Artificial feeding-Terri Schiavo

Kyriaka · Mar 18, 2005

Well, the latest today is that the husband kicked the family out, removed the tube...then his girlfriend gave a press conference!! The girlfriend. Not the husband.

Talk about weird.

Kyriaka · Mar 18, 2005

she only has use of her brain stem. that is why she can breathe. you see your brain stem contols breathing and blinking and other VERY basic life functions. terri has lost cognitive neurological functions, which are controlled by the upper part of the brain. basically, she cannot form words, thoughts or purposefully coordinate movements. this is called living in a persistive vegatative state. there is no evidence of anybody ever regaining brain function after brain death[the upper brain is what i mean, i know she still has a brain stem] she will never think or speak or feel pain again. I hardly think that breathing and blinking constitutes living or quality of life. I have never met anybody who wants to breathe and blink while family members suffer emotionally for years and years and tons of money and time are spent keeping you alive so you can poop on yourself, be covered in bed sores, be repositioned, have desitin smeared on you, be contracted and never do anything but breathe and blink. make involuntary movements. i cannot understand why anyone fights to keep somebody in a state of limbo. it is not natural. it seems to me that if you cannot feel pain because that part of your brain is dead, starving would not hurt. just common sense. i think she will be in a better place with no glucerna, desitin, diapers, diahrrea[tube feeding can cause HORRIBLE diahrrea] and other unpleasant realities. just give the woman some peace.
would you want to live like that honestly?

___________________

Yes. I would.

If my family wanted to care for me.

I do have a written directive which states very clearly that I want a feeding tube.

ktwlpn, LPN · Mar 18, 2005

I am amazed at the comments with seeminly no concrete evidence to back them up. I am a hospice nurse and realize that this is a complex case and emotional for all parties involved. It seems a lot of comments are being made from personal beliefs rather than looking at best practice from a nursing standpoint. I do not feel the need to state my position on this case, but found a link that may be of some interest. It gives a little insight into the philosophy of hospice/palliative care regarding this issue. Artificial hydration/feeding, I suspect, will always be a very emotionally-bound issue no matter how much evidence is out there due to our cultural/religious beliefs.
http://www.aahpm.org/education/arthy.pdf
Angie

THanks for the link Angie- but I'll be surprised if anyone actually reads the info..Mis-information continues to be quoted ad nauseum....I am not in hospice but have taken care of numerous residents that refused feeding tubes and died from "starving and dehydrating" I know that with symptom control and good oral hygiene this is not painful....Terri's patients have said "she has trouble swallowing"...she has been given "spiritual communion" regularly but not given the communion wafer orally....SHe is considered to be in a persistent vegetative state and is unable to obtain nourishment orally.....A tube into the stomach sounds like an artificial and invasive procedure to me.....THis case may effect our ability to make this decision for ourselves and our loved ones someday.....The government should NOT be making this decision....We need to preserve the right to determine how we live and die.......We are being distracted by the politics,the right to life orgs,the disabled orgs and the church.....

allnurses Guide · Mar 19, 2005

THanks for the link Angie- but I'll be surprised if anyone actually reads the info..Mis-information continues to be quoted ad nauseum....I am not in hospice but have taken care of numerous residents that refused feeding tubes and died from "starving and dehydrating" I know that with symptom control and good oral hygiene this is not painful....Terri's patients have said "she has trouble swallowing"...she has been given "spiritual communion" regularly but not given the communion wafer orally....SHe is considered to be in a persistent vegetative state and is unable to obtain nourishment orally.....A tube into the stomach sounds like an artificial and invasive procedure to me.....THis case may effect our ability to make this decision for ourselves and our loved ones someday.....The government should NOT be making this decision....We need to preserve the right to determine how we live and die.......We are being distracted by the politics,the right to life orgs,the disabled orgs and the church.....

The problem is the government IS making the decision. The State is telling Terri's parents to not only step aside but to watch, helpless to do anything for their daughter.

There is alot of disagreement over whether this is a PVS and if is it, what stage. She definitely responds - I read a definition in an article today from Senator Frist's speech on the floor of the US Senate yesterday: from "HARRISON'S PRINCIPLES OF INTERNAL MEDICINE." IN THE 16th EDITION, WHICH WAS PUBLISHED JUST THIS YEAR, 2005, ON PAGE 1625, which states the different degrees of disability.

