Artificial feeding-Terri Schiavo

BRANDY LPN · Mar 22, 2005

Absolutely TRUE! A business man in So Cal offered him something like 10 million bucks to release guardianship to her parents.
My humble opinion, give this woman 30 days of PT, OT, SLP etc. Give her every opportunity ONCE AND FOR ALL in a neutral facility with no intervention on the parent's or husbands part. After 30 days, have her evaluated by a neutral, court appointed physician to determine the viability of continued therapy. If yes, have her declared a ward of the state and resume treatment, if no, resume the starvation. What say you all?

That is my thoughts too, why not court order a swallow study, a PET scan, an MRI and then give her a year of aggressive therapy and re-evaluate. 30 days would not be enough time IMHO to prove anything. Then IF she did not respond to therapy her parents would KNOW for certain that everything that can be done has been done and hopefully then they would be able to let go. If it was my child I would want definate proof that there was no hope before allowing them to die.

Tweety, BSN, RN · Mar 22, 2005

Absolutely TRUE! A business man in So Cal offered him something like 10 million bucks to release guardianship to her parents.
My humble opinion, give this woman 30 days of PT, OT, SLP etc. Give her every opportunity ONCE AND FOR ALL in a neutral facility with no intervention on the parent's or husbands part. After 30 days, have her evaluated by a neutral, court appointed physician to determine the viability of continued therapy. If yes, have her declared a ward of the state and resume treatment, if no, resume the starvation. What say you all?

I don't see the harm in that. I wonder after 14 years though what her rehab potential is, but certainly wouldn't hurt to find out once and for all as you have one camp saying she's been this way for 14 years and isn't going to change, and another camp saying she's rehabable.

Here's an article: http://www.sptimes.com/2005/03/22/Tampabay/Videotape__beyond_the.shtml

The Florida Legislature saw a half-dozen video snippets of Terri Schiavo in 2003 and hastily passed an unconstitutional law that kept her alive for more than a year.

Last week, Bill Frist, majority leader of the U.S. Senate and a doctor, reviewed the video images, pronounced her conscious and decried her "starvation." Then, he and his congressional colleagues also passed a "save Terri" law.

Through it all, well-meaning people all over the country have called Schiavo's husband a murderer and compared Pinellas-Pasco Circuit Judge George Greer to Adolf Hitler.

Why do these video images hold such power?

For starters, the six brief scenes posted on http://www.terrisfight.org were chosen by her parents and their supporters to make the strongest possible case that Terri Schiavo - damaged though her brain might be - is still a conscious being.

Secondly, there is simply no denying that a few of the images are disturbing - even after years of medical testimony and court decisions have concluded she has no real consciousness and never will.

Go to the Web site and watch Schiavo arch her eyebrows after being told to open her eyes. Maybe this is a reflexive action, as some doctors say, but it's easy to see why lay people might be moved.

In late 2003, I reviewed all four hours of videotape from Terri Schiavo's court-ordered medical evaluations, not just the four minutes and 20 seconds that are posted on the "terrisfight" Web site, and wrote a story about it. The complete videos - the latest ones - are part of the court file.

With the Web site still stirring a nation, the question remains: Do these brief images represent her condition or are they a result of creative editing? Are her reactions purposeful or as unthinking as a sea anemone that contracts upon touch?

The full four-hour version was taped in 2002 under the supervision of doctors. On it, Schiavo's parents, Robert and Mary Schindler, repeatedly coax their daughter to perform. It was their chance to show Judge Greer firsthand that Schiavo still had spirit. The video is poignant and, at times, painful.

Mary Schindler bends to her daughter's face to chat and coo. On two occasions, Schiavo's eyes seem to focus and her mouth seems to broaden. Could that be a smile?

When her mother plays some loud, tinkling music, Schiavo's moans grow louder while her face remains relaxed. Is she enjoying the sound?

Her eyes follow a balloon on three separate occasions, surprising even a doctor selected by her husband, Michael Schiavo.

But more often than not, the parents' and doctors' ministrations elicit no apparent reaction - at least not to someone unfamiliar with the nuances of her expressions. She mostly lies in bed with stiff limbs, loose jaw and unfocused eyes - no matter how hard her parents try.

"It's Mommy. Look this way," Mrs. Schindler urges to no avail. "Can you say, "No, no, no' like you did before? No, no, no?"

"Terri, Terri, Terri. Can you look over here, sweetheart?"

At one point, Robert Schindler gets gruff while trying to get his daughter to follow a Disney-character balloon. "Come here, Terri, no more fooling around. No more fooling around with your Dad."

He pokes her in the forehead to make sure she's awake. "No more fooling around with your Dad. Listen to me. You see the balloon? You see Mickey?"

Later, he apologizes. "I'm not going to lecture you anymore. I was scolded. No more lectures. You do as you please."

Neither Schindler's gruff admonition nor soothing apology seem to draw any reaction from his daughter.

