Skip to comments.Expert: Schiavo's feeding tube likely to be removed
Posted on 01/14/2005 8:55:14 AM PST by BykrBayb
The Terri Schiavo Case Expert: Schiavo's feeding tube likely to be removed A noted bioethicist says courts will ultimately side with Terri Schiavo's husband and remove it. By LISA GREENE, Times Staff Writer Published January 14, 2005
TAMPA - The law is clear on what should happen to Terri Schiavo, a noted bioethicist said Thursday: Her feeding tube should be removed.
Arthur Caplan, a bioethicist and author, predicted the tube that has kept Schiavo alive for 14 years will be taken out by the end of the year.
"That is what the courts ultimately will go to," Caplan said. "I know what they're going to decide."
Caplan said he sympathizes with the family, and that both Schiavo's parents, Bob and Mary Schindler, and her husband, Michael Schiavo, seem to be acting with "loving motives."
"This is a bad case in the sense that you have a family torn apart," Caplan said.
Still, Caplan said, courts have consistently ruled loved ones can act as surrogates in such cases, and say what a person who can't respond would have wanted.
Those decisions also have spelled out an order in which family members are called upon: spouse, parents, siblings, other relatives.
In other words, Terri Schiavo's husband, Michael Schiavo, who says she would want the tube removed, takes precedence over her parents, who want it to stay.
The case shows the importance for everyone, young and old, to put their wishes in writing, Caplan said. People should say what treatment they would want, or who they would want to make such decisions if they no longer were able.
"If you don't like your spouse, parents, siblings or other relatives," he said jokingly, "you better write that down."
Caplan is director of the Center for Bioethics at the University of Pennsylvania, author of several books and a regular commentator on questions involving medical ethics.
In Thursday's presentation, sponsored by the University of South Florida Health Sciences Center and Tampa General Hospital, Caplan also predicted that the debate over how Americans die will shift ground over the next few years.
Before long, Caplan said, people will find themselves fighting doctors and hospitals not for the right to refuse costly medical interventions and die quietly, but for the right to receive them even when doctors think it would do little to prolong their lives.
"The next round of court cases is going to be hospitals coming in and saying, "She's 87 (and gravely ill) and you can't order us to treat.' ... I think we're going to see them flip to the other side."
Fears that hospitals and health insurers may prefer not to treat is part of the reason that the Schiavo case has become so controversial, Caplan said.
Past cases drew controversy because people feared hospitals' refusal to stop treatment, but he believes people's views have shifted.
"There's a tremendous fear of undertreatment," he said. "The cultural attitudes have changed."
Caplan laid out a history of the laws governing the right to die. As recently as the 1950s, doctors' decisions were absolute: they treated patients. Among the first to challenge such treatment were Jehovah's Witnesses, who do not believe in blood transfusions.
Gradually, that right to refuse treatment expanded until people could refuse any treatment for any reason. A series of court cases, however, limited parents' ability to refuse treatment for their children.
In 1976, Karen Ann Quinlan became the center of a right-to-life fight after her parents asked the hospital to remove her ventilator. The hospital refused. Eventually, courts ruled in favor of the parents, although Quinlan lived for several years after the ventilator was removed.
[Last modified January 14, 2005, 00:30:19]
Not good prediction from "expert"
This "expert" is either an idiot or has a death agenda. No honest and reasonable person could attribute "loving motives" to Michael Schiavo.
I've noticed the ethicists always are lacking in ethics. He claims to be an expert, but he obviously hasn't reviewed the case. His prediction for the future of ethics is pretty scary though. I hope that's not where his expertise lies, but I bet it is.
This was quite a remarkable case because of the legal and moral intricacies of the parents' argument. What should be noted from that case is that in involved the removal of the patient from a ventilator -- and the parents did not pursue their case further by demanding to have Karen's feeding tube removed. She lived for nearly ten years after being taken off the ventilator.
It would seem to me that the feeding tube option is not to provide any relief to the patient but rather relief to the caregiver since they could rationalize that their action was not the direct cause of death. Ethically, isn't that rationalization false? Isn't it a complete reversal of the Hippocratic Oath?
Too bad a Senator didn't ask the torture experts about withholding feeding and hydration during the AG hearings. That would have been enlightening. Maybe the solution is to transfer Terri to Abu Grab Prison for her protection - she would have more rights as a prisoner than she does now as a patient.
So who's going for the murder indictment? The Attorney General?
