Tube feeding controversy

Long Term Care Columnist / Guide · Mar 21, 2005

I hope so, too, penguinurse! However, the Schiavo case is not about someone in the process of dying (although she undoubtedly would have years ago if her feeding tube had never been inserted). She is severely brain-damaged, but otherwise healthy.........but I won't go into my personal opinions about that here.

Unfortunately, Americans tend to have the attention span of a flashcube; after this is over, we'll probably go back to our old way of blissfully ignoring the remote possibility that, someday, we MIGHT die. :rolleyes: It's sad; our culture is still so hung up on youth, and so afraid of decline and death, yet it's a reality for each and every one of us. Sure, we'll continue to have those urgent but hushed midnight heart-to-hearts with our spouses after an acquaintance dies from cancer, or our parents will raise the subject after one or the other experiences a bout of chest pain, but when we land in the hospital with a sudden illness, will we actually fill out and sign that advance-directive form we're given along with our admission paperwork? Will we sit down with our adult children and talk honestly about what we want if we become incapacitated and can no longer make our own decisions?

I doubt it, but if this tragic story forces even a handful of Americans to fill out advance directives, make a living will, or go see their attorneys about designating a POA, then perhaps Terri Schiavo and the people who have come to care about her in these past months will not have suffered in vain.

allnurses Guide · Mar 21, 2005

On another thread about this, the subject was brought up about mixing Hospice with this case. And the negative outcome that could be for the Hospice movement.

Terri is not about Hospice. She is not terminally ill. She is simply brain-damaged.

Good post Marla.

steph

Long Term Care Columnist / Guide · Mar 21, 2005

Thanks, Steph. It's kind of funny, how I usually look at the gray areas in almost all areas of life, but in this case, what can and cannot be done is black and white in my mind. You can allow nature to take its course when someone suffers a terminal event, like Terri Schiavo did back in 1990 when her heart stopped due to an electrolyte imbalance. What you CAN'T do is unring the bell........she's been fed through a tube for 15 years, and other than being brain-damaged, she is healthy and sound. Removing the tube now is a deliberate act with the sole intention of causing Terri's death, and the last time I checked, that was a crime. :angryfire

Long Term Care Columnist / Guide · Mar 21, 2005

Oops.........I wasn't going to go into my personal opinions on this thread. Sorry. :imbar

seinna48 · Mar 21, 2005

This ruling will set a precident for future cases. No attacks intended on hospice. To use a cliche, some of my best friends are hospice workers, but I so one instance of hospice taking over a patient that we had, placed her on Roxanol, stopped feeding her, and she died in two weeks, This was the family's decision...they wanted her out of the way. She had no major illnesses that would indicate the need for hospice. I brought the situation up to my supervisor and the state was called in for evaluation. What do you think? They found no reason for hospice not to be involved and assist her to her death.

I worked with the woman and I knew her conditons. None the less, I am not working at the particular place.

I am all for hospice and I feel that Terri should have been evaluated long before this.

Thanx,

Seinna

What's everybody thinking about the potential impact of the Florida case on our jobs? Stopping a tube feeding is fairly routine for hospice; do you think the new national attention will change that in any way?
I hope that if nothing else it raises awareness of the importance of having living wills or DPOA's in place before the need for them arises.

seinna48 · Mar 21, 2005

I am a 57 y. o. nurse. I think that personal opinions was what got the attention of the government in the first place. Why did hey wait so lonf beforee they decided to make this ruling?

I have htree adult children. I have told them my wishes if I were in certain states. About three months ago, I was admitted to the hospital with possible CHF. When I signed all the "proper" forms, I was told by one of the nurse in ICU that it was not up to me but the doctor.

As you have seen in my responses, I am adamant about life and other issues. I have seen so many changes in nursing that I can barely stand to hear about new laws.

I love my job! I will be carried out of the building when I die because I love what I do. Always speak your opinion along with facts if need be, how else will we make the future a better place for all?

Seinna48

I hope so, too, penguinurse! However, the Schiavo case is not about someone in the process of dying (although she undoubtedly would have years ago if her feeding tube had never been inserted). She is severely brain-damaged, but otherwise healthy.........but I won't go into my personal opinions about that here.
Unfortunately, Americans tend to have the attention span of a flashcube; after this is over, we'll probably go back to our old way of blissfully ignoring the remote possibility that, someday, we MIGHT die. It's sad; our culture is still so hung up on youth, and so afraid of decline and death, yet it's a reality for each and every one of us. Sure, we'll continue to have those urgent but hushed midnight heart-to-hearts with our spouses after an acquaintance dies from cancer, or our parents will raise the subject after one or the other experiences a bout of chest pain, but when we land in the hospital with a sudden illness, will we actually fill out and sign that advance-directive form we're given along with our admission paperwork? Will we sit down with our adult children and talk honestly about what we want if we become incapacitated and can no longer make our own decisions?
I doubt it, but if this tragic story forces even a handful of Americans to fill out advance directives, make a living will, or go see their attorneys about designating a POA, then perhaps Terri Schiavo and the people who have come to care about her in these past months will not have suffered in vain.

seinna48 · Mar 21, 2005

Can you say brain-damage is healthy and sound? I don't think any of us would want to be in her position. I remember a movie in which Robert Deniro came back after a period of time. The things that he went through to get to justa functional state were horrible, yet he was able to walk, talk (with a slur), and do many of the things that we (I) may be able to handle.