Two doctors chosen by the Schindlers testified that the medical evaluations and video images show that she retains some level of consciousness. Two doctors picked by Michael Schiavo and one doctor appointed by Greer said her reactions are reflexive and involuntary - like a sunflower following the sun across the sky.

CAT scans show significant damage in her brain, they said.

Yes, a Web site image shows what could be a smile when her mother talks to her. But at other moments, not shown on the Web site, Schiavo makes similar expressions to no apparent stimulus. That doesn't square with smiling at Mom, some of the doctors said.

The majority of doctors, Greer and appellate judges concluded that Schiavo meets the definition of "persistent vegetative state," required under Florida law for feeding tubes or other life prolonging procedures to be removed. To meet that standard, the statutes say, people cannot exhibit any voluntary action or cognition "of any kind."

The single most dramatic moment on the video occurs when William Hammesfahr, a Clearwater neurologist picked by the Schindlers, asks Schiavo to open her eyes.

At first, her eyelids barely flutter. She slowly turns her head toward Hammesfahr, gradually opening her eyes. Then her eyebrows lift into an exaggerated arch - the kind of face a cartoonist might draw to show astonishment.

It's the only time in four hours that she makes that expression, which would appear to rule out coincidence. A lay person could easily conclude that some part of her, somewhere, responded to language and followed a command.

"Good job!" Hammesfahr exults. "Good job, young lady!"

But she never pulls it off again, or anything remotely like it. For nearly an hour, her parents and the doctor tell her to open her eyes, close her eyes, look this way, look that way, with little apparent response.

New Jersey resident Linda Lariviere said she has an idea why Schiavo only opened her eyes once. Doctors diagnosed her husband as living in a vegetative state - until she showed them videos of him "crying appropriately to music and emotionally evocative statements," she wrote to the Times in 2003. Doctors then upgraded his diagnosis to "minimally conscious," a standard that would not allow removal of a feeding tube in Florida.

Schiavo "can't perform consistently, the way a normal person would," Lariviere wrote. "The command or request has to be processed first. Maybe it makes it to completion, enabling Terri to respond, while other times it doesn't.

"Responding is real hard work for Terri and very fatiguing. Of course there would be long periods of taping with no obvious cognition going on. She is severely brain injured."

[Last modified March 22, 2005, 06:59:05]

KRVRN, BSN, RN · Mar 22, 2005

Well, hospice should be involved now... now she is terminal.

Kyriaka · Mar 22, 2005

:chair: Is it ok if that brought a little chuckle?
steph

_________

Yeah. Its ok.

Kyriaka · Mar 22, 2005

Well, hospice should be involved now... now she is terminal.

_____________

You got that right!

barefootlady, ADN, RN · Mar 22, 2005

The debate is over, the feeding tube will remain out. There was a constitutional issue here that was settled. That being said, I hope we all say a prayer for her parents today and everyday, it is never easy to lose a child, but this will be very, very difficult for them to endure.

I find it strange that celebrities have made statements regarding how horrible her death would be without really understanding what it would really entail. I have lost respect for some of the publicity seekers who spoke without knowing the facts of how she will probably expire.

Remember, I have kept my opinion to myself, it would surprise some you to know it, but I do have sympathy and concern for all involved.

I do hope the spouse and parents can have private, meaningful visits with her before she slips away, I doubt the press will allow this though, and will wait like the vultures they are for one more headline. :scrying: :crying2:

Kabin · Mar 22, 2005

1. she is most definitely responsive; the videos indicate that. saying otherwise is simply ignoring the evidence.

there's an obvious distinction that you choose to neglect. terri only has brain stem reflex and that's not enough to sustain life. but more importantly, terri decided that pvs is a state she did not want to exist with. if only the schindler family would humanely accept her wish the agony would have been over long ago.

5. we can believe whom we want to believe. but michael schiavo, i continue to remind people says the following:
"when is she going to die?"
"has she died yet?"
"when is that ***** gonna die?"
"can't you do anything to accelerate her death - won't she ever die?"
and her nurse pointed out that "when she wouldn't die, michael would be furious."
i am disinclined to believe that someone who makes such statements is someone worthy of believing.

assuming the quotes are factual, they still need to be taken in context. there's alot of agony in this and it's not easy for anyone. who knows what any of us would do or say after this many years of nonsense.

i place more importance on the validity of the umpteen unanimous court decisions that fly in the face of your quotes. obviously, the courts have analyzed the issue far deeper than any of us have time to.

6. since i'm not privy to the mind of the schindler family, i won't presume to guess that they are being "selfish." maybe they love their daughter, and don't want her to die. why is that such a problem?

bioethics is clear in this regard. in a nutshell, it's not the schindler family's decision.

LadyMadonna · Mar 22, 2005

The only sick alive people involved in this case are the Shiavo family. They need to grasp reality that Terri has long since past. It's reported that an MRI has shown her cerbral cortex to have been liquified many years back. Instead, the family uses video and anecdotal experiences to manipulate congress and the public. Just yesterday on CNN Terri's father was quoted that he talked to Terri about taking her out for breakfast and she supposedly responded. Right! That family needs counseling.

