There are 3 items, all lengthy, but worth the read, which explains how Terri came to her current position.
This is what we are up against, and what we are fighting in order to save Terri.
1) Last Acts' new mobilization
In view of Last Act's new mobilization (see article 1 with comments by Ron Panzer), it's important to know the background of it's leaders.
The decidedly right-to-die oriented agenda of Last Acts and
Partnership for Caring is steaming right ahead with conscious cooperation from all the hospices, hospice organizations and other members of the groups... working together to lobby for changes in the laws of our states
and the federal government, and work to change society's attitudes toward "choice" in dying to include assistance in dying, hastening death, as part of the end-of-life mission. The actions of these groups, while helping in
many ways to promote better end-of-life care, threaten to sabotage the very best of end-of-life care, because "aid in dying" (killing the patient) is incompatible with dedication to provide the very best care till a NATURAL
death occurs in its own timing! - Ron P]
[from LastActs.org]
LAST ACTS PARTNER CALL: HONORING OUR ACHIEVEMENTS, CHARTING OUR FUTURE TOGETHER
[excerpts only]
We are proud to announce the upcoming merger of Last Acts and Partnership for Caring. This new, national, nonprofit organization-Last Acts Partnership- presents many exciting opportunities for all its organizational partners. For example, Last Acts Partnership will engage in vigorous
advocacy efforts in which all partners can participate. Last Acts Partnership's power to promote social change will be vastly increased as it coordinates, assists, and mobilizes Last Acts' 1,200 national, state and local Partners; Rallying Points' 360 local and state coalitions; and Partnership for Caring's 20,000 individual members. Through Last Acts Partnership, these individuals, organizations, and coalitions are already forming a powerful voice working to improve how people die in our society.
Together, we are empowering and engaging consumers, informing medical and health professionals, and acting as advocates for quality end-of-life care through policy reform.
This organizational change comes after remarkable success in improving end-of-life care in America by Partnership for Caring and Last Acts, which has been the beneficiary of 6 years of support and grants from The Robert Wood Johnson Foundation (RWJF) and others. We have recruited stellar board members for Last Acts Partnership who can provide extraordinary substantive leadership and fund-raising acumen, and another RWJF grant is in process that will help Last Acts Partnership transition to "multiple funding
streams." But the new RWJF grant will not cover all the organization's costs. So, while Last Acts Partnership is working to streamline its operations AND maintain services and benefits to you, it also will be seeking funds from new sources. The biggest change for you will be in the need for Last Acts Partnership to ask for reasonable annual dues.
Every individual voice, every coalition, every partner organization is important in our ongoing efforts to improve care near the end-of-life.
We invite current Last Acts Partners and our collaborating organizations to learn more about Last Acts Partnership by joining us on December 11 for a conference call titled, "Last Acts Partners: Honoring our Achievements,
Charting Our Future Together." The call, which begins at 11:00 a.m. ET, will be hosted by Last Acts National Program Director Karen Kaplan, M.P.H., Sc.D.
Participants will learn more about the merger of these two organizations and hear from Last Acts Partnership leaders about the exciting new programs currently under development. In addition, two Last Acts Partners will
explain why their organizations have joined Last Acts Partnership as "founding" members.
To download a flyer and registration form, visit:
http://www.lastacts.org/files/resources/declaxpcall.pdf 2) 2001 article by Rita Marker gives background information about such groups and their funding.
http://www.philanthropyroundtable.org/magazines/2001/january/marker.html Dying for the Cause Foundation funding for the "right-to-die" movement
By Rita Marker
Few people realize the vital role private foundations play in promoting societal change. More often than not, major shifts in public attitudes and public policy come not from grassroots clamor but rather from the hard work of a committed few-activists with the ideas and the donors who fund them.
This is especially true for movements that begin with shallow popular appeal or in which much work is needed to change public attitudes. Without the money that is the mother's milk of public advocacy, those inspired to
agitate for change would not get very far.
