Artificial feeding-Terri Schiavo

UnewmeB4 · Mar 25, 2005

I posted this before. But here it is:
http://www.miami.edu/ethics2/schiavo/CT%20scan.png

This is a CAT scan of Terry's brain (not sure when it was taken, don't think it is recent). It is from a reputable site (University of Miami).

You don't need to be an expert to see that she has this huge ventricle in her brain (the big blue blob in the middle). If you look closely, the same shade of blue in the ventricle are also all over the brain (especially toward to top part of the brain). You do see the white stuff (I pressume those are brain tissue) sort of are here and there however mixed in with the deep blue (the ventricle color).

So as for your question, technically according to this scan, you do not have liquid instead of a cortex because you can see the brain tissue (assuming I am interpreting it right given that I have no idea how to interpret a CAT scan, I am just doing educated guesses here). However, you can see there is quite a bit of damage all over the brain (especially in the middle and up on top).

Obviously with that much structural damage, it is going to adversly affect function also (as we all learn in A&P).

-Dan

I can't believe people have still not read this! It is unbelievable...imho. We in nursing are so much into "evidence based practice". It is in the court records. You may also want to quit vilifying Michael. You would be quite surprised to read all he HAS done for Terri.

There is very interesting comments made by a Father Murphy, who tesified in court. Something he said really struck me. It is cases like these that drive the Eutanasia/right-to-suicide people.

Dan, thank you so much for putting this site up again. I think is is very important, as there is no media interpretation.

KarafromPhilly · Mar 25, 2005

About the husband's motives--does anyone else think that he might be acting out of loyalty to Terri? That is, he's hanging on and won't divorce her because he KNOWS that she didn't want to live like this, so allowing her parents to care for her in her present state would be abandoning her? I like this idea--is this a really strange thought?

Penguinurse · Mar 25, 2005

A question for those who support reinserting the feeding tube (and this is an honest question, not an attack :):

If there were incontrovertable proof, such as a living will or videotaped statement, that this patient wouldn't want to be sustained artificially, would you still support her parents fight to keep her on the feeding?

I ask because I'd like clarification about your reasons for supporting the feeding...is it a general issue, meaning that you believe no one should ever be removed from a tube feeding, or an individual issue, because there is no such proof that this patient ever said she wouldn't want to live this way?

If a lot of people around the country believe that no one should ever come off a tube feeding, that's scary to me...does that mean we are obligated to use any/all technology available in every situation? Case in point: when I was in the OR, one of our ortho surgeons did a bipolar hip replacement on a woman who was 104 yrs. old, end-stage dementia, GT, unable to communicate with the world, contracted into a fetal position. She'd been dropped during a transfer. :stone

Thanks to all who post rational, polite entries...we don't have to agree, but let's all respect.

begalli · Mar 25, 2005

--is this a really strange thought?

Not at all.

bonnieL123 · Mar 25, 2005

This is sad when this poor lady is being used between mom and dad and husband. They are not thinking of her.

danu3 · Mar 25, 2005

A question for those who support reinserting the feeding tube (and this is an honest question, not an attack :):
If there were incontrovertable proof, such as a living will or videotaped statement, that this patient wouldn't want to be sustained artificially, would you still support her parents fight to keep her on the feeding?
...
Thanks to all who post rational, polite entries...we don't have to agree, but let's all respect.

As for me, I used to be more on the husband side before I got more familiar with the case. As I gotten more familiar with the case and especially seeing the video on the parents' site, I lean more with the parents. Then after reading the Wolfson report (and I even read the fine footnotes) and seeing the CAT scan, I swung back to more neutral but still a bit hesitent on pulling the tube.

In your scenerio, if they have great proof like you mentioned, I personally will have no problem in pulling the tubes. My indecision has to do with the following random thoughts:

