Artificial feeding-Terri Schiavo

Nurses General Nursing

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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 "allowing her to starve to death" The Vatican says " To starve her to death is pitiless" Most everyone agrees that it is one's right to refuse to initiate artificial feeding but somehow this situation "is different" How? The patient "starves to death " in both cases-so why has this one galvanized the WORLD? My husband read me a quote from the Bible -forgive me because I can't remember it in detail-it was something along the lines that a woman marries and leaves her father's house and her husband becomes her family....My husband is my POA I hope no-one in my family questions his motives -He KNOWS exactly what I want....I can't question her husbands motives-I know that some suspect foul play and state the results of a bone scan support this...That bone scan was obtained 53 months after she went into her coma-after her body suffered the effects of her eating disorders for a number of years.... Her present level of responsiveness does not pertain to this matter IMHO-she CAN'T eat naturally--she did not ever want to "be kept alive like that " and she can't state otherwise at this point...So- #1 can someone PLEASE make me see why this case is" DIFFERENT" and #2 How do YOU support your patients and their loved ones when they are agonizing over this decision? ONe thing I always ask is "Did your loved one ever give you any idea of what they would want if something like this happened" and if they did then I advocate that stance for that pt as much possible.......I believe that death is the last great trip we'll go on and we should PLAN it as much as possible.The greatest GIFT we can give to our loved ones is an itinerary...........

If I were the nurse and the husband said "no rehab, you cannot do ROM, you cannot perform basic nursing interventions to prevent contractures" I am sorry but I would NOT obey this. I do not need a doctor's order to perform basic nursing tasks such as ROM and positioning to prevent contractures. It would be MY LICENSE on the line if I neglected my pt in the way that is being described!! I don't care WHO said I was not to perform these basic functions, it would be up to me and MY NURSING JUDGEMENT to decide if I followed these orders! There have been numerous referrences made to this ladies "contractures" and contractures are the result of poor nursing care, you do not need an OT or a PT to perform ROM, you do not need a dentist to provide good oral care. So basically my question is why on earth are these nurses complying with this mans "orders"? And how on earth have they avoided discipline by the BON? Why has this not been reported? These nurses are supposed to be held to the standard of care, or what another prudent nurse would do in that situation, Would any of you have treated this pt in the same manner being described? I am just curious we are supposed to be pt advocates and I dont see how it would matter which side of the arguement you are on even if you believe te feeding tube should be removed shouldn't she still recieve AT LEAST basic nursing care while she is alive?

Please respond to this post, this is something that bugs me way more than any other aspect in this case, the apparent lack of nursing interventions. I am still on the fence on the greater issue of feeding tube vs. no feeding tube and without seeing ALL of the evidence assessing the pt and reviewing the medical record I can't make a decision, I know what *I* would want but this is not me. But please respond as to your feelings on the standard of care this pt has recieved.

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Brandy - I agree with you. It is standard nursing care as you said. And this makes this whole story even more suspect.

We need more investigation - way more investigation.

steph

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Specializes in Public Health, DEI.
What a terrible and tragic situation for all those involved. It is unforunate that this situation has reached the point that the government feels that they should step in and intervene. I don't mean to sound harsh but the government has bigger issues they should be dealing with (the war in Iraq, terrorism, gas prices, etc). Think of the precendent that will be set and the ramifications that it will have. What effect, if any, will it have on advanced directives??

This situation has made me do some serious soul searching. I have made it abundantly clear to all of my family members that I wouldn't want to live in a chronic vegatative state and I've signed an advanced directive. They all understand and I'm sure they would appreciate not having to make these difficult decisions if God forbid, the need should ever arise.

The only effect it might have on advanced directives is to increase the number of people who have them. If Terri Schiavo did, we wouldn't be having this conversation, because it wouldn't be up to her husband or her parents to be making these decisions. Her intent would be clear to everyone involved.

