What is your opinion

Just curious as to what everyones opinion is on the Terri Schiavo case in Florida.... Could you be the person that maybe eventually had to pull the feeding from her? How would it make you feel if you had to do that task? I know as nurses we all have to do something that we may or may not want to do... Thanks for your input on this.

I am certain I would NOT pull the feeding tube! It is appalling such a decsion would have to go to court. I watched the videos at Terrri site. She does respond to her family!

If it was her (or her family's) wish that the tube be pulled, I'd pull it in a heartbeat.

I see it as no different than the family of a incapacitated oncology patient who is suffering terribly asking for a morphine drip knowing it will result in death very quickly.

She has an irreversible, chronic condition that cannot be reversed or improved. It is a horrible state with little if any quality of life to it.

How often have you been told by a family member that the patient "wouldn't want this." I'd respect the husband's wishes. I'm sorry, her parents are her parents, not her husband. Unless they were in the process of filing for divorce at the time of her incapacitation his decision should take precedence.

They are doing their daughter a disservice by prolonging a life that according to her husband, she would not want to live.

Andrew Lopez, RN
http://www.4nursing.com

I agree I would have no problem pulling the tube...In fact I have had to pull a feeding before it is not easy but if I have an order I have to do it... Actually the order sat through two shifts ( 3-11 and 11-7) neither of them nurses wanted to do it... I had no choice so I did it... Did I feel bad YES I did and I cried about when the man passed ... But she has a husband he should have the ultimate decision an her parents need to deal with it ... they have 15 years of this to say good bye ... they need to let her die .. she has no life and no chance of recovery.. but that is just my opinion ... and I thank you for yours

I would hope someone would pull my tube..and if someone fought the idea and I did "wake up" in 20 years the one that wouldn't let it be done would then be in for a butt kicking. I don't know if this husband wants it done because that's what she'd want or just because he wants to remarry but for whatever reason her parents are holding on. I haven't followed it all but can he get divorced if that is his reason?

I agree with Andrew. If you've been in this life-saving business very long at all, you've seen over and over again that sometimes "we", the medical community, have too much knowledge and too many new techniques to save lives that God is obviously trying to take. I've done ICU over 10 yrs and believe me there are worse things than a dignified death. I would pull the tube and feel sorrow and relief at the same time.

I am still mixed up about one thing in this case. If her husband "knows" that she would not want to live like this, who authorized the placement of the feeding tube in the first place? I have to assume he did. So why the change of heart now after all this time? I most certainly would not pull the tube simply based on a physician's order. The fact that this woman is alive, no matter what others think of the quality of her life, is causing no harm to anyone. Certainly there are many instances where extremely aggressive care is given to patients in whom it seems inappropriate. These cases can always be taken up by the ethics committees at hospitals, etc. Just because some families seem unreasonable in their requests or expectations for care or recovery of their loved ones is no reason for healthcare professionals to rob families in general of their autonomy in making these decisions. I agree with the sentiments of those who say they would not want to live that way. I would not either, nor would I want anyone I love to linger that way. It is important to remember that patients and families do not come to these situations armed with extensive knowledge about such things. More communication from healthcare providers about what is reasonable to expect, etc, would go a long way towards helping these people come to grips with reality.

We place many PEGs and Trachs in my ICU. Most of the time it's done with the knowledge that the patient is *going* to recover but only after a long rehab (other times, the family just can't accept reality). The tubes were placed with the assumption the patient would eventually recover to the point of not needing them anymore. Some times these assumptions don't play out as planned. Then what do you do?

I helped my grandmother with the decision to place a PEG in my grandfather mostly because we thought he would recover (we all knew he didn't want to be kept alive by machines or with no hope of recovery) and partially because she wasn't ready (his illness was extremely sudden - he had never been sick a day in his life). While he didn't linger on for years (only a few weeks), we did only plan for it to be a temporary measure to be able for him to recover (the very real potential was there).

I would imagine Terri's husband thought the same thing many years ago when he allowed the tube to be placed. But unfortunately, that hope did not become a reality.

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smbrn said:
The fact that this woman is alive, no matter what others think of the quality of her life, is causing no harm to anyone.

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Our Prime Directive (to borrow from Star Trek) is to 'Do No Harm.' Do you not consider it harmful to the patient with PIV to maintain them in this state when they had no wish to exist like that?

Just food for thought......

I can understand what her husbands thinking. But, he is going to starve her to death. I can understand when someone is on a vent with not chances of ever waking up again, but she is awake. She had brain damage and is breathing on her on. Do not starve a person to death.

Lisa RN

Is she awake or existing?

what is her website address?

I heard on the news tonight there is some person in Calif who has offered the husband several million to withdraw his suit to remove the tube and he's turned them down..they said it was not the first offer he's had. I thought it was a little weird for that stranger to offer that. I think they were some right to life person

I heard that as well....I am going to check on that

I am rather upset with the decision to pull the tube. I can see if she was near death, but not like this. First, we do not know how much mental capacity she has. Even if she cannot express herself, she may retain some ability of thought. Second, starvation is a horrible way to go. The body just disintegrates as it starts to digest itself. If her life is to be terminated, isn't there a more humane way. Third, the ethical question: When is it murder and when is it not? Will this decision eventually include those with dementia who are unable to care or feed themselves who are also on feeding tubes?

To MedicRN: It has not been established that Ms Schiavo had "no wish to live like that". The fact that her husband, at this late date, makes this claim is suspect at best.

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smbrn said:
To MedicRN: It has not been established that Ms Schiavo had "no wish to live like that". The fact that her husband, at this late date, makes this claim is suspect at best.

