Artificial feeding-Terri Schiavo

[ktwlpn]

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...........

[Spidey's mom, ADN, BSN, RN]

Peter Singer has been professor of bioethics at Princeton University since 1999. Previously, he was professor of ethics at Monash University in Melbourne, Australia. He was a founding member of the Green Party in Victoria, Australia and was a Green Party senate candidate. He has taught at Oxford University and New York University, among others. His work in ethics is part of academic syllabuses around the world and his 1975 book Animal Liberation is the seminal work of that movement.

Princeton Philosophy Professor Peter Singer is among the far extreme of right to die advocates but he is also working at a well-respected university and holds many well-respected offices. But his philosophy is barbaric. His belief that animals deserve more respect than human beings is well known. Here's just a little excerpt of his beliefs . . . and one of the reasons I'm afraid of the slippery slope this "right to kill" case with Terri Schiavo.

Q. You have been quoted as saying: "Killing a defective infant is not morally equivalent to killing a person. Sometimes it is not wrong at all." Is that quote accurate?

A. It is accurate, but can be misleading if read without an understanding of what I mean by the term "person" (which is discussed in Practical Ethics, from which that quotation is taken). I use the term "person" to refer to a being who is capable of anticipating the future, of having wants and desires for the future. As I have said in answer to the previous question, I think that it is generally a greater wrong to kill such a being than it is to kill a being that has no sense of existing over time. Newborn human babies have no sense of their own existence over time. So killing a newborn baby is never equivalent to killing a person, that is, a being who wants to go on living. That doesn't mean that it is not almost always a terrible thing to do. It is, but that is because most infants are loved and cherished by their parents, and to kill an infant is usually to do a great wrong to its parents.

Sometimes, perhaps because the baby has a serious disability, parents think it better that their newborn infant should die. Many doctors will accept their wishes, to the extent of not giving the baby life-supporting medical treatment. That will often ensure that the baby dies. My view is different from this, only to the extent that if a decision is taken, by the parents and doctors, that it is better that a baby should die, I believe it should be possible to carry out that decision, not only by withholding or withdrawing life-support - which can lead to the baby dying slowly from dehydration or from an infection - but also by taking active steps to end the baby's life swiftly and humanely.

Q. What about a normal baby? Doesn't your theory of personhood imply that parents can kill a healthy, normal baby that they do not want, because it has no sense of the future?

A. Most parents, fortunately, love their children and would be horrified by the idea of killing it. And that's a good thing, of course. We want to encourage parents to care for their children, and help them to do so. Moreover, although a normal newborn baby has no sense of the future, and therefore is not a person, that does not mean that it is all right to kill such a baby. It only means that the wrong done to the infant is not as great as the wrong that would be done to a person who was killed. But in our society there are many couples who would be very happy to love and care for that child. Hence even if the parents do not want their own child, it would be wrong to kill it.

************

A newborn baby is not a person?

steph

[fergus51]

Karen - I'm a member of a Christian Bio-Ethics organization. People in bio-ethics run the gamut from pro-life Christians to pro-euthanasia relativists.

Just because someone serves on a Presidential committee doesn't mean we have to agree with his or her values.

There is a large and open and contentious debate going on is this country regarding the direction we shall take in the future. All sides are part of it - even on Presidential commissions.

steph

By the same token, a medical professionals diagnosis and ethics are not necessarily suspect because of their belonging to an organization. This man didn't fake her eeg. I find this to be a troubling part of our society nowadays. Attacking the messengers credibility because he has some opinions on end of life care and what that means is sad. I have a lot of opinions too, but it doesn't change my nursing care. I have looked after kids with a lot of ethical grey areas and I never tried to convince the parents to change their minds regarding treatment because it isn't what I would do in their place. Maybe I'm alone in this, but I do think it's possible to remain honest and compassionate with families even when you don't see every situation in the same way that they do.

Edited to add: I think Singer is a little crazy Steph, but I thought he still thinks killing a baby is a "terrible thing to do". I've never heard him advocate killing any unwanted child for fun.

[Spidey's mom, ADN, BSN, RN]

By the same token, a medical professionals diagnosis and ethics are not necessarily suspect because of their belonging to an organization. This man didn't fake her eeg. I find this to be a troubling part of our society nowadays. Attacking the messengers credibility because he has some opinions on end of life care and what that means is sad. I have a lot of opinions too, but it doesn't change my nursing care. I have looked after kids with a lot of ethical grey areas and I never tried to convince the parents to change their minds regarding treatment because it isn't what I would do in their place. Maybe I'm alone in this, but I do think it's possible to remain honest and compassionate with families even when you don't see every situation in the same way that they do.

Edited to add: I think Singer is a little crazy Steph, but I thought he still thinks killing a baby is a "terrible thing to do". I've never heard him advocate killing any unwanted child for fun.

I'm not saying you do this, but there have been comments on the bulletin board and actually in the media, where someone's opinions are discounted because they come from a certain perspective.