In those days, feeding a disabled patient wasn't equated with feeding a dead horse. The times they are a changin'. And just in time for the baby boomers, who would be a big drain on society in a few years if we don't come up with a solution. The Final Solution sounds pretty good to ethicists?
I figured you'd have decoded "ethics expert" to meaning nuancing your way to rationalizing anything and everything.
BykrBayb's Dictionary of Then to Now translations.
Then: Doing the right thing.
Now: The science of discerning what you can and cannot get away with.
He's a 'bio-ethicist', meaning he has none.
The "expert bioethicist", is, in fact, extremely confused on the whole issue.
In the article linked below, he expresses his views in a clumsy manner not expected from anyone beyond the 8th grade level of education. The hysterical headline of the article, "Must we all die with a feeding tube?", sets the stage. The fact that this man is an esteemed professor at one of the finest universities in America does not bode well for the future.
Schiavo is not acting in Terri's best interests. His agenda is to be rid of Terri so that he get on with his new life. There must be some insurance money which precludes other options. Terry's family is acting in Terri's interests. This court is corrupt.
We are free to consider that the Pope may be right and that the 'powerful social consensus' that he propounds may in fact be powerfully wrong. Wouldn't be the first time our nation was headed in the wrong direction on an issue.
See my post #11. I think this guy is an expert in "Ethics Now." He doesn't know the difference between right and wrong, but he has a pretty good handle on what he can get away with. In his article that you you linked to, he doesn't distinguish between a patient's right to refuse medical treatment, and a relatives right to deny them that treatment. He claims that ever since the Cruzan case, Americans have all agreed food and water is a medical treatment that should be withheld. Everyone in the field of medicine, and everyone in the field of law agree. No mention of the patients. No mention of all those in the fields of medicine and law who don't agree. No mention of the fact that even prior to the Pope's statement, most Catholics (most everyone else too) believed suicide and murder were wrong. He says that autonomy means that if you can't express your wishes, your relatives should have the right to impose their wishes on you, and that makes you autonomous. He's an idiot!
After all, the result of either action is the desired death of the subject, right?
Actually, no. Death does not have to be the "desire" for the feeding tube removal. My DNR/DNI order doesn't mean I have a desire for death; it just indicates my preferences. In this case, the legislative process prevents any way to achieve a less-traumatic deliverance, even if we had clear indication that's what Mrs. Schiavo would have wanted.
I can only pray my preferences are respected. Frankly, I think it's as unethical to ndisrespect a person's wishes as it is to remove a feeding tube and have a person die of dehydration. I suppose I can also hope I have a compassionate physcian or other medical personnel who could slip in some morphine if it came to tube removal.
Even that part of marriage was disrespected years ago, when her parents were allowed to interfere (and I don't think there's any killing going on here...I think there's just a removal of the food and hydration tubes--i.e., no longer keeping her body alive, not killing it off.
Perhaps Mr. Schiavo feels, like many people do, that Mrs. Schiavo was gone long ago. I don't know.
The expert is a pro-death advocate.
To compare Karen Quinlan to Terri is improper and misleading by design. Quinlan was on a ventilator and Terri BREATHES ON HER OWN. She's not hooked up to machines, except when nutrition and hydration is being delivered.
If Terri wasn't held hostage (caged) in one room, she could be enjoying the lovely grounds at the Hospice facility that she doesn't even BELONG IN.
ALL SICKENING AND CRIMINAL BEYOND COMPREHENSION. Michael Schiavo refuses to repair TERRI'S WHEELCHAIR even though as the guardian, he is supposed to "take care of the ward". That wheelchair's been broken for a number of years.
TERRI IS INDEED A HOSTAGE-PRISONER.
I wish I knew if there was someone in the UNITED STATES with a backbone who would arrest the perps. I'm still looking.
I hope the US Supreme Court accepts Jeb's appeal or Jeb may not have any fight left in him to keep helping Terri.
It's so frustrating that they've attempted to murder her twice and they want to go for three. Knowing there's a murder that could be prevented but law enforcement has their orders from the judges doesn't help Terri. THE BIG FIX. Yes, it is.
FIGHT FOR LIFE - Terri Schindler Schiavo is shown here with her mother, Mary Schindler. (CNS)
Terri's 'Exit Protocol'
On Oct. 27, 2003, Michael Schiavo, the husband of the cognitively disabled Florida woman, Terri Schindler-Schiavo, appeared on Larry King Live to explain why he was fighting so hard to remove his wifes feeding tube.
