Artificial feeding-Terri Schiavo

Tweety, BSN, RN · Mar 24, 2005

Putting her now in a very passive condition into this family's total control and care....it quite likely would be her worst nightmare and a type of abuse in and of itself.
Her parents have also indicated that no matter what her wishes were, they would still push to keep her alive.

Interesting perspective. While her husband is under the microscope for what went on during their marriage, wonder why the parents aren't under that same microscope for the upbringing she had, especially at the onset of her eating disorder.

danu3 · Mar 24, 2005

Another thing that this case bring to mind... I think we all personally need more than an advance directive. We need to get our family members all agree to our decision (whatever it is) and have them sign it so if that times comes, nobody would cause trouble. Basically the sign paper is not saying they have to agree with the person position, but agree to not interfere if that time comes.

Getting all family members to sign is hard, so maybe there should be some kind of service offer to mediate this before anything bad happens.

-Dan

dd_txrn, ASN, BSN · Mar 24, 2005

I've been a nurse for over 20 years also and I have about had it with hearing about this poor woman. I think it's sick to flash this woman all over the news every single day. I have a friend in her 40's who was in a very tragic car accident who suffered massive brain damage. What made her who she was was taken away from her. If she new what her fate was ( spitting at staff, unable to attend her children's marriages/graduations, unable to eat normally ( and she was a nurse for a long time), she would be mortified if her family plastered her pictures on the news daily. It is not NEWS. It is no one's business but her family's. Her parents are absolutely ridiculous for allowing this. It's ironic that she suffered cardiac arrest because of an eating disorder which we all know is usually caused by the patient feeling he has no control over her life and now the parents want to continue having control over her and FEED her. I don't believe that nurse's account of what was going on in the nursing home. If that's true, there is an agency called "the state" that oversee's nursing homes and that's who she should have called if she felt the patient's rights were being violated. That's her job. I worked in a nursing home and that was stressed all the time. Call the board of nursing, the police, etc. If she didn't care about losing her job, then why would she care about calling all of these agencies. This is why I find this woman very difficult to believe. I don't think her husband is a saint, nor do I think her parents are any better, but it should never have been in the news and the government should stay the heck out of this. I had a discussion with my husband the other night about living wills ( he has one) and about heroic measures and what we don't want to live like. My parents know now how I feel, but no one was in the room when we had these discussions so who's to say that Terri and Michael didn't have these discussions? We need to leave Terri alone and let her die with dignity and not a three ring circus.

Kudos ValerieB! I agree wholeheartedly.

boxermom · Mar 24, 2005

Aren't nurses supposed to behave nonjudgmentally? Hmmm.... :stone
It seems as if everyone has passed judgment in this heartbreaking saga.

As a nurse, I hope everyone of you are patient advocates.

Healthone · Mar 24, 2005

[QUOTE=James Huffman] We -- as a society -- arrest people who don't feed their animals. Again, why is Ms. Schiavo treated worse than an animal by being slowly and deliberately starved when she is not, in fact, dying, apart from being starved?

3. Why are some people against "assisted suicide because it's murder"? Perhaps because, as you said, it IS murder.

Jim Huffman, RN

Terri Schiavo is not being treated worse than animals. The feeding tube is part of the life saving measures endured to sustain/prolong life. What if it were oxygen?

100's or 1000's of people have already devised a living will, I am one of them. It is my wish no such measures be taken to sustain my life. And, if an error occurred and I was placed on a feeding tube, I would want it removed. Period. I would not want to endure seeing life and not being able to move, make sound....and more. I do not want my family to endure it either.

Again, why are so many afraid of death? It is a natural part of living.

danu3 · Mar 24, 2005

Her parents have also indicated that no matter what her wishes were, they would still push to keep her alive.

That is actually not exactly accurate. If you read the Wolfson'r report (you might have gotten the above information from the report since I don't know if you have read the report in details) very carefully, you'll see that actually is not true. The Wolfson report did state in graphic details how her parents at one point was corner to say that they will push to keep her alive no matter what. But also in the same report (toward the end of the report), it also say they parent's position is not so. Here is a quote from the end of the report

"...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..."

