CodeBlueBlog: Terri Schiavo and Stem Cell Research

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I absolutely agree that 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?" she should be continued on her parenteral nutrition ad infinitum. BUT the jury that heard her case felt that she expressed the opposite desire. It's her wishes that matter, not her husband's or her mother and father (or mine for that matter). The jury felt that the preponderance of evidence was that she would not have wanted to go on that way. The florida state senate who was NOT privy to the testimony tried to pass a law that flatly went against personal autonomy. If that law is constitutional then the senate has the power to force anyone to undergo any medical therapy that the state feels necessary. The question is not "How can the state allow Ms Schiavo to be starved to death?" but instead "How can the state force a feeding tube down Ms. Schiavo throat and force-feed her over the judicial finding of a jury that she would not have wanted that?" This case is the best example of the need for "living wills" (I hate that term) and clear cut power of attorney assignment as I've seen. In case your wondering my wife (also a doctor) is under strict orders to "pull the plug" stop my tube feeds or whatever she has to do to let me die in this or a similar situation and if the GA state assembly tried to pass a law to keep me alive against my will they better hope I don't get better.

Posted by: Bladedoc | September 29, 2004 at 03:45 PM

PS I thank you for the reply.

Bill B.

Posted by: BladeDoc | September 29, 2004 at 03:46 PM

I realize that the courts have lumped feeding tubes in with respirators and pacing wires, but I believe these are different cases and that the courts, as usual, fail to draw an adequately sharp line. As a physician, I do not want the courts to force ME to actuate a death that otherwise would not occur. Would I stop feeding a severely retarded or demented person (who cannot feed himself) if the court ordered me to? I couldn't. That's not what I do. Put me in jail.

It wasn't that long ago that I scoffed at the idea that neural tissue could regenerate. Then I saw what they were doing at the University of Miami, and the stem cell experiment in frogs that showed definitive growth of new neural tissues.

If you don't have a terminal illness and your cortical centers of cognition are wiped out, why would you want your wife to pull your feeding tube? I want mine to stay in -- but, on the other hand, I don't want to be on a respirator with a pacer wire beating my heart while my pH is 7.2.

It is I who thank you for your informative, incisive, and cogent posts.

Posted by: CodeBlueBlogMD | September 30, 2004 at 12:08 PM

That's exactly why living wills are so important -- the patient's desires are paramount so they should be clear. As for me, I am a believer in consciousness=me. If I am not cognizant (signifificant CHI, anoxia, alzheimer', etc.) that which is ME is already dead. I don't care how long you can keep my body alive. But I wouldn't force that belief on anyone else.

Posted by: BladeDoc | October 04, 2004 at 02:02 PM

I enjoyed this entry, but wanted to correct a common misconception.

Terri's wishes have already been adjudicated under Florida law.

For those people like Terri who do not have written advanced directives, Florida law provides that oral hearsay testimony may be used to determine a person's end of life wishes.

Accordingly, the oral testimony by Terri's husband and his relatives was judged to be "clear and convincing" by the trial judge (and appellate justices as well)

What that means today is that the decision to remove the feeding tube has been made, and stands legally as Terri's decision.

You or I can be as upset with the process as we wish, but legally are obligated to respect that decision (her parents continue to challenge, but were you the attending physician would have no standing to challenge her wishes as ajudicated)

It is NOT the same as having a living will.

It is more closely analagous to myself for examplem, coming in with my grandmother from her nursing home with her health care POA in my hands.

If I tell you (as her health care agent) not to treat her sepsis with antibiotics, as specified in the health care POA, you can't legally start antibiotics, no matter your personal views.

Posted by: Bill | October 23, 2004 at 09:27 PM

I wouldn't be your grandmother's health care agent in this hypothetical case. You can not tell me not to treat your grandmother with antibiotics, nor more than you can tell me to starve and dehydrate an Alzheimers patient to death, or to starve to death someone with an IQ 0f 20. Put me in jail.

If, as a society, we are not able to take out a fine-point felt-tipped pen, and draw a line down the paper between allowing the terminally ill to die in comfort and actuating death under the auspices of HEALTH CARE (efforts made to maintain or restore health especially by trained and licensed professionals) then I, as a professional, will not participate. The "courts" can adjudicate anything they want.

I suggest that we set up camps around the country to send all these people to (the people whose relatives are holding the POA's), where they can be amassed and then terminated by some specially designated class of "health care takers" so that we physicians do not have to participate in an act which is inimical to everything we ever thought medicine and health care was about.

Posted by: CodeBlueBlogMD | October 24, 2004 at 01:38 PM

Sorry, my original post was not specific.

In my hypothetical, I meant grandma already had a written directive spelling out their health care wishes and she met the conditions defined below, per state law (in my state you can wrap that into the health care POA).

Usually reads along the lines of "if I have a terminal illness, suffer severe dementia, or am in PVS, I desire to NOT have the following interventions...antibiotics, artificial nutrition/hydration, respirator, etc. However, I desire all palliative measures."

As health care agent, once the first part of the above is met, then it is my responsibility to see that the latter part is carried out.

Do you really object to not inserting a feeding tube for a stage 7 (Reisburg scale) dementia patient who took the time to write down their wishes and have them legally validated, in accordance with state law?

Posted by: Bill | October 24, 2004 at 06:04 PM

I am a physician, board certified in internal medicine, pulmonary medicine, and critical care medicine. Unfortunately, I have to deal with situations like Terri's frequently in my practice. Medical technology today is able to use tubes and machines to keep the heart beating nearly indefinitely. If we don't set any limits to care, we will fill our hospitals with vegetative and comatose patients who can be kept alive for years. We already have a severe shortage of critical care physician in the United States, and we already have limited money and resources to care for those who have a reasonable chance of a good functional recovery.

Please understand that Terri is not being "starved to death." If Terris were capable of "eating," whe would be given food and drink by mouth. In her condition, andy food that would be given by mouth would likely go down into her lungs rather than her stomach, because she has lost the ability to swallow.

In most situations when given a choice, patients choose not to have a feeding tube. It is a burden that is not a natural way to receive nutrition. Frequently patients who are not vegetative actually pull the tube out when it is placed without there agreement. If god intended for people to be fec using an electric pump to force liquid formula directly into the stomach, we would not have been given the sense of taste, we would not have been given teeth, we would not have been given the ability to swallow. Only until modern times would it have been considered abnormal for someone to be allowed to die once they are not able to safely or consciously swallow. Only in the United States of America would it seem unreasonable not to forcefully pump liquids into the stomach of a person who does not have the ability to resist.

Finally, when asked, the majority of people choose not to have a feeding tube. When given the option, many choose hospice care, which focuses on quality of life. By no means will Terri be allowed to suffer with hunger, pain, or discomfort. Her caretakers have great experience with the process of dying, and they can ensure that Terri passes aware peacefully and naturally, and she will not have to suffer in her hospital bed any longer. Finally, she will be allowed to move on to a better place, as was intended for her 14 years ago, before artificial intervention interfered with nature.

Sincerly,
Alan Betensley MD FCCP

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