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If I were the nurse and the husband said "no rehab, you cannot do ROM, you cannot perform basic nursing interventions to prevent contractures" I am sorry but I would NOT obey this. I do not need a doctor's order to perform basic nursing tasks such as ROM and positioning to prevent contractures. It would be MY LICENSE on the line if I neglected my pt in the way that is being described!! I don't care WHO said I was not to perform these basic functions, it would be up to me and MY NURSING JUDGEMENT to decide if I followed these orders! There have been numerous referrences made to this ladies "contractures" and contractures are the result of poor nursing care, you do not need an OT or a PT to perform ROM, you do not need a dentist to provide good oral care. So basically my question is why on earth are these nurses complying with this mans "orders"? And how on earth have they avoided discipline by the BON? Why has this not been reported? These nurses are supposed to be held to the standard of care, or what another prudent nurse would do in that situation, Would any of you have treated this pt in the same manner being described? I am just curious we are supposed to be pt advocates and I dont see how it would matter which side of the arguement you are on even if you believe te feeding tube should be removed shouldn't she still recieve AT LEAST basic nursing care while she is alive?

Please respond to this post, this is something that bugs me way more than any other aspect in this case, the apparent lack of nursing interventions. I am still on the fence on the greater issue of feeding tube vs. no feeding tube and without seeing ALL of the evidence assessing the pt and reviewing the medical record I can't make a decision, I know what *I* would want but this is not me. But please respond as to your feelings on the standard of care this pt has recieved.

You make some wonderful points. There is way more going on in this case than we will ever know. It's too bad that it has all come to this. But I do think our country needs to make a clear decision as to what is considered euthanasia and what to do about hydration and nourishment when an advanced directive is not present. This IS where the legislature needs to step in. My feeling is that we should err on the side of life, not death.

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What a terrible and tragic situation for all those involved. It is unforunate that this situation has reached the point that the government feels that they should step in and intervene. I don't mean to sound harsh but the government has bigger issues they should be dealing with (the war in Iraq, terrorism, gas prices, etc). Think of the precendent that will be set and the ramifications that it will have. What effect, if any, will it have on advanced directives??

This situation has made me do some serious soul searching. I have made it abundantly clear to all of my family members that I wouldn't want to live in a chronic vegatative state and I've signed an advanced directive. They all understand and I'm sure they would appreciate not having to make these difficult decisions if God forbid, the need should ever arise.

The government didn't feel they should step in and intervene . . our representatives were petitioned, by it's citizens, to help. Which is exactly what our government is supposed to do.

Listen to it's citizens.

As to advanced directives . . it will only address those situations, as mercy said, where there is no clear intent.

Fortunately this seems to be a rare case.

steph

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You make some wonderful points. There is way more going on in this case than we will ever know. It's too bad that it has all come to this. But I do think our country needs to make a clear decision as to what is considered euthanasia and what to do about hydration and nourishment when an advanced directive is not present. This IS where the legislature needs to step in. My feeling is that we should err on the side of life, not death.

I agree with this . . . our country has been in a great debate about the death penalty and putting innocent people to death and wanting to err on the side of life . . so too we have been debating about the treatment of prisoners and erring on the side of treating them according to the Geneva Convention . . .

Terri's husband is suspect. Why should he get to make this decision simply because he is married to her? What about Scott Peterson - if Lacey had ended up in a PVS due to a fall against the fireplace which he would say was an accident. He looks like a nice guy. We would never have known about his propensity to being a sociopath. Would you trust old Scott to do what is right for Lacey?

Just because you are married to someone does not mean they have your best interests at heart. Look at the adultery rate in this country. :rolleyes:

steph

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You know, this case has raised lots of different concerns. One concern I have now is what it is doing to the image of hospice. Especially if it ended up being associated with the right-to-die movement (hospice philosophy is very different). Hospice have enough distortion from the public already.

-Dan

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You know, this case has raised lots of different concerns. One concern I have now is what it is doing to the image of hospice. Especially if it ended up being associated with the right-to-die movement (hospice philosophy is very different). Hospice have enough distortion from the public already.

-Dan

I worry about this too! In my clinical experience I've found that most pts and their families are misinformed about what hospice is to begin with. There needs to be better public education regarding hospice care and philosophy.

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I worry about this too! In my clinical experience I've found that most pts and their families are misinformed about what hospice is to begin with. There needs to be better public education regarding hospice care and philosophy.

Yea, there is one link in one of these posts (too many posts, can't find it again) which allerge there may be some corruption with the hospice that Terri is in. Whether it is true or not, that is a bad image for hospice. I just hope the public don't think hospice is a place you kill people or something like that.