What the report also say about both parties is this

"... 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..."

It is sad that we demonize one party over another (depending which postition you personally take). I guess nurses are human too...

It is unfortunate that the above quotes are in small footnotes and toward the end of the report which probably many people have not read.

-Dan

KB75 · Mar 24, 2005

I think this is a sad situation for everyone involved. But I don't think that this case should be any different than any other person who is in the same situation. If the husband's motivation is money it sad on his part but hasn't he spent tons on lawyer fees for the last 7 years. No one knows but him what he feels about Terri we only know what the media wants us to think about the situation. And as far as the parents are concerned I'm sure they are acting out of love but aren't they being selfish to Terri? What type of life has this poor girl had? And if she was put back on the feeding tube what happens to her after they die? Will the burden of taking care of her be put on someone else? Or will it be ok for her to die then?

My professor brought up a good point about this case as well. Why is it that congress held an emergency meeting to make a ruling on this case when there are some many other issues regarding healthcare that gets swept under the rug. It's sad how politicians find a way to manipulate situations for there personal gain.

rn/writer, RN · Mar 24, 2005

one of the unfortunate aspects of this case is that a number of important issues have become entangled like a big plate of legal and moral spaghetti.

one its face, this looks like a "right-to-life"/"right to die" tug of war. for some, it might be just that simple and such polarization makes the dilemma unlikely to be resolved through legal or other measures. someone will win and someone will, of necessity, lose.

i suspect, however, that there are a number of people (myself among them) who would agree, however sadly and reluctantly, to respect terri's wish to leave her earthly struggles behind provided that a) they were certain that terri was in a persistent vegetative state, b) that being allowed to die if in such a condition really was terri's wish, and c) that her death did not involve prolonged deprivation and suffering.

there is considerable disagreement among eminently qualified experts about whether terri's condition is truly vegetative. her responses may be primitive. her brain is obviously damaged. and the persistence is a given. but there have been many accounts of her responding to various stimuli, even trying to speak, that demonstrate she is not a "flat-liner." terri will never be restored to the woman she once was, but this doesn't have to be an all-or-nothing choice. if she is capable of receiving love, if she can register the presence of those who care for her and react in however rudimentary a fashion, her life can still have meaning.

even so, had she left an advanced directive that said this minimal awareness level would not be enough for her and she would wish to be let go, her autonomy would have to rule.

what would terri have wanted? that is the big question, isn't it? the courts have chosen to take the word of michael schiavo that she would want to die. i'm concerned about this for a number of reasons.

there are reports that terri had fractures at the time of her cardiac arrest that were not consistent with the events reported by michael. was that investigated? could michael's insistence on cremation (despite terri's religious beliefs) be a measure to avoid any posthumous examination? what about his opposition to various kinds of therapies? according to a number of interview subjects, michael was vocal and demanding that terri be dressed in street clothes and have her hair and make-up put on daily. at the same time, there are others who say that his interest was limited to the superficial and that he adamantly opposed speech therapy, ot, pt, and swallow studies. i think i would feel very differently if these restorative efforts had been aggressively pursued early on. as it is, we'll never know how far terri might have been able to come back.

for many reasons, michael schiavo seems a questionable person to be deciding terri's fate. not the least of these is a de facto marriage (complete with two children) to another woman. then there is the idea that it took seven years for him to say that terri wouldn't have wanted to live in her current condition--a condition to which he contributed by not allowing aggressive rehab.

fianlly, if terri had left an advanced directive and her current situation called for her to be allowed to die, there has to be a better way of bringing about her demise than withholding hydration and nutrition. she has been treated for a number of infections over the years. had medication been withheld, she could have been given comfort measures only and allowed to slip away peacefully. even if she is not experiencing great suffering (and that is highly debatable), those around her certainly are.

as many have said, the one good to come of this is that many more people will now take seriously the need to make these decisions while they are able. and to document them and talk about them with loved ones. would that terri had known to do this.

