blog.bioethics.net

The woman could swallow. Or at least she could last week, before she was purposefully dehydrated.
The tube did not need to be pulled. They could have simply stopped using it. They could have been giving her ice chips, liquids and sips of liquids all along, too.
For those who don't know, each of us makes 1-2 quarts of saliva a day and 1-2 quarts of nasal solutions. Terri Schiavo has swallowed these liguids - one of the hardest things to swallow if there is a disorganization of the reflexes at all - all along. Otherwise, she'd have drowned or died of aspiration pneumonia by now.
The tube was for efficiency of intake of calories and the convenience of the
staff and caretakers.
Y'all suppose the Vatican would okay pinching the nostrils of women when they[re extubate them so they won't get oxygen?

- by Beverly Nuckols, MD on Mar 25, 2005 at 1:17 AM | link

Beverly, please don't worry. A Jesuit is no more Catholic than Art is. And this Jesuit's reasoning is every bit as dishonest as anything you'd see here.

- by Thomas on Mar 25, 2005 at 2:59 AM | link

"A Jesuit is no more Catholic than Art is." And you say this based on what? His reasoning is DISHONEST? Did you even READ the article? It was based on history, and an understanding of what the Vatican says, what the Pope says, what is an official teaching verses a comment made in a speech.
You maybe a doubting Thomas, which is fine, but making pronouncements based on your own lack of understanding is just sad.

- by spocko on Mar 25, 2005 at 4:30 AM | link

..sure brings out the best in people. As a physician, it is astonishing to me how casually other MD-observers who have never examined Schiavo, and whose understanding of the case is from news reports, are willing make blanket pronouncements about Terri Schiavo's neurologic status that contradict a decade's worth of exhaustive examination by other competent physicians.
Why do these doctors insist on subverting what they know (and don't know) to what they believe? Bill Frist watches an edited video and talks to a neurologist buddy, and now he's "convinced" that Terri is not in a PVS, contrary to the assessments of several neurologists before him who have actually examined the patient.
As to Dr. Nuckols's stunning revelation (bolstered, I assume by no actual objective assessment of Terri Schiavo) that Terri *can* swallow because she makes saliva and nasal secretions....perhaps it is worth remembering that:
1) Her cerebral cortex has liquified;
2) Her EEG is flat. Flat.
3) Swallowing is a brainstem reflex. Absent voluntary control, it becomes an involuntary (and inconsistent) reflex.
4) An inconsistent but functioning swallow reflex results in some aspiration, but not enough to be clinically significant.
5) Physiologically normal humans might make 1-2 quarts of secretions a day, but the sympathetic nervous system of a patient in a PVS whose entire source of exogenous fluid consists of tube feeding and ice chips...might make a little less than that.
If Dr. Nuckols doubts the truth of these premises, perhaps she would support the attempts of protesters to "bring Terri a cup of water." After all, if she "can swallow," then why all the hubbub about a feeding tube?
The anti-Catholic bigotry in these posts don't really deserve any response at all. The only interesting thing about them is how old these cheap and intellectually lazy these little anti-clerical ad hominems are. Sorry Thomas, but you do a disservice to your other thoughtful posts.

- by Boy, this case.. on Mar 25, 2005 at 8:17 AM | link

Anonymous,
Logic and experience allow for the conclusion that Terri Schiavo can swallow. If she couldn't, she would have died from aspiration pneumonia by now.
Feeding tubes are efficient, convenient and decrease the risk of aspiration. Aspiration is not a worry at this point, is it?
Breathing is a brainstem reflex, too. But, we wouldn't put a pillow over the face of someone who was extubated.

- by Beverly Nuckols, MD on Mar 25, 2005 at 12:28 PM | link

I read the article all right. But I didn't see a mention of the fact that Mr. Paris has intervened in the case, by signing a brief to the court urging that Terri Schiavo be starved to death.
And I didn't see any mention of the Catholic Church's teaching on the intentional taking of life in such circumstances.
A reasonable disucssion of the ethics of removing artificial nutrition and hydration would include, if originating from a Catholic perspective, a mention of the necessity of continuing the provision of food and water by ordinary means.
In this case, the court has ordered that no one may even attempt to provide food and water by ordinary means.
Which leaves no doubt about the intended result, does it?
And that's an intended result that Mr. Paris, S.J., has signed off on.
Now, we shouldn't be surprised that a Jesuit would do such a thing. As most of us know, most Jesuits aren't Catholic, and it isn't antiCatholic bigotry to say so.