His appearance was only days after the Florida legislature intervened to have Terris feeding tube reinserted for the second time in two years.
Michael Schiavo insisted that he wanted to help his wife die with dignity. He told King: Its painless, and probably the most natural way to die. It is a very easy way to die probably the second best way to die, the first being an aneurysm
At the same time he was speaking on national television, Terris medical file contained a document prescribing for her a slow and painful death by starvation and dehydration.
Called an Exit Protocol; the document contains explicit instructions for how Terri will be treated during the grisly series of events that will occur should the courts decide to withdraw her feeding tube. Terris fate remains an active issue in both the Florida state and U.S. federal courts.
The nurse who discovered the Exit Protocol, Cheryl Ford, R.N., a Tampa nurse, was reviewing Terris medical file at the request of the Schindler family when she found the document. For the benefit of our readers, Ford agreed to explain this document in detail. [Editors note: The protocol, in bold print, is followed by Fords comments.]
Patient Care NotesThe Hospice of Florida Suncoast 4/19/01 Clinical Pharmacy Re: Medication review and symptom management. The patient is a 37-year-old woman in a vegetative state with no apparent signs of distress. Enteral tube-feeding to be discontinued on 4/20/01.
This is a very critical piece of information from a nurses point of view; Ford said. We have a patient with no apparent signs of distress, yet enteral tube feeding is going to be discontinued on 4/20/01. This is murder. And its premeditated murder, because look at the dates notes were prepared the day before the tube was supposed to be withdrawn
What would make the death more difficult is that Terri is a healthy woman, weighing approximately 138.5 pounds, which means she will endure longer than other patients who are in the midst of a natural-death process.
I was an oncology (cancer) nurse; Ford said. These people are very weak and gaunt. Their bodies are already shutting down, and their tube feedings are withdrawn when their body systems can no longer handle it. But Terri is not a cancer patient thats what bothers me. Shes a healthy young woman
Upon discontinuation of enteral feeding the following signs/symptoms may or may not occur. The following is a brief list of symptoms for which to monitor and recommended interventions.
Monitor symptoms of pain/discomfort. If noted, medicate with Naproxen rectal suppository 375 mg. Q8 prn [Q8 prn; means eight times a day as needed].
If someone in a persistent vegetative state cannot feel pain, as Michael Schiavo and his attorney, George Felos, have consistently told the world, why do Terris charts tell nurses how to treat her for pain?
According to Ford, that is because Terri can and will feel pain during this process and a lot of it.
Think about what hunger pains are like if you havent eaten in a while; Ford said. You start to get that gnawing feeling, almost a burning in your stomach. Most people dont extend themselves into the depths of hunger. They grab a cracker or bread if theyre out shopping for a while just to make themselves feel better
Terri would not have this option, however. Within several hours, shell start to feel this kind of hunger pain; Ford said.
Dehydration would only add to the discomfort: When she starts going into the dehydration stage, her metabolism will start to change. Her electrolytes will get imbalanced. Shes going to get uncomfortable and will start to writhe.
Advance a couple days without food or water. Now her mouth is parched, her lips, her gums, her tongue will start to crack and bleed. The nasal cavities will start to dry, crack and bleed. The stomach will get dry and shrink, causing vomiting and heaving; Ford said.
(a) Inability to clear secretions reposition and swab mouth, consider scopolamine patch behind ear every 3 days.
When you first go into dehydration, your body will automatically compensate by making saliva. But when she gets into the stage where the stomach shrinks and nausea begins, theyre going to stick a patch behind her ear for the nausea. What the patch also does is dehydrate you by taking away this fluid
(b) Dyspnea nebulize low dose 2-5 mg. Morphine sulfate Q4 prn [four times a day as needed].
Dyspnea is when you have difficulty breathing. What theyre going to do is use a nebulizer the way you might use for asthmatics only instead of giving a histamine to help her breathe, theyre going to give Terri morphine sulfate, which only suppresses respiration more. In the later phases shell start gasping for air
In seven to nine days, as most of her body fluids are lost, her blood pressure will go down and her heart rate will rise. The blood will be shunted to the central part of the body from the periphery of the body, so that usually two to three days prior to death, the hands and feet become extremely cold. They become mottled and have a bluish appearance. The eyes will become so dry the patient cant move them anymore because there will be fluid in them.
Multifocal myoclonus or terminal agitation [sometimes caused by electrolyte imbalance]. Consider diazepam rectal administration 5-10 mg. May repeat in 4 hours if not resolved then daily twice daily as needed.
