Another Question
I have another question for the “Terri Schiavo should be allowed to die” crowd. Do you oppose an attempt to feed her liquid, to see if she can swallow it on her own? If so, why?
William Anderson says:
There is no reason, medical, moral, or legal, to refrain from an attempt to provide Terri Schiavo with orally administered liquids.
There are only two possible explanations for having employed gastric tube feeding. Either (1) her neurologic damage has brought about a swallowing dysfunction with danger of aspiration pneumonia; or (2) it was simply a matter of convenience to avoid labor intensive hand feeding.
In either case, no medical reason now exists to refuse a trial of natural drinking. She may have impaired swallowing function, but that at its worst cannot be as bad as death by dehydration.
Allowing her to drink water would be the definitive test of swallowing function. She may be able to swallow water and other clear liquids, in which case she will avoid death by dehydration, even if she later succumbs to malnutrition. Or she may be able to swallow pureed food, which will avoid death by malnutrition. Or she may not be able to swallow water without aspiration into the lungs, and so would develop pneumonia, and have a quicker and more peaceful death.
As to legal concerns, a guardian may refuse any medical treatment, but drinking water is not such a procedure. It is not within the power of a guardian to withhold it, and not in the power of a rational court to prohibit it.
The moral case speaks for itself. When we awaken from this queasy nightmare, people will ask how it could have been that a court could post a police officer by the bedside to insure that a dying woman succumbed to a ghastly death by thirst.
How can anyone possibly quarrel with this?
By the way, the vaunted Judge Greer has forbade it. You can read his “explanation” here. Just don’t expect it to make a lick of sense.
(Link to William Anderson article via Amy Wellborn.)
UPDATE: A picture of the real criminal in all of this.
If you can’t explain Judge Greer’s order to us, Patterico, it cannot be explained.
Your work on Terri’s case has been heroic. Deepest thanks from me, and I think, all your admirers.
tom van dyke (bc9910) — 3/23/2005 @ 5:53 pmI can’t understand it because I can’t see the pleadings that he claims are alternatives.
actus (e8ffe9) — 3/23/2005 @ 6:31 pmWatched the Fox News, Special Report, tonite.
Mr. Kondracke assures us that starving to death
is a painless way to die, providing a “sense
of euphoria”, I believe he said, quoting a report
from somewhere.
This kind of comment seems hard to square with
Randall Tanner (a30354) — 3/23/2005 @ 6:38 pmother reports from people who have lived to tell
about it.
I have a question for the “warm temperature is life” crowd. Should Nixon and Reagan been allowed to live an extra week? There is pretty clear evidence that both could have been kept warm for a few more days, if it weren’t for decisions made in their inner circles.
Ladainian (91b3b2) — 3/23/2005 @ 6:47 pmLadainian,
What do you mean by their inner circles? I expect that both men left fairly explicit (and private)instructions. So they participated in their own decisions, and apparently had unified familes to carry out their wishes. What could be further from the Terry Schiavo case?
Mike (fe4212) — 3/23/2005 @ 6:57 pmI don’t think of myself as belonging to the “let Terri die” crowd — they don’t sound like a very savory bunch. I can’t answer your question, anyway. I just scanned that order you linked to and it makes reference to Florida law I don’t know anything about. When you’re judging a judge, though, the right question is usually “in applying the law, to what extent is the judge ‘breaking new ground’ in order to reach a specific result?” That is to say, is the judge being an “activist?” To answer that question here would require a fair-minded and knowledgeable Florida trial attorney. Anybody else can tell you their opinion or their moral beliefs, but if they jump from there to a conclusion about what the judge should have done, they’ve misunderstood the judicial process.
(If anyone should honor me with a reply to this comment, I hope they’ll take a second first to note that I’m not defending the morality of the judicial process. Thanks.)
Lance McCord (796dd3) — 3/23/2005 @ 7:25 pmWell, time for Justice Kennedy to step up to the plate for Terri.
He must remember his roots.
Let us help him NOT forget! Blog it!
Flap (f32e2f) — 3/23/2005 @ 8:52 pmActus and others,
Putting aside the judge’s reasoning, what possible justification could there be for ordering that nobody can try to see if she can drink on her own??