The assisted suicide/euthanasia movement typifies this phenomenon. Often referred to euphemistically as the "right-to-die" or "death with dignity" movement, it seeks nothing less than legalization of mercy killing via a two-step process: the acceptance of assisted suicide and, later, a shift to active euthanasia.
Assisted suicide refers to a death in which the person who dies takes the final death-causing action after receiving assistance. For example, a doctor may intentionally prescribe a lethal dose of drugs and a family member may
mix it into pudding, but the patient performs the death-inducing act of swallowing. In euthanasia, someone other than the victim performs the final death-causing action, as when a doctor administers a lethal injection.
In 1995, the newsletter of a group called Choice in Dying listed seven organizations in a "Guide to Right-to-Die Organizations." At least four of them (Compassion in Dying, Death with Dignity Education Center, the Oregon Death with Dignity Legal Defense and Education Center, and Choice in Dying itself) have attracted funding from large foundations.
One such foundation is George Soros's Open Society Institute (OSI). The OSI, through its Project on Death in America, gives millions of dollars for enhancing end-of-life care and none of the Project's money is used for
assisted suicide purposes. But the OSI provides grants for assisted suicide advocacy through OSI's President's Fund in its U.S. Programs office.
OSI's stance also illustrates another aspect of support for the "right to die," namely, that funders generally see a great distinction between euthanasia and assisted suicide. As Gara LaMarche, director of U.S. programs for OSI, puts it, "We never use the word 'euthanasia' around here."
Creeping Respectability
What undermines this attempt is the fact that all of the major right-to-die organizations have their roots in attempts to legalize not only assisted suicide, but also euthanasia. Like Eliza Doolittle, they have become
respectable over time and no longer wear euthanasia advocacy on their sleeves.
Compassion in Dying was founded after the 1991 defeat of a Washington state initiative to legalize euthanasia and assisted suicide. The group's main purpose was to offer suicide assistance for "deserving cases." In a 1994
interview, the group's first executive director, Ralph Mero, described Compassion in Dying as an outgrowth of the Washington State Hemlock Society, which Mero had directed until taking over the helm of the new group.
As the first U.S. group publicly to admit offering assistance in committing suicide, the Hemlock spin-off was formed, in its own words, "to help terminal patients retain control over how their lives come to an end, including the option of hastening inevitable death." Compassion's actions,
again according to the group's own materials, include "ask[ing] the patient's own primary care physician to prescribe lethal quantities of barbiturates for those patients who have decided on intentional death." As detailed by Mero himself in a 1996 journal article, Compassion was involved in 24 deaths, all involving overdoses of prescription drugs, during its first 13 months of operation. The organization then clammed up and refused to divulge its involvement in subsequent deaths.
In the summer of 1996, Barbara Coombs Lee (who had been the chief petitioner for Measure 16, the 1994 ballot initiative that legalized assisted suicide in Oregon) left her position as vice president of a large Oregon managed
care company to take over the leadership of Compassion in Dying and moved the group's headquarters to Portland, Oregon.
Under Lee's leadership, Compassion in Dying unsuccessfully argued before the United States Supreme Court that assisted suicide is a constitutional right. The group is currently challenging Alaska's ban on assisted suicide before that state's highest court.
Foundation funding enabled Compassion in Dying to grow into a national organization, the Compassion in Dying Federation. The group received $100,000 from the OSI in 1997, more than $300,000 from the Gerbode Foundation during 1995-1999, a $300,000, three-year grant in 1998 from the
Columbia Foundation, and $50,000 from the Donald A. Pels Charitable Trust in the same year.
The Death with Dignity Education Center grew out of a failed 1992 California attempt to legalize "physician-aid-in-dying" (defined to include both assisted suicide and euthanasia). The unsuccessful campaign was headed by
attorney Michael White who, in 1994, became the Center's first president (the group is now headquartered in Washington D.C. under the name Death with Dignity National Center). With White in charge, the Center's purpose was to
support change in the health care system to allow for "physician aid-in-dying."