for me, the conflict is not so much that terri will likely die soon. she believed eternal life awaits her and i think that will be the one hope and confidence her parents and siblings can cling to for comfort.

no, the disturbance arises from questions about michael's motives, the lack of investigation into certain aspects of the case, her parents' and siblings' pain, and the thought that she is suffering during this long process of dying. at this point, there are no easy answers.

god bless her and her family.

miranda f.

camay1221_RN · Mar 24, 2005

Regardless of how much "experience" J. Huffman has, I'd certainly rather have him as my nurse as opposed to Bugsbe. He has explained his thought process & reasoning instead of the attitude of if one doesn't agree, then they must be wrong or inexperienced.
I am so amazed at callousness of some of the posts.

I agree with you wholeheartedly Katmease!

Healthone · Mar 24, 2005

[color=seagreen]i found this at yahoo, and followed a link.

posted on thu, mar. 24, 2005

family history

husband, in-laws once were united in caring for terri

before the fighting, michael schiavo and his in-laws cared for terri schiavo together. the schindlers urged him to date, and later agreed on the extent of her damage.

by cara buckley

[email protected]

pinellas park - for years, even after suspicion drove them apart and pitted them in a fierce legal fight, michael schiavo and his in-laws seemed to agree on one thing: that terri, his wife and their daughter, was in a persistent vegetative state.

during a january 2000 court battle in which bob and mary schindler sought to wrest terri's guardianship from michael schiavo, the schindlers repeatedly conceded that their daughter's brain damage was extreme.

''we do not doubt that she's in a persistent vegetative state,'' pam campbell, then the schindlers' lawyer, told the court. later, michael schiavo's lawyer, george felos, asked mary schindler, ''is terri in a vegetative condition now?'' to which she replied, ``yes. that is what they call it.''

whether or not terri schiavo is in a persistent vegetative state has become a hotly contested flash point in the raging debate surrounding the severely brain-damaged florida woman, whose feeding tube was removed last week.

many of the schindlers' supporters insist terri is very much alert. michael schiavo has also been cast by detractors as an adulterous, heartless husband who wanted to remove terri's feeding tube in order to access her trust fund.

but testimony from court files documenting the 12-year struggle over terri schiavo's fate tells a far more complex story.

beyond accepting that their daughter was in a vegetative state, the schindlers had, years earlier, encouraged michael to date. when the schindlers later accused michael of greed, he offered to donate terri's entire trust fund to charity.

up until a bitter falling out in 1993, michael schiavo and the schindlers were united in efforts to rehabilitate terri.

they moved in together after terri's collapse in february 1990, and michael called the schindlers ''mom and dad.'' a year later, the schindlers encouraged their son-in-law to get on with his life and date. they even met some of the women he saw.

''i looked at that as maybe he was starting to take a step in the right direction and get his life back together,'' bob schindler said in a 1993 deposition. ``he's still a young man. he still has a life ahead of him.''

worked together

the schindlers later said that they urged michael to see other women because they ultimately hoped to gain guardianship of their daughter. but they still worked feverishly with michael to ensure terri had the best possible care.

to raise funds for medical costs, they sold hot dogs and pretzels on the beach, threw a valentine's day dance and made appeals on local news stations. in 1991, the city of st. petersburg beach declared feb. 17 ``terri schiavo day.''

terri was frequently moved between hospitals, hospices and nursing homes. each rehabilitation facility treated her with aggressive physical, recreational, speech and language therapy, moving her arms and legs, trying to rouse her with scents.

but according to court filings, terri was not responsive to neurological or swallowing tests. mary schindler testified that a neurologist told her, ``this might be where she's going to be for the rest of her life.''

michael schiavo and the schindlers brought terri home briefly in the fall of 1990, but were overwhelmed. then they sent her to california to have experimental platinum electrodes implanted to stimulate her brain. michael slept by her bedside for five weeks. terri sat up and her eyes burned brightly when the implants were turned up high, michael testified, but the doctor told him the reactions were mere motor responses.