- by Thomas on Mar 25, 2005 at 2:21 PM | link

Thomas: "As most of us know, most Jesuits aren't Catholic," Righhht. And most of us know that in Heaven there is no beer. And that's why we drink it here.
One second you are talking about "a reasonable discussion" and the next you are making blanket statements about an order of CATHOLIC priests. I suppose in doubting Thomas world it is just fine to assume your defination of Catholic and Jesuit is shared by "most of us".
I would stay here and argue with you about what Paris said and didn't say, (he also didn't say that most people commenting on the topic have no F***king clue what they are talking about) but that just seems a waste of your valuable time.

- by spocko on Mar 25, 2005 at 2:42 PM | link

In response to Thomas...Wow, I don't know who "most of us" are, but I did not know Jesuits weren't Catholic. I will have to tell my son and daughter who were educated by Jesuits. We all thought they were being taught by highly educated Catholic priests, with a well developed ability to reason and think.

- by Fran on Mar 25, 2005 at 2:53 PM | link

makes a useful reference to Catholic doctrine vis a vis ordinary and extraordinary means of sustaining life. Ordinary is morally obligatory, extraordinary is not.
Were Terri Schiavo given a glass of water, she would almost certainly aspirate it, which could lead to aspiration pnemonitis and quite possibly cardiopulmonary arrest. I don't know what "logic and experience" Dr. Nuckolds is referring to, but I guess her clinical experience is with critically ill patients far different from the ones I see every day.
I doubt inflicting such a violent death on Schiavo is compatible with anyone's view on the sanctity of life, or anyone's view on death with dignity.
As to pillows over faces, I wonder if Dr. Nuckolds believes in the concept of brain death? I'm not suggesting that Schiavo is brain dead (she isn't) but such a concept is widely accepted in the medical community and ensconced in the law. Such patients are taken off of respirators every day...indeed their organs are often harvested for donation. Pillows aren't required. Is this practice just glorified cannibalism?
If Dr. Nuckolds believes that removing a feeding tube and putting a pillow over someone's face is morally equivalent, we can agree to disagree. Arguing that there is no difference between active and passive euthanasia is a respectable position. But if Dr. Nuckolds believes that taking a brain-dead person with brainstem function off a respirator is equivalent to murder, that would put her well outside the mainstream of Western medical practice.

- by Aha. Thomas on Mar 25, 2005 at 2:57 PM | link

Thomas, Terri Schiavo is not "brain dead." Her EEG is not "totally flat" as Anonymous stated. The brainstem is alive, so neither condition could be true.
If Terri can handle saliva, she could handle sips of water (not a glass), ice chips, and probably thickened liquids. Water (similar to the saliva) would be the hardest for her to handle.
Turning off a ventilator and removing the ventilator tube are equivalent to stopping feedings through the tube and pulling the feeding tube are equivalent. Prohibition of oxygen and prohibition of oral liquids are equivalent.
Although the treatment of this woman is euthanasia since oral liquids are forbidden, it is not passive - because the tube was removed by an act of medical technology. If feedings had been stopped without removing the tube while forbidding oral liquids, that would have been "passive" euthanasia.
As matters stand, Michael Schiavo has arranged matters so that we will never know whether Terri could swallow water unless someone is willing to be arrested for their attempt.
If I'm wrong, the outcome won't change. Michael could have sped the process up years ago by encouraging oral feeds.
Thank God for the hospice nurses I've worked with, who would offer Terri ice chips or a popsicle for this woman, or at least a wet wash cloth or oral care stick.
T

- by Beverly Nuckols, MD on Mar 25, 2005 at 3:47 PM | link

Fran and Spocko--Really, this is too much. Are you suggesting that Jesuits have a reputation for orthodoxy in the Church? Is there some position that the Church takes that isn't disputed, controverted, or contradicted by a Jesuit somewhere?
Fran, I too was educated by Jesuits. My local bishop asked me at the time why I didn't go to a Catholic school instead.

