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Sunday, March 20, 2005

A lot of Buts

I've read several articles about the depths of persistent vegetative states, and of the history of the Schiavo case. If you're not sure what I mean, here's a brief overview.

The persistent vegetative state is not a coma. Someone in that condition is in a no man's land. They can laugh, smile, or scream. They move. They blink. But if you tried to poke them in the eye, they wouldn't have the reflex blink that we all would. But they have recordable asleep and awake states. But again, if you ask her, Terry, blink once for yes and two for no, she wouldn't. They do not consistently respond to commands (meaning, it may appear they do once, but it is coincidental).

I asked my son what he would do. He said that if you cannot appreciate the kind of life you have, then why live it. Pretty succinct. I know he's not referring to insensitive clods who don't appreciate how good they have it in life. He's specifically speaking of people in states like Terry, who apparently unable to appreciate and respond to her environment.

I agree. But I was also thinking yesterday evening as I was driving to hockey:

When I was in that horrible mixed state for a few months in summer/fall 2003, I know the horrible images and thoughts that were going through my mind. But I was operating on auto pilot and NO ONE KNEW. NO ONE KNEW. NO one could see inside and see what level of mental instability was there.

What if Terry is aware but is unable to respond?

That would haunt me. It's a horrible decision to have to make: to potentially let her suffer in a purgatory of nothing, or to let her die, while she is aware but unable to say "stop".


Blogger Dreaming again said...
This case may seem like no body's business but theirs, but it is so important that families discuss these issues.

My mom and I have discussed it. She doesn't want long term 'machines' keeping her alive. But ...under no circumstances, does she want food/water withheld. So, if she was in Terry's shoes, she would want to continue to be kept alive. I agree.

I know not everyone would, but that's why we all need to talk about it with our families. Some would want extraordinary measures, ventilators etc to keep them alive indefinitely, some like mom, just feeding tube & IV.
Me? You better make DARN sure it ain't my MG ... you best keep me alive long enough to make sure I'm brain dead not just muscles not working. THEN you can turn the machines off. BUT ... don't take that feeding tube & IV away.

anyway ... I hope families are taking advantage of this horribly tragic situation to talk about it with their families as you have with your son!  

Blogger moodymicello said...
The smarter we get at keeping people alive the tougher the choices. It would be ever so helpfuul if along with out great knowledge of how to stay alive we knew what kind of life we were maintaining. As you said, Blondzila, what if it is that confused state where you can't respond;; but would I want to remain in that state for a lifetime???????????????????????I can think of some mood states I've experienced that I certainly wouldn't want to endure indefinitely. There's a thought that will send chills up my back and down to my elbows.  

Blogger Franikins said...
Medical science does not know everything there is to know about "persistent vegetative states." Instead of erring on the side of life, the choice by Terri's husband, lawyers, and all in his corner is to let Terri die.

I see a big conflict of interest in Mr. Schiavo being her 'advocate' because he already has another family with another baby on the way.

I would hate to be a stroke victim trying to communicate and have nobody know what was going on in my head because I couldn't speak, move, or telepathically indicate my wishes. What if that is the case with Terri? What if she cannot get her body to do what she wills it to do to say, "FEED ME!"

Why not err on the side of life and caution instead of heading down the sippery slope of killing those who cannot defend their right to live?

(Fran steps down off her soap box, then steps up again, then down, then up forgetting that this is NOT step class.)  

Anonymous Anonymous said...
I could not, would not want to be like that. It is not living. It is persisting.

I want to get a tattoo on my chest that says, states, simply:

D N R

And have my Living Will tattooed there as well...heheheh.

And now having the President intervene? Please...let this stay with the family. They should decide. The husband is her closest...the family is where this decision should rest. And they have taken it to a court where a decision has been made.

Let that be done. And let this rest.

-Banjk  

Blogger synergy said...
Personally, don't keep me alive in that state. This is a family's personal decision. It must be wrenching enough with having the entire nation weigh in to offer their opinions and second guess everyone's judgement.

But what truly offends me is that the situation being used for political gain by the Republicans to promote their agenda. The Republican argument is that if there is any doubt, keep her alive. Yet, the Republican party is still willing to support the death penalty despite the numerous instances that it is shown to be wrong.