Funding for the Center has included grants from OSI ($100,000 in 1997), the Gerbode Foundation ($544,900 since 1996), the Columbia Foundation ($200,000 since 1998), and the Walter and Elise Haas Foundation ($57,500 during
1996-97). Other past support for the center has come from Donald A. Pels Charitable Trust ($50,000 in 2000), the Atkinson Foundation, the Women's Foundation, and Varian Associates (an electronics firm).
Oregon Right to Die (ORD) was formed in 1993 for the purpose of writing a right-to-die law for Oregon. Early drafts of the bill (which became Measure 16) included both euthanasia and assisted suicide, but proponents wanted to
avoid the specter of a syringe-wielding physician that had successfully scuttled similar proposals in Washington and California. They settled on an assisted-suicide-only version (the first proposal in the country to do so) and, in November of 1994, voters narrowly approved it. The law went into effect in late 1997.
As a result, Oregon doctors may deliberately prescribe drugs for the purpose of causing a patient's death. Remarkably, because it is now considered a medical treatment, Oregon Medicaid covers the cost of assisted suicide (at the same time that it rations some wanted, life-extending care).
Following Measure 16's passage, ORD leaders formed the Oregon Death with Dignity Legal Defense and Education Center to implement the new law and to defend if from legal challenges. Since its inception, combined foundation
grants to the Center from the Pels, Gerbode, and Columbia foundations and from the OSI have totaled more than $550,000.
Looking the Other Way
Some private foundations that fund assisted suicide groups prefer to distance themselves from the actual controversy, no matter how implausibly. William Stubing, president of the Greenwall Foundation, explains, remarkably enough, that Greenwall "takes no stand on any issues which it funds."
According to Stubing, Greenwall's mission is to bring out information about issues.
Still, following the passage of Oregon's Measure 16, Greenwall funded a project called "Support for the task force to improve care for the terminally ill" at Oregon Health Sciences University, which in turn published The Oregon Death with Dignity Act: A Guidebook for Health Care
Providers, a step-by-step guide on implementing the assisted suicide law.
Greenwall's grantees include a group called Choice in Dying (in 2000, Choice began "evolving into a new organization," called Partnership for Caring). Stubing takes issue with even referring to Choice in Dying as a right-to-die group, even though Choice is in fact the first and best-funded of all such groups. In recent years, Choice has received grants from a myriad of foundations, including the Nathan Cummings, Robert Wood Johnson, and the Fan Fox and Leslie R. Samuels Foundations.
The grants have been overwhelmingly for the purpose of advancing Choice's programs addressing patient decision-making and advance directives (an advance directive can be either a living will or a durable power of attorney for health care). According to Karen Orloff Kaplan, Choice's president and CEO, the organization has viewed itself as "an information broker-a broker of unbiased information about both sides" of issues.
The group's Winter 1999 newsletter states that, for the past 62 years, Choice in Dying and its predecessor organizations had "worked to achieve a 'good death' for all." But that work has not been without controversial
aspects.
Since its 1938 incorporation in New York State, the organization has filed several amendments to its articles of incorporation, but they have only reflected name changes-from the Euthanasia Society of America to Society for the Right to Die (1975), to National Council on Death and Dying (1991), and finally, to Choice in Dying (1992). The group has never amended its stated corporate purpose:
To disseminate information to the public by all lawful means of the nature, purpose, and need of euthanasia, and to foster its general adoption.
By the term "euthanasia" is to be understood the lawful termination of human life by painless means for the purpose of avoiding unnecessary suffering and under adequate safeguards.
In 1939, the organization proposed legislation which, its president told the New York Times, was intended eventually to legalize euthanasia for "born defectives who are doomed to remain defective, rather than for normal persons who have become miserable through incurable illness."