Multifocal myoclonus means seizures taking place in various parts of the body. Because of the electrolyte imbalance, Terri will begin to have seizures; Ford said. Shell start to twitch. You dont see this in an oncology patient because theyre already dehydrated. Even the elderly, who are going into the natural process of death, their bodies are doing what God created them to do slow down.
Our job as health-care professionals at this point is to understand the death process and to oblige the process God has given these people to help them in comfort measures palliative care not to enhance death. But Terris not terminal; Ford said. What theyre doing here is starving a healthy person to death. This is the only reason why shell go into multifocal myoclonus
Grand Mal seizure, which is highly unlikely given current conditions and lack of contributing factors (meds) [medication]. Recommend diazepam 15 mg. rectally as indicated in seizure management orders.
If she happens to make it into a grand mal seizure, they will give her 15 mg. of valium. … The valium wont make this easier, it will just help to bring her to death faster, because she wont have the ability to fight her way out of it; Ford said. Her body will not be in good shape at this point. You wouldnt look at her and say she was comfortable. Shes been without food and water for a long time. Shes pretty much withered, her skin is broken down, her metabolism is broken down, her kidneys havent received anything. Her body is reacting to the lack of food
At this point, death is imminent.
During the Oct. 2003 tube withdrawal, Ford saw Terri before the process began.
They started off by dressing her in wool sweaters and long pants, then wrapped her in a wool blanket to ‘sweat her out to make her deyhdrate faster; Ford said. She was horrified, especially because it was only October and its still hot in Florida in October.
This is not a painless or dignified way to die; Ford said. Its against the law to dehydrate and starve to death a prisoner on death row. Why should we allow it to be done to a disabled woman or anybody?;
The cruelty Ford has seen Terri endure is not even believable; she said. In this case, Dr. Kevorkian would be more humane than what they intend to do to Terri
Often disguised by the name "mercy killing," euthanasia also is a form of homicide. No person has a right to take his own life, and no one has the right to take the life of any innocent person.
In euthanasia, the ill or elderly are killed, by action or omission, out of a misplaced sense of compassion, but true compassion cannot include intentionally doing something intrinsically evil to another person (cf. EV 73).
EV John Paul II, Evangelium Vitae (The Gospel of Life)
Voter's Guide for Serious Catholics
Catholic Ping - please freepmail me if you want on/off this list
This is one big CROCK of CRAP!
This expert does not know MUCH about the history of Terri's case...let's inform him...if he has not been paid by Felos to write that crap, or is NOT a FRIEND of Felos, doing as a favor,,,,,we will turn him around pronto.
Unless he, too, is missing a heart.
Terri ping! If anyone would like to be added to or removed from my Terri ping list, please let me know here or by FReepmail.
I've had it with the cavalier attitude toward the disabled and FORCED EXITS ARE ILLEGAL BUT FOR SOME REASON, JUDGES IN FLORIDA ARE MESMERIZED BY THE PROPOSITION OF OPENING THE FLOODGATES TO KILL INNOCENTS WHO ARE NOT DYING OR IN A DISEASE PROCESS...
EVERYONE SHOULD READ TERRI'S ACTUAL EXIT PROTOCOLS at your 26. They take away her nutrition and water, put her in a turtleneck and warm blankets to sweat all fluids out of her, then they TURN DOWN THE A/C so she'll get pneumonia while they are STARVING HER. Then they DRUG HER. I encourage folks to read the entire post at 26.
Seems to me that studying 'ethics' is a poor substitute for having a religious foundational lens for looking at life. Like, 'If you don't know what you believe, be an 'ethicist' and you can make it up as you go along.'
Maybe he meant when hino is DOING HIS CONCUBINE. That's as close to love as hino can get. Oops, that's ANOTHER WOMAN! AND TWO ILLEGITIMATE CHILDREN TO BOOT!!! No problem. He can be STILL Terri's guardian because he's such a good guy. Like when Michael said "When's the bitch gonna die?" what a loving thing to say about your wife.
HORSEPUCKY!!! The Sixth Circuit Judges are OUTTA CONTROL AND THEY ARE NOT HELD ACCOUNTABLE!!! That's why Terri needs freeper help. Join: firstname.lastname@example.org.
You don't need a heart if you are equipped with horns and a tail.
That seems to be the rule.
I disagree with this "bioethicist". The law is clear. But it doesn't say that Terri's feeding tube should be removed. It says that IF Terri was PVS (which she isn't because she shows response), they could proceed with removing her feeding tube in the absence of a living will or advance directive. The point of a living will or advance directive is that the person is supposed to have "informed consent" of the consequences of their decision.