Did Michael Schiavo suddenly remember that Terri once said that, if she couldn’t lift a glass of water to her own lips, she wouldn’t want anyone else to do it for her???
Patterico (756436) — 3/23/2005 @ 9:08 pmTo answer your specific legal point, Lance, what have you seen in any of the legal documents in this case that suggests that Terri Schiavo considered it an extraordinary measure for someone to lift a glass of water to her lips?
Ladainian,
You didn’t answer the question.
To all:
I am not seeing an answer . . .
Patterico (756436) — 3/23/2005 @ 9:11 pmI, personally, have no objection to what you propose. I believe that the reason that judge Greer has forbidden it is that he has already determined that Michael Schiavo is the decision-maker with regard to the care of Terri and that, therefore, Michael’s wishes must be respected. The clear and sole intent of doing what you propose would be to find a reason to prolong Terri’s life, which, the court has already determined was not Terri’s wish.
Craig R. Harmon (557e82) — 3/23/2005 @ 9:13 pmThe clear and sole intent of doing what you propose would be to find a reason to prolong Terri’s life, which, the court has already determined was not Terri’s wish.
No. The court determined that Terri would not want “artificial life support” — a phrase the court applied to a feeding tube (which I find odd).
Now, you are extending that definition to simply being fed.
Do you truly believe that simply feeding someone by hand, where they can swallow on their own, constitutes “artificial life support”?
Stop a second and listen to what you’re saying.
Patterico (756436) — 3/23/2005 @ 9:17 pmAnd, by the way, it is Terri’s wishes that must be respected, not Michael’s.
Michael Schiavo is apparently desperate to end her life, even if she can eat on her own. I believe that.
But I am aware of absolutely no evidence that she did not wish to be fed by hand.
Patterico (756436) — 3/23/2005 @ 9:19 pm“”Fox News, Special Report, tonite.
Mr. Kondracke assures us that starving to death
is a painless way to die, providing a “sense
of euphoria”, I believe he said, quoting a report
from somewhere””
God bless Mort for all his suffering over Millie’s death, but I can’t square it either, considering that Kofi Annan regularly upbraids the USA for permitting people in Africa to starve. If it was a euphoric and painless death, why the faces contorted with agony, the distended bellies, the children crying so hard their tears run dry…?
Starvation is a horrible thing. This judges order to starve Terri, specific language prohibiting giving her aid until she is dead, will go down in history alongside Dr. Mengele’s papers and the warrants of Judge Roy Bean. But even Bean was only punishing the guilty. This judge is worse.
Dave (fec3a3) — 3/23/2005 @ 9:36 pmActually, as I stated, I have no objection to your proposal of testing whether Terri is able to swallow fluids. I’m merely attempting to explain why the judge has ruled as he did and I stand by it. I believe that this is the reason for the judges ruling.
Actually I am extending the ruling to the extension of Terri’s life by whatever means. I believe that when a person says that they wouldn’t want to be kept alive in situations such as Terri has existed, that it is not the means by which their life is being extended to which they object but, rather, that it is the extension of their life in such a condition to which they object.
Yes of course, Terri’s wishes are those which must be respected but the court has determined that Michael is the person in the best position to know what Terri would want. That you do not believe that Michael is acting in Terri’s best interest is hardly reason for Congress to step into this case.
Craig R. Harmon (557e82) — 3/23/2005 @ 9:39 pmI honestly think the man has lost all perspective — and now kids are getting arrested for trying to give her a drink or water.
Absolutely unbelievable.
Patterico (756436) — 3/23/2005 @ 9:39 pm—-Should Nixon and Reagan been allowed to live an extra week? There is pretty clear evidence that both could have been kept warm for a few more days, if it weren’t for decisions made in their inner circles.—-
Give it a rest. There is little doubt that Reagan had been away for a very long time and was not coming back. In Terri’s case, there is nothing BUT doubt. Michael and his ghoulish judge are hell bent on Terri being dead, on denying the family and a curious public the opportunity to actually learn more ABOUT her condition… and why it was the Michael steadfastly refused her the most basic and humane levels of care and therapy. Come on… no TV, no radio, no SUNLIGHT? No PT? They say she might have learned to swallow again with some basic therapy, but Michael tyrannically refused. He’s a freakin’ monster. We’re starving the WRONG PERSON.
