:smack: This thread, most interesting part of this thread. “Most interesting part of this” could easily be misconstrued or else I wouldn’t even bother with the correction.
This is just my opinion, but I think that I have a unique perspective on this matter. In June 1995 I was in an automobile accident and received a traumatic brain injury. I am told that on the ambulance ride to the hospital my heart stopped and I had to be resusitated twice. At the hospital I was put on full life support, this was how my wife saw me again.
Over the next four days, my wife received an education on brain function. She was shown my EEG which looked good, I was probably alive, but I was still reliant on machines. They stuck the heels of my feet with sharp objects, I felt pain (it took nine months to file off the callouses). I am an organ donor, the organ procurement doctor was always on hand. My wife made the decision to remove life support, I would live or die, God’s will.
My right frontal lobe was bruised, not the cereberal cortex, when I became concious I had lost control of motor function and my memory. I do not know the first month of being awake, I was in some kind of delusional state. No one knew who or where I would believe I was when I woke up. It took me six months to learn how to walk. I would learn to read and do math again over the next three years.
I had minor brain damage compared to that of Ms.Shiavo and it has taken most of five years for me to recover and she will never recover. She is alive now in the same sense that a potted plant is alive. Trust me she feels nothing she should be le go.
I am going to have DNR tattooed upon my chest. NO ONE WILL EVER DO CPR TO ME AGAIN.
hlanalee - thanks for your perspective.
Curious - are you saying you would prefer that you had not been resucitated - which would mean you would now be dead? Or are you saying that having gone thru that once was quite enough, thank you?
My closest contact with this type of an issue is with a co-worker of my wife’s. His wife was resucitated repeatedly, and existed for years in a vegetative state. Different people might handle such situations differently, but it would be hard to overstate the emotional and economic costs those developments imposed on that guy and his kids.
Yes - Dinsdale - Once was quite enough, thank you. I will also admit that the last 8 years of my 40 have been the most rewarding and productive.
I think the bigger question here is not so much let her live or die… as I believe she is already dead. The question is: do we starve her to death like hideous monsters or do we allow euthanasia in cases like this?
Thank you, Kalhoun. It just seems like removing the feeding tube is a passive way of ‘letting her die’ which allows people to avoid dealing with the issue. To euthanize her would require acknowledgement that yes, she is being killed, and that in fact, it’s merciful. Letting her slowly starve is horrifying, for her family if for nobody else. All they’d have to do would be to give her a big dose of morphine or something.
This debate strikes close to the heart of my nightmares, as I’ve been an ICU nurse for several years.
Advances in medicine have given us benefits people couldn’t have imagined years ago; then, when a person had a cardiac arrest or a major injury, they simply died.
Today, it is possible to salvage most people. In the best of cases, they return to their normal lives. I actually work with two such people: JV was in a car wreck at age 17 and had the sort of head injury that was untreatable in the not-so-distant past. We have photos of her when she was a patient in our unit, her head shaved to accomodate the bolt in her brain, comatose, nearly dead. Today she is an RN and the only sign of her injury is a large, horseshoe-shaped divot in her skull (the neurosurgeon had to remove part of her skull to allow her damaged brain to swell; he put it back later) which is only detectable by rubbing her head. I like to rub her head because it makes me feel better about what I do for a living.
Our unit clerk, aged 30, had a cardiac arrest in the stairwell and was not expected to live. Thanks to the prompt attention of her co-workers, she is now alive and well, although she has a pacemaker/defibrillator and we won’t let her go near the stairs.
Most of our “saves” result in outcomes worse than death. Many exist in a vegetative state and reside in nursing homes until they eventually die of an infection. Often, people in PVS’s are admitted to our unit again and again, so we can “save” them again and again.
All the while, we nurses are repelled by what we are called upon to do. If the next of kin wants the person “saved”, we must do our best to save him. Money plays no role in our actions. For example, we have labored for months to rescue a convicted child molester/ murderer at a cost of half a million dollars (your tax dollars at work!) I once performed CPR 3 times on a 95 year old man who was dying of end-stage Alzheimer’s disease, yet his family insisted he have coronary artery bypass surgery.
I have given a “fatal” dose of morphine to a dying man when not giving the drug may have delayed his death by perhaps hours or even days. He was in pain; I chose to relieve his pain at the risk of hastening his death. I have also had families who prohibited me from administering pain medication to their dying loved ones because they knew it might hasten death. In one memorable case, the poor man was literally rotting inside and out; the stench of decomposing flesh could be smelled all over the unit, and still his family refused to let me give him anything for pain.
My opinion: the poor woman who is the subject of the OP should be allowed to die, but removing her feeding tube isn’t necessary. The next time she has an infection (bedbound people are terribly prone to respiratory, urinary tract, and wound infections) don’t give her the antibiotics. No doubt she would have died years ago if this had been done (or not done).
I wish more people would communicate their wishes to their families before a terrible decision has to be made. If you cannot trust your next of kin (your spouse if you’re married, your parent(s) if you’re not, your siblings if your parents are deceased or incapacitated) to follow your wishes, you must designate a medical power of attorney.
Personally, I have made it well known that I would rather die than spend a single hour on a ventilator, even if my full recovery was 100% guaranteed. My husband would want “everything done” to save his life; he is obviously not an ICU nurse. Still, I will respect his wishes if the time comes.
