In news reports, Terri is described as a quadriplegic. Doesn’t that mean her inability to swallow is connected to spinal damage, not to whether or not she knows there is food in her mouth? Or is the term quadriplegic inaccurate?
Being a quad doesn’t necessarily affect the upper parts of the spinal cord. The damage could be by the seventh cervical vertabra (the last one in your neck), which should mean that you have full and complete use of your head. The term just means that she doesn’t have control over her legs or her arms, as opposed to a paraplegic, who doesn’t have control over the legs. This may be due to spinal damage, progressive neurological disease, or brain damage.
I’ve never heard anything about the woman ever suffering spinal damage, so I doubt very seriously that her inability to eat is connect with such injury.
She’s a quadraplegic because the part of the brain that controls voluntary movement of the limbs is a part of the cerebral cortex, and it died 13 years ago with the rest of her cerebral cortex. The facial muscles, tongue, and muscles involved in swallowing are controlled by nerves which do NOT originate in the cerebral cortex - those are brainstem functions. But awareness that there is something in your mouth to swallow requires conscious perception - signals are sent from the brainstem nerves to the cerebral cortex, which a decision is made (swallow or not swallow), and the signal for the appropriate action is passed back down to the brainstem, where the action is initiated. Terri can’t swallow even though the nerves involved in the swallowing action are still functional, because she no longer has any perceptual abilities (unlike, for instance, a person who’s had a small brainstem stroke, who is quite aware that there’s food in his mouth but who can no longer properly coordinate the swallowing muscles because the nerves to them have been damaged).
OK, let me make this as simple as possible;
When there is this much controversy over wether someone should live or die, I say choose live. If it was as clean cut as you poeple espouse this wouldnt be a national issue, with new laws created in wake of. This obviously isnt a typical case so I think we have to look outside the box on this one.
I mean, if you going to care about an issue so much, it should be in favor of someone living, not dying. Why put up a stink because someone gets to keep living, think about that for a moment.
…and I see no-one responded to my thoughts about killing the elderly, many who are in the exact same situation as Terry. There are elderly out there who are bed ridden, savaged by mental illness, and who need to be fed in similar fashion.
Actually, this isn’t as unusual a case as you seem to think it is. It’s not uncommon for some family members to disagree about how far supportive measures should be extended; what’s unusual about this case is that the government is over-riding the decision of the family member who legally should have the final say in the matter. Terri Schiavo’s husband is her legal next of kin; HE should be the one who makes the decision about what happens to Terri Schiavo, not her parents.
Because the reasoning used in this case jeopardises the principle of patient autonomy. As someone earlier in the thread mentioned, in marriying Michael Schiavo, Terri granted to him the responsibility to make decisions for her should she become incapacitated. Why should her choice of guardian be arbitrarily overturned?
Many people participating in these threads, after reading about this case, have said “Guess I need to prepare a Living Will and talk to my spouse about this sort of thing”. But what use is preparaing a Living Will and talking to your legal next-of-kin going to be if the courts can step in at will and overturn your legal guardian’s decision because someone else objects to it? Should your spouse, your parents, your grandparents, your siblings, your children, your aunts and uncles and cousins and nieces and nephews, etc, ALL have to be in agreement about your care before your wishes can be carried out? That’s the precident this case is setting, and it’s a dangerous one.
And most of them never receive feeding tubes, IVs, and other such aggressive support, or they have their feeding tubes withdrawn once the family has come to terms with the reality of their permanent impairment, and are allowed to pass on quietly. There is no legal obligation to offer such interventions to a person who is profoundly and irreversably disabled. And mercifully, most families eventually recognise that doing so is merely prolonging the person’s dying rather than helping them, and choose to let their family member go peacefully.
Yes, indeed, and when my great-aunt got in that sort of shape due to Alzheimers, we let her go…in accordance with her living will. She didn’t want a feeding tube, and she didn’t get one. We watched her dry up and drift away when she was too out of it to be hand-fed anymore. It was an awful way to watch her die and I think she would have been much better served by 30meq of IV KCl push, but I don’t think that she suffered for a second.
You know, I don’t really think saying, “When in doubt, keep 'em alive” counts as thinking outside the box. It seems to be a one-size-fits-all solution to the problem. Of course, my “When in doubt, side with the party most likely to know the patient’s wishes” is pretty much the same. Terri’s mental status or lack thereof aside, it’s an issue of whether a young married woman is more likely to discuss this stuff with her parents or her husband. Considering myself and my friends, I’d lean towards the husband.
See, I don’t really give a flying fuck whether this vegetable that used to be a woman lives or dies. I care very much, though, that her wishes be carried out. When her husband says that she would not have wanted all this, I have to take his word for it, because he’s the one she’s most likely to have talked to about it. Near as I can tell, her parents aren’t arguing that she would have wanted to be kept alive in a PSV, but rather that she’s not in a PSV.
When doctors agree that a patient is in a PSV, and her husband or other medical proxy says she wouldn’t want to continue life support, it’s time to pull the tubes. When in doubt, err on the side of “This is what she told me she wanted,” rather than, “Oh, she’s gonna be all right. Besides, I know what my baby would have wanted.”
I think she should be allowed to be let go. Granted, I am not a family member, but there’s something about her parents that just rubs me the wrong way. Doctors have diagnosed the cause of her heart attack as a potassium deficiency (upthread, someone said that her heart attack was due to anorexia. I haven’t been able to find a site for that, but that would fit with her electrolytes being wacky). But her parents have suggested that her husband tried to strangle her (no ligature marks though) and want an investigation into her condition re-opened. To my eyes, they seem like the type of people that just can’t understand that sometimes bad things can happen, even to good people. And as I read in the NYTimes earlier this week, they’re doing their best to insure that they outlive their child. Which just seems selfish to me.