Dave (fec3a3) — 3/23/2005 @ 9:43 pmSchiavo Links
The Southern California Law Blog (f2a7ef) — 3/23/2005 @ 10:31 pmI have not posted much about the Schiavo case. There are other blogs out there doing so. Below are some links. FindLaw has posted all of the opinions filed in the case here Outside the Beltway has consistently good posts…
Patterico, with regard to your comment #9,
I didn’t mean to make a specific legal point; just to offer some framework for judging judges.
There are activist judges, no doubt, all across the political spectrum. There’s bad judging aplenty, too. I don’t know much about Greer, but if I wanted to make a convincing argument that he’s futzed up this case (intentionally or un-), then I’d need to come with more than displeasure over the outcome, and more than a cursory understanding of Florida law. For example, if Greer’s rulings are wrong on the law, then to make my point I’d need to explain why the judges who’ve heard the Florida appeals were also wrong.
To put it another way: If Florida law offers sufficient process for parties like Terri or her parents, then either they’ve their fair day in court, or else a number of state court judges have incorrectly applied that process. If it’s the former and you don’t like the outcome, you need to explain what’s wrong with the law. If the latter, you need to explain how and at what point the judges (not just Greer) blew it. If, on the other hand, Florida doesn’t offer sufficient process, then the Florida legislature is the remedy.
Lance McCord (796dd3) — 3/23/2005 @ 11:01 pmI think he blew it when he decided that there was “clear and convincing evidence” that Terri wouldn’t want to be fed through a feeding tube, based upon what he had before him. That opinion is only confirmed by the corroboration that has since emerged. I’ve written about it at length before and it’s late, so if you’re really interested, stick “Schiavo” into my search engine and take a look.
I would also change the law to require a jury determination beyond a reasonable doubt in life-and-death situations like this, where the patient’s wishes are reasonably disputed.
Patterico (756436) — 3/23/2005 @ 11:47 pmI have yet to hear anyone (but me) call for what really needs to happen here. Regardless of whether Terri lives or dies, we still need to IMPEACH INJUSTICE GREER!
The man is a hazard, with a history of disregarding cases because “there’s not enough evidence.” And yet he makes no demands for obtaining such evidence!
Basic medical procedures (MRI, PET), as well as a comprehensive medical evaulation, which could determine “beyond a reasonable doubt” the mental and physical condition of Terri have not been performed, and have actually be opposed and effectively blocked by M. Schiavo! If the court can order her feeding tube removed, it could certainly mandate further testing, but “The Court”, in the person of one InJustice Greer™ has refused to do so.
It is time to call for the impeachment of a judge who will hear only the voice of the one man who stands to benefit the most (financially, and otherwise) from Terri’s death. It sounds almost like an episode of Law and Order, only, there doesn’t seem to much of either in this case.
We need to start a grassroots movement to impeach this miserable excuse for a jurist before he is allowed to preside over another senseless and preventable death.
Stop him before he kills again!
Partisan Pundit (155e23) — 3/24/2005 @ 2:07 amThey’re getting loonier and loonier.
Richard Bennett (c5751d) — 3/24/2005 @ 2:33 amThe risk of mercy
medvedfans.blog-city.com (054c2e) — 3/24/2005 @ 3:15 amPatterico nails it (please read the linked post before commenting): I have another question for the ?Terri Schiavo should be allowed to die? crowd. Do you oppose an attempt to feed her liquid, to see if she can swallow it on her own? If so, why?
Questions
Sierra Faith (51b069) — 3/24/2005 @ 4:05 amPatterico asks: Do you oppose an attempt to feed her liquid, to see if she can swallow it on her own? If so, why? This by the way, may be the question that provokes Governor Bush to Executive action.
“Putting aside the judge’s reasoning, what possible justification could there be for ordering that nobody can try to see if she can drink on her own??”