-Dan

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Yea, there is one link in one of these posts (too many posts, can't find it again) which allerge there may be some corruption with the hospice that Terri is in. Whether it is true or not, that is a bad image for hospice. I just hope the public don't think hospice is a place you kill people or something like that.

-Dan

I share your concern. As we've seen with this issue, there is alot of misinformation going around. (Terri is not in a coma or brain dead, for example). :o

Our Hospice nurses are compassionate and awesome people. We have a Hospice room in our acute care which families can choose if things get too hard for them at the end. I've been privileged to care for many of these people.

Hospice is wonderful and shouldn't be mixed up with this situation.

steph

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Wow! You folks have written so many thoughts that I have had today. You have put them down so well.

As a Gerontology specialist, I have views, probably different from yours.

I did not realize that ther could have been some foul play envolved, as one person stated in her remarks.

I am just looking at it as a real sad thing. I wonder at the aspect of our Congress being envolved, for Congress was allowed to "tresspass" into that family's life.

This will show the world how important a Living Will and Health Care Proxy can be. If a spouse is not allowed to exert his or her authority, then I guess things need to be written down.

I am concerned as to what one Neurologist said re Terry's potential for improvement. One gaze onto her face tells me that things are pretty bleak for her. She is certainly "not there".

I have so much enjoyed this site, for one is able to be presented with so many different viewpoints.

I guess the thing that concerns me is that there are so many others out there who are like Terry Schiavo, and no one seems to enter the lives of their families and disrupt their lives.

Will congress be able to do this again? I hope not

[email protected]

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If I were the nurse and the husband said "no rehab, you cannot do ROM, you cannot perform basic nursing interventions to prevent contractures" I am sorry but I would NOT obey this. I do not need a doctor's order to perform basic nursing tasks such as ROM and positioning to prevent contractures. It would be MY LICENSE on the line if I neglected my pt in the way that is being described!! I don't care WHO said I was not to perform these basic functions, it would be up to me and MY NURSING JUDGEMENT to decide if I followed these orders! There have been numerous referrences made to this ladies "contractures" and contractures are the result of poor nursing care, you do not need an OT or a PT to perform ROM, you do not need a dentist to provide good oral care. So basically my question is why on earth are these nurses complying with this mans "orders"? And how on earth have they avoided discipline by the BON? Why has this not been reported? These nurses are supposed to be held to the standard of care, or what another prudent nurse would do in that situation, Would any of you have treated this pt in the same manner being described? I am just curious we are supposed to be pt advocates and I dont see how it would matter which side of the arguement you are on even if you believe te feeding tube should be removed shouldn't she still recieve AT LEAST basic nursing care while she is alive?

Please respond to this post, this is something that bugs me way more than any other aspect in this case, the apparent lack of nursing interventions. I am still on the fence on the greater issue of feeding tube vs. no feeding tube and without seeing ALL of the evidence assessing the pt and reviewing the medical record I can't make a decision, I know what *I* would want but this is not me. But please respond as to your feelings on the standard of care this pt has recieved.

Brandy, thank you very much for bringing up what is one of the obvious issues in this case for nurses.

Why no nursing intervention?

Reading between the lines, I see several things going on here:

1. Michael Schiavo sounds like an intimidating person, and it sounds as though the staff was scared of crossing him. Those who chose to cross him were either fired, or left. I suspect that the intimidation factor went all the way up in the care facility where Terry Schiavo was treated. I say this because one nurse's affidavit spoke of records being deleted and changed when her nurse spoke of Terry having favorable responses to treatment or stimuli.

2. Apart from the care facility staff, it sounds as though Michael Schiavo doc-shopped to find physicians who would basically take his orders as far as Ms. Schiavo's "care."

3. Michael Schiavo has manipulated the media in this situation, portraying himself as the poor, aggrieved husband who is only seeking to carry out his wife's wishes, and the media has been slow to point out the many, documented evidences of abuse on Michael Schiavo's part.

4. There are -- sad to say -- a group of nurses who either don't believe they have professional responsibility in such situations, or are afraid to go out on a limb in providing care for a patient. ROM, oral care, and many other such procedures are not extraordinary care, but are routine, ordinary, nursing-101 responsibilities.

Jim Huffman, RN

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