I read they are going to DC her feeding tube again. This is such a sad story. I was wondering what nurses are thinking about this?
I know as far as quality of life some may say she would be better off, but seeing the family's emotional response to this makes it kind of hard to know what would be the best in this situation.
How do we know someone would be "better off"? Maybe they would be by our standards, but I have seen people who didn't have much quality to life cling to their last breath. How can we know what is going on in Terri's mind?
Roland . . I'm on your side. :) I think he is a terrible person even if he didn't abuse Terri. Common and kind interventions are hardly "end of life" decisions. Letting your wife get her teeth cleaned or take communion seem to me to be simple courtesies.
Specializes in LTC, assisted living, med-surg, psych.
I did an advance directive shortly after witnessing my first code at age 37. (I'm a DNR.) My husband is aware of my wishes, but I chose my sister as my POA for health care because I know darned well he'd never be able to let me go, and in her absence my oldest daughter can make those decisions.
Steph is right; most people outside health care---and inside as well!---don't make these decisions ahead of time. Nobody wants to think about death or being in such a state that they can't speak for themselves, but in truth, that's the only way to avoid tragedies like Terri Schiavo's case. The poor woman should probably never have been put on life support, but once it was initiated, that's it.......you don't just stop it and allow an otherwise healthy patient to starve/dehydrate to death. The parents want to take care of her; I think Hubby Dearest ought to let them, and move on with his life (he pretty much has already, anyway).
I did an advance directive shortly after witnessing my first code at age 37. (I'm a DNR.) My husband is aware of my wishes, but I chose my sister as my POA for health care because I know darned well he'd never be able to let me go, and in her absence my oldest daughter can make those decisions.
Steph is right; most people outside health care---and inside as well!---don't make these decisions ahead of time. Nobody wants to think about death or being in such a state that they can't speak for themselves, but in truth, that's the only way to avoid tragedies like Terri Schiavo's case. The poor woman should probably never have been put on life support, but once it was initiated, that's it.......you don't just stop it and allow an otherwise healthy patient to starve/dehydrate to death. The parents want to take care of her; I think Hubby Dearest ought to let them, and move on with his life (he pretty much has already, anyway).
Roland, if someone is implicated criminally in an assault case they lose decision making power. That isn't the case here as far as anyone knows.
If you were wondering, I want my advance directive applied no matter how I got into that situation (even if my imaginary husband beats me into a coma). "Otherwise healthy" is not how I would describe that poor woman and if I am ever in that state I want to be dehydrated to death (I'd prefer a drug OD, but it isn't legal). If my decision maker just forgets about that and moves on with his life because my parents don't want to let go, I would never forgive him.
My question came because I have heard many people say that Terri's parents have offered to give him all the money if he will just go away and stop fighting for her feeding tube to be removed. If that's the case, I don't see what nefarious motive he has for trying to have it removed. There's no way she's regaining consciousness and implicating him in anything unfortunately.
My point is that I believe that a good deal of assault and in some cases murder is not so obvious as to immediately implicate the offender. I think this might be such a case. I also think that people should have the right to advance directives if they want them. However, keep in mind that people sometimes come back from comas that medical professionals believe to be permanent. Now a "persistent vegitative state" may be a different matter. On the other hand there has been and continues to be a dispute as to whether or not Terri is in such a state (her parents have provided Dr's who say she is not, and her husband has provided different neurologists who say she is).
Also, since no one has ever suffered death via dehydration, and or starvation and then come back to describe the experience, how can we be certain that it is a painless, easy death? Also, many religions including Christianity, Islam, Spiritualism, Hindu and others teach that there may be reasons for everything including persisting in a vegetative state. The Christian might believe that it is to inspire others into extremes of caring and love that they might not otherwise experience. Hindu's might believe that it is a way to "work out" bad karma, and thereby reduce the reincarnation cycle (some Catholics might subscribe to a variation of this perspective by believing that it reduces their time in purgatory). The point of course is that such an existence is not necessarily without purpose. Even the agnostic, or atheist might wish to retain their life as long as possible in the hopes of being saved by advancing medical science (which while unlikely to make a difference conceivably could especially in light of research involving nanotechnology, and stem cell research. Indeed, a leading atheist Physicist Paul Davies subscribes to a theory that we will one day be able to reduce all of human existence down to computer/like programs which will permit essentially eternal existence. Stephen Hawkings subscribes to a similiar hypothesis, but believes this will be accomplished via a "merger" with machines).
I personally don't relish the thought of persisting in such a state and certainly wouldn't want prolonged aritificial respiration. On the other hand I'm not so certain that I would want to be denied food and water until death. I still remember the last days of my mother as she expired from lung cancer in hospice last year. She was too weak to eat and could only drink via the teaspoons of ice chips that I fed into her mouth. Indeed, almost everyone said that she wasn't able to communicate. However, she would whisper to me in words and sentences that were BARELY audible (with her eyes barely open) that were completely cogent and indicative of a LOC far in excess of what I would have assessed her at had I not been at her side for days.
Roland, for myself, I just don't think the reason I wind up in a coma is the issue. I don't want to "live" like that, not even to spite someone who tried to kill me. I would want that tube out. We can't be sure dehydration is a completely painless way to die, but none of us are guaranteed a painless death even with the best planning and best medical care. That isn't realistic unfortunately and I did consider that when making my decisions about the level of intervention I want for myself. I doubt most of us will die without pain and I know I would prefer my pain to last a few days or weeks rather than a few years or decades. Permanent brain damage is permanent and I wouldn't want to spend decades lingering like that because my parents don't want to face reality. I also don't subscribe to the notion that all suffering is meaningful like some religious people may, so it isn't a consideration for me. If that's what God wants from me, too bad.... I guess I'm going to dissapoint. I do not intend to spend years in that state to please Him/Her (if He/She even exists).
