neither do you what all was damaged in the brain...particular nerons may or may not be there for her to feel the symptoms, I pray they are not.

    In comparison to what she has gone threw for 15 yrs of life...and what we all know will happen if she has the tube replaced..to me that is worse. I stand by the fact I don't wanna live like that..what quality of life do you have in a bed??? Not any imo!

    If the government/courts feel Micheal is so wrong, grant him a divorce...hence removing his legal obligations and rights and make her family pay for the medical care that she is recieving. I have said this once before and I will say it again...if this wasn't a power trip for the family they should have offered to pay all medical cost...sign legal aggreements...if the government feels this is wrong...then they should grant him a divorce...plain and simple.

    I understand why he has moved on. In respect to the blinds being closed, lots of camera's would love to get pictures of his wife..how would you feel with your wife stuff in a bed, brain dead to your knowledge, not particularly looking the best, those things I can understand...

    Now if he denied treatmeant to make her more comfortable that isn't right, if he denied treatment because he felt if would be more harm then good.

    IMHO, the family needs to stop fighting the tube issue and fight for the courts to grant a divorce and then take over all legal obligation of the patients medical cost and them be her HCPOA. To me this seems like a huge power trip of a womens life...it is a whole lot of hearsay...Why haven't the family requested to take over the cost? Fight the courts for a divorce for her daughter? Or ask Micheal for a divorce? That to me makes there story fishy...

    I have read what that nurse states in the sworn statement...alot of it to me sounds ridiculous and as if she is trying to get back at that LPN, which what was the point of mentioning her name?? It really made no sense, also IMO she didn't stand up to her obligations as a nurse..if she really saw or believed half of the things she is saying then why didn't she do more than just chart??? Is this nursing home being investigated for fraudulent records??? I think if that came out that state board of nursing would be all over that...Also if she has sworn this why hasn't it been on tape of him saying those things...because those are death threats and simple law enforcement can interact with that...also if she saw her chart notes being deleted, why didn't she start to copy them or print them out depending on the system used? As for the nursing home following what micheal says about not calling the family...THAT IS THE LAW, unless Terri says or has something put into place...that nurse could have been/probally was in deep trouble for calling the family. Don't get me wrong I think the family should know too, but it isn't my place to decide that or tell them that. Finally, if I thought a patient of mine was being abused by spouse/family, I sure the hell wouldn't sit back and not open the door...I would use excuses like time for this or that, or Micheal you have a call...come on this is a nurse who sounds like she messed up and is trying to fix it or make her record of employeement look clean. If she came and stated some of things she did then fine but some of it is just to far fetched...She is accusing this nursing home of corrising with Micheal...that is a conspiracy..don't you think that the Fed. Govern. would be getting involved right about now???

    In conclusion imo, the fight shouldn't be about the tube it should be about the family taking over financial responsibility and getting the courts to grant a divorce.

    What Terri may have to go threw is horrific, but the fact remains that Micheal is in control, we can't change that..however the family could if they would fight for legal rights and get that divorce. I just keeping asking myself, why hasn't that been done or thought of yet??? Perhaps because it is more of a power trip than a love trip???
    I realize you may just be jumping in here so you may not know some information.

    Terri's parents have offered to care for their daughter, take over all financial responsibilities, have asked Michael to divorce their daughter . . . Michael has refused all this. That is not Terri's parent's fault.

    The family IS FIGHTING for legal rights. They have been for years.

    steph
  3. by   boxermom
    Quote from Kyriaka
    ____________
    But you see, it is easier to view a person in this way.

    If you ever saw the movie Awakenings, Robin Williams character tells another Dr., "how do you know there is no consciousness there"? Speaking of people who appear to be in a catatonic state.

    And the Dr. replies, "because to think otherwise is the unthinkable".

    Based on the true story of a research physician who uses an experimental drug to "awaken" the catatonic victims of a rare sleeping sickness.

    Kyriaka and others that are standing up for life. Keep up the good work. The Human Life Alliance at www.humanlife.org is a great organization. The Pope has a stand on this for any Catholic nurses. I tried in the past to express myself on this issue of Terri, but you have had the patience to carry on. May God bless you, for opening the eyes of many people.
  4. by   ayndim
    If the husband has behaved so horribly why have the courts not taken away his right to make medical decisions? If he had something to do with her condition why have the courts allowed him to remain in control of his wife's medical care? Obviously, there is not enough proof or the courts would have taken action.