Painting with Softer Hues
On it's web site, in a section titled "A Historical perspective," Choice in Dying lists among its legal achievements the 1968 introduction of the first living will statute in Florida. That proposal-which was sponsored and
reintroduced over a period of five years by Representative Walter Sackett-provided for removal of care from severely retarded persons in state hospitals.
After the San Francisco Examiner reported Sackett's estimate that, with the bill's passage, "$5 billion could be saved over the next half century if the state's mongoloids were permitted merely to succumb to pneumonia," the National Association for Retarded Children passed a resolution vowing to oppose it and any similar legislation. Subsequent living will legislation was less inflammatory, and by the 1980s, Choice in Dying had shed the radical image of its founders and was firmly ensconced in the mainstream.
In 1989, however, with funding from a grant in memory of Joseph S. Kornfeld, Choice convened a group of physicians to pen a report that PBS's MacNeil/Lehrer News Hour called the "strongest public endorsement of doctor-assisted suicide ever published." The report, which appeared in the
New England Journal of Medicine, concluded that it is morally acceptable for doctors to give patients information about suicide and the necessary drugs to accomplish death. The article made front-page news across the country and
catapulted advocacy of assisted suicide into the realm of respectable debate.
At the time, Dr. Ronald Cranford, one of the report's 12 physician authors stated, "We broke new ground and we were very aware we were doing it. We felt it was an opportunity to make a statement that's very controversial and stand by it." He acknowledged that assisting suicide is "the same as killing the patient."
While Cranford was blunt in describing assisted suicide, five years later, Choice's Karen Kaplan was painting with softer hues. During a 1994 CNN interview following passage of Oregon's assisted suicide law, Kaplan described the law as simply a pain control measure. The law, she said, "really does limit physicians' intervention" and is only about "giving medication that will control pain at the end of life even though it may hasten death."
Misleading statements like the latter underscore the movement's fervent desire to appear mainstream, in part to avoid scaring off potential donors. The OSI's Gara LaMarche acknowledges that the donor base for right-to-die groups is small, and, to assist in expanding that base, OSI last year
convened a group of individual philanthropists and foundation officials to hear presentations by the directors of Compassion in Dying and the Death with Dignity Center.
Yet, far from reflecting any grassroots desire for "death with dignity," the major right-to-die organizations are well-funded, "top down" creations. And if they are successful in transforming the "right to die" into just another "medical treatment," these little-known nonprofit organizations will be in a position profoundly to affect everyone.
Rita Marker is executive director of the International Task Force on Euthanasia and Assisted Suicide. This article is the first in an occasional series on foundation involvement in end-of-life issues. The March-April issue of Philanthropy will contain an article by Dr. Kathleen Foley,
director of the Open Society Institute's Project on Death in America.
3) From Last Acts itself and gives short bios about its leaders-minus, of course, any euthanasia connections.
Unfortunately, note that one of the leaders is Sylvia McSkimming who is with an organization comprised of 15 Catholic health care organizations with a "combined presence in 49 states."
This is not to say that every one of these people is pro-assisted suicide but the background of Last Acts' CEO Karen Orloff Kaplan should be a concern, not to mention her recent editorial for Last Acts on Terri Schiavo
(online at:
http://www.lastacts.org/scripts/la_eln01.exe?FNC=SeeFeature__Ala_eln_features_html___5244) Nancy V.
This is from Last Acts itself:
KAREN ORLOFF KAPLAN, M.P.H., Sc.D.
President and Chief Executive Officer
Karen Orloff Kaplan, M.P.H., Sc.D., is the president and chief executive officer of Last Acts Partnership. She is a nationally known, experienced leader in the end-of-life care field with special expertise in health and aging issues, and in developing health and social policy.
Previously, Dr. Kaplan was the president and chief executive officer of Partnership for Caring: America's Voices for the Dying (PFC). She also served as the national program director for Last Acts, a communications campaign to improve end-of-life care sponsored by The Robert Wood Johnson Foundation.