Furthermore, it is a clear issue of states rights and the federal government is overstepping its bounds, in addition to the thousands of taxpayer dollars that were used to return members of the House to Washington in order for them to vote in person.

I'm getting off my soap box, but I find the situation horrible on many fronts.  

Blogger synergy said...
The New York Times had a good editorial on the Shiavo case and the dangers it presents to the US legal system.

http://www.nytimes.com/2005/03/22/opinion/22tue1.html?hp  

Blogger Dangerous Mind said...
I have every sympathy for the family, and the husband is probably not the best person to make the decision in this particular case.

Given that judicial system is there to address this matter I agree politicians should not be interfering in this case. And that is probably the most worrying aspect of this case. Unfortunately politicans prove time after time they are the last people who should be making decisions, an dseem incapable of making good decisions.

Speaking in more general terms... we are not going to live forever and we all have to go at some point. Fifthteen years is long enough to tell us someone is not going to recover.  

Anonymous Anonymous said...
It is Liz from http://lizditz.typepad.com.

Have you yet made an advance directive for health care? No? Then don't talk here, get with the program.

And the case of "no food, no water"? Is that bad? Is Terri "starving to death"? No. Ask a hospice worker. Many folk with terminal conditions lose interest in food and water. To a person in good health, thirst would be a torment. To a person like Mrs. Schiavo....it is not.

----------
http://seeingthedifference.berkeley.edu/schneiderman.html

There has been a great debate about whether to withdraw artificial nutrition and hydration. And I still run into physicians and families who say, "Oh, we can't let them starve to death. Oh, we can't let them die of thirst." Fortunately, we've had Hospice, which has pointed out that terminally ill patients, patients who stop eating and no longer seem to want to drink except perhaps sips of water, die more comfortably than patients on whom we force artificial nutrition and hydration--we increase respiratory secretion, we increase the risk of nausea, vomiting, aspiration, pneumonia; we increase the amount of incontinent urine that they produce. So, in a sense, we influence the time of dying just by one simple measure of not force feeding.
---------

Calm and factual from somebody you may not read:

http://www.stcynic.com/blog/archives/2005/03/the_schindlers.php
http://www.stcynic.com/blog/archives/2005/03/official_report.php

--------
http://nielsenhayden.com/makinglight/archives/006178.html#006178

If you’re a pro-lifer, please realize that these people have no respect for you or your beliefs. To them, you’re just a button to be pushed.

Back in his Texas days, Bush happily signed legislation that made it easier for hospitals to pull the tubes on unresponsive patients, even ones whose known wishes ran contrary to it, whose families were opposed to it, and who might conceivably have had a better-than-zero chance of recovery.

What made the difference? That legislation back then was about money. This legislation now is about votes. None of it has anything to do with moral beliefs. Throwing the Schiavo case into the federal courts was a bleak and conscienceless piece of hypocrisy, undertaken at the expense of a family that has already seen far too much suffering.
------------

http://abstractappeal.com/schiavo/infopage.html

http://en.wikipedia.org/wiki/Terri_Schiavo

Rather than make the decision himself, Michael followed a procedure permitted by Florida courts by which a surrogate such as Michael can petition a court, asking the court to act as the ward's surrogate and determine what the ward would decide to do. Michael did this, and based on statements Terri made to him and others, he took the position that Terri would not wish to continue life-prolonging measures. The Schindlers took the position that Terri would continue life-prolonging measures. Under this procedure, the trial court becomes the surrogate decision-maker, and that is what happened in this case.

The trial court in this case held a trial on the dispute. Both sides were given opportunities to present their views and the evidence supporting those views. Afterwards, the trial court determined that, even applying the "clear and convincing evidence" standard -- the highest burden of proof used in civil cases -- the evidence showed that Terri would not wish to continue life-prolonging measures.
------

http://cumc.columbia.edu/dept/neuro-icu/patient_info.html

The terms "withholding and withdrawing of life support" refer to the processes in which various medical interventions that have been deemed medically futile are either not given to, or are removed from critically ill patients with the expectation that they will die as a result. These interventions may include mechanical ventilation, surgery, antibiotics, blood pressure medications, general medications, blood transfusions, blood draws, feedings, and fluids.

Most people make the decision to withdraw life support when they realize that further aggressive care will not alter the expected final outcome (i.e. death), but will extend and prolong the patient's suffering.  

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