Artificial feeding-Terri Schiavo

Tweety, BSN, RN · Mar 29, 2005

But you said that this was "due to the schindlers." So what explicit evidence do you have that they did this, even indirectly?
Jim Huffman, RN

Even though the Schindlers hired lawyers and have activists on their side, it's not their fault it became a media circus and lunatics from around the country threated Michael's life.

Perhaps if they had been a bit more private it might not have happened, who knows. But they wouldn't have gotten congress or the governor involved without the publicity, so I can't blame them for getting in front of the media all those times, or to have a family spokesperson speak to media.

jnette, ASN, EMT-I · Mar 29, 2005

I think it's sad that some would be annoyed with ANY parent for wanting to keep them alive... regardless of their condition. It might not be what WE would do, but certainly understandable from a parent's heart. I cannot imagine ever having to allow MY daughter to die this way.

While we all have our opinions on this, I just don't see any need for anger or fingerpointing or judging. May none of us ever be in this situation with a child of ours.

I was surprised to hear from a friend in Germany (which is QUITE liberal in these matters and others) that they are appalled over there about this situation. While removing a patient off a vent, etc, is accepted, removing a feeding tube is not, as it is not considered "artificial/mechanical life support".

I would have thought they wouldn't bat an eye over this, but apparantly many Europeans are quite dismayed... and they are far more liberal about human rights issues in many respects.

Not that anyone here may care.. just thought it was interesting to note.

mysticalwaters1 · Mar 29, 2005

For this reason a lot of nurses are afriad to give morphine to a dying patient, afraid to give the so-called "death dose". In my experience, I've given morphine and had the patient die within 10 minutes. Did the morphine kill her? No, cancer did.

I had one pt dying from respitory failure. The doctor took him off bypap saying why are we torturing him because he kept trying to take it off. He was also more lethargic that day and a DNR. Anyway he was using accessory muscles to breath and it looked uncomfortable but overal he seemed peaceful. Just incase since he was still struggling a bit I gave morphine 2mg knowing he was dying and no drip so thought well lets help a little. Anyway the family came in and mind you he was already lethargic prognosis very poor in the chart and the family could not comprehend he was dying. He was talking a little the day before and now when they came he could open his eyes but woud not talk. I told them did the mds talk about his prognosis they said no and i know some mds don't but i could have sworn through the md note squggles them updating the family. They told them he was dying and now that he is the wife just did not understand. I guess people don't realize in resp distress they breath difficult and the only thing is try to keep sats up with various o2 masks or nc and provide COMFORT care. I told her this and that i had given morphine a half hour ago to try and make him comfortable and she treated me as if I brought the entire dying process on or that's how i felt. She thought he was unresponsive due to the morphine. Not to mention they knew he had loads of ativan the night before due to him removing the mask when maybe that was it and felt when i gave morphine that was really going to keel him over. Finally i had enough and thank god the dr on call was the main dr and he was annoyed at me but how can i explain it any clearer and the doctor will set them straight and confirm what i said. Then they seemed more accepting of it. I just get sometimes they make people a dnr the doctor says prognosis is poor and some when finally it looks near the end seem utterly perplexed? Maybe it's a denial thing but i think sometimes people just don't realize it.

Anyway back to pain meds because of this I was going to give morphine at the end of my shift but because the wife was so concerned i gave it i felt uncomfortable giving it again. He did have respitory difficulty but was sleeping so the point is you don't know well maybe he's in some pain better be safe than sorry but i let the family dictate my care instead of the pt but i'm finding this more and more especially if a family member is at the bedside. I mean you listen sometimes because they know their loved one. Anyway what horrible situations especially when you are only trying to help all parties.

mysticalwaters1 · Mar 29, 2005

OH also she thought the morphine made him unresponsive but yet he could open his eyes and not only that she was complaining about him breathing difficulty. Now I felt perplexed so i tried to explain it all and that he would breath like that and we were to provide comfort to him as best we can. Anyway when she left i did forget to mention she said she felt that it was not the pt's time to go and she really felt he would pulll through. I guess maybe but jeeze I only want to help! I felt stuck with the situation and that's why i ultimately called the doctor to talk to them because the more i'd explain the more confused as if they wanted more action when they agreed no extrodinary means.

begalli · Mar 29, 2005

I was surprised to hear from a friend in Germany (which is QUITE liberal in these matters and others) that they are appalled over there about this situation. While removing a patient off a vent, etc, is accepted, removing a feeding tube is not, as it is not considered "artificial/mechanical life support".

I think this is one of the larger misunderstandings of this whole thing.

Feeding tubes are a medical life-saving intervention, nothing more, nothing less. It's NOT the same as giving a hungry person food. The result of removing the feeding tube is dehydration NOT starvation. If anyone were given water only, then THAT would be starvation and inhumane and cruel.

I hope I can articulate this well enough to make sense....

People can live for several weeks to months without food, but we can only live for a couple weeks without water.