- by Thomas on Mar 25, 2005 at 4:25 PM | link

She says:"Michael could have sped the process up years ago by encouraging oral feeds."
This is a misunderstanding Michael Schiavo's position that is revealing. Michael's position, then and now, is not that wanted her to die, but that it would not have been her wish to continue this way.
Dr. Nuckols's position seems to be that if Terri aspirates and dies from being fed orally, that is okay. On the other hand, removing the feeding tube by "an act of medical technology" would represent a grave moral wrong. That certainly is a novel way of looking at it. It does raise the question about whether or not some of the opponents of removing the feeding tube really care about whether Terri lives or dies.
She notes, "If I'm wrong, the outcome won't change." That fits. On this reasoning, the protestors seeking to give Terri food and water may kill her by causing her to aspirate, but they didn't *mean* to do so, even though that outcome is entirely forseeable.
Of course, this kind of reasoning is what gave Double Effect a bad name, right Thomas?

- by Dr. Nuckols clears it up: on Mar 25, 2005 at 5:06 PM | link

Dr. Nuckols -
Assuming the intent to kill, necessary for an act to count as euthanasia, is present, I still have a question about your interpretation of the active/passive distinction...
I understand that _removal_ of the tube is "active." The removal of the tube, however, is not the "direct" cause of death. It seems to be dehydration (or, if some unlikely circumstances obtain, malnutrition) that fills this causal role. So how does removal of the tube translate into _active_ euthanasia?

- by Bob Koepp on Mar 25, 2005 at 5:31 PM | link

If it is Michael Schiavo's contention that Terri would never have wanted to live connected to a feeding tube, then he's guilty of a battery, isn't he? I mean, he ordered the tube connected didn't he, and didn't petition the court for its withdrawal for several years.
The Dr. merely points out that the court has ordered that no attempt be made to offer Terri food or hydration. No attempt is permissible, whether she can swallow or not.
Are you suggesting that offering food and water to Terri would somehow wrong her? How is that, unless she lives?

- by Thomas on Mar 25, 2005 at 5:32 PM | link

Thomas. "Are you suggesting that Jesuits have a reputation for orthodoxy in the Church?" That was not the statement that I was discussing. You just switched from "As most of us know, most Jesuits aren't Catholic," to "Are you suggesting that Jesuits have a reputation for orthodoxy in the Church?" Your definition of Jesuits as priests who don’t “have a reputation for orthodoxy" is not equilivant to Jesuits "aren’t Catholic".
You reveal the source of your definitional bias when you relate the comment by your local bishop. It is a popular in-joke by some orders of priests to say Jesuits aren't Catholic. It's a false definition and, more importantly, a weak joke. Shall I say most of us know that Diocesan priests are ignorant jerks because that’s how I see them? You are saying Jesuits aren’t Catholic because they don’t meet YOUR definition of Catholic.
Wow, Thomas was educated by the Jesuits? Maybe you should see about getting your money back, they clearly didn't do a very good job teaching you definitional skills.
Fran, the "most of us" rhetorical technique employed by Doubting Thomas is similar to the "some say" technique popular with Fox News anchors. With Fox, the "some say" device is used to misrepresent or put words in the mouths of their "opponents" so they can then bash them. Some times it is used to set up a straw man argument. (See the movie OutFoxed for a hilarious take on this technique). The "most of us" device is used to add weight and credibility to Doubting Thomas’ inaccurate statement. The next step will most likely be quoting a survey that shows that based on calls to 150 people 76 agree with the statement "most of us know Jesuits are not Catholic." Therefore, he may opine, “Proof exists that for my statement!”. Of course he will fail to reveal the statistical and scientific underpinning of this survey or even the education level or background of the people called. At one time "most of us" would have agreed that the world was flat. That did not make the statement correct either scientifically or linguistically.

- by spocko on Mar 25, 2005 at 5:51 PM | link

Oops, I meant to write, "Therefore," he may opine, “Proof exists for my statement!”. Just like the Pope, I make mistakes. Please forgive me.

