blog.bioethics.net

there were reports terri schiavo could swallow and they stuck her with a feeding tube anyway.
a doctor insisted on inserting a feeding tube in the following patient. the patient's family refused saying the patient could swallow. the doctor insisted patient would die within so many hours without it. patient left the hospital against the doctors medical advice. over a year later - patient is doing fine and no feeding tube.
how can a doctor be that wrong???
maybe a doctor was that wrong about schiavo?
theangrypatient.com

- by the angry patient on Dec 30, 2005 at 2:02 AM | link

Read the autopsy report. Terri Schiavo's brain was completely and utterly destroyed. She could not see, think or swallow.

- by Art Caplan on Dec 30, 2005 at 11:39 AM | link

What does seeing have to do with anything?

- by Karama Neal on Dec 30, 2005 at 12:24 PM | link

But you're right, of course, Art. Thanks for this post, and the earlier one on how to get a living will.

- by Karama Neal on Dec 30, 2005 at 12:50 PM | link

Art, calm down. You're the one who brought the subject to the forum. With an exclamation point.
It is unusual that a woman who "could not swallow" did not require suction for her saliva or die much sooner from aspiration of that saliva.
The euthanasia entailed court-ordered prohibition of both enteral and parenteral feedings. With simultaneous administration of morphine, for some odd reason. Either (or both) the morphine and the ban on oral fluids was gratuitous.
The proponents of the "popular" and "legal" death of this woman are the same "right to die" activists that push physician assisted suicide and other forms of euthanasia. They have had millions of dollars in funding and the bias of the elitists who decide who can see, hear and swallow well enough to be "persons."

- by Beverly on Dec 30, 2005 at 2:13 PM | link

Bev
This case simply shows how values can distort the facts. It is not unusual at all for people in PVS to have suctioning for saliva but not all do--read the literature on saliva production after many years PVS!
You are talking right through your hat if you do not realize what fine care the hospice in Pinnellas County gave to Terri and to every patient they care for. Those people are absolute heros and to suggest they mistreated her or did not comfort her is utterly irresponsible in addition to being untrue.
Morphine is used to treat family members --not the patient. There is no reason and certainly was none to use it for Terri Schiavo's sake. Again, the autopsy ends all discussion of that matter. When morphine is given it is done as a placebo to make the family feel ok. I dont think that is wrong but that is what is going on.
I am not a friend of physician assisted suicide or euthanasia. But the continued effort by some to fly in the face of the absolute incontrovertible facts about the total, utter and complete destruction of Terri Schiavo's brain despite claims by her family that she spoke!, requested water!!, begged not to die!!! and by fraudulent doctors who said they could CURE her (where are these doctors now since there are no shortage of people in PVS states?) is beyond tolerance.
I am agitated when agitprop continues to go unchallenged and that is what happened during the Schiavo fiasco and continues to occur on the part of some today.

- by Art Caplan on Dec 30, 2005 at 3:38 PM | link

"Sips and chips" (Ice chips and spoonsful of liquids) would have treated the family well, too.
The hospice tradition that I know is not at all consistent with uncomfortable patients or families. I don't doubt that the whole mess was misery for the caring nurses and staff in Florida.

- by Beverly on Dec 31, 2005 at 12:29 AM | link

Art, you indicated that treating the patient for the benefit of the family (in the Schiavo case, use of morphine in this PVS patient) was "not wrong". But surely, if this was done in the Schiavo case, it produced a controversial benefit for the family as well as public relations.
Though the practice of treating the patient strictly for the benefit of others is not rare. I would like to understand why it is ethical. ..Maurice.

- by Maurice Bernstein, M.D. on Dec 31, 2005 at 2:38 AM | link

Maurice
If a family member 'feels better' because morphine is used in caring for a PVS or brain dead person then while I think the use of the drug is pointless I have no problem making the family member feel better at a very difficult time. My experience is that breaking into lectures and dialogue about brain death and pvs is not always an appropriate strategy with a parent or a sibling.
That is why I said this seems to me to be akin to placebo as therapy.

- by Art Caplan on Dec 31, 2005 at 12:55 PM | link

What's the false positive rate on PVS diagnoses? It's not zero, is it? If Terri were my daughter I would fight like hell to keep her fed and hydrated. People at my workplace were pretty horrifying with their "just yank the tube" talk. What vultures they seemed to be.
My mother-in-law required a feeding tube for just three or four weeks last year, and it took her a few days to re-learn how to swallow. An on-the-spot test on her first attempt would have concluded that she couldn't do it. She eats like anyone else now.
Finally, without data on what the brain of a non-brain-damaged person would look like if they were stuck in a hospital bed, blind and with no aural or tactile stimulation, for ten years, I don't think Terri's autopsy results were very meaningful.

- by Laura(southernxyl) on Jan 1, 2006 at 9:25 PM | link

The morphine decreases the rigorous breathing, reflexive vocalizations, and, as Art says, makes those who are near feel that "something" is being done.
As a family practitioner, I see nothing wrong with treating the family.
I do think a wet washcloth and some ice chips would have made everyone feel better.

- by Beverly on Jan 2, 2006 at 2:21 AM | link

People believe about Terri Schiavo what they believe. It was not euthanasia. Nor, in my view, was it just. But that is a minority view.
I don't recall doctors saying they could cure Terri. No one believed seriously that she would ever be anything but profoundly disabled. But credible people believed she might be able to be taught to swallow food and fluids and could be improved.
Her brain was not totally, utterly and completely destroyed. That would be brain death. Overstatements are your forte, Art. Her brain was profoundly, catastrophically damaged, consistent with PVS or perhaps, MCS. I believe, from speaking with many people who were with her who are not Kool Aid drinkers, that she could probably hear. But maybe not.
Bottom line, it didn't matter to me, or her parents and siblings. They fought for her life in a noble struggle founded in deep love. They should be honored. Not scorned.

- by Wesley J. Smith on Jan 2, 2006 at 3:26 AM | link