Feeding tubes and priorities

This is Dave Young's Forum.
Can you really bridge the gap between reality and training? Between traditional karate and real world encounters? Absolutely, we will address in this forum why this transition is necessary and critical for survival, and provide suggestions on how to do this correctly. So come in and feel welcomed, but leave your egos at the door!
Mark Weitz
Posts: 397
Joined: Fri Feb 27, 2004 4:27 pm
Location: Toronto, Canada

Post by Mark Weitz »

Sometimes the only way the law gets written or changed is by moving it outside of the arena of the individual and the family or friends.....
Yes, but that is unavoidable. I suppose it's an inherent irony that lawmakers create statutes that enshrine in law the rights of individuals and/or families and their appointed substitute decision makers.

It's interesting to note the split among Republicans over this issue. According to Joe Conason of The New York Observer,

[/quote]In the Senate, Republicans circulated a "talking points" memo last week discussing Ms. Schiavo's fate in terms that emphasized political opportunism. "This is an important moral issue and the pro-life base will be excited that the Senate is debating this important issue," that memo explained.


This is the kind of bottom-feeding, self-serving opportunism that makes me hurl. Yet many Republicans are understandably outraged at the President's clear abuse of power, some calling it a violation of the constitution and the principle of federalism.

Interestingly, when W was governor of Texas he signed a bill in 1999 making it easier for people who are in situations similar to Shiavo's to have treatment discontinued.
This statute directly contradicts Bush's actions while Governor of Texas. Then, Bush signed a bill that allows hospitals to stop feeding a patient whose prognosis is so poor that further care would be futile, if the patient cannot pay his or her medical expenses. Just this past week, a baby was pulled off life support in Texas, against his mother's wishes.
Marjorie Cohn

Apparently, W found his love for these patients as president when it could pay him considerable political capital.

Mark
IJ
Posts: 2757
Joined: Wed Nov 27, 2002 1:16 am
Location: Boston
Contact:

Post by IJ »

Well, I guess it will always "depend."

But it mostly depends on whether a few, very far out situations arise. Almost everyone otherwise agrees there are things worse than death, at least in the hospital. For a quickie example of outside the hospital, what would the supreme court and most convicts choose if you let them decide on manner of execution:

1) lethal injection at 12 am on day x.
2) a day of slow, brutal, excruciating and terrifying torture that began at 12am on day x.

I have to run right now, but I'll tell you about the few exceptions to my rule later on. Suffice to say major cultural barriers were universal.
Last edited by IJ on Fri Mar 25, 2005 5:27 pm, edited 1 time in total.
--Ian
User avatar
Panther
Posts: 2807
Joined: Wed May 17, 2000 6:01 am
Location: Massachusetts

Post by Panther »

Mary S wrote: And do you have a living will?
Do now!
Do you have a medical power of attorney?
It's at the attorney's office...
Do you have a will?


Have for a long time...
Do any of you who have posted on this thread?
I agree with Bill on this... the gubermint should butt out.
IJ
Posts: 2757
Joined: Wed Nov 27, 2002 1:16 am
Location: Boston
Contact:

Post by IJ »

So, more on situations where it has been valued more highly to push on at all costs at the expense of suffering, rather than die peacefully although sooner. We're taught, and I believe, that the family decides goals and the doctors decide means. However the norm I've witnessed is to dump the whole decision on patients without guidance, which I think is unfair. They usually don't know as much about what's in store for their loved one or whether they actually have a reasonable chance.

It's fairly common to have patients who are critically ill that the medical team thinks is not going to live, and the family is sure is going to wake up and be fine.

--sometimes the family is wrong and there is obviously evidence of permanent brain damage or irreversible and progressive organ failure. I've had a college student cardiac arrest with brain damage, or a mule suffer a ruptured bag of coke and then a huge stroke, with family insistence that they'll recover. Or, someone dying of a rapidly progressive metastatic cancer for which chemo already failed and they could not tolerate. These people don't benefit from "life support."

--sometimes the doctors are wrong. I had a bedbound, elderly, mute, demented nursing home patient suffer a severe pneumonia and was on 4 pressors (medicines to support blood pressure; being on one is bad). We told the family she was surely going to die, but she surprised everyone and didn't. We didn't feel we'd done her any service, but they did.

--sometimes everyone knows what's wrong and its just a tough situation. For example, elderly man with lung cancer is put on life support during experimental palliative procedure; fails to improve from it and gets progressively worse. Daughter knows we should withdraw care because he is suffering, but can't bring herself to say the words; instead, wishes he'd just die "on his own."

