Artificial feeding-Terri Schiavo

Boston1 · Mar 20, 2005

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.

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,.

Kyriaka · Mar 20, 2005

Kyriaka and others that are standing up for life. Keep up the good work. The Human Life Alliance at http://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.

danu3 · Mar 20, 2005

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.

danu3 · Mar 20, 2005

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.

Kyriaka · Mar 20, 2005

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-news/1131600/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..."

allnurses Guide · Mar 20, 2005

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 http://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 http://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 http://www.terrisfight.org/press/BJWnarrative.html; Narrative by Barbara Weller on visit with Terri February 24, 2005, accessed on February 25, 2005 at http://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.

Kyriaka · Mar 20, 2005

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!!

BRANDY LPN · Mar 20, 2005

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.

nurse4theplanet, RN · Mar 20, 2005

taken from http://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.

nurse4theplanet, RN · Mar 20, 2005

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!!

What was their source?

Kyriaka · Mar 20, 2005

What was their source?

______________

Here is an article that ran today. Apparently, she was diagnosed with PVS without an MRI and the husband refuses to have an MRI done saying PVS is only a clinical diagnosis.

http://www.nationalreview.com/comment/johansen200503160848.asp

This is from the article:

"So why hasn't an MRI been done for Terri? That question has never been satisfactorily answered. George Felos has argued that an MRI can't be done because of thalamic implants that were placed in Terri's skull during the last attempt at therapy, dating back to 1992. But Felos's contention ignores the fact that these implants could be removed. Indeed, the doctor who put them in instructed Michael to have them removed. Michael has never done so. "

TheCommuter, BSN, RN · Mar 20, 2005

The spouse's decision should carry more weight than the wishes of Terri's parents. My opinion probably sounds cruel; however, the parents shouldn't interfere. Comatose people do not have quality lives. I've worked with them; it's quite depressing. I am doubtful she's ever coming back to the same sharp mental state.