A commentor, BladeDoc, left these two posts concerning my Terri Schiavo pieces:
The vast majority of ethical debate (and by this I mean debate about ethics not...you get it) about enteral and parenteral supplemental nutrition has come down on the side of it being solely one of the myriad possible medical interventions, no different than a ventilator or antibiotics. Your horrified statement could equally be made about any of those interventions. For example "The Florida Supreme Court has decided that it is OK for Floridians to suffocate someone to death. This is hard to understand." or "The Florida Supreme Court has decided that it is OK for Floridians to let someone die of an infection . This is hard to understand." If you believe that Ms. Schiavo would not want to live like she is now (as did the court that heard the case) then how can you ethically continue to treat her against her perceived wishes? In abbreviated med. ethics jargon "autonomy trumps beneficence." Just because Terry is unable to resist unwanted medical care doesn't mean you have the right to force it on her. Of course if you don't believe in withdrawal of medical support under any circumstances or if you don't believe that Ms. Schiavo wouldn't want to live like this than all of the above is moot.
I also just re-read the entry and I have to say that this paragraph "It is a common practice in medicine to always treat certain conditions in terminal patients -- even those who have signed a DNR ("Do Not Resucitate") order; For example, we will not allow DNR patients to suffer sepsis, and antimicrobial therapy is used." is basically true but inaccurate. DNR is what it stands for -- if the heart stops, don't try to bring it back BUT it is NOT comfort care only. A DNR patient gets EVERY advantage of modern medicine right up until the heart stops and then nothing else. This is ABSOLUTELY not the same thing as withdrawing support on a terminal patient. It is routine in every ICU in the country that when a patient/family requests withdrawal of support (i.e. off the ventilator, stop pressors, etc.) the antibiotics stop. Sometimes it's decided that no escalation of therapy be instituted -- continue everything but don't add anything. It is flatly untrue that antibiotics never get withdrawn. To reiterate, it is unethical and ILLEGAL (assault) to treat anyone against their wishes. That's why no one forces (adult) Christian Scientists into the hospital or makes Jehova's witnesses receive blood transfusions even if they're going to die without one. If a patient or their legal representative refuses a therapy (ANY therapy) you cannot institute it or continue it. Tube feedings (like Ms. Schiavo) are ethically no different -- although emotionally they are.
This is my response:
First, according to the AMA:
"DNR orders only preclude resuscitative efforts in the event of cardiopulmonary arrest and should not influence other therapeutic interventions that may be appropriate for the patient."
Why did they issue this guideline? Because, at the time, the original debate was centered around hopelessly ill and/or terminal patients (where it should have stayed). Granted, the concept has been outrageously expanded since then, but my efforts were to draw attention to this intent.
Terri Schiavo did not have a living will or any other document which would indicate her desire to die in her current situation. As stated in the Patterico blog:
Ms. Schiavo left no written expression of her wishes, and her own family does not recall her saying anything about the issue. The evidence of her alleged desire to die consists entirely of hearsay testimony from Mr. Schiavo, his brother, and his sister-in-law, concerning statements they say Ms. Schiavo made in casual conversation.
It is my belief that withdrawing food and water is quite different from pacing someone's heart and aerating one's lungs artificially; however, that is not the ethical issue that concerns me most in this case; it is the removal of food and water from a living person who is not terminal (any more than you or me). This has GOT to bother a physician. That is my problem. It really bothers me.
Apparently Terri Sciavo expressed her "desire" not to be kept alive, in front of her husband, during a television show about Karen Quinlan.
What if she had seen a show about stem cell research showing the regeneration of neural tissue? Do you think she might have said "Gee, if I weren't suffering, and there is research like that out there...maybe staying alive peacefully on food and water might not be such a bad idea?"