The real ethical disputes in my experience, however, have been from major cultural barriers (by which I mean, systems for making tough decisions were derived from situations and ideas where these problems did not exist):

--Russian orthodox family whose unconscious mother has large brain tumor pressing on her brain stem and making her stop breathing demands life support (so her body can live another month with no hope of improvement). NEARLY came to crisis, but they agreed to hold off. She died and was pronounced; they cried with her; we came back 2 hours later and they were holding her and sobbed: "so, there's nothing you can do for her?" A clearer demonstration of "not getting it" I have never seen.

--Similar family informed of impending death of relative insists, "even if you told me you had sawed though her neck and the head was only hanging by a string, we would still say to do everything."

--Persian family with 90 year old matriarch dying of cancer who is choking on own secretions demands "the antibiotic, the IV fluid, and the calorie," and when informed this will not help her, and will cause worsening secretions and choking and pain, and may accelerate her death, they say, they still want it because it is their job to do everything to avoid feeling guilty in the future.

I've got others... the point is, all of these families cited belief systems that were not designed to deal with / had not been updated for these situations. I'm not trying to malign them, but it is my belief they don't work well for tough medical decisions. Otherwise, nearly everyone agrees that there are fates worse than death and that when death is imminent and inevitable, quality trumps quantity.
--Ian
benzocaine
Posts: 2107
Joined: Wed Jul 09, 2003 12:20 pm
Location: St. Thomas

Post by benzocaine »

People talk about sanctity of life. Being in a vegatative state being fed through a tube and having others clean you, dress you, and everything else for you.. is not a life.

Nope, I'd rather be dead.
2Green
Posts: 1503
Joined: Thu Sep 23, 1999 6:01 am
Location: on the path.

Post by 2Green »

Terri is not on life support.
She is living, breathing, digesting on her own. Her "life" functions are intact.
She only requires feeding. Her family has pledged to attend to this.
There is testimony that as recently as 8 days ago she was attempting cognitive communication.

I am in shock and awe that this public execution by starvation is taking place on CNN.
It seems the benefit of the doubt is given to death, not life -- in a civilization where heroic efforts are ROUTINELY applied to preserve life.

I just don't "get it". I feel sickened and ashamed. Her husband seems to have no problem with all this -- well, he's "moved on", and enjoying a new life.

Why can't Terri's family have her back, if no one else: her husband, the courts, the Governer of Florida -- wants her around?
It's not like anyone else would be burdened.
Why can't those who CARE about her care FOR her?

NM
User avatar
Dana Sheets
Posts: 2715
Joined: Mon Feb 25, 2002 6:01 am

Post by Dana Sheets »

Please review the timeline at this link.

Teri's husband intially advocated for experimental treatments, sued her physicians over malpractice and put the monies into a trust for her care and was eventaully banned from being in the facility that by a restraining order the hospital brought against him because he was demanding too much care for his wife.

http://www.miami.edu/ethics/schiavo/timeline.htm

He fought like the dickens for her beyond what hopes the medical community ever had for her for 8 years. He exhausted the possiblities and finally arrived at a conclusion that her wishes, as he knew them, would be to not continue in the state she was in and began legal procedures to bring about the end of her life. It doesn't seem like this came easily to him at all.
Did you show compassion today?
Mark Weitz
Posts: 397
Joined: Fri Feb 27, 2004 4:27 pm
Location: Toronto, Canada

Post by Mark Weitz »

Terri is not on life support.
She is living, breathing, digesting on her own. Her "life" functions are intact.
She only requires feeding. Her family has pledged to attend to this.
There is testimony that as recently as 8 days ago she was attempting cognitive communication.
Yes, she is biologically existing. You're making an assumption that Shiavo was "attempting cognitive communication". There's no evidence whatsoever that her upper brain functions were operating at the time and plenty of evidence that she is incapable of any thought. The sounds that came out of her mouth were "ahhhhh" and "waahhh". From that the Schindlers heard, understandably, "I want to live", or at least that's what their attorney claimed.
I am in shock and awe that this public execution by starvation is taking place on CNN.
"Public execution" is a bit presumptuous. I understand that you feel her life is just as worthy as anybody else's and here I completely agree with you. But acting on a person's prior treatment wishes, to not be preserved in her current state, is not an execution. Judge after judge has ruled that Michael is acting on Terri's wishes so this is not an execution. The media circus is shameful and manipulative.
It seems the benefit of the doubt is given to death, not life -- in a civilization where heroic efforts are ROUTINELY applied to preserve life.
Putting aside the issue of treatment wishes, this is the philosophical debate. I will never understand how existing in Terri Schiavo's state is "life", how feeding her body so it can biologically exist while she wastes away is life enhancing in any way. And this is why consent and capacity issues are so fundamental. Nobody has the right to assert their morality and ethics on another person. Many choose to exist under these conditions and enshrine this in a living will while others make the opposite equally clear.