I think there’s been enough intermeddling in this family squabble.
actus (e8ffe9) — 3/24/2005 @ 4:51 amI think there’s been enough intermeddling in this family squabble.
The classic Actus non-sequitur. In response to my question: what authority does the judge have to issue an order like this? I’ll take that answer to mean: I dunno.
Because, as far as I can tell, there is no answer to that. He has no such authority.
Patterico (756436) — 3/24/2005 @ 6:11 am“In response to my question: what authority does the judge have to issue an order like this? I’ll take that answer to mean: I dunno”
You asked for justification. Legal I don’t know, as I don’t know either the claims that the judge is ruling on nor the citations. To me the non-legal justification is that there has been enough meddling. Or maybe the UN could have a vote?
actus (e137d7) — 3/24/2005 @ 6:51 amTerri Schiavo
cerdipity (7df988) — 3/24/2005 @ 6:51 amI had thought that Tubetti wanted to weigh in and give a rant on the Terri Schiavo situation, but it appears that she hasn’t decided to yet. On that subject, here are some websites that describe how I feel about…
It’s “meddling” to see if she can swallow on her own?
Patterico (756436) — 3/24/2005 @ 7:28 amIts meddling to keep on interfering with this family. I think people and the government and the politicians ought to leave them be.
And I think the swalling issue has been resolved. Didn’t the guardian that reported to Jeb resolve this?
actus (e137d7) — 3/24/2005 @ 7:39 amThe swallowing issue can be resolved only by seeing whether she can do it — something the judge is preventing.
Patterico (08c813) — 3/24/2005 @ 12:34 pmThe risk of mercy
medvedfans.blog-city.com (054c2e) — 3/24/2005 @ 12:46 pmPatterico nails it (please read the linked post before commenting): I have another question for the ?Terri Schiavo should be allowed to die? crowd. Do you oppose an attempt to feed her liquid, to see if she can swallow it on her own? If so, why?
“The swallowing issue can be resolved only by seeing whether she can do it – something the judge is preventing”
what i mean is that i recall at least one reference to this in the litigation, and thus i’m fine in classifying it with the issues that have been litigated.
actus (ebc508) — 3/24/2005 @ 3:34 pm“what i mean is that i recall at least one reference to this in the litigation, and thus i’m fine in classifying it with the issues that have been litigated.”
Actus – how can you reasonably assert something like estoppel to the changing conditions of a human being’s health? Sure, if a court ruled that a breach of contract occurred, we shouldn’t re-litigate the matter. But why would you impose the same restrictions here?
Mike (41e87f) — 3/24/2005 @ 4:32 pmThe “we shouldn’t meddle with a family decision” argument is so LAME.
Hello! The family does not agree.
If you’re going to cite Florida law and tell me that “her family” consists of Michael Schiavo, then just say, “it’s her husband’s decision” rather than trying to disguise what you really mean.
Bostonian (a37519) — 3/24/2005 @ 5:23 pmYou have lost your way on this, dear respected friend. Your logic is off the mark.
RJN (c555d7) — 3/24/2005 @ 5:54 pm“Actus – how can you reasonably assert something like estoppel to the changing conditions of a human being’s health?”
I’m not asserting estoppel. I’m asserting more the moral arguement that a whole process has been gone through. That process has decided, reviewed, and come to the conclusion as to how the family and individual interests play out in this situation. Which is not to say that there isn’t evidence on both sides, its to say that a whole lot of process has gotten us here. And I think strangers ought to leave that alone.
“The “we shouldn’t meddle with a family decision” argument is so LAME. ”
I think it reaches the heart of the matter. What is it, 10 some years of family court litigation? That has gotten us here, in the determination of what will happen to that family. I don’t think the family court system there is broken. I also don’t think that every decision it makes is the same that I or you would make. But I also think that its time we let this family alone.
actus (e8ffe9) — 3/24/2005 @ 6:20 pmYou have lost your way on this, dear respected friend. Your logic is off the mark.
Assuming that’s directed at me, could you explain how?