I am not afraid of old age ( I am already there) I am afraid of living to see the way the future is going.

It is not 2008, it's 1984!

Seinna48

Thanks, Steph. It's kind of funny, how I usually look at the gray areas in almost all areas of life, but in this case, what can and cannot be done is black and white in my mind. You can allow nature to take its course when someone suffers a terminal event, like Terri Schiavo did back in 1990 when her heart stopped due to an electrolyte imbalance. What you CAN'T do is unring the bell........she's been fed through a tube for 15 years, and other than being brain-damaged, she is healthy and sound. Removing the tube now is a deliberate act with the sole intention of causing Terri's death, and the last time I checked, that was a crime. :angryfire

Long Term Care Columnist / Guide · Mar 21, 2005

Can you say brain-damage is healthy and sound? I don't think any of us would want to be in her position. I remember a movie in which Robert Deniro came back after a period of time. The things that he went through to get to justa functional state were horrible, yet he was able to walk, talk (with a slur), and do many of the things that we (I) may be able to handle.
I am not afraid of old age ( I am already there) I am afraid of living to see the way the future is going.
It is not 2008, it's 1984!
Seinna48

What I meant was, her BODY is healthy and sound.......and it will probably take her many days to dehydrate to death.

I'm with you, however, on the frightening possibilities that await us down the road if the current administration stays the course and continues to chip away at our constitutional protections. While I believe intervention was necessary in this particular case, I agree that it could set a terrible precedent for the future. That's why I can't wait till 2008, so we can get some saner minds in power before the USA as we know it is gone forever. :stone

OneThunder, BSN, RN · Mar 25, 2005

What's everybody thinking about the potential impact of the Florida case on our jobs? Stopping a tube feeding is fairly routine for hospice; do you think the new national attention will change that in any way?
I hope that if nothing else it raises awareness of the importance of having living wills or DPOA's in place before the need for them arises.

stopping a feeding tube is NOT routine in hospice, at least not the hospice that I work for. We are about comfort and symptom control. Tube feedings are "cut back" if the digestive system does not handle the amount of feeding that is going into the body, (thus causing vomiting, bloating or other painful symptoms) and discontinued as the digestive system shuts down . Remember, we are about COMFORT CARE.

allnurses Guide · Mar 25, 2005

stopping a feeding tube is NOT routine in hospice, at least not the hospice that I work for. We are about comfort and symptom control. Tube feedings are "cut back" if the digestive system does not handle the amount of feeding that is going into the body, (thus causing vomiting, bloating or other painful symptoms) and discontinued as the digestive system shuts down . Remember, we are about COMFORT CARE.

People are unfortunately confusing the Terri Schiavo case with Hospice for terminally ill people.

I really do hope this doesn't create a negative image for our wonderful Hospice program, nurses and docs.

steph

leslie :-D · Mar 25, 2005

stopping a feeding tube is NOT routine in hospice, at least not the hospice that I work for. We are about comfort and symptom control. Tube feedings are "cut back" if the digestive system does not handle the amount of feeding that is going into the body, (thus causing vomiting, bloating or other painful symptoms) and discontinued as the digestive system shuts down . Remember, we are about COMFORT CARE.

onethunder,

i think you must be referring to those hospice patients that have a few months left, re: not stopping a fdg tube.

but every single fdg tube pt i've had in hospice, it has caused them considerable discomfort, albeit they were pretty advanced in their illnesses.

stopping a fdg tube and the subsequent dehydration is NOT uncomfortable at all. contrary to what most people believe, tube fdgs cause more discomfort to the dying patient. as you already mentioned, you stop it when the gi system starts shutting down but in the meantime, there are other systems that are failing, still contributing to the discomfort of fdg tubes.

when you're body is in a half-starved state, your brain releases all these endorphins that actually act as an analgesic and makes the pt more comfortable. people seem to think it's a tortorous act. it's not. and this has nothing to do with terri's case at all.

i don't know what hospice you work at, but all of my patients usually go pretty quickly UNLESS i stopped a gtube fdg, then it seems to take forever.

thank God for roxanol.

but i've also had oncs that sent me pts stating they had a few months to live and they came with fdg tubes at 100cc/hr yet there were no bowel sounds, abd distended, vomiting and i'd end up aspirating hundreds of cc's worth of gastric contents and bile. :angryfire and i would have to tell the family that their loved one would probably pass within the next few days. this has happened to me a few times.....but i'm getting sidetracked. i guess my point is, when you receive your pt, it's mandatory you do a thorough head to toe assessment as wel as talking to them and sometimes reading between the lines.

leslie