I don't really know what Terry wants. The reason is that there are so much emity between the two parties that I don't exactly trust either side. Plus we all tend to think we know what Terry wants because we put ourselves in Terry's shose and go this is what Terry wants because it is what we would have done. Well, we are not Terry.
The husband having children with another woman while still legally married with Terry just does not sit well with me even if the parents did encourage him to do it and even though, yes, he has his needs. For me, the proper thing is to do is the divorce and then go with the other woman. If the husband did not have another woman, I would have sided with the husband probably long time ago.
The husband said something to the effect that he live for Terry at Larry King show and that just turned me off because he has another woman. I suppose that could happen, but it just did not sit well with me.
One of the neurologist is suppose to be active in the right-to-die movement (I did not verify whether it is true or not) and if that is true, that also does not sit well with me.
On the other hand, I can see how badly damage is the brain.
I have no problem with dying of dehydration if the person is actively dying (e.g. from a terminal disease) because as the system shuts down, it can actually cause more suffering in certain cases if you force hydration.
In a PVE state, that is a grey area for me because the person is not actively dying.
The economic argument also does not sit well with me because it implies we can place a monetary value on a person. It implies that if we are not productive, we are not value, we should be discarded.
Since Terry is not actively dying, I do have a question of how much pain she will suffer if they do pull the tube. Will she be like a person who starve in Africa or will she be like a cancer patient who is dying and all the system are shutting down? The video at least give the impression she will sense pain. The CAT scan however raised doubt given the massive damage it shown (the CAT scan is old and if they take another one now, it may even be worst).
I do have some glimps of understand how the parents feel (it does distube me when people accuse them of being selfish and in denial) because after taking care of someone you love for 15 years or whatever, you are going to develope an extremely strong bond. I took care of my mom for 6 years before she died and the bond that was developed is extremely strong. Instead of the right-to-life crowd urging them on to not pull the tube and the right-to-die crowd condeming them with a holier than thou attitude, and both sides yelling the sky is going to fall, I think the parents need someone who is compassionate to walk beside them, acknowledge their deep bond to Terry, acknowledge their devotion to their daughters, and help them grieve which takes time. After they gone through the difficult process of grieving, they may be willing to let go if both sides don't get in the way and use them as pawns.
As nurses or future nurses, we are trained to address thing in a wholestic way. We have critical thinking, but critical thinking with a heart, with compassiion. We also acknowledge the emotional aspect of things and work with it because that is part of being human. We do not dismiss the emotion part of an issue.
Talking about emotion, I have reserve emotionally about pulling the tube in a PVE state if we do not know what Terry want. Now if Terry has an infectiion and they decided not to treat it and let the infection take over and they pull the tube, I for some reason don't have a emotional problem with it. Don't know why.

So for me, it is a mixture of reasoning and also emotions which I do take into account. I guess in my case, the right-to-die philosophy just turns me off. Now the hospice philosophy I don't have any problems with.

-Dan

LydiaNN · Mar 25, 2005

A question for those who support reinserting the feeding tube (and this is an honest question, not an attack :):
If there were incontrovertable proof, such as a living will or videotaped statement, that this patient wouldn't want to be sustained artificially, would you still support her parents fight to keep her on the feeding?
I ask because I'd like clarification about your reasons for supporting the feeding...is it a general issue, meaning that you believe no one should ever be removed from a tube feeding, or an individual issue, because there is no such proof that this patient ever said she wouldn't want to live this way?
If a lot of people around the country believe that no one should ever come off a tube feeding, that's scary to me...does that mean we are obligated to use any/all technology available in every situation? Case in point: when I was in the OR, one of our ortho surgeons did a bipolar hip replacement on a woman who was 104 yrs. old, end-stage dementia, GT, unable to communicate with the world, contracted into a fetal position. She'd been dropped during a transfer. :stone
Thanks to all who post rational, polite entries...we don't have to agree, but let's all respect.

Of course not. The whole struggle comes down to both sides honestly believing (or so claming in court) that their decision is the one Terri "would have wanted". If what she would have wanted was known, this case would not even be in the news.

roxannekkb · Mar 25, 2005

This is an interesting article from Deutsche Welle, about how Europeans see the Terri Schiavo case. We tend to think of Western Europe as a very liberal place when it comes to end-of-life issues (ie, euthanasia), but in reality, they have very strict rules about who is "permitted" to die. According to this article, Terri Schiavo would remain on her tube because she left no written directive.

When my boyfriend's grandmother (she lived in Berlin) was dying of breast cancer a few years ago, she refused food and water. But she had to sign a document that the doctor gave her, and clearly state that she did not want to be fed, and that she understood the consequences of her actions. They really want to be sure that this is what the patient wants.

Europeans Reflect on Schiavo Case

The legislative and judicial battle over a Florida man's right to end his comatose wife's life has drawn some surprise reaction in Europe, where legal sympathy for euthanasia is widespread.

