Must we all die with a feeding tube?

allnurses Guide · Nov 11, 2004

I recall Jeb Bush interfering with the Terri Schiavo case-maybe this is what the poster is referring to? I don't believe his opinion should matter to that case....

I know she was referring to this case. Jeb Bush didn't force the tube in the first place. The tube was already there and her husband was trying to get the feedings stopped and her parents wanted them to continue. The tube was then removed when he won and her parents fought it. Then the tube was reconnected. I guess I wish that Terry's wishes had been in writing so the tube was never put in in the first place, if that was truly her wish.

I have no problems with stating ahead of time that you don't want to have a feeding tube or be on a vent or have cpr, etc ....

The active act of taking out a feeding tube and starving someone to death is a little more of a gray area for alot of people.

There should certainly be no surprise here that this is controversial.

steph

ktwlpn, LPN · Nov 11, 2004

I know she was referring to this case. Jeb Bush didn't force the tube in the first place. The tube was already there and her husband was trying to get the feedings stopped and her parents wanted them to continue. The tube was then removed when he won and her parents fought it. Then the tube was reconnected. I guess I wish that Terry's wishes had been in writing so the tube was never put in in the first place, if that was truly her wish.
I have no problems with stating ahead of time that you don't want to have a feeding tube or be on a vent or have cpr, etc ....
The active act of taking out a feeding tube and starving someone to death is a little more of a gray area for alot of people.
There should certainly be no surprise here that this is controversial.
steph

You are correct in that the tube was already in place-On October 21, Governor Jeb Bush signed House Bill 35-E into law in response to pleas from the right to lifers and Terri's family and disability organizations..... The law gave the Governor authority to issue a one-time stay to prevent withholding hydration and nutrition from incapacitated persons under certain circumstances.He then exercised that authority by issuing an executive order ordering that the feeding be restarted after the husband won the right to stop the feeeding...He also tried to get the Fla Supreme court judges involved in the case recused ....(He does promote advance directives in most of his statements but that does not change the fact that he used his office to try to influence the outcome of the situation...and that bill has since been over-turned as unconstitutional...)

URO-RN · Nov 11, 2004

I am filled out my POA and I am taking it with me on my next doc visit.

I just went through a similar situation with my dad who passed away this year. I don't want that to happen to me.

My personal belief is that if the patient wants to go, let him go. If I was on dialysis, and I was tired of it and I felt that I had enough, then, respect my wishes. I am comfortable with death. I don't fear it. I know were I am going.:)

I think that often it is not the patient who refuses to let go, it is us professionals who are not comfortable with letting people die. After all, we went into this prof. to save lives.

KRVRN, BSN, RN · Nov 12, 2004

I'm always surprised that you don't hear about this in babies as much as you hear about it in older folks. If we have a baby with severe brain damage without hope of a meaninful life, we will withdraw care. If the baby is ventilated, we extubate and let the parents hold...death usually comes within 1 hour. But if the baby isn't ventilated, we have to withdraw feedings and IV fluids...this can take up to 10 days.

The statements about a body that's shutting down not feeling hungry don't apply as well when you withdraw nutrition on a body that's not yet shutting down. I'm in no way attacking or disagreeing with these statements, but I am always surprised that you don't hear more about it. A harsher way to say "withdrawing nutrition" would be to say "dehydrate a baby for 10 days until it dies." Certainly people have the same ethical, moral feelings towards this, but you never hear much about it.

leslie :-D · Nov 12, 2004

The statements about a body that's shutting down not feeling hungry don't apply as well when you withdraw nutrition on a body that's not yet shutting down. I'm in no way attacking or disagreeing with these statements, but I am always surprised that you don't hear more about it. A harsher way to say "withdrawing nutrition" would be to say "dehydrate a baby for 10 days until it dies." Certainly people have the same ethical, moral feelings towards this, but you never hear much about it.

but under what circumstances would you withdraw nutrition when the body isn't grossly compromised and/or shutting down?