Patterico (756436) — 3/24/2005 @ 7:46 pmJudge Greer rebuffs Gov. Bush
Krotchety Kegler (59ce3a) — 3/25/2005 @ 7:47 amOne of the most disturbing aspects of this case is the fact that the judge has not only prohibited any further feeding by artificial means, he also has prohibited any attempts to feed and hydrate Mrs. Schiavo naturally. Mrs. Schiavo has not had a swa…
A couple of clarifications.
First, as I undertand it, an MRI cannot be done without first performing surgery to remove the thalmmic stimulators that were inserted during an experimental procedure performed in California. The cost of the $100,000 procedure, and year long inpatient treatment, was raised by Michael and her family, through community fund raising events in Florida, after Terri’s insurance company (Prudential) refused to pay for it, because it was experimental. This fact was widely reported in Florida papers at the time, but has not been picked up by any national news service since. The procedure and treatment, failed to yield any improvement. Surgery is normally performed to correct a condition, to prolong life, or make a patient more comfortable. It is questionable whether a court could force a patient to undergo surgery, in order to allow the patient to undergo further testing.
The issue of the degree of pain and discomfort felt through the withdrawal of artificial food and hydration, really needs to be unpacked.
Terminally ill patients often choose to stop eating and drinking, as a way to hasten death and also lessen pain and side effects. Forcing patients to continue eating and drinking, often creates pain and discomfort, because the patient’s digestive, and respiratory systems are shutting down. Continuing to eat and drink, can result in intestinal blockages, and fluid overload. Fluid overload, which occurs when the kidneys are shutting down, causes severe edema, and fluid around the lungs and heart, which is very uncomfortable and makes breathing difficult.
A study of Oregon patients, who had chosen to stop food and hydration, evaluated their comfort and pain. The study indicated that patients felt less pain and experienced fewer side effects of their disease, and on a scale of 1 – 10, (“1” indicating severe pain and discomfort), they scored an “8”. Although patients stopped drinking fluids, they and all patients, like Terri, who are withdrawn from food and hydration, continue to receive comfort care, that consists of hydrating swaps and sprays applied to the lips, mouths and throat. Studies have shown that thirst can be controlled when the throat is kept moist.
Hunger generally goes away within 24 – 48 hours, and as someone who has fasted for up to 10 days at a time for health reasons, I can attest that one does experience a greater sense of euphoria. The gnawing hunger one feels from starvation, occurs when people are not fasting, which means no intake of calories, but when they are taking in severely restricted amounts of calories. When a person continues to eat, say even 100 calories a day, the chemicals the body produces that surpress hunger, are not released.
Of course, the issue of thirst and hunger really shouldn’t even be an issue if a patient is in a PVS.
Emmetropia (b39d2c) — 3/25/2005 @ 4:04 pmThere is very good reason not to feed or hydrate her orally: aspiration. If she does not have the capability of swallowing with consistency (if she did, the hospitals/nursing homes she was in would have fed her that way, not through a PEG tube which requires surgery and leaves her open to infection). She would die from aspiration pneumonia and the likely resultant ARDS.
Also, she will not die of starvation, she will dehydrate (she will neither be hungry nor thristy) her organs will start to malfunction and she will slip into a coma then die a peaceful death. This is actually very common in older patients during end of life care (people who are conscious towards the end of life tend to lose their appetite and stop drinking; they do comment that they’re just not not hungry or thirsty). This is very different from what those who go through the stages of hunger, malnourishment and starvation go through due to poverty.
Ol Cranky (7214c4) — 3/26/2005 @ 5:02 amThe risk of mercy
medvedfans.blog-city.com (054c2e) — 4/1/2005 @ 7:24 amPatterico nails it (please read the linked post before commenting): I have another question for the ?Terri Schiavo should be allowed to die? crowd. Do you oppose an attempt to feed her liquid, to see if she can swallow it on her own? If so, why?
The risk of mercy
medvedfans.blog-city.com (054c2e) — 4/4/2005 @ 11:57 amPatterico nails it (please read the linked post before commenting): I have another question for the ?Terri Schiavo should be allowed to die? crowd. Do you oppose an attempt to feed her liquid, to see if she can swallow it on her own? If so, why?