Prior to her appointment as President and CEO of PFC, Dr. Kaplan served as Executive Director of Choice In Dying, Inc., a 60-year-old not-for-profit organization known for developing living wills and for its advocacy for people who are dying and for their loved ones. Before CID, she was the
founding Executive Director of the National Center for Social Policy and Practice, the research and policy arm of the 140,000-member National Association of Social Workers.
Dr. Kaplan also served as a health staff associate to Congressman Ron Wyden (D-Oregon). Dr. Kaplan advised the Congressman about health and social issues, particularly as they related to the elderly. Dr. Kaplan served as spokesperson for Representative Wyden with the Health Care Financing Administration (HCFA), the U.S. Public Health Service, the National Institutes of Health (NIH) and various Congressional committees.
Dr. Kaplan's work has also included spearheading a non-profit research and consulting group with projects that included health care cost containment, and inpatient utilization studies.
Dr. Kaplan's previous academic positions included posts as clinical instructor at Tufts University and the University of Cincinnati School of Medicine.
Dr. Kaplan received her Doctorate in Science and Masters in Public Health degrees from the School of Hygiene and Public Health, The Johns Hopkins University. She received her Masters in Social Work from Ohio State University.
Tom Koutsoumpas
Executive Vice President, Public Affairs
VITAS Healthcare Corporation
Tom Koutsoumpas brings more than 30 years of experience in government, public policy, politics, issues advocacy and public relations to his position as the Washington, D.C.-based head of public affairs for VITAS Healthcare Corporation, the nation's largest and one of the nation's oldest providers of end-of-life care.
Operating out of the office of the Chairman, Tom is an integral member of the senior executive management team directing the activities and operations of VITAS, which each day provides care for more than 7,900 terminally ill
patients in 24 metropolitan areas in eight states.
As Executive Vice President of Public Affairs, Tom specifically is responsible for public policy oversight at both the federal and state levels, corporate relations with trade and advocacy groups, public relations and communications, community relations, corporate philanthropy, and special events. He is well known for his advocacy and passion both for terminally ill patients, as well as for the physicians, nurses, nurses' aides, social
workers, chaplains and volunteers who care for the more than 800,000 patients who die each year in the care of America's 3,000 hospices.
Prior to joining VITAS, Tom served as a senior aide to then-Indiana Governor Evan Bayh. Prior to his work with Gov. Bayh, Tom was a member of the government relations division of the Washington law firm Hogan and Hartson, and earlier he helped develop the government relations division for one of the nation's leading public relations firms, Burson-Marsteller. Tom began his work in public policy serving in a variety of staff and legislative functions both in Washington and Indiana for U.S Senator Birch Bayh.
In March, 2003, Tom was named to the Board of Directors of the National Hospice and Palliative Care Organization (NHPCO). He also serves on several NHPCO committees, including the Public Policy Steering Committee.
In addition, Tom is the Chairman of the Board of Directors of the Last Acts Partnership; he is a member of the Business-Government Relations Council; he is executive vice president of the board of the Foundation for End-of-Life
Care; he is a member of Board of Trustees of the Florida House; and he is a former member of the Georgetown University Board of Regents,
Tom is a graduate of Georgetown University in Washington, D.C. He and his wife, Carrie, reside in Chevy Chase, Maryland, with their two sons. November, 2003
Sylvia McSkimming, PhD, MBA, RN, CNAA
Executive Director
Supportive Care of the Dying
Coalition for Compassionate Care (Est. 1994)
Sylvia McSkimming is Executive Director of Supportive Care of the Dying: A Coalition for Compassionate Care (The Coalition). This non-profit organization is comprised of 15 Catholic health care organizations dedicated to transforming end-of-life care in this country. The Coalition's members have a combined presence in 49 states. She was principal investigator of the Coalition's national focus group research study "Living and Healing During Life-Threatening Illness" (1996), which has served as the roadmap for the Coalition. Under her leadership, the Coalition has initiated additional research and development projects affecting end-of-life care delivery. The Coalition's Organizational Assessment Tools (1999) for measuring end-of-life care delivery are now in use nationally and internationally. The CALL Care Project, supported by a grant from The Robert Wood Johnson Foundation, is developing models at 12 sites nationwide for improving continuity of care across the spectrum of end-of-life services. Other Coalition sponsored projects have investigated strategies for addressing the spiritual,
relational and emotional needs of persons with life-threatening illness and of caregivers and have addressed methods for using existing community resources to support persons with life threatening illness.