In the same article there was an email quoted:

LET ME CLOSE WITH AN E-MAIL THAT I RECEIVED, A FRIEND OF MINE SENT ME THIS E-MAIL ONCE THEY SAW THAT WE WERE PERSONALLY-OR WE AS A BODY WERE INVOLVED IN THIS CASE. AND THE E-MAIL READS: "I KNOW YOU ARE DEALING WITH SO MANY MAJOR ISSUES BUT I BELIEVE THIS ONE THREATENS TO SEND US DOWN ANOTHER SHAMEFUL PATH WE MAY NEVER RECOVER FROM. I DON'T THINK I EVER HAD AN OCCASION TO TELL YOU THAT I HAVE A SEVERELY BRAIN DAMAGED ADULT DAUGHTER THAT I CARED FOR IN MY HOME FOR 20 YEARS. SASHA'S FUNCTIONING LEVEL IS FAR BELOW TERRY'S BUT SHE'S BEEN SUCH A BLESSING IN MY LIFE. DEITRICH BONOFFER SAID NOT ONLY DO THE WEAK NEED THE STRONG BUT THE STRONG NEED THE WEAK. IT'S HARD TO STRAIN IN A DAY AND AGE WHERE PHYSICAL PERFECTION IS SO HIGHLY VALUED BUT I KNOW IT TO BE TRUE. SENATOR FRIST, AS YOU FIGHT THIS BATTLE TODAY, HOLD FAST. IF EVER THE WEAK NEEDED A CHAMPION, IT IS NOW. ON BEHALF OF MY SWEET SASHA,"

http://www.nationalreview.com/comment/frist200503181027.asp

The reason so many of us are concerned about this is we see it as an attack on helpless people who, as someone already mentioned a few posts back, are a financial drain on society and their families.

We also don't believe in taking action that will kill someone, especially as nurses. This case, to me, is different than removing a brain dead person from a ventilator.

Here is another excellent article that states how some of us feel:

http://www.nationalreview.com/mccarthy/mccarthy200503180920.asp

March 18, 2005, 9:20 a.m.

Conservatives & Terri Schiavo

The Washington Post gets it totally wrong.

The Washington Post editorial this morning regarding Terri Schiavo is shamefully disingenuous. It tut-tuts at the alleged inconsistency of conservatives, who have led the fight to limit federal courts from using habeas-corpus procedures to second-guess state court rulings involving even capital defendants, but who are nonetheless seeking to thrust federal judges onto to state courts of Florida for a review that might save Terri's life. After blathering at some length in this vein, the paper winds up by declaiming that Congress's "message to state courts is that they can do as they will with accused criminals and rely on federal law to shield them from review, but Congress will pull out the stops to overturn rulings-however local-that members don't like." (Italics mine.) How ridiculous. . . . . . .(see link for remainder of article).

The truth is we just see this differently. And I'd rather side on the side of people who cannot speak for themselves and for life rather than an active taking of a life. One where her parents just want to take care of her. How awful to stand by and watch this for them.

Of course none of us would wish to end up like Terri. But to start down the euthanasia street is very scary to me. . . . people aborting over the sex of a child or because the child has a cleft palate. That is really scary. People putting pressure on our elderly disabled folks to just die and save us time and money - that is scary to me.

Maybe I've been reading too much Peter Singer but he certainly sounds like the people who are advocating for Terri's starvation/dehydration killing.

steph

Antikigirl, ASN, RN · Mar 19, 2005

I have thought long and hard about this case. To me, this case is at the heart of nursing...and is very important for each nurse to come to terms with their own feelings with situations like these.

I don't know, I guess I feel that when they placed the feeding tube in Teri, then that was that! After that, she had a way to gain nurishment... So what happens when you take food away...patient dies. So to me the deliberate act of withholding food when you have a way to give it is murder. This become purposeful, premeditated and with the intent for death!

With my patients (geriatrics) who have something sudden happen and they loose the ability to speak or eat, the risks of tube placement are carefully considered. Will they make it through surgery, will they be well enough for establishment of site, will this even be benificial for quality of life, or even whether even nutrition will help. Many things are considered BEFORE the placement of a tube! WHY? Because once in, you don't take it out and you use it for the purpose of nutrition and hydration.

I know the tube was placed with much debate, but once it was in and established (for many years and taken out/put back twice already!!!! Which I find INSANE!) well...it is to me like using a defib and reviving a patient, only to have someone complain, so you give them another shock to kill them because "ooops they should have died naturally...my bad".

Now, I am all for letting someone go if their quality of life is going to be severely comprimised, but the thing is...I let my patient choose. Teri can not choose, and therefore we must aire on the side of life as medics. But as we know...the medics are not really considered in this debate. Medics have had their say, but it is coming down on courts more on the emotional issues, and ovely lengthy debates about who should choose whether she should live or die...

What I can't belive is that they found a surgeon and nurses that will perform the removal! Court order or not, I couldn't be involved in such a procedure as this...

Anyway..that is how I see it today (and for a while). Very complex issues involved, severely dynamic...and the fact that there really doesn't seem to be a right/wrong definitive answer really makes things very very grey!

ktwlpn, LPN · Mar 19, 2005

The problem is the government IS making the decision. The State is telling Terri's parents to not only step aside but to watch, helpless to do anything for their daughter.
h

The Congress and the house are both trying get the tube re-inserted.....