meanwhile, michael filed a malpractice suit against two of terri's doctors, unwittingly setting into motion events that tore him and the schindlers apart.

michael initially expected a multimillion-dollar award, and the schindlers said he promised them a share, which would enable them to care for terri at home.

by then, the schindlers were almost broke. after selling his share of a successful industrial equipment company, bob schindler lost his savings in a florida business venture that went sour. the couple declared bankruptcy in 1989, bob schindler testified. he told a court that michael schiavo promised to help.

but michael said he never committed to sharing any award money with the schindlers, especially when the award ended up being far smaller than hoped. roughly $700,000 was earmarked for a trust fund for terri, and $300,000 for michael.

the schindlers still expected part of michael's share to help care for terri. on valentine's day 1993, they confronted michael in terri's hospital room. the discussion quickly turned ugly. michael said the schindlers demanded the money, so he lied and said he did not have it. disgusted, the schindlers left, their trust in michael irrevocably breached.

''the fact that he was going back on his word upset me,'' bob schindler testified in 1993. ``i was devastated.''

michael soon began believing doctors who told him that terri had effectively died in 1990. in a 1993 deposition, he testified that terri had said she would never want to live by artificial means. he imposed a ''do not resuscitate'' order. hospice staff challenged the order's legality, so he reversed it.

horrified, the schindlers launched the first of many exhaustive battles to become terri's legal guardians. they accused schiavo of being abusive, citing his admitted belligerence to hospice staff. they also said he wanted to kill terri for her money.

but in 1998, when one of terri's court-appointed guardians noted this conflict of interest, michael offered to donate terri's estate to charity, as long as the schindlers stopped fighting his decision to remove terri's feeding tube. the schindlers rejected this proposal. all but $50,000 of the award has since gone to terri's care and court costs.

numerous problems

by the mid-1990s, terri's physical therapy had been stopped, enraging her parents.

court guardians concluded that terri was cared for extremely well, but her condition still led to numerous complications and hospitalizations. she suffered from bile stones and kidney stones, according to court papers, and had to have her gallbladder removed. she has ''drop foot,'' where her foot twists downward, and the ensuing pressure resulted in the amputation of her left little toe. she frequently developed urinary tract infections, diarrhea and vaginitis. several cysts were removed from her neck. several times, her feeding tube got infected.

in 2000, despite conceding their daughter's persistent vegetative state, the schindlers said they still believed she knew when they were there. when felos, michael schiavo's lawyer, asked bob schindler if he thought terri would be tormented by her current state, he replied ''yes,'' but added, ``she's not that cognizant to be aware of it.''

several years ago, a few doctors said terri was, in fact, responsive, evidently causing her parents to believe that the terri they knew could at least partially be brought back. but judges repeatedly sided with the medical opinion that their daughter's chances for improvement were nil.

the schindlers never stopped believing. mary decorated terri's room during holidays and saw light in terri's eyes when she softly sang, ``terri, it's mommy.''

''i think she understands. i think she knows i'm there,'' mary schindler told the court in 2000. ``she just . . . i just want her to live.''

bugsbee · Mar 24, 2005

What a waste of taxpayers money and DCF services. We need DCF to being doing their job and not fighting issues that should be between the families not the courts. The courts have ruled and that is what the laws say.

begalli · Mar 24, 2005

People with eating disorders have marked weaknesses, breakdown, and loss of bone. They fracture very easily.

Something that people keep bringing up that really bothers me is the fact that Terri's husband has created a life for himself with another woman and has children. SO WHAT?! Is he suppossed to live a life of celibacy and alone and devoid of the companionship of another because of this tragedy?

If anything good can come of this it's the awareness that it's causing about the need to TALK about what individuals want when it comes to the end of life. This is a lesson for all of us. If people don't learn from this, it would be a proverbial slap in the face to Terri and just plain stupid.

All of the media coverage and the congressional, presidential, gubernatorial interference in Terri's life is SICKENING.