- by spocko on Mar 25, 2005 at 5:58 PM | link

You ask: "Are you suggesting that offering food and water to Terri would somehow wrong her?"
"Offering" Terri food and water would not harm her. You can hand her a glass of water, but she won't pick it up. Feeding food and water to her orally would almost certainly harm her, for the reasons I've outlined above, but briefly, she would aspirate, resulting in a chemical irritation in her alveoli and bronchial tree, resulting in inflammation, hypoxia and ultimately cardiopulmonary arrest.
That is why she has a feeding tube.
So, I guess I'd consider that wrong, because it results in unnecessary physical harm. Dr. Nuckols seems to disagree, but I find her position ghoulish.
As to moral harm, I think it depends on one's assessment of what Terri Schiavo would have wanted, based on the information available. I don't have any idea what she would have wanted, though it is hard for me to plausibly construct a set of reasons why anyone would want to persist in a vegetative state. Nevertheless, people believe all sorts of things.
If Terri didn't want this, then both the symbolic and actual act of offering food and water to her at this stage constitutes a moral wrong. The symbolic act mocks the autonomy of her previous self, the actual act, knowing the consequences, would be a grotesque act of self-righteous aggrandizement at the expense of Terri's body. Sort of like Achilles dragging the body of Hector behind his chariot after killing him.
What is really concerning to me about this case is the degree to which the executive and legislative branches have attempted to manipulate the rule of law in this case. An earlier post cited Scalia's superb opinion vis a vis the Cruzan case, articulating the (classical) liberal case for a strong federalism in these matters. Its easy for left-liberals to invoke a federalism they don't believe in when it suits their argument, but it doesn't detract from the fact that Scalia was (and is) right, Frist/Bush/Bush are wrong.

- by Dear Thomas, on Mar 25, 2005 at 6:22 PM | link

...Michael Schiavo, and what he is about, consider this from yesterday's Washington Post:
"Inside Woodside Hospice, Michael Schiavo likes to hold his wife's hand, according to his brother Scott. Today will be the seventh day Terri Schiavo has gone without the feeding tube that sustained her. Her husband sits vigil with her most of the day, his brothers Brian and Bill on hand to support him. Michael adjusts Terri's positions, moves her, makes sure there will be no bedsores. And he talks to her -- talks to her the way one talks to the headstone of a loved one at the cemetery."
http://www.washingtonpost.com/wp-dyn/articles/A64459-2005Mar24_4.html

- by For those of you who think you on Mar 25, 2005 at 7:08 PM | link

Oh, and Thomas...as to your question about wroning Terri Schiavo? From the same article:
"For Michael, Scott Schiavo says, the days are filled with sadness and frustration and anger at the politicians and their attempts to intervene in what he considers a very personal decision. Michael, Scott says, wanted this to be a private moment.
The Schiavos are grieving, too, he says. He says Terri wasn't a sister-in-law to him, she was a sister. He breaks down.
"It's so sad that they've turned this wonderful person into a sideshow," Scott says, his voice shaking. "Into a media circus. It's such a shame. It really is. The one that's hurt the most here is Terri. Her memory. They're taking away whatever dignity she had left. They're taking it away. And it really stinks." "

- by For those of you who think you on Mar 25, 2005 at 7:10 PM | link

Anon, you've built a strawman. I have stated that I believe that Mrs. Schiavo is able to swallow. I'm impressed that she's done so well without an aspiration pneumonia for all these years. The lack of apiration effects leads me to believe that she's not apirating.
Michael, on the other hand, seems to want her dead, since he not only pulled the tube (when he could have simply clamped it and ceased using it) but he also forbids anything by mouth. And has for years.
Speaking of Jesuits, have any of you read the story told by Robert Spitzer about the race with no elbows? We all depend, at least metaphorically on somone else providing our food and water, unless we live on a completely self-sustaining farm with a good spring.
Mr. Koepp, removing the tube while simultaneously refusing to allow Terri's caretakers and family to give oral fluids is active euthanasia, but I'll admit to being a "lumper" who insists on tying the intention and a progression of actions and deliberate inactions together.

- by Beverly Nuckols, MD on Mar 25, 2005 at 7:40 PM | link

spocko, someone who misrepresents the teachings of the Church, particularly when he is entrusted with great responsibility regarding such teaching, and whose misrepresentations of such teaching are invoked to justify, and are intended to be invoked to justify, the wrongful death of a woman--that's what we're talking about here, isn't it--doesn't need me to say he's left the Catholic Church. Lucky for him, there is both discipline and reconciliation in the Church, and with grace he may receive both.
If you can help me with getting my money back, it'd be greatly appreciate.