Sylvia has led the Coalition's work in knowledge transfer. She served as principal planner for a national conference focusing on understanding cultural context as we design and deliver end-of-life care (Recovering Our Traditions . . . A Catholic Perspective on End-of-Life Care, Tucson, Arizona, 2002). In addition to expanding use of the Coalition's newsletter for knowledge transfer, she fostered development of the Coalition's web site www.careofdying.org.
Sylvia lectures frequently and has published in Journal of Palliative Medicine; American Journal of Hospice and Palliative Care; Western Journal of Nursing Research; Journal of Shared Governance; and Health Progress. She
is a member of the Last Acts and Rallying Points national advisory committees and has served as an evaluation consultant with The Robert Wood Johnson Foundation's Community-State Partnership initiative. Sylvia is
involved in a variety of professional associations including the International Association for Human Caring (Corresponding Secretary and member, Board of Directors), National Hospice and Palliative Care Organization, and Sigma Theta Tau (Past President, Beta Psi Chapter).
Prior to her current position Sylvia has held a variety of clinical, administrative, consulting, and faculty positions. She holds a PhD in Family Studies from Oregon State University, a MN from Oregon Health Sciences
University School of Nursing (focus on care of children and families with developmental disabilities and life threatening illnesses), and an MBA from Marylhurst College. She also earned post-doctorate certification in
Clinical Health Care Ethics at the University of Washington.
JUDITH R. PERES, LCSW-C
Vice President, Policy
Judith R. Peres serves as the vice president, policy advocacy at Last Acts Partnership. She is responsible for developing and executing the organization's strategy on national policy issues relating to care at the end of life. She has a proven track record in building collaborative
relationships and coalitions, and she is knowledgeable about and well-respected by the healthcare community.
Ms. Peres joined the Last Acts National Program Office in July 2001. As the deputy director of National Program Office for Last Acts, she provided the on-going, day-to-day management and guidance for the more than 31 members of
the communications team. She also helped guide Rallying Points, Last Acts' newest initiative designed to help community coalitions continue their efforts to improve care and caring near the end of life.
Her career spans three decades in both health policy and direct clinical work. Prior to her appointment as deputy director, Ms. Peres served as
director of health policy for the American Association of Homes and Services for the Aging, specializing in quality, reimbursement, and workforce issues. Her clinical practice includes employee assistance program work for the
Shepherd Pratt Institute in Baltimore, Maryland. In addition, she was a practicing psychotherapist for Kaiser Permanente with a specialty in cognitive behavioral therapy. She has counseled numerous individuals and
families dealing with loss and death.
Ms. Peres has held the position of director of health policy for the Villers Foundation (currently Families USA). She also has a distinguished career in Medicare and Medicare reimbursement and financing policy for the US
Department of Health and Human Services.
Ms. Peres has a Masters in Social Work from the University of Maryland and additional training at the Mind Body Institute in Washington, DC and Rational Emotive Behavioral Therapy at the Albert Ellis Institute in New York.
MARY L. MEYER
Vice President, Consumer and Constituent Services
Mary L. Meyer brings to Last Acts Partnership (LAXP) special expertise in developing education programs and materials for consumers concerning end-of-life issues. She is also serving as the program director of the National Consensus Project for Quality Palliative Care, a consortium of organizations working to create consensus clinical guidelines for excellent palliative care.