We watched a video of a frog that's brain had been pulvarized and it was downright creepy to watch what kind of actions that frog was capable of doing.

I say the most merciuful thing would be to let her go. I don't believe anyone in their right mind would look at themselves in such a way and want to live like that.

lpn3324 · Mar 22, 2005

I tell you what I am deeply confused about. Michael Shiavo is the "witness" that she said she did not want such and such. I find that very interesting.
When I did a living will I had to have 2 witnesses to my decision. NEITHER of these individuals could be mentioned as beneficiaries at all in my estate.
For those of you who do have living wills, what about you?? Could your witness(s) be someone in your family?

The last page of my Florida Living Will Declaration states "Only one witness may be a spouse,blood relative,heir,or person responsible for the patient's health care costs" I had to have two witnesses. My son who lives out of state is my health care surrogate,because I know that my husband and other son will not be able to carry out my wishes.

How can anybody say for sure what Terri's wishes were if they are not in writing.

danu3 · Mar 22, 2005

thanks pizzigirl for posting the link re schiavo timeline maintained by university of miami.
...
wolfson's report
governor bush's response to wolfson's report
...

i'll would skip governor bush's response just to save time reading and because it is basically a generic thank you.

the wolfson's report is worth reading. about 40 some odd pages. i personally learned a lot. and this is probably the most "neutral" report i've read. dr wolfson is a doc and an attorney. in the midst of all the emotions on both side, i am just thankful this country still have people like dr wolfson.

i would recommend even reading the fine print and the appendix at the end.

i find the small, very small footnote on page 37 on interesting. here is the quote:

" but that is not enough. this evidence is compromised by the circumstances and the emmity between the parties. until recently, while both michael schiavo and the schindlers agreed that theresa was in a persistent vegetative state, they could not agree as to the matter of discontinuation of life support. recently, the schindlers have adopted what appears to be a position that theresa is not in a persistent vegetative state, and/or that they do not support the fact that such a medical state exists at all. yet throughout the nearly ten years of litigation, it is the issue of her ability to swallow, ingest food and hydration, and the findings regarding any residual cognitive ability that have marked the medical substance of this dispute.

of the schindlers, there has evolved the unfortunate and inaccurate perception that they will "keep theresa alive at any and all cost" even if that were to result in her limbs being amputated and additional complex surgical and medical interventions being performed, and even if theresa had expressly indicated her intention not to be so maintained. during the course of the gal's investigation, the schindlers allow that this is not accurate, and that they never intended to imply a grusome maintenance of theresa at all costs.

of michael schiavo, there is the incorrect perception that he has refused to relinguish his guardianship because of financial interests, and more recently, because of allegations that he actually abused theresa and seeks to hide this. there is no evidence in the record to substantiate any of these perceptions or allegations.

until and unless there is objective, fresh mutually agreed upon closure regarding measurable and well accepted scientific bases for deducing theresa's clinical state. theresa will not be done justice. there must be at least a degree of trust with respect to a process that the factions competing for gheresa's best interest can agree. to benefit theresa, and in the overall interests of justice, good science, and public policy, there needs to be a fresh clean-hands starts.

the schindlers and the schiavos are normal, decent people who have found themselves within the construct of an exceptional circumstance which none of them, indded, few reasonable and normal people could have imagined. as a consequence of this circumstance, extensive urban mythology has created toxic clouds, causing the parties and others to behave in ways that may not, in the order of things, serve the best interests of the ward."

this is probably one of the least nonjudgemental, level headed, empathitic position i've seen. dr wolfson should be a nurse...

-dan

tonalee · Mar 22, 2005

Families are supposed to make these decisions for their loved ones. My main problem with this case is that the parents are trying to take control for the husband and in our country spouses are supposed to take precedence over parents.

I have been reading through here and I have read about how Terri's husband should have the last say in this because he is her husband.PLEASE don not tell me that you believe all husband are the right choice to be doing this!I was in a relationship that was hell on this earth and I would have been dead in a moment if he could have done it in a quiet way that he could justify.I hope my duaghter meets Mr.Wonderful some day but if he turns out to be an ugly frog you can bet I will take over and protect her.Yes,I believe there are good points on both sides but if it just can't be agreed on then Terri's husband should let go of his marriage and go on with his life.If he has children with another women he has no place having a say anymore.He gave up his marriage when he went to bed and had children with someone else.He then gave up the right to have a say about this.HeIf he had to go on with his life he can do it legally too.

danu3 · Mar 22, 2005

I think somebody recommended this site already, not sure. But here it is if it is not recommended already:

http://www.miami.edu/ethics2/schiavo_project.htm

You have both sides on this site. So whichever side you are on, read the other side.

http://www.miami.edu/ethics2/schiavo/CT%20scan.png

This is an old CAT scan of Terri's brain. Brush up your neuro stuff for those of us who have not deal with it for a while.

-Dan