- by Thomas on Mar 25, 2005 at 8:08 PM | link

Terri Shiavo's EEG is flat, despite the assertion of armchair neurologists:
"Dr. Ronald Cranford, a neurologist and medical ethicist at the University of Minnesota Medical School who has examined Ms. Schiavo on behalf of the Florida courts and declared her to be irredeemably brain-damaged...He said there was no doubt that Ms. Schiavo was in a persistent vegetative state. "Her CAT scan shows massive shrinkage of the brain," he said. "Her EEG is flat - flat. There's no electrical activity coming from her brain.""
http://www.nytimes.com/2005/03/24/national/24doctor.html?

- by By the way... on Mar 25, 2005 at 10:06 PM | link

I'm sure that Dr. Cranford was exaggerating, since if there is absolutely no electrical activity, the brain stem would be dead and so would the patient, by the criteria for brain death. No one has ever lived more than a few days after brain death, even with the most sophisticated technological intervention.

- by Beverly Nuckols, MD on Mar 25, 2005 at 11:19 PM | link

..if you don't like Dr. Crawford's opinion, perhaps Timothy Quill's analysis in this week's New England Journal of Medicine:
"Computed tomographic scans
of her brain eventually showed severe atrophy of her cerebral hemispheres, and her electroencephalograms
have been flat, indicating no functional activity of the cerebral cortex. Her neurologic examinations have been indicative of a persistent vegetative state, which includes periods of wakefulness alternating with sleep, some reflexive responses to light and noise, and some basic gag and swallowing responses,
but no signs of emotion, willful activity, or cognition."
As to her capacity to swallow, consider the report from her Guardian ad Litem in 2003:
"Three independent sets of swallowing tests were performed early in Theresa's medical treatment: 1991, 1992, and 1993. Each of these determined that Theresa was not able to swallow without risk of aspiration (and consequent infection)....The ability to orally ingest food and water - to swallow substances other than saliva - is predicated on a level of cognitive capacity. Without cognitive capacity, the act of oral nutrition and hydration is likely to lead to aspiration."
http://news.findlaw.com/hdocs/docs/schiavo/1203galrpt.pdf
Anyway Doc, this is getting old. I hope you encourage your patients to compose a living will and get a durable power of attorney for health care. Broader awareness of the need for these documents is perhaps the only good thing to come out of this legal and political monstrosity.

- by Okay.... on Mar 26, 2005 at 6:58 AM | link

Good: "cerebral cortex" waves were absent, not total brain. By definition, if her brain stem waves were unequivocally flat, she would meet the criteria of "brain dead." The local equivalent of a coroner takes over the case at that time.
I apologize to the rest of the group, but, since you have access to NEJM, Table 1 of this article differentiates between the EEGs of several conditions of altered consciousness:
http://content.nejm.org/cgi/content/full/330/21/1499
As to the swallowing tests: She's had the best test of all as to her ability to handle frequent, small amounts of thin liquids: her lack of choking on her saliva over a period of years. More, her rate of pneumonia has been much lower than I'd expect from any bed-bound patient, much less one with a less than optimum level of cognitive functioning.
Logic should trump old records, don't you think?
What is the "risk" of allowing oral fluids or at least frozen liquids, compared to dying of intentionally inflicted dehydration? The latter is 100%.
Anon, I understand your fatique with the conversation. It is difficult to make a logical case that the removal of the tube and the prohibition of oral nutrition are equivalent.
And yes, I'm an advocate for Advanced Directives and DPA, as well as for our local hospice in appropriate cases. Far too many patients are referred too late and cases such as these propagate the myth that hospice aides in speeding the death of patients, rather than giving optimum end of life care.