On a continent where physician-assisted death is far more commonplace than in the United States, the case of Terri Schiavo has struck a chord.

Schiavo, who has been in a persistent vegetative state since collapsing in her home in 1990, has been at the center of a legal fight between her husband -- her legal guardian -- and her parents over her husband's right to end her life since 1998. Michael Schiavo went to court eight years ago for the right to remove her feeding tube, saying that she would have never wanted to live in such a state.

This past week, the US Congress forced the case from the Supreme Court, which had ruled in Michael Schiavo's favor, back to a Florida district court. The court on Tuesday denied Schiavo's parents the right to restore her feeding tube, a decision that will be appealed.

Holland: 2,000 assisted in death each year

European countries like the Netherlands, Switzerland and Belgium allow physician-assisted death in various incarnations. In Holland alone, about 2,000 people die through assistance from their doctor each year. But Schiavo wouldn't be one of them.

Dutch laws, like those in Switzerland and Belgium, require that the patient clearly and insistently request death. Schiavo, had she ever requested death should she fall into a vegetative state, did not insist on it. For this reason, even relatively socially liberal groups, like the Union of Protestant Churches in Germany, or the German Medical Association, have not recommended removing Schiavo's feeding tube.

Question of recovery divides

"The patient's doctors are required to continue to treat her and to feed her, because it's not clear what will happen next with her illness," said Jörg-Dietrich Hoppe (photo, right), the head of the German Medical Association.

Doctors consulted by Michael Schiavo have testified in court that Terri will never recover from her state -- in which she cannot think or speak and is unaware of her surroundings. Doctors brought by her parents disagree and say it would be against Terri's religion, as a Roman Catholic, to die this way.

Hoppe said there have been cases "of people who lived for 20 years in a 'waking coma' and then later came back to consciousness. The patient is certainly not dead."

Dutch pave way for euthanasia legalization

Fifteen years ago, Holland had a case similar to Schiavo's, A judge allowed the husband of Ineke Stinissen, who had been in a coma for several years, to remove her feeding tube. She died of starvation, and her case paved the way for Holland's pro-euthanasia legislation.

In Germany, Schiavo's case would have gone to court much in the same way it did in the US. German law forbids doctors to actively assist in a patient's suicide but allows them to passively allow death if the patient clearly wills it. But Ruth Mattheis, the former head of the medical association and a doctor for more than 50 years said she could not remember such a case every making it to trial.

"Quite often, families addressed me and asked for help, mostly families who wanted to stop nutrition (where) the doctors opposed it," she said. "In such situations, I always tried to bring both parties together to find a solution."

http://www.dw-world.de/dw/article/0,1564,1526731,00.html

LydiaNN · Mar 25, 2005

This actually doesn't much surprise me. I think many of us that have qualms about this case are troubled not by Terri's right to die, but by the question of whether it is, in fact, what she would have wanted.