In this case, Terri could never have given informed consent, EVEN IF she did say that she didn't want to be "hooked up to tubes". IF she uttered these words sometime in the years before her collapse, she couldn't have meant she didn't desire food and water to be delivered, because that was not legal at the time. How could she give informed consent to a law that wasn't yet law until nine years AFTER her collapse? If Terri didn't want tubes or anything, why did Michael allow them to insert a PEG tube whereby she would be administered food and water? Didn't he respect her decision then? Oh wait, there was no malpractice money awarded at that time! He only remembered this "wish" of hers EIGHT YEARS after she collapsed!
Need I remind people that Terri lives and breathes on her own? Every day she lives because it is her will to live! Her body is her BEST evidence of her strong desire to live! If Terri really wanted to die, she would have gone by now, because she has had many life-threatening infections in just the last couple of years alone! Yet, she's still here!
"I know what they're going to decide."
Only God knows the outcome .... Dear Lord, please continue blessing Terri with undeterred, unshakable LIFE. Please bless her family with the strength required to successfuly complete this test of love, patience, and Christian and family love. Amen.
This is spurious, since there are many people who have tried to die by will alone and have been unsuccessful. The body will try to function as a biological machine, even if the will and the mind are gone, so we can't draw conclusions from that.
Note that Terri's law would have REQURED her to be PVS to be applicable.
I think you pointed out the good point that Mr. Schiavo and his actions should be investigated more, rather than try to just pit parents versus husband.
The description of her death from starvation and dehydration is unbelievable. Better she be given an overdose of narcotics :-(
I hope and pray that there is a way for Terri to be saved.
I NEVER like that the baseball team here was named the DEVIL RAYS. And, fyi, they play like hell too. lol
This is murder. Nobody in the court believes this.
Took a science & ethics class in college. Wound up learning that airplanes, rockets, and missles are sexist because they're phallic symbols.
The judges have permitted the guardian so called husband to violate 363 guardian laws. The question then becomes, how many guardianship and criminal laws have the judges broken?
EXCEPT FOR GOVERNOR BUSH TRYING TO, no one will investigate but THE FLORIDA SUPREME COURT WILL NOT ALLOW GOVERNOR BUSH TO CONDUCT AN INVESTIGATION. That is what this needs, an investigation with witnesses and evidence gathering.
The Judiciary in Florida believes they are omnipotent.
She can breathe on her own and I repeat, Terri is "not hooked up to machines." (I know you know, OFF, but it needs to be stated over and over).
My mom, who suffered from advanced Alzheimers and dementia, decided one day that it was time for her to be with my dad. Except for her mental condition, she was as healthy as a horse. He passed away in 1996, and it facillitated her rapid decline. Within 2 weeks she was dead from respiritory failure. I went from the hospital directly to the care facility to personally tell her care givers. That's when I was told about her wanting to "go". Only God knows the hour and the day. She passed on my dad's birthday.
Michael Schiavo continues to conspire, with the court's blessings, to commit murder.
If the local judges don't wait for the US Supreme Court, Terri's in danger every single day.
"Bioethicist" is the modern word for proponents of eugenics. These people follow in the bootprints of the Nazis, deciding who shall live and euthanizing anyone they deem defective. Their grasp of ethics is the same as that of Dr. Mengele.
Michael Schiavo wore a dress on the street in front of Hospice the day they pulled her feeding tube. He made an ugly woman. He was "hurt" by the signs that said he was a murderer. Well, we also called Judge Greer a murderer and Hospice Auschwitz. WE DIDN'T SINGLE OUT ANY SPECIFIC PERPETRATOR OF THESE CRIMES.
So sorry his little feelings were hurt while Hospice was inside starving Terri for him.
AND THESE FAMOUS WORDS FROM JUDGE GREER: "I don't want anyone feeding that girl." Or this from the Police Dept. "Hospice is worried that YOU ARE GOING TO KILL THE GRASS."
"May Michael Schiavo burn in Hell...right next to Judge Greer" BTTT.
Hospice offered to have their FAKE NEW AGE minister fake it. Monsignor said "no thanks." He came outside and HELD A PRESS CONFERENCE that he wasn't permitted to administer Holy Communion BY AN OFFICE OF THE LAW.
See why we are always asking people to join Terri's Fight? This is America's Fight. The Email Address is: email@example.com
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