Heck, I've posted things from Townhall.com and some people discount it completely because it is a conservative site.

Peter's opinions are worse than that example - I just thought that related to our discussion.

He is nuts but he is listened to.

steph

[fergus51]

I don't think it's right to do this either way, that was sort of my point. This MD is apparently basing his diagnosis on things like an EEG. If someone has a problem with his diagnosis, they should try to discuss the EEG, not the man. I work with pro-lifers, pro-choicers, Christians, atheists and everything in between. I don't know anyone I would not trust to be honest about a clinical diagnosis regardless of their philisophical beliefs.

[heart queen]

quoting all sides, aside. there is NO health care proxy. the hospital ethics committee needed to first appoint a law guardian and then go through the stages from hospital to law. There is no court appointed guardian as I know.

In any conflict of interest in the family, a law guardian needs to be appointed, interview the family and continue in the judicial process as HER defendent.....

My knowledge, correct me please, shows that this hasn't happened,(no legal guardian) yet it's so commonplace. all our theories be damned.... this is about what terri would want. Not the husband, or her parents..... period.

if it can't be determined, against my personal beliefs, we need to carry on and let nature take its course along side a full medical regimine of treatment.

not what I want, or would choose for her.... but by not deciding .... she has chosen, on full recusitation measures.... life support and yes feeding.

I say pull the tube, but this is the process that must take place.... mind you I'm against leaving the tube in.... but unless she made it clear otherwise it is assumed that all measures to maintain life will continue.

This cannot continue as a husband/ family... he said... she said war.... it seems to be done... and terri will loose albeit our attempt at either end.

If guilty of wrong doing, the husband has not and will not be convicted of anything

her family, god love 'em can't see that terri is gone. She is not able to substain life with oral feeding, (sure she can swallow, just not enough to keep her alive, therefore, her basic brain function of being able to substain life is gone and she requires LIFE support, in the form of feeding. hence the feeding tube to prevent deterioration which will result in death.

working the ICU I see families keeping guppy breathing brain frazzled patients alive because at least the patient is still there.... the mourning, the loss does't have to come as long as the body is in the bed, no matter how little is left, and the focus from the patients right to die over the families right to not grieve, loss and morn can't be distinguished by them.

I support a court appointed guardian to absolve the husband and family of their fight. If terri was able to substain life without life saving measures.... she would be fed by mouth...

terri is incapable of substaining her own life. Neither the husband or parents are able to determine her wishes....

it needs to be removed from all their hands, and yes the court must dedide.

[KRVRN, BSN, RN]

I caught a little snippet of an interview with Dr. Ronald Cranford last night and I was surprised to hear in passing that her EEG had been flat. That is not something that I've heard before.

Now, I'm not a neuro nurse, so can someone please review what the implications of a FLAT EEG are?

[tonalee]

I'm not saying spouses get to decide no matter what. But, barring any illegal acts and when they are in agreement with doctors, it's their decision. If your daughter marries a frog, then that's her choice. You don't get to be her decision maker forever because you are her parent. Sorry, that's just the way it is. It may not be ideal, but it's the system we have. There are a lot of jerk spouses and jerk parents out there.

Would you feel the parents should get to make the decision if it was the other way around? (I mean if the parents wanted to remove the feeding tube and the husband wanted to keep it in).

I don't think that the parents should let her go on like this.I just question the husbands real intetions and reasons for them.I think in this case it is best to look at who is in the best place to be making this kind of decision.This is so sad.Can I go as far as saying with the intense emotions behind this that God will just quietly take her in a way that isn't anyones fault?Is that possible?

[UnewmeB4]

Very simply and compassionately stated - this says it all. Thanks.

I'll say it again - the problem is Terri never left any legal instructions.

The problem for me is I don't believe that a feeding tube is heroic measures either.

steph

Read the court documents. They tried to take care of her in 1990. It lasted 49 days. They were overwhelmed, and she was taken back to Bayfront hospital for additional aggressive rehab efforts. Her parents even encouraged Michael to date other women.

This information was from the man appointed to be the "Guardian Ad Litem" for Terri, Jay Wolfson in the brief he sent to Gov Bush.

[tantalus]

Well, here goes....I understand the differences between her parents and her husband.....I also understand that her parents did once try to care for Terri.

My problem is this.....surely starving someone to death is euthanasia/murder.

Why has no-one suggested that Terri not receive further active treatment (maybe they have, feel free to correct me on this one). No more antibiotics for infections etc. Could this not have been a compromise between the two sides?

[KRVRN, BSN, RN]

Double post.

[KRVRN, BSN, RN]

I bet both sides have already agreed on withholding treatment should anything come up, and I'm sure she is already DNR (yes, I know DNR doesn't mean do not treat).

However, she is fairly young and healthy and (was) fully nourished... so I wouldn't think her health would decline anytime soon to let her go that way.

[tantalus]

As I understand she has been being treated for such things as chest infections with antibiotics as they've occurred and from what I can gather that was a fairly regular thing.