- by Beverly Nuckols, MD on Mar 26, 2005 at 2:53 PM | link

...at least we agree about hospice.
As to "logic," I'll take old records, which at least represent facts, rather than speculation. If you want to get specific about it, Ms. Schiavo *does* aspirate at least some of her secretions, as all humans do, whether they are in a PVS or not. The germane issue is whether such "micro" aspirations are clinically significant. In Schiavo's case, they have not been clinically significant thus far, probably because she has not been challenged with an substantial oral load for more than a decade.
I admit to confusion about your interest in feeding Terri orally. You don't seem to mind if it leads to aspiration and her death. She's failed three swallowing studies in 1991, 1992, and 1993, as my post above indicates. Do you think her swallowing ability has improved in the interval decade? Furthermore, what kind of "fluids or frozen liquids" would have the volume low enough to not be repeatedly aspirated and still provide Terri's caloric requirements? Your plan would starve her, only a little slower.
Your position seems to be: So long as we actively do something to feed Terri, it doesn't matter if it leads directly to her death. But if we withdraw food and water, that would be morally wrong. Your posts seem to suggest that whether Terri lives or dies is really of secondary importance, and what is morally crucial is that we feed her. And, if it doesn't make a difference to you if she lives or dies, why does it matter whether she dies from dehydration, or from aspiration?
If we agree that her cerebral cortex is no longer present to a degree that would register on an EEG, then perhaps you can agree that (a) she cannot feel pain, since that requires higher cortical function, (b) her facial expressions and utterances are brainstem reflexes only, and (c) Terri wouldn't "feel" much of anything in expiring from dehydration versus aspiration. So it can't really be that Terri would suffer more or less from one form of dying versus another.
As to establishing the moral difference between these two exits from life...the cliche about the measure of a society being judged by how it treats its dying is germane. Force-feeding her orally, may not cause her to suffer more or less than dehydration, but it merely imposes the self-aggrandizing will of others on the cortically-empty vessel that once was Terri Schiavo.
I think we agree that the "risk" of feeding Terri Schiavo is not a risk of her corporeal suffering. It is now only we that suffer, empathetically, and in different ways, for her plight, and that of her family. The risk of feeding Terri is moral: to do so would be to treat Terri as a means, rather than as an end in herself.

- by Well... on Mar 26, 2005 at 4:52 PM | link

"Here’s the question I ask of these right-to-lifers, including Vatican bishops: as we enter into Holy Week and we proclaim that death is not triumphant and that with the power of resurrection and the glory of Easter we have the triumph of Christ over death, what are they talking about by presenting death as an unmitigated evil? It doesn’t fit Christian context."
That is exactly what has been bugging me most about this. Since when did physical life itself, deprived of all consciousness and therefore of moral consciousness too, become more important than the soul, the dignity, the privacy of a person suffering?
What Rev. Paris says about the Catholic official position and difference between moral theology vs. commmentary on current affairs is also what everyone who lives in Italy and/or is familiar with Vatican policies, structure and modus operandi knows. It's astounding to see such ignorance esp. on the Jesuit thing. I thought that notion of Jesuits being heretics had faded in the 18th century...! So many recognised Catholic universities in the world were funded by Jesuits and in Italy they still publis Civiltà Cattolica, the only "official" Vatican magazine (the Vatican Secretary of State approves every copy before publication).
Tell me again how Jesuits are not Catholics or not orthodox enough?

- by laura on Mar 26, 2005 at 5:19 PM | link

Anonymous and laura, it is not the death that is the evil or wrong. It is the fact that government, regulated medicine and her guardian are intentionally acting to cause and to ensure the death.
We cannot control a patient's cerebral function, we can only control what we do to those patients. It is wrong for "us" as government, society, and medical professionals to act to cause the death of a patient. The act of removing the tube and the continuing act of prohibiting oral feedings - of even allowing the trial of feedings - is intended to and can only cause the death of Terri Schiavo.
It was wrong to remove the feeding tube a week ago in the absence of more reliable "records" and the dispute. I'm not sure that replacing the tube would be correct or another wrong, but I am certain that the order of Michael Schiavo which prohibits anything by mouth and the legal order supporting and enforcing it are wrong.
Anon, you change placing ice chips on the lips and spoon feedings to "force feedings." If the patient does not swallow the fluids, then it would be appropriate to stop them because in that case, feeding her would be an assault. If she does, then it is not force feeding.
We will never know about Terri Schiavo, barring a real miracle. More than likely she past the point of no return. I hope she is completely unconscious by now. I hope that she was last week.
My personal interest is that the death of this woman is being intentionally caused in a very public manner using public means, including real and virtual guns. She is not herself a means or an end or any of the other philosophical euphemisms - she is a living human being. The Schiavo and Schindler families have made her death a public matter more than most cases ruled on by courts and acted on by regulated personnel.
There are consequences to every act. In the case of very public acts such as the treatment of Terri Schiavo there will be more public consequences. I am concerned about what those consequences will be for law, medicine, hospice as well as for Mrs. Schiavo herself.
Which way will the backlash go?