Ms. Meyer gained her expertise through her involvement, beginning in 1988, with the predecessor organizations of LAXP. These grass-roots organizations actively worked to secure recognition for the rights of individuals to
control their own medical treatment, pioneered the development of living wills and created the first national hot-line to enable consumers to receive accurate and independent information regarding their rights to consent to or refuse treatment. Ms. Meyer has produced education materials for the public and professionals including a manual for institutional caregivers to aid them in complying with the public education requirements of the Patient Self-Determination Act and several award winning question and answer booklets on end-of-life care. She has also served as the editor of the organizations' newsletters.
To further the public education goals of the organization, Ms. Meyer has developed training programs for volunteer speakers to provide community based-education about advance directives, as well as a special outreach program to New York City's Latino community. She participated in curriculum
development for programs on pain management and end-of-life decision making for nurses, and for corporate employee assistance personnel developing policies and programs for the workplace.
Ms. Meyer recently served as the co-principal investigator for a Robert Wood Johnson Foundation funded research project to explore patients' and their health care agents' understanding about the role of health care agents and
needs they might have to help them fulfill this difficult role effectively. She also served as the program administrator for a project to improve the quality of education in medical schools funded by the Greenwall Foundation. Ms. Meyer has made many presentations to lay and professional audiences about issues concerning care at the end of life.
Ms. Meyer is a founding member and secretary of the board of directors of the New York Citizens' Committee on Health Care Decisions. She also has served as a consultant to The Langeloth Foundation; a New York based family awarding giving grants in the areas of convalescence, rehabilitation and recovery. She received her Bachelor of Arts degree in Political Science from the University of California, Santa Barbara.
This is who has held Terri hostage, along with county, state and govn't officials who support these people and their project of euthanasia.
http://biz.yahoo.com/prnews/031205/laf025_1.html Who's in? Who has the dedication to stay the course on this?
Email from Cheryl:
I wrote the following back when Terri's tube was pulled. I am sending it on again as a reminder to the issues at hand and to remind everyone if they have not written their Advance Directives, to take the time to do so now. Feel free to post or forward on as you desire.
Cheryl
Fight4Terri@aol.com I am a Registered Nurse with 25 years of medical training.
I voice my opinion from viewing similar patient situations as Mrs. Schiavo's. I've also been involved in several seminars and discussions surrounding ethical questions related to those proposed in Mrs. Schiavo's legal debate.
In my professional and personal opinion, it is too late for Mr. Schiavo to be requesting a feeding tube be removed from his wife. In all the years of my nursing experience, our protocol was very clear, and as follows:
1. In the acute phases of a patient's trauma, should a patient present with a legal living will and DNR (DO NOT RESUSCITATE) declaring that if in the event of trauma, where they were suddenly physically and or mentally incapacitated; not capable of making decisions for themselves with regard to life support issues, i.e. ventilators, gastrointestinal and nasogastric feeding tubes, Total Parenteral Nutrition via intravenous feedings, etc., and had indicated that they wanted no medical intervention whatsoever, the patient was then allowed to die in accordance to their wishes and without ANY medical intervention.
2. However, if there was not a legally written DNR, living will, or durable power of attorney present to indicate the patient's wishes;
the patient was then declared a Full Code and all medical interventions were taken at the time to ensure life support measures. All implemented in an effort to maintain the patient's life. This included, intravenous infusions, tube feedings, ventilators, etc.
Prior to enacting the necessary life support measures, we did not sit around with each other, or with the patient's family, discussing or debating what we "thought" the patient's "quality of life" was at the time.
Or, what we "thought" it was going to be in the future.
Or furthermore, if any of us thought that because the patient's quality of life was acceptable, or not, we then had the right to declare them a code, or no code, providing them with life support measures, or not.
The FACT is, and was,.... if they did not have the appropriate paperwork to declare what their wishes were at time of admission, then all other discussions, and or assumptions, were a moot issue.