This is an interesting article from Deutsche Welle, about how Europeans see the Terri Schiavo case. We tend to think of Western Europe as a very liberal place when it comes to end-of-life issues (ie, euthanasia), but in reality, they have very strict rules about who is "permitted" to die. According to this article, Terri Schiavo would remain on her tube because she left no written directive.
When my boyfriend's grandmother (she lived in Berlin) was dying of breast cancer a few years ago, she refused food and water. But she had to sign a document that the doctor gave her, and clearly state that she did not want to be fed, and that she understood the consequences of her actions. They really want to be sure that this is what the patient wants.
Europeans Reflect on Schiavo Case
The legislative and judicial battle over a Florida man's right to end his comatose wife's life has drawn some surprise reaction in Europe, where legal sympathy for euthanasia is widespread.
On a continent where physician-assisted death is far more commonplace than in the United States, the case of Terri Schiavo has struck a chord.
Schiavo, who has been in a persistent vegetative state since collapsing in her home in 1990, has been at the center of a legal fight between her husband -- her legal guardian -- and her parents over her husband's right to end her life since 1998. Michael Schiavo went to court eight years ago for the right to remove her feeding tube, saying that she would have never wanted to live in such a state.
This past week, the US Congress forced the case from the Supreme Court, which had ruled in Michael Schiavo's favor, back to a Florida district court. The court on Tuesday denied Schiavo's parents the right to restore her feeding tube, a decision that will be appealed.
Holland: 2,000 assisted in death each year
European countries like the Netherlands, Switzerland and Belgium allow physician-assisted death in various incarnations. In Holland alone, about 2,000 people die through assistance from their doctor each year. But Schiavo wouldn't be one of them.
Dutch laws, like those in Switzerland and Belgium, require that the patient clearly and insistently request death. Schiavo, had she ever requested death should she fall into a vegetative state, did not insist on it. For this reason, even relatively socially liberal groups, like the Union of Protestant Churches in Germany, or the German Medical Association, have not recommended removing Schiavo's feeding tube.
Question of recovery divides
"The patient's doctors are required to continue to treat her and to feed her, because it's not clear what will happen next with her illness," said Jörg-Dietrich Hoppe (photo, right), the head of the German Medical Association.
Doctors consulted by Michael Schiavo have testified in court that Terri will never recover from her state -- in which she cannot think or speak and is unaware of her surroundings. Doctors brought by her parents disagree and say it would be against Terri's religion, as a Roman Catholic, to die this way.
Hoppe said there have been cases "of people who lived for 20 years in a 'waking coma' and then later came back to consciousness. The patient is certainly not dead."
Dutch pave way for euthanasia legalization
Fifteen years ago, Holland had a case similar to Schiavo's, A judge allowed the husband of Ineke Stinissen, who had been in a coma for several years, to remove her feeding tube. She died of starvation, and her case paved the way for Holland's pro-euthanasia legislation.
In Germany, Schiavo's case would have gone to court much in the same way it did in the US. German law forbids doctors to actively assist in a patient's suicide but allows them to passively allow death if the patient clearly wills it. But Ruth Mattheis, the former head of the medical association and a doctor for more than 50 years said she could not remember such a case every making it to trial.
"Quite often, families addressed me and asked for help, mostly families who wanted to stop nutrition (where) the doctors opposed it," she said. "In such situations, I always tried to bring both parties together to find a solution."
http://www.dw-world.de/dw/article/0,1564,1526731,00.html

igloorn93 · Mar 25, 2005

About the husband's motives--does anyone else think that he might be acting out of loyalty to Terri? That is, he's hanging on and won't divorce her because he KNOWS that she didn't want to live like this, so allowing her parents to care for her in her present state would be abandoning her? I like this idea--is this a really strange thought?

I Believe I mentioned that thought myself a few days (or nights ago!) He was married to her and presumably knew her wishes and spouses quite often know things about their in-laws that the in-laws don't want them to know. It could very well be that Terri had issues with her parents and didn't want them to know of her wishes. Unfortunatley we will never know. Sad and so very tragic.

caroladybelle, BSN, RN · Mar 25, 2005

Correct me if I am wrong, but isn't "last rites" by the Catholic church now known as the "anointing of the sick" officially. And I will lay odds that she has had numerous "last rites" done given her medical history.

Home Health Columnist / Guide · Mar 25, 2005

since the family is very religous, i'm sure she has had the annointing of the sick on several occasions which is within catholic church guidelines.

testimony presented in court:

theresa schiavo told her husband that if she were dependent on the care of others she would not want to live like that. and also theresa schiavo mentioned to her husband and to her brother and sister-in-law that she would not want to be kept alive artificially.

not disputed. testimony of father gerard murphy

shows that withdrawing of feeding tube is in acordance with catholic church doctrine. my prior hospice education, work in catholic hospitals, hospice program and homecare, we used the same criteria for deciding on treatment versus withdrawl of life support.

i agree with kara that michael appears to be a strong loving husband who is following his wifes wishes in this case. he is staying married so he can ensure follow through on advocating for what terri wanted,

saw him on larry king show this week and was impressed with quiet eloquence in way he spoke. he tried to get best care for her initially: took terri to california for thalmic brain stimulator surgery, followed by 4 years of aggressive rehab in fla facilites. but when no improvment developed after eight years, it was time to follow her wishes to be not kept alive by artifical means. usa law supports the right to self-determination and refussal of treatment. numerous court cases have ruled micheal is following her wishes and granted permission for tube removal.

from my twenty years experience in homecare and having had clients in similar situation at home 90% were men being cared for by wives; 10% were woman cared for by husbands. i've had many couples divorced for years, remarried who take in a former spouse when terminally ill and care for them--all because of love and respect to give as much quality to remaining life of person. that's why i perceive micheal to have terri's best interest at heart.