I went back to my A&P books because I knew there was something that explained this and I knew it had something to do with catabolism, but I just couldn't pull the info from the deep recesses of my memory!

So what I was able to confirm for myself is that we can live only a limited time without water because of the catabolism that takes place in our bodies in the absence of the molecules that food provides. The complex process of catabolism breaks down organic molecules into ATP which we all know is the required energy to sustain life. It's all about creating ATP. While the body expends ATP during these breakdown processes (catabolism), it results in a net gain of ATP. But it can only go so far in the absence of water before there is no more ATP to expend because water is required in the reaction.

Some examples of catabolism are glycolysis, proteins into amino acids, and triglycerides into fatty acids.

What feeding tubes do is provide those molecules and the water needed to produce that ATP through metabolism (not catabolism). The only thing that feeding tubes might do to provide hunger satiety is act upon the stretch fibers in the stomach that tell the brain that the stomach is full. Feedings do nothing to satisfy the need to chew or taste, for example. The normal enzymes of digestion do not come into play at all. I'm pretty confident that normal CNS signals such as hunger, pain, itching, etc., DO NOT make it to Terri's brain and even if they did, I don't think she has the physical capacity of know or sense it. Remember, Terri's brain is mostly fluid...she has no cortex.

Without water, the kidneys shut down and everyone knows that once this happens, other organ systems shut down as well (multiorgan failure). This really is a peaceful way to go.

This stuff happens every single day. I withdrew support from a patient on Sunday night. His kidneys were already shut down. He was with us for only about 48 hours. We were only maintaining his blood pressure with iv meds (water) and his oxygenation with bipap. He did not have a feeding tube, but as his family reports, he also hadn't had an appetite for days. People die. My patient did not suffer and Terri is not suffering.

There is catabolism going on in a person's body when they are starving themselves to death with anorexia. They survive for a limited time only because of the water that they take in. Eventually the body runs out of glycogen stores, etc. that catabolism uses. That's one of the reasons why anorexia is so dangerous.

INtoFL_RN · Mar 30, 2005

excerpt taken from msnbc today... (original link: http://www.msnbc.msn.com/id/7293186/ )

morphine use disputed

bob schindler on monday said he feared the consequences of morphine that has been used to relieve his daughter's pain.

"i have a great concern that they will expedite the process to kill her with an overdose of morphine because that's the procedure that happens," he said.

felos disputed that, saying that hospice records show schiavo was given two low doses of morphine-one on march 19 and another on march 26-and that she was not on a morphine drip.

hospice spokesman mike bell said federal rules kept him from discussing schiavo specifically, but said "a fundamental part of hospice is that we would do nothing to either hasten or postpone natural death."

comfort measures, including morphine drips, are used in consultation with a patient's guardian, physician and hospice care team, bell said.

felos said he had visited terri schiavo for more than an hour monday and said she looked "very peaceful. she looked calm."

"i saw no evidence of any bodily discomfort whatsoever," felos said, although he added her breathing seemed "a little on the rapid side" and her eyes were sunken.

bob schindler's comments really make me mad. like hospice spokesman bell said, that is not what hospice is about. the public is already confused and misinformed enough about what hospice is and other end-of-life issues! it worries me because people like my mother in law are coming to me ranting and raving about this whole case and taking word the schindler's say as gospel truth.

caroladybelle, BSN, RN · Mar 30, 2005

Could this be included in the other Schiavo thread which is discussing the exact same issue?

Hardknox · Mar 30, 2005

Michael Shaivo has been made out to be the devil incarnate by many but I have no respect for the Schindlers. Mama can't visit Terri anymore--so overcome. Daddy is setting the hospice movement back many years with his comments. Now they are selling names of supporters.

Local - WKMG MyCFNow.com

WKMG MyCFNow.com

List of Schiavo Donors To Be Sold

If you expressed your support to Terri Schiavo and her parents fight to keep her alive, you may begin to receive a steady stream of solicitations, according to a Local 6 News report.

Terri Schiavo's parents have agreed to sell their list of supporters to a direct-mailing firm, Local 6 News reported.

The company, "Response Unlimited" pays about $150 a month for 6,000 names and $500 a month for 6,000 e-mail addresses.

A spokesperson for the Schindlers confirmed that they had agreed to sell the information, but won't say for how much.

begalli · Mar 30, 2005

Terri Schiavo's parents have agreed to sell their list of supporters to a direct-mailing firm, Local 6 News reported.
A spokesperson for the Schindlers confirmed that they had agreed to sell the information, but won't say for how much.

They are also selling video tapes of Terri for a "donation" to the representatives of the Schindler's cause.

The parents had to give consent for this.

Why would anyone exploit their own daughter like that?!

yuck.

Hardknox · Mar 30, 2005

Terri has received only two suppositories for pain, no drips or IV pushes. Funny how people can twist things around.

The father that is worried that those suppositories will overdose his daughter has found a way to make $ off his dying daughter.