2Green, do you feel that the feeding tube is the deciding factor here, that she can breathe on her own? As I mentioned in a previous post a mother in Texas was denied the right to have life support continued for her baby. There was no public outcry that I'm aware of for this baby and no emergency bill signed by W to keep the respirator going. Do you see something very different about the feeding tube over the respirator?
Why can't those who CARE about her care FOR her?
It seems there are different ways of caring for someone and the law states that Michael is her guardian, not her parents. You're making a big assumption that Michael doesn't care about her so he's willing to let her die. As Dana points out, this is not an easy decision for Michael, he tried a number of treatments that failed and after these failed and money was secured for her care from a malpractice suit, he decided to act on her wishes. Assuming that this is true, which almost every judge that's heard the case believes it to be, it is caring to act on someone's wishes. You assume that Terri didn't make this wish known to Michael, that there's evidence to the contrary, or at the very least, we don't know enough so we should side "with life". Michael was her spouse and has cared for her for many years. Now that he is trying to act on what he and the courts have determined were her wishes people say this is uncaring. I don't agree that there is something innately caring about maintaining people under such conditions when so many court-appointed doctors have testified that she cannot think, perceive, or feel emotion about her environment existing as Bill described, a "living corpse". The only way to care for someone in any moral way here is to act on their wishes about whether to exist unders such conditions. I'm satisfied that after so many rulings and testimony, that Michael is doing that. And I could be wrong and the doctors could be wrong but I think the legal process and the decisions made are the most ethical in this case.



Mark
User avatar
Bill Glasheen
Posts: 17299
Joined: Thu Mar 11, 1999 6:01 am
Location: Richmond, VA --- Louisville, KY

Post by Bill Glasheen »

Don Henley got it right.
We got the bubble-headed-bleach-blonde who
Comes on at five
She can tell you ’bout the plane crash with a gleam
In her eye
It’s interesting when people die-
Give us dirty laundry

Can we film the operation?
Is the head dead yet?
You know, the boys in the newsroom got a
Running bet
Get the widow on the set!
We need dirty laundry
Funny how a survey showed that over 60% of the public sided with the husband and the courts. And 75% thought that Congress never should have gotten involved (including 68% of Republicans). Furthermore, GW's approval rating has dropped to a low since intervening in this.

Then they covered all that up, because this is all soooo newsworthy.

Where are OJ and MJ when we need them? :evil:
Kick ’em when they’re up
Kick ’em when they’re down
Kick ’em when they’re up
Kick ’em all around
- Bill
IJ
Posts: 2757
Joined: Wed Nov 27, 2002 1:16 am
Location: Boston
Contact:

Post by IJ »

"It seems the benefit of the doubt is given to death, not life -- in a civilization where heroic efforts are ROUTINELY applied to preserve life."

It's been a decade of wrangling all about what's best for a single, unresponsive woman, who is incapable of experiencing anything. People argue about whether that life is worth living but in the end, its none of their business--it's Terri's call, and her husband is her susbtitute decision maker. And that's that.

Meanwhile, I worry a lot more about a culture that's willing to underfeed millions while the rest of us gorge, where education is in many places marginal, where healthcare coverage is spotty and preventive measures out of reach for many, and where more and more passes are given to companies that disregard such things as playing fair, our health, our national resources, and our futures ust to make a buck.

There are a lot of conscious people with futures to look after.
--Ian
IJ
Posts: 2757
Joined: Wed Nov 27, 2002 1:16 am
Location: Boston
Contact:

Post by IJ »

And now we're going to review the issue. Again. What new evidence might we uncover this time? Who do we anticipate this extra million bucks in court costs and attorney fees is going to help, besides the news networks? Prioritize, people.
--Ian
User avatar
Mary S
Posts: 1472
Joined: Mon Aug 16, 1999 6:01 am
Location: Halifax, NS Canada
Contact:

Post by Mary S »

Rest in peace Terry Shiavo.
IJ
Posts: 2757
Joined: Wed Nov 27, 2002 1:16 am
Location: Boston
Contact:

Post by IJ »

--Ian
Post Reply

Return to “Realist Training”