I’ve learned that death is not the worst thing that can happen to a person; often it is the best thing. Still, I do not approve of euthanasia. With today’s technology, more often simply withholding some aspect of care is all that is needed to ensure a patient’s death. Overt acts of killing are unnecessary and, in my opinion, wrong.
Wow! Thanks for that insight, hh.
One question - how do you distinguish your administration of “a fatal dose of morphine” from euthanasia?
My concern is this:
We don’t know for sure what Mrs. Schiavo’s wishes were. It’s just the word of her husband that she would not want to have been kept alive ‘artificially’.
Barring any concrete evidence of her wishes, shouldn’t the law err on the side of life rather than death?
Also, Mrs. Schiavo had been refused, since day one, any sort of rehabilitative treatment. This treatment was ordered by the court as a stipulation of the malpractice suit. She may be beyond hope now, but what if she had been given some sort of treatment? Who is to say that her quality of life could not have been improved?
It bothers me that so many would be so quick to try and ‘put her out of her misery’ without knowing concretely that she would have preferred this.
Why didn’t the court step in and take control of her rehab, especially if they’re the ones that ordered it? Sounds fishy to me.
XJETGIRLX, her brain was gone by the time she got to the hospital. It sounds to me like the parents are making a specious objection - I can’t imagine anything could ever have been done.
Kalhoun, ‘starving her to death’ isn’t quite the same as you or I starving to death. If you look at some of the quotes above, she can’t feel pain. The idea may sound monstrous, but it seems that it’s really not.
by Marley23
She may very well not feel a thing, but her family can. Put aside the woman’s vegetative state for a minute and consider how pathetic it is that her family will have to stand by and watch the one they love dry up like this. At least Timothy McVeigh’s parents were spared such a barbabic sight.
XJETGIRLX, I think most people here understand your objection, it just isn’t borne out by what’s known about this case. Please go back and look at some of the links posted above that are not sponsored by her parents. Five separate courts have agreed that her wishes were expressed that she did not want to be in this state.
Let’s simplify:
1: Terri has no brain left.
2: There is no sense of pain or pleasure.
3: Rehabilitation, drugs, and surgery cannot re-grow brain tissue.
4: There is no “quality of life” to improve. There hasn’t been since before the malpratice suit.
5: I don’t think that thirteen years is “quick”.
The law has “err[ed] on the side of life” for thirteen years. How much more time should the familiy have to wait and hope for a miracle?
Yes, it’s terrible. Then again, if not for them, this wouldn’t have dragged out for 13 years. (Despite their insistences, they’ve put her husband through a lot of pain as well.) I’m sure it’s hard to say goodbye, but they should have said their goodbyes a long time ago. The woman died in that accident, despite what you say. Tim McVeigh’s parents not only watched their son die, they watched with the knowledge that a lot of people were enjoying it.
Mentally she may be deader than the tree stump across the street, but her body clearly is not dead. Her parents are not convinced that she is dead, either, and all the CAT scan evidence in the world hasn’t convinced them otherwise. Now I’m not saying she should be kept alive just to appease their feelings; I’m just saying there has got to be a better way than “letting nature take its course”. If death is the inevitable outcome of removing the feeding tube, then why not euthanize the poor thing and be done with it? Why add another layer of suffering to this drama?
I’ve seen footage of Terri and it is understandable why her family believes she is still mentally viable. She doesn’t present in a stereotypical coma. I can just imagine how terrible they will feel watching their daughter die in this fashion.
I don’t disagree, but there’s nothing that can be done about that from here.
As far as the parents, yes, I understand what they’re seeing. But after 13 years and however many objective doctors telling them what’s really happening, they’re only interpreting these things as life because they want to.
Really, really stupid question: when we have these cases of brainless people, yes, people with only a tiny fraction of compressed brain tissue, wandering around functioning just fine in life, can we be sure that she feels no pain? Did the doctors on the panel actually examine the young woman themselves, or did they just review her case and CAT scans?
sugaree, The answer seems to be “both”:
From In Re: Guardianship of: Theresa Marie Schiavo, Incapacitated
The “double effect principle” defines the difference. This says that it’s OK to do something that has both good and bad foreseeable outcomes as long as
–the good outcome is intended, and not the bad,
–the good outcome cannot be otherwise achieved,
–the good outcome is necessary enough to outweigh the bad, and
–the good outcome is not achieved by means of the bad.
Here, the intention is to treat the patient’s pain, even if you know the dose of morphine necessary to treat the pain will probably also kill him. You don’t mean to kill him, you just want to treat the pain, and if you could do it another way, you would. You’re also not relieving pain just by causing the patient’s death.
You wouldn’t do this for a young healthy patient who will probably be OK two days from now, because in that case the good does not outweigh the bad. For a patient in his last weeks of life, however, whose pain is not going to improve, the good would outweigh the bad.
That’s an overly long and academic answer. The short answer is that if you don’t mean to kill the patient, and you’re trying to do something else that’s desirable but can’t without probably killing the patient, it isn’t euthanasia and it’s generally considered OK. It’s all about intentions.
Dr. J
Question: Is she legally dead? Because if she is, wouldn’t the administration of drugs that would arrest heartbeat not be considered euthanasia?