    I would also like to know how the doctors should have known she was bulimic. Apparently, the parents and husband didn't even know. As a former bulimic, let me tell you no one knew until I decided to seek treatment. Bulimics are experts at hiding it.
  5. by   Boston1
    He was awarded a sum of money with calculations made and the understanding that the money would be used to care for her. He agreed. That's why he wanted the money, supposedly to care for her. Then, ONCE HE GOT THE MONEY, he somehow remembered or decided she wouldn't want it be this way - but, of course, he wants to keep the money. I don't believe him. He got what he wanted, now he wants more without the original obligations attached. He is, really, no longer her husband. He's got children by another woman. There's enough documentation for those who want to find it to determine he has no interest in his "ex-wife" any longer. Why doesn't he just give the money to the family and let them use it for her care? That's why it was awarded.

    Quote from KARRN3
    It seems to me, the one piece being missed here is that this woman has already been in a vegetative state for fifteen years. The family stating that they think she can get better makes it sound like this just happened last week and already her husband wants to disconnect life support. What kind of life does this woman have, who would want to exist like that. It's a disgrace that the politicians and the courts have gotten into this power struggle. I believe her husband is fighting for what he knows she would want. If he didn't care about her, he would just take the path of least resistance, divorce her and let her live in this vegetative state forever. The other piece to this is, who is paying for her to live in this vegetative state in a time when almost a quarter of our people have no health coverage,.
  6. by   Kyriaka
    Quote from boxermom
    Kyriaka and others that are standing up for life. Keep up the good work. The Human Life Alliance at www.humanlife.org is a great organization. The Pope has a stand on this for any Catholic nurses. I tried in the past to express myself on this issue of Terri, but you have had the patience to carry on. May God bless you, for opening the eyes of many people.
    _____________
    Sometimes a stance is not always popular.

    I am a Greek Orthodox Christian (sort of a Catholic! heheh --perhaps a bit more conservative in some ways and less in others)

    I back away from pro life organizations because I do believe that removal of a feeding tube is acceptable if there is a written directive. My problem in the Shiavo case is that we are going on the word of one person.

    But I will check into the human life org. Thanks for the information.
  7. by   danu3
    Quote from asoldierswife05
    Utilitarianism.... we all learned about it in school. Part of ethics...

    Which decision would benefit the greatest number of people?

    Option A: Terri's tube is re-inserted

    Her husband would not have closure.
    Her parents would continue to put false hope in her recovery and continue to grieve for her and her circumstance.
    Terri remains in total care, strapped down to keep her from pulling the tube out (that came off her parents website)
    Millions of taxpayers dollars will be paid for care
    About the millions of taxpayers dollars will be paid for care, is that true? I thought they are paying it out of some funds (I could be wrong). Someone who is familiar with this case, please correct one way or another.

    About Terri being strapped down to keep her from pulling the tube out, please give the actual url as the parents website is big and has no search box.
  8. by   danu3
    Quote from asoldierswife05
    Utilitarianism.... we all learned about it in school. Part of ethics...

    Which decision would benefit the greatest number of people?

    Option A: Terri's tube is re-inserted

    Her husband would not have closure.
    Her parents would continue to put false hope in her recovery and continue to grieve for her and her circumstance.
    Terri remains in total care, strapped down to keep her from pulling the tube out (that came off her parents website)
    Millions of taxpayers dollars will be paid for care

    Option B: Terri's tube is left out

    Her husband can move on with his new family
    Her parents can complete the grieving process
    Terri passes naturally and enters the Kingdom of God where she will be restored
    Millions of taxpayers dollars will be redirected to others who CAN recover from dibilitating accidents

    the choice seems clear to me...
    Yes, we learn about utiltarianism in school. But we also learn about other ethical system like deontology. In deontology (which is probably what the parents are using), one could conclude either putting the tube back in or taking out of the tube depending on the underlying principles the person is working from.

    Also in nursing ethics, we don't always use utilitarianism or deontology. In real applicatiion, we most likely use a mixture of some sort.