LydiaNN · Mar 19, 2005

I have thought long and hard about this case. To me, this case is at the heart of nursing...and is very important for each nurse to come to terms with their own feelings with situations like these.
I don't know, I guess I feel that when they placed the feeding tube in Teri, then that was that! After that, she had a way to gain nurishment... So what happens when you take food away...patient dies. So to me the deliberate act of withholding food when you have a way to give it is murder. This become purposeful, premeditated and with the intent for death!
With my patients (geriatrics) who have something sudden happen and they loose the ability to speak or eat, the risks of tube placement are carefully considered. Will they make it through surgery, will they be well enough for establishment of site, will this even be benificial for quality of life, or even whether even nutrition will help. Many things are considered BEFORE the placement of a tube! WHY? Because once in, you don't take it out and you use it for the purpose of nutrition and hydration.
I know the tube was placed with much debate, but once it was in and established (for many years and taken out/put back twice already!!!! Which I find INSANE!) well...it is to me like using a defib and reviving a patient, only to have someone complain, so you give them another shock to kill them because "ooops they should have died naturally...my bad".
Now, I am all for letting someone go if their quality of life is going to be severely comprimised, but the thing is...I let my patient choose. Teri can not choose, and therefore we must aire on the side of life as medics. But as we know...the medics are not really considered in this debate. Medics have had their say, but it is coming down on courts more on the emotional issues, and ovely lengthy debates about who should choose whether she should live or die...
What I can't belive is that they found a surgeon and nurses that will perform the removal! Court order or not, I couldn't be involved in such a procedure as this...
Anyway..that is how I see it today (and for a while). Very complex issues involved, severely dynamic...and the fact that there really doesn't seem to be a right/wrong definitive answer really makes things very very grey!

ITA. Great post.

MaleRN2B · Mar 19, 2005

As a practicing and "devout" Catholic I believe in life from its natural beginning to its natural end. Modern medicine can keep a body alive indefinitely. Obviously, not all my views on this are in line with the Catholic church. I shudder at the thought of unskilled and untrained people performing abortions on women (or on themselves) or women taking medications or herbs to induce abortions at home, but that's another topic altogether.

If I were in Terri's position I hope that someone would let me go Home and leave congressmen, perhaps even parents and everyone else out of it. Let my tombstone read "Gone to join the ancestors"! Death is a natural part of life and it's often painful. Life support as a bridge to better health is a good thing but when there is no hope of recovery, why prolong the agony?

Celebrate life!

MJ

danu3 · Mar 19, 2005

I am amazed at the comments with seeminly no concrete evidence to back them up. I am a hospice nurse and realize that this is a complex case and emotional for all parties involved. It seems a lot of comments are being made from personal beliefs rather than looking at best practice from a nursing standpoint. I do not feel the need to state my position on this case, but found a link that may be of some interest. It gives a little insight into the philosophy of hospice/palliative care regarding this issue. Artificial hydration/feeding, I suspect, will always be a very emotionally-bound issue no matter how much evidence is out there due to our cultural/religious beliefs.
http://www.aahpm.org/education/arthy.pdf
Angie

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

webblarsk · Mar 19, 2005

yeah but she's been like this for 14 years (almost 15). of course, i'm not her nurse, but i have never seen reports of bedsores, etc. she does respond to stimuli as well as interacting with her enviroment. she tries to mouth words even... there's a video on the website www.terrisfight.org...
she can't do it and she seems to become preplexed and upset.
she also begins to cries when her parents leave occasionally.
i guess that there is some debate among her physicians about how much of her brain is damaged. some of them think that she could be higher functioning if given proper treatment. she's playful (goo goos and ga ga's) and laughs. all of her actions make me think that she does feel pain.
i think there is a difference after someone is acutely ill and when someone has been like this for almost 15 years. they should have done this stuff 15 years ago instead of dragging it out.

Wow, I hadn't watched the video of her. She is definitley not brain dead. Brain damage yes. She definitley interacts with her mom. No wonder the parents have fought so hard. I would to!

kbclary4 · Mar 19, 2005

All I can say is right or wrong, the husband has the legal rights, not the parents. He says she would not want to be in that state and if he's lying, he'll have to answer for it eventually. If it were me and I had not written a will, I would not want my parents or any other family or friends trying to over-rule my husband's decision because he knows what I want and legally he is my next of kin. I read on MSNBC that someone offered the husband one million to leave it in and he refused which leads me to believe money is not his motive. Really his motive is not an issue because legally, if there is no will the spouse's decision is the one upheld by the law.

LydiaNN · Mar 19, 2005

All I can say is right or wrong, the husband has the legal rights, not the parents. He says she would not want to be in that state and if he's lying, he'll have to answer for it eventually. If it were me and I had not written a will, I would not want my parents or any other family or friends trying to over-rule my husband's decision because he knows what I want and legally he is my next of kin. I read on MSNBC that someone offered the husband one million to leave it in and he refused which leads me to believe money is not his motive. Really his motive is not an issue because legally, if there is no will the spouse's decision is the one upheld by the law.

I don't think the debate here is who has the legal right. I think it is whether anyone, be it the husband or the parents or whoever may be next of kin, should have the right to make a decision under these circumstances.