An Undignified End
The Bitterness Over Terri Schiavo’s Court-ordered Starvation and Dehydration Will Not End With Her Death.
By Perry Hicks
The term, “artificial life support,” conjures up images of machines substituting for failed human organs, or where total brain death has occurred, performing the anatomic functions necessary to sustain life. Particularly in the latter case, along with other hi-tech apparatus, a feeding tube would be required for long term nourishment of the body. In this context it is understandable how any court would consider percutaneous endoscopic gastrostomy (PEG,) or tube feeding, artificial.
This was the decision the U.S. Supreme Court made in the Nancy Cruzon case back in 1990, the same year Terri Schiavo collapsed under mysterious circumstances. The high court ruled that tube feeding is artificial and can be refused by competent patients. Coupled with the earlier Karen Ann Quinlan case that established that legal guardians may curtail artificial life support, the stage was set for the battle over whether Terri Schiavo would live or die an agonizing death.
The question as to who should make the decision over life or death, and the almost ghoulish sci-fi nature of end-of-life medicine, has caused many pundits to draw an analogy to the Nazi program of treating people with disabilities by killing them, and then consider the alarming medical experiments by Nazi Doctors during World War II. After all, the Nuremberg Code of 1947 (inspired by the cruel Nazi experiments) protects patients from unwanted medical treatments.
This Nazi association begs the question: Who should be making these decisions when the wishes of the patient are in doubt? It is also appropriate to question the decision to allow a husband to make a death call when there is an apparent conflict of interest. After all, too much controversy has swirled around Michael Schiavo, supported in part by his own conduct. Then there is the chilling possibility, if enough of the allegations are actually true, that Schiavo could have actually used the law, and Judge Greer, to kill his wife.
Interestingly enough, in an article posted on the website, “The Doctor Will See You Now,” Dr. David E. Milkes states his view that PEG is actually “a form of forced feeding” since performing the procedure and nourishing the patient does not require their cooperation. Thus, pro-death advocates can, and do, argue that poor Terri Schiavo was “forcibly” fed against her wishes to die- as expressed, of course, by her loving husband, Michael.
The flip-side to that argument is what Dr. Milkes also admits; the decision to not use PEG is also made without the patient’s consent.
The reason a PEG procedure is performed is usually straight forward; the patient cannot eat normally because of head injures (both trauma and stroke,) esophageal obstructions caused by cancer, certain vascular disorders, and neurological disease. PEGs are inserted only if the patient requires long-term feeding as defined by a period longer than 30 days.
While PEGs are considered routine and quite safe, there can be serious complications in their use to include pain, bleeding, infections to include infectious peritonitis, Necrotizing Fasciitis (gangrene,) pneumonia, and tumor seeding. Minor complications such as infections occur in no more than 10% of patients and major complications are limited to no more than 2%. PEG mortality is a mere 1%.
However, those numbers represents patients presumably receiving appropriate treatment. Note that ample testimony exists that from 1993, Michael Schiavo directed, against the orders of her doctors, Terri receive no treatment for infections or be given therapy of any kind. This includes training on how to swallow.
Taking food orally is central to Judge Greer’s order to kill Terri. Greer not only ordered the tube removed, he ordered her not to be fed orally. Thus, Terri could not even be given ice chips, a common practice given to comfort the dying.
This order flies in the face of ample testimony that Terri not only could be taught to swallow, that she was fed Jell-O by at lease one nurse. Thus, assertions that it would have been “harmful” to give food or water to Terri while she was starving to death are absurd.
It also speaks to the airport-like security Terri’s family and friend’s had to endure just to see her. Visitors into the hospice are reported to have had to pass through several security checkpoints to include metal detectors.
Animus A Factor
MSNBC, like most mainstream news outlets, has repeatedly reported the majority of Americans support Michael Schiavo and his fight to “allow Terri to die.” They also make a point of saying that Republican leaders in congress and the president have taken a big political hit for attempting to intervene into a private family matter.
This report is probably true given the kind of questions the respondents were asked characterizing Terri as actually dying. However, a Zogby poll using more neutral questions has indicated that Terri’s parents have considerable support from the public.
For example, if the question is framed where the patient is not otherwise terminally ill, being tube fed, and has not having previously expressed their wishes, 79% believe that the assumption should be made on the side of life vs. a mere 9% still favoring starvation.
Or death by dehydration, as Dr. Cranford argumentatively asserted on MSNBC’s Scarborough Country, “She is not starving to death, she is dehydrating to death.”
And he should know what he is talking about. Cranford told Scarborough. “….I have done this 25 to 50 times….. I've done it 25 to 50 times in similar situations. And they die within 10 to 14 days.”
Terri Schiavo expired on day 13.
When questioned whether there was any doubt about Terri’s condition, Dr. Cranford labeled two of the doctors testifying on behalf of the Schindlers, as “charlatans.” This claim was specifically applied to Dr. William Hammesfahr who was nominated for a nobel prize in 1999 for his rehabilitative work in the areas of brain injury and stroke.
This sort of arrogance does not speak well for the Schiavo side, but Dr. Cranford is hardly the only character in this macabre play to show their temper. Michael Schiavo lashed out at congress for attempting to curtail his plans for Terri, calling House Majority Leader, Tom Delay, “a slithering little snake pandering for votes,” and mockingly asking both President George W. Bush and his brother, Florida Governor Jeb Bush, to “Come on down…. and meet my wife.”