    Even in utiliarianism, there are possible different outcomes than the one proposed above. For example, here is another alternative:

    Option A: Tube put back in


    • Husband is hopping mad.
    • Parents... who knows what they feel like... probably all kinds of mix emotions.
    • Right-to-Die movement will scream bloody murder and Terry's husband will become a pawn for the right-to-die movement.
    • Terri - No idea. If she is in a persistent vegetative state, maybe she won't feel anything. If she has some awareness, then probably continue to suffer.
    • Media will have a field day.
    Option B: Tube taken out
    • Husband can go on, or so he thinks.
    • Parents will become extremely bitter because they view Terry husband "murder" their daughter "legally". So they will somehow sue Terry and we will have a full blown WAR between Terry's husband and the his in-laws. You think this is bad now, you have not seen anything yet.
    • The right-to-life movement will scream bloody murder and parents will become a pawn for this movement.
    • All kinds of laws will get pass so something like Terry case won't happen again and these laws will get all of us in trouble.
    • Terry is at rest after going through some horrific pain of being starved and dehydrated to death as her body is not currently shutting down due to some terminal illness before the tube is full.
    Option C: Parents win legal divorce (as mention by another poster)

    • Husband is really jumping mad.
    • Nobody care about Terry anymore really because this is WWIII between the husband and the in-laws. Accusation of each other start to fly left and right (you think this is bad now, just wait) and the media has a field day.
    • Parents assume all expenses and all responsibility of Terry.
    • Eventually the parents financial resources ran out and medicare (or whatever) has to kick in.
    Option D: Tube put back in and Terry has an infection
    • The infection spread fast and eventually killed Terry. Since they are under hospice, the parents were convinced by hospice to remove the tubes. The parents agree and Terry went peacefully with her system slowly shutting down as the infection slowly takes over.
    • Parents grieved.
    • Husband went on with his life.
    Option E: Other options I have not think of.
    Last edit by danu3 on Mar 20, '05 : Reason: Corrected some grammar
  9. by   Kyriaka
    Quote from danu3
    About the millions of taxpayers dollars will be paid for care, is that true? I thought they are paying it out of some funds (I could be wrong). Someone who is familiar with this case, please correct one way or another.

    About Terri being strapped down to keep her from pulling the tube out, please give the actual url as the parents website is big and has no search box.
    _________________
    My understanding is that a medical malpractice settlement has been paying for this, but it is has almost run out.

    The husband says it has almost run out, the parents say he has blown over a million on himself.

    I did find an old story where the parents were told they now had to pay a fee to see their daughter http://www.freerepublic.com/focus/f-...posts?page=350

    From this article I found mention of the funds:
    "A couple of years ago, Michael Schiavo contacted Terri's parents and offered to give the balance of Terri's money over to charity. He and his attorneys used this a talking point for the media - claiming that Michael had no financial interest in Terri's death. What they neglected to mention was that that particular offer was predicated upon the Schindler's agreeing to Terri's dehydration and starvation death..."
  10. by   Spidey's mom
    I posted this in another thread - but with the question about funding Terri's care I thought I'd post it here too. It is a timeline with footnotes about this case. Medicaid does help pay for some of her care.

    What You Need to Know about Terri Schiavo
    March 7, 2005

    by Carrie Gordon Earll

    Terri Schiavo's fight for life has been widely publicized in the media but do you know the facts?
    Terri Schindler Schiavo is a 41-year old disabled Florida woman at the center of an on-going legal despite between her estranged husband, Michael, and her parents.

    In 1990 at 26-years of age, Terri collapsed in her home when her heart temporarily stopped, cutting off oxygen to her brain and leaving her severely brain damaged.

    Terri is not dying or terminally ill; she is not brain-dead or in a coma. She is an otherwise healthy mentally disabled woman. The diagnosis that she is in a "vegetative state" is disputed by many medical experts, including neurologists. Some neurologists believe it's possible that Terri is in a "minimally conscious state" (MCS)-- a neurological diagnostic criteria first defined in 2002. 1 Researchers are beginning to test this criteria against that of "persistent vegetative state" (PVS) with other patients. 2

    Terri breathes on her own without the aid of a ventilator. Her only dependency is on a feeding tube into her stomach for liquids and nourishment. 3 She swallows her own saliva, a fact that leads some experts in speech pathology to believe that with sufficient time and therapy, she could regain her ability to swallow fluids by mouth. 4 As recently as 1997, nursing staff who cared for Terri testified that she could swallow fluids and Jello-O, follow people with her eyes and even speak. 5

    An attorney for Terri's parents, Barbara Weller, has posted narratives on the Internet describing her recent visits with Terri. During these visits, Weller witnessed purposeful interaction between Terri, her parents and other visitors. 6

    At the time of her collapse, Terri did not have a written advance medical directive. Since her disability, medical decisions have been made by her husband, Michael Schiavo.