No where in all of my 25 years in the medical profession has any family member, friend, adinistrator, lawyer, health care professional, etc., been allowed to determine that after so many years of a patient successfully sustained life via tubes of any kind, and who had maintained the same status over those years, could anyone suddenly walk into a facility and make a random decision without justification, that the patient was not worthy of such intervention any longer. To then request that the tubes be discontinued.
If, on the other hand, the patient began showing a rapid decline in health, clearly showing no signs of improvement, and or ability to be maintained at the same palliative level of care, then the DPOA or next of kin could open a legal case requesting that extraordinary life support measures be discontinued.
However, I've seldom seen that happen. I think mainly because if the patient suddenly had a change in status and began a rapid decline, their life usually ended in a relatively short time, and on their own.
I reiterate, because Terri Schiavo is no longer in the acute phases of her trauma and it is apparent that when her trauma had occurred she did not have a written, legal DNR or living will indicating what her choices were in the event of such a situation (verbal hear say via spouses, friends were not admissable).........should anyone now be allowed to suddenly come along and decide that it is time to terminate her, or anyone's life for that matter.
Dr. Kvorkian spends time in prison for assisting in voluntary suicide.
The irony in this particular case is....Mrs. Schiavo isn't even allowed to verbally volunteer her own suicide. Therefore, removing Mrs. Schiavo's tube feedings at this point in her life...in my nursing opinion, would
be no different from Mr. Schiavo insisting on legal assistance to enact upon a form of homicide.
The laws up until this situation were pretty clear and without question.
If Mr. Schiavo is allowed to do this at this time.....I question how many
other patients who are now residing in nursing homes and who have been successfully nourished via feeding tubes will suddenly have family members appear demanding removal of them. I think that the legal system needs to remain in the courtrooms and leave the ethically and legally clear DNR/living will protocols alone. Up until now, there has never been a question as to how, when, or on who, medical intervention would, or would not, be initiated.
Mrs. Schiavo's situation should be a good lesson for people of all ages to:
1. Recognize the importance of appointing themselves a DPOA (Durable power
of attorney) who clearly understands and has access to the necessary paperwork to substantiate their wishes in the event of such circumstances.
2. Have a legal Living Will and DNR written. Maintain the papers in a safe place where a family member could access them. It is also a good idea to provide a copy to your family physician.
At the very least, Michael Schiavo and the judge have violated Terri's "Patient's Rights." Terri deserves a swallow evaluation to see if she indeed can consume any form of nutrition on her own. If you take the time to read the affidavits from her previous caregivers, prior to removing her tube, they had been slipping her Jell-O, sips of juice, ice chips (without Michael's knowledge) and she managed to swallow.
Michael NOR the obvious demented judge has the right to disregard or violate Terri's patients rights. And this is exactly what they are doing!!!
It is SAD! For a supposedly intelligent nation, we sure have a lot of apathy in this country. We allow things like this to happen, DO NOTHING about it..and then wonder how it happened to us when we find ourselves in such predicaments. One cannot help but wonder why thousands were led into gas chambers and no one did anything to stop it!
Americans become proactive when you know something is blatantly wrong! You will never know when a situation like Terri's may be in your lap.
This is not a matter of your feelings as to whether you agree, or disagree, with her quality of life. It is a matter of advanced directives, patient rights and laws that are being broken and violated by a judge and a crazed spouse who obviously has some ulterior motive other than what he states his wife supposedly wanted.
If Michael truly believed Terri had wanted this...... then why did he allow them several years ago to place the tube in her???
He indeed had to sign a pre-op consent to allow the tube to be placed.
Why didn't he adamently voice his opinion back then about what Terri's wishes were????? Perhaps, because he at that time needed her for evidence until the court case was settled!
Does it not seem peculiar that he motioned the court to remove her tube several days after he won a 1.2 million dollar settlement?????
I have written the Governor, the judge...and various forums. We must unite and find a way to over rule the judge. He is not GOD!
Geesh!
Cheryl F. RN
Former EMT & Paramedic