No doubt fueling some of this animus is the assertions the Schindlers have made charging Michael Schiavo with abusing Terri. In their charge they cite a long list of events that if true, no one could conclude would be humane, much less beneficial.
One nurse, Carla Sauer Iyer, even charged Michael with trying to repeatedly murder Terri back in 1993 by injecting her with regular insulin. Iyer claims she brought the matter to the police who refused to investigate unless Iyer could attest that she had directly seen Michael do the injecting. Iyer says that she could not because Michael would close the door and was in the room alone with Terri for about 20 minutes. Iyer does say Terri’s blood sugar levels would be zero after these visits, and once she claims she found an insulin vial in the trash bin. Iyer also says she found needle marks at various points on Terri’s body.
Depending on who you talk to, radiological scans have also been reported to have had some indications of bone breakage, including damage to the neck area. The Schindlers have advanced this as evidence that Michael may have physically abused Terri and possibly choked her into her present state.
Detractors point out that the scans are not conclusive and that such indicators could actually point to bone deterioration due to her many years of being bed-ridden.
In order to cut short suspicions that cremating Terri was an effort to burn evidence, Michael Schiavo permitted an autopsy and the results should be released by April 15th.
Wherein Lies The Person?
The principle argument that Terri should die centers on what is believed to be irreversible damage to Terri’s cerebral cortex; this is the area researchers have found to be the centers of cognition and possibly has a central role in long term memory. Thus, pro-death advocates insinuate damage to the cerebral cortex is synonymous with death and their use of "vegetative state" suggests that, like a plant, there was absolutely no intelligence left inside the brain of Terry Schindler Schiavo. In short, if the cerebral cortex goes, then so do you. Anything else is simply "reflex.”
While cognition is centered in the frontal lobes, there is far more to personality than the executive functions we know to be suspended during normal sleep. There are extant theories that cognition is actually a kind of neural society formed from several little understood components- evidenced by how some of these components continue on through the night processing information and considering matters as the left and right cerebral hemispheres slumber away.
Broadly speaking, memory is thought to be stored nearly everywhere throughout the brain and is continually accessed during sleep, as evidenced by our dreaming. Motor centers are active rotating our body positions in response to restricted blood flow on resting pressure points, the visual cortex pans over associations involved with dreams, and even the sensory centers continue to stand sentinel should the highest order of cognition be needed.
This "background" processing, mulling over problems and considering issues, continues even during our wakeful hours. In the process of you "thinking" about an issue, how many times has a new idea or angle just "come to mind?" Hence, considerable, even massive intelligence is involved in subconscious thought.
Terri’s autopsy will show how much of her cerebral cortex remained. It will likely not be very much. However, even if totally absent, when the Schindlers contend that Terri tried to communicate with them, that she recognized them, that nurses reported that Terri took pleasure in being bathed or loved the taste of juice or Jell-O in her mouth, or that she responded differently to different kinds of music, and that at one time she even formed words, they could well be stating fact. Some of Terri's memories could have been intact if much of her remaining brain matter remained.
So would be much of her emotions because they are thought to reside deep in the thalamus (also called the reptilian brain,) along with her ability to sense pain. The fact that they would administer an opiate abrogates any claims that Terri did not suffer as she lay dying. Simply put, the Schindlers may not have imagined to have interacted with their daughter because some of Terri was still in there.
This begs the question, how much of a person must remain before you can allow them to live? But more importantly, is an unconscious person still human?
Basic Human Decency
Dr. William Hammesfahr and several other doctors contend that Terri was not in a vegetative state at all, but existed in a state of minimal consciousness. While Terri would likely never recover from her injuries, Dr. Hammesfahr contends that with therapy, Terri’s condition might well have improved.
But even if she didn’t, would it have diminished the love afforded to her by her parents, Mary and Robert Schindler, who have fought to save Terri’s life since 1998? They begged Michael to name them guardians and simply divorce her; something that occurs in up to 90% of brain injury cases.
Terri’s continuance shouldn’t have mattered to Michael, who has been living with another woman by whom he has reportedly fathered 2 children. If Terri is as brain dead as Schiavo claims, then allowing her body to live on would have caused Terri no discomfort at all. Indeed, giving her over to her suffering parents would have been the humane thing to do.
It is precisely this animus on Schiavo’s part and this dogged determination to see her die that is the most disturbing. It will keep the public’s curiosity fueled and will likely spawn a half-dozen “tell-all” books; a cottage industry will likely spring up around this case to bring us ever more “surprising new facts.”
Rest assured, amid the super-market tabloid claims of miracle diets, 3 legged twins, and the depredations of space aliens, you won’t be hearing the last of Terri Schindler Schiavo.
More on the Terri Schiavo Story
Perry Hicks is a former Mississippi Coast resident and was a correspondent for the old Gulfport Star Journal. He has appeared on Fox News Channel’s “The O’Reilly Factor.” Perry has also hosted his own radio talk show on the auto industry with a mix of politics. Perry is a frequent contributor to GCN. His articles can be found in the GCN Archive.
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