    Michael Schiavo won a medical malpractice case on Terri's behalf in 1992, pledging to use the money for Terri's rehabilitation and care for the rest of her natural life. 7 The court awarded more than $1 million: $300,000 directly to Michael for his loss and additionally, more than $700,000 for Terri's care. 8 Terri's parents, Bob and Mary Schindler, claim that prior to the settlement a neurologist recommended progressive therapy for Terri and that Michael agreed to provide such therapy, only to deny it and confine Terri to a nursing home after receiving the jury award. 9

    It was after the settlement that Michael first claimed that Terri had previously stated that she didn't want to be kept alive by artificial means-a statement he never mentioned during the malpractice trial. 10

    As guardian, Michael Schiavo controls the $700,000-plus trust fund awarded for Terri's care. 11 As of fall of 2003, Michael Schiavo's attorneys reported that the trust fund was down to $50,000, with more than $430,000 going to "pay for court costs associated with her husband's legal battle to remove his wife's feeding tube." 12 Meanwhile, Medicaid helps to pay Terri's $5,000-a-month nursing costs at a hospice in Pinellas Park, Florida. 13

    Since 1995, Michael Schiavo has lived with a girlfriend, Jodi Centonze, with whom he has two children. 14 Michael remains legally married to Terri, as well as her guardian.

    In 1998, Michael Schiavo petitioned the court to have Terri's feeding tube removed.

    Terri's parents have offered to take care of Terri at their own expense, allowing Michael to keep all money remaining in the trust fund. To date, Michael Schiavo has refused, insisting that Terri die from dehydration.

    Florida Sixth Judicial Circuit Judge George Greer has set Friday, March 18 at 1:00 p.m. EST as "date and time" certain to remove Terri's feeding tube-an act that will cause the painful death of an otherwise healthy disabled person whose body processes and benefits from the nutrients and fluids she receives daily.



    TIMELINE: 15

    On February 25, 1990, 26-year old Terri Schindler Schiavo collapsed in her home when her heart temporarily stopped, cutting off oxygen to her brain and leaving her severely brain damaged.

    In November 1992, her husband, Michael, won a medical malpractice lawsuit after claiming that doctors failed to diagnose the chemical imbalance that caused the heart attack. The court awarded approximately $1 million in damages with $300,000 to Michael for his loss and another $700,000 to Michael for Terri's guardianship and care.

    In July 1993, Terri's parents, Bob and Mary Schindler, petition the court to have Michael removed as Terri's guardian-a request that is denied in August 2001.

    In May 1998, Michael Schiavo petitions the court to have Terri's feeding tube removed, claiming that Terri told him that she did not want life-sustaining intervention in the event of her incapacitation.

    In February 2000, Florida Circuit Judge George W. Greer rules that the feeding tube can be removed.

    After several court appeals, it is removed on April 24, 2001. Two days later, Florida Circuit Judge Frank Quesada orders doctors to reinsert Terri's feeding tube.

    In October, 2001, the Florida 2nd District Court of Appeals indefinitely delays the removal of Terri's feeding tube pending the examination of Terri by five physicians: two selected by Michael, two by the Schindler's and one by the court. The two doctors selected by Terri's parents tell the court that she can recover; the remaining three stated that she is in a vegetative state with no hope of recovery. The following month, Judge Greer again orders the feeding tube to be removed again. More court appeals follow.

    On October 15, 2003, Terri's feeding tube is removed for a second time.

    October 20-21, 2003: the Florida State Legislature passed legislation (dubbed "Terri's Law") allowing Governor Jeb Bush to intervene, ordering the reinsertion of Terri's feeding tube-six days after it was removed.

    May 6, 2004-January 24, 2005: Various courts, including the Florida Supreme Court, strike down "Terri's Law" as unconstitutional; the U.S. Supreme Court refuses to hear the case.

    March 2005: Members of the U.S. Congress and the Florida State Legislature introduce legislation to intervene on behalf of Terri and other medically vulnerable patients.