KRVRN, BSN, RN · Nov 12, 2004

It's usually the birth asphyxiated babies that had to be coded for several minutes at birth. Then they start posturing and having seizures. CT scans will show HIE (hypoxic ischemic encephalopathy) and neuro will consult and see that normal baby functions such as sucking are abnormal or absent. Somewhere in there the baby's body recovers enough to start breathing effectively on it's own. Unfortuneately that leaves withdrawing nutrition.

mlynn · Nov 12, 2004

I am an RN working for hospice. What we try to explain to families is that "People who are terminally ill do not die because they stop eating, they stop eating because they are dying".

Katmae RN · Nov 12, 2004

I was referring to Terry Schiavo in my earlier post. I saw her husband and his lawyer on Larry King discuss the long drawn out process involved in letting Terry go. Then after years of fighting in the courts for what they believe were Terry's wishes Jeb Bush stepped in to put her feeding tube back in. I work with a woman who for 14 years has laid in a bed..turned every two hours, fed by tube, bathed, cleaned of her incontinence. She cannot move, cannot communicate other than moan at times. Her husband and son have since died. It really takes a toll on one's concept of what life is and isn't. The tube feeding prolongs her "life" indefinetly. Medicare has paid hundreds of thousands, if not millions to keep her alive this way for fourteen years. I picture Terry when I care for her. Helpless, totally dependent, not able to decide anything, eat anything, say anything..I would not want to be kept this way, and I can't imagine anyone who would. So who will speak for helpless Terry. What parent could ever want this for their child? Maybe it's because I am a Christian and I know death is not a punishment..but a gift in such circumstances. Yes death is difficult for their survivors, but for those afflicted with such illness, it is a blessing to be free again. I am against tube feedings in cases of this kind, or any terminal illness.

cwazycwissyRN, RN · Nov 12, 2004

I am an RN working for hospice. What we try to explain to families is that "People who are terminally ill do not die because they stop eating, they stop eating because they are dying".

Thank you mlynn. My dads feeding tube was accidentally pulled out when he was extibated. We did not have it put back. His death was closed at hand, it really felt more humane to leave it out. Prolonging his pain was not a pleasant thought. Two days without a feeding tube is not starving anyone, but can still be a grey area. We were able to give him a few ice chips. He did have a living will. Made our decisions so much easier. I do not believe the pope or anyone else has the right to dictate our health care paths. The paths curve and can go in unpredictable directions tooo easily.

talaxandra · Nov 12, 2004

Maybe it's because I am a Christian and I know death is not a punishment..but a gift in such circumstances. Yes death is difficult for their survivors, but for those afflicted with such illness, it is a blessing to be free again.

I find it interesting that there aren't more Christians who feel the same way. For some reason it seems that the people who most strongly believe in the worth of any life at any cost - a moment of life, even in torment, is better than not having that moment - are also the people who believe in a glorious afterlife.

Conversely, many - but by no means all - of those who believe in facilitating a more peaceful but rapid death also believe that there is nothing more than this.

Would that there were more like you, who see death as a gift in such circumstances.

Katmae RN · Nov 12, 2004

Guess after 17 years at the bedside I have seen a great deal of human suffering. Prolonged by trach's, GT's etc. My own Dad in the end with terminal cancer as well. I got to be with him as he left this world..and although it was deeply painful to me, I saw his body relax after a last breath..and it was such a relief to me to see his suffering end. I feel he went to Heaven to be with our creator. I am not a church goer or a person who tries to push my values on others. But this is what helps me form what I feel is right or wrong about prolonging life in cases that we have talked about in this thread.

PamUK · Nov 14, 2004

hi all... i'm new to this site and nurse in the uk

i was surprised at something bill levinson said earlier in the thread... " i was actually going to have a feeding tube put into my father when he stopped taking fluids and nutrition". also, cwazycwissyrn said "my dads feeding tube was accidentally pulled out when he was extubated. we did not have it put back"

i am assuming that in both situations, both fathers were not conscious and therefore not able to consent to a feeding tube. in which case i ask, do relatives make the final decision about the insertion of feeding, or indeed any treatment, in the usa? i know in the uk, that the doctor would make the final decision based on the patients "best interests" (the uk doctors regulatory body have some excellent guidance), any known views of the patient, the opinions of the rest of the health care team and the views of relatives. a relative cannot insist on any treatment, although their views are considered.

look forward to your comments