- by Beverly Nuckols, MD on Mar 26, 2005 at 8:54 PM | link

You argue that orally feeding Terri Schiavo is morally obligatory. I argue that orally feeding Terri Schiavo would result in her aspiration and death, and such an event is entirely forseeable based on what is publicly known about her medical condition. One doesn't have to start feeding her to know this, since her swallowing studies from more than a decade ago prove it.
If, as a physician, one attempted to orally feed a patient who was not in a PVS but had failed the same swallowing studies, that would constitute malpractice. Furthermore, as best I can tell she is not forbidden ice chips...but the degree of "feeding" you describe is of negligible caloric value, thus from a physiologic stantpoint, of negligible value to her.
Hence the value of "feeding" Terri is entirely symbolic. It is not of value to her...it is merely of value to others. Hence she is being treated as means for others, rather than as an end in herself. If you think that is just a semantic trick, that is your prerogative, but most of the readers of this blog understand the difference, and why it is important.
I don't hope Terri is unconscious. I know she is. And since you agree that Terri has no cortical function, I guess you know that, too.
As to the consequences....we'll see. Polls suggest that somewhere between 70-80% of those asked disagree that the executive and legislative branches should have continued to interject themselves in this case. It has broadened the awareness of the need for living wills and durable powers of attorney for health care. It has resulted in folks like Randall Terry exclaiming that there will be "hell to pay" if Terri dies. I think the elected members of the Republican party will need to decide if they really believe in federalism, or whether they believe in something else instead.
I think the consequences will be that people across this country will take more initiative to protect their personal liberty, and not just with regard to health care. And that, at least, is a good thing.
Peace be with you.

- by Fine. on Mar 27, 2005 at 10:07 AM | link

I don't agree that Mrs. Schiavo has no cortical activity. EEG's aren't that sensitive or specific. I"ve followed the conversations over the years of doctors involved in harvesting organs. There's observer bias. Even 3 out of 5 doctor's opinions plus and EEG would not trump one blood flow study or PET.
The judge has ordered no nutrition or hydration by "natural means."If she's getting ice chips, someone is at risk of arrest.
And if she can tolerate ice chips, then she can tolerate popsicles and thickened liquids if her family wants to provide them to her.

- by Beverly Nuckols, MD on Mar 28, 2005 at 3:31 AM | link

Fran, Laura, et al., perhaps it's unwise to make overgeralizations about religious orders, but the Jesuits make it too easy to forget that. I know many good you Jesuits, ones inspired by Pope John Paul II, of happy memory, to enter the priesthood, and who have the moral fortitude to withstand the assualt on Church teaching advanced, all too often, by their brother Jesuits. They will, one can hope, restore that order to the orthodoxy its founder, St. Ignatius, would embrace. But most of the current age 50+ Jesuits will have to die or go to nursing homes (where, hopefully, Fr. Paris will not be waiting to cut off their nutrition) before there is much chance of reformation in that order. Fran, I believe you said that you thought your kids were taught by "highly educated Catholic priests, with a well developed ability to reason and think." Almost right. Take the word "Catholic" out, and you're a lot closer. A quick look at the syllabii of classes at current "Catholic" institutions of higher ed will clue anyone with a faint idea about authentic Church teaching in on what is wrong. Unfortunately I had to experience this myself (Georgetown) for a short time. Trust me...it is happening. You might want to run, not walk, with your children to the nearest orthodox priest to see what damage might have been done during their time in Jesuit school. Perhaps they came through unscathed. Unlikely, but possible if you trained them well. The fact that you are just now becoming aware of the dangers of these universities to Catholic students, though, does not give me much hope for your children. Please look into this, for their sakes.

- by Amazing on Apr 9, 2005 at 11:17 PM | link