    --------------------------------------------------------------------------------
    1 Affidavit of Neurologist Beatrice C. Engstrand, M.D., March 3, 2005; Affidavit of Neurologist Jacob Green, M.D., February 22, 2005; Affidavit of Neurologist Lawrence Huntoon, M.D., March 3, 2005. Affidavits may be accessed on-line at www.terrisfight.org
    2 J.T. Giacino, et al., "The minimally conscious state: Definition and diagnostic criteria," Neurology, February 2002; 58: 349-353; Melanie Boly, et al., "Auditory Processing in Severely Brain Injured Patients," Archives of Neurology, February 2004, 61:233-238.
    3Abby Goodnough, "Governor of Florida orders woman fed in right-to-die case," The New York Times, October 22, 2003.
    4Affidavit of Speech Language Pathologist Sarah Green Mele, July 25, 2003; Affidavit of Carolyn Heron, M.D., March 3, 2005; Affidavit of Neurologist Beatrice C. Engstrand, M.D., March 3, 2005; Affidavit of Speech and Language Pathologist Jill Joyce, PhD, March 3, 2005. Some affidavits may be accessed on-line at www.terrisfight.org
    5Affidavits of Certified Nursing Assistant Heidi Law, September 1, 2003; Registered Nurse Carla Sauer Iyer, September 1, 2003.
    6Narrative by Barbara Weller on visit with Terri December 24, 2004, accessed on March 1, 2005 at www.terrisfight.org/press/BJWnarrative.html; Narrative by Barbara Weller on visit with Terri February 24, 2005, accessed on February 25, 2005 at www.alliancealert.org/2005/20050225.htm
    7Vickie Chachere, "Michael Schiavo says money, activists motivate in-laws," Associated Press, October 28, 2003.
    8Patrick Kampert, "Parents or husband: Who decides?; Courts to choose victor in battle over woman's life," Chicago Tribune, October 12, 2003.
    9Interview with Robert and Mary Schindler, Larry King Live, September 27, 2004.
    10Kampert, Associated Press.
    11Hugo Kugiya, "Decision for Death; Florida woman's feeding tube pulled after court okays action, Newsday, October 16, 2003.
    12William R. Levesque, "Schiavo's husband says he'll fight back," St. Petersburg Times, October 24, 2003; Chris Gray, "Both sides in Schiavo fight point to control of money," Philadelphia Inquirer, October 29, 2003.
    13Mary McFachlin, "Schiavo case a growing legal, moral morass," Palm Beach Post, October 26, 2003; Levesque, St. Petersburg Times.
    14Rich McKay and Maya Bell, "How to deal with Terri Schiavo's tragedy splits family," Orlando Sentinel, October 26, 2003; Warren Richey, "Can state intervene in medical decisions?" Christian Science Monitor, August 3, 2004.
    15With assistance from "Key Dates in the life of Terri Schiavo," Associated Press, January 24, 2005.
  11. by   Kyriaka
    I dont know where the information about her brain is functioning or not.
    Today C-span reported she hasnt had an MRI or CAT scan in 15 years!!
  12. by   BRANDY LPN
    Why can't the courts order a swallow study, a MRI or CAT scan, order rehab therapy for a stated period of time (say one year) and then at the end of the year reevaluate and see if she is improving see if she can be WEANED from the feeding tube see if she does have brain function? I know it is a little late for all of that but why didn't the courts order that to begin with.
  13. by   nurse4theplanet
    taken from www.alliancealert.org/2005/20050225.htm


    ...When Mr. Gibbs and I (Terri's Family's Lawyer) entered the room with Bob, Mary was already there.* Terri was again sitting in her lounge chair, at nearly an upright angle.* Mary was perched on the arm of the chair with her head right next to Terri's head.* Mary was talking to Terri and kissing her and Terri's eyes were wide and locked onto her mother's eyes.* Mary was saying "I love you" and trying to get Terri to repeat the words after her.* Mary would say "I-I-I-I" and Terri would answer back "Aa-a-u-u-ugh."* Mary would then say "l-o-o-o-v-v-v-v-e" and Terri would repeat "Aw-w-w-w-w-w."* Mary then said a staccato "you" to which Terri did not audibly respond....

    We must be careful not to see or hear what we want to see. As nurses we must be objective, and not take sides or get emotionally involved while giving care. I am afraid that is happening in this case. The family sees Terri trying to speak because they want her to, the lawyer of course sides with them, and nurses that sympathize with their pain will take their side and perceive the same. However, a nurse that does not sympathize with the family will have a more objective point of view. That is why I feel that the court decision was made correctly. I believe that both sides were given equal opportunity to prove their case, and after careful consideration the judge objectively ruled in favor of the husband.

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