That's why I can't just dismiss this man's desire to see the tube pulled as being only for selfish reasons (because I know if I was her I would expect him to do the same thing and be grateful for it). Whatever problems they had, this was the man she chose. Without some real evidence that he caused her injury, I can't just ignore what he says she would have wanted, especially if he has declined taking the money and leaving. Considering this assault theory can't be proven and is only being advocated as a possibility by one doctor... it just isn't enough to make me dismiss him. I would think if she had been beaten by her husband someone would have noticed before.
I understand that some people believe her life has meaning and that it should continue. I just think they need to admit the possibility that it isn't what Terri would have wanted. It may be, but it may not be. The husband may be a good for nothing loser... He may also be a good husband doing what he knows his wife wants him to do.
Fine, but do the autopsy. This is one of those situations where I wish I was wealthy. I would offer the guy a million dollars to take a polygraph examination from a competent examiner.
this reminds me of a case where i had to discontinue a patient's gtube fdgs....
she had been clinically depressed for yrs., eventually stopped eating (trying to die); did have some comorbidities and got sick frequently with resp infections and chf.
the dtr., who lived in another state and who was the legal guardian, had little involvement.
but the son visited frequently and HE signed the consent form for ect.
after a few sessions of the ect, this patient was now ambulating, eating and smiling!!!!
but once the dtr found out that her brother had consented to this, she halted all treatments all together, professing that ect does much damage.
we even showed a picture to the dtr.., of her mother with a beautiful smile, and standing w/her walker.
nevertheless, all ect was stopped; the pt lapsed into her severe, catatonic depression and gtube fdgs resumed.
the pt went into another bout of acute chf; the dtr signed dnh papers, sat by her mother's side then decided she wanted the feeding tube pulled since she had no quality of life.
i spoke with the np, who had a fit stating we couldn't do this.
the np then called the md who stated yes, we could.
it is legal in massachusetts.
and i was ordered to stop all fdgs and remove the gtube.
this had to be one of the most difficult tasks ever done.
we put her on morphine, comfort care.....she stayed alive (w/her eyes open and cognizant) for 1.5 weeks..
the dtr never left her side until her mother passed.
to this day, this case haunts me, as the mother DID greatly improve with the ect and was functional.
why did the dtr have the right to stop treatment, in spite of its' positive effects?????
for me being such a black and white person, this undoubtedly was the ugliest shade of gray i ever encountered.
2. This case illustrates that when you make someone a legal guardian and or health care representative, you had better be darn sure that their opinions match your own on these issues.
3. You said that the patient was "smiling and ambulating" on the ect therapy (whatever that is). Later you said that she was cognizent. My point is that if her LOC was sufficient to express her own desires then those should have overridden the opinions of her daughter even if she was a legal guardian (unless the patient had been legally declaired mentally incompetent, and even then there are provisions for recognizing the fact that some people "regain" mental competency). This is especially the case given the fact that stopping the treatments were essentially a death sentence.
4. Part of the problem with this issue (In my never humble opinion) is that the assumption is that the "guardian" is expected to have the "best interests of the patient" in mind. Unfortunately, (and for reasons that I will not even attempt to outline) many of us believe that there is a significant proportion of the population that are little more than borderline, self interested, sociopaths. These are people more interested in what happens to their relative's inheritence than they are in their well being(or would rather see them "go away" because it would make their lives easier or relieve them of guilt).
2. This case illustrates that when you make someone a legal guardian and or health care representative, you had better be darn sure that their opinions match your own on these issues.
3. You said that the patient was "smiling and ambulating" on the ect therapy (whatever that is). Later you said that she was cognizent. My point is that if her LOC was sufficient to express her own desires then those should have overridden the opinions of her daughter even if she was a legal guardian (unless the patient had been legally declaired mentally incompetent, and even then there are provisions for recognizing the fact that some people "regain" mental competency). This is especially the case given the fact that stopping the treatments were essentially a death sentence.
4. Part of the problem with this issue (In my never humble opinion) is that the assumption is that the "guardian" is expected to have the "best interests of the patient" in mind. Unfortunately, (and for reasons that I will not even attempt to outline) many of us believe that there is a significant proportion of the population that are little more than borderline, self interested, sociopaths. These are people more interested in what happens to their relative's inheritence than they are in their well being(or would rather see them "go away" because it would make their lives easier or relieve them of guilt).
Any of you know what Mr. Schiavo does for a living?
He's an ER RN.
Terri was dieting when this incident occurred, as well as being a bulemic. Now just try to picture it yourself: you're in your twenties. You're so concerned about your appearance that you jeopardize your health knowingly by crash-dieting, using diet pills, and by binging/vomiting--which could cause a K crisis and a heart attack.
What do you imagine that Terri Schiavo would want? To look like a vegetable? To be fed via a feeding tube and spend her days in a room by herself in a nursing home?
I don't know the answer any better than any of you, true, but even with all the news reports I'm a tad amazed that they keep leaving out that one important piece of information: Mr. Schiavo is a practicing ER nurse. You don't get to work in this state as a nurse--or if you do, you don't practice for very long--if you're as cruel as he was reported to be in that article.
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Spidey's mom, ADN, BSN, RN
11,305 Posts
Roland . . I'm on your side. :) I think he is a terrible person even if he didn't abuse Terri. Common and kind interventions are hardly "end of life" decisions. Letting your wife get her teeth cleaned or take communion seem to me to be simple courtesies.
steph