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You are correct.... WE never heard HER make that statement. And on the same token, what proof do we have that she didn't?

The loving husband did not make that statement until 7 years after the injury. He fully expected her to die much earlier, but she really messed things up for him. Read the sworn aug '03 statement of one of the nurses who cared for Terro '91 through '93 (Carla Sauer Iyer--you can read her statement on www.freerepublic.com or www.worldnetdaily.com.

To MedicRN:Are you saying that Ms Schiavo's parents should be expected to prove a negative? That the husband's statement, late into the game, should simply be taken at face value? Anyone could make such a claim in a case like this and then demand that his/her adversaries prove him wrong. That makes no sense, nor does the law require it so far as I know. rnsince83 is right. People should read the sworn statements of the registered nurse who took care of Ms Schiavo. No matter what, this poor woman's mere existence posed no threat to anyone. The husband can't have things both ways in terms of public image. He is on the one hand the "loving husband" who only wants to do what his wife would have wanted, so he says. On the other hand he is an adulterer with a new common law wife and two children. He is, of course, free to do what he wants with his life, but he did not have to demand his legal wife die. He could have at any time legally divorced her if he wanted to be rid of her and move on. I believe money had something to do with his reluctance to do that. I cannot get over the number of nurses who seem to believe that since they themselves would not want to live in a certain physical/mental condition, that it is then acceptable to withdraw such basic care as food and water. Since when are nurses so judgmental about what kind of care patients deserve? Would such attitudes be tolerated about persons with AIDS?

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smbrn said:I cannot get over the number of nurses who seem to believe that since they themselves would not want to live in a certain physical/mental condition, that it is then acceptable to withdraw such basic care as food and water.

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This is a no-win argument. Everyone on this forum will argue till they are blue in the face in support of their beliefs - be they nurses or janitors.
MY *PERSONAL* wish is to never be like this. Although we have Living Wills, I would hope my husband would not allow be to linger in this fashion (believing there was hope of recovery). To me, this is NOT quality life (yes, he is well aware of my wishes).

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Since when are nurses so judgmental about what kind of care patients deserve? Would such attitudes be tolerated about persons with AIDS?

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I have never judged the kind of care received/not received/withdrawn by patients. I am there to support the decisions made by the patient or medical DPOA (if applicable). Only they know what they want. This includes patients of all diagnosis - from head colds to cocaine-relate MIs/CVAs to AIDS

It is such a sad situation...I have so many mixed emotions about this case...I honestly do not think we are hearing the whole story... the parents should stand behind the decision of the husband regardless..If he says that she had no wish to live that way.. then end of discussion move on....The pictures we are seeing of her on TV are from 7 years ago... what I don't understand is if this was not what she would have wanted then why was a feeding tube put in in the first place...The husband is going to have to live with this decision..And I read somewhere that feeding tubes are removed all the time..I have even been in the room with a fellow nurse when she had to remove one on a hospice patient..per request of the doc, hospice, and family...believe it or not the patient lived another 3 weeks..the husband has obviously moved on with his life... if he didn't want to be responsible for her anymore then why not say to the parents "ok you guys take care of her" I hope I am not sounding cold and heartless because truly I am not.

Let this be a lesson to all of us. PUT YOUR WISHES IN WRITING!!!!!!
I think it is murder to starve a person to death. It is one thing to allow someone to die that is terminal. Terri was NOT terminal! She was brain damaged. To me a vegetative state is when you are basically in a coma, and Terri was not in a coma. Who knows what thoughts are going through her mind or what pleasures she has? Sure there is not much hope that she would recover any further than she has already but that does not give anybody the right to starve her to death! If her so called husband cared for her so much, why did he have a girlfriend and have children with her? There are laws against adultery!! His children are proof that he is an adulterer and may be he should be prosecuted.

I agree with MartinRN and think that the rest of you should take a serious look at yourselves and think about what you are saying and the profession you are in and have some ethics and some moral value. I have worked with developmentally disabled individuals for five years now and when people say that she has no quality of life..how dare you. You don't know what she is capable of or if she even knows what is going on. She may not know much if any of what is happening to her, but what if she does? I have seen the individuals I work with make great progress over the years and sure it takes much longer that it would a "normal" person, but they still deserve some compassion and the right not to starve to death.

I'm just a nursing student so I really can't state a "professional" opinion. My personal opinion however, is that it is morally wrong to starve a person to death. I keep hearing from the press that she is not suffering but the other night the husband's attorney quoted the nurses notes as stating that during placement of a suppository the patient grimaced and I think he said squirmed. I'm no expert but isn't grimacing an indication of pain on a pain scale?

The Shiavo case is complicated due to disagreement among her family -- Michael Shiavo vs. The Shindlers.

If there was agreement in the family, the story would not be on national news. Withdrawing feeding tubes is done every day and the person dies without news coverage.

Admittedly, I am biased because I had the experience of watching a fairly cognizant woman die of starvation over about four weeks. I felt like a murderer. The woman suffered and cried out. She was in her nineties and had been in long term care for several years. One day, her nieces and nephews decided to take her tube away. No one ever visited her. I was horrified to watch her slow death.

From the little I have seen on television, Terri is probably less cognizant than this woman but does have some awareness. I would have trouble starving her. I have seen other people in vegetative states that I would be more willing to see starve as an act of mercy.

On the other hand, she had been a lovely young woman who was somewhat shy and avoided cameras. How heinous that she is now seen all over television in a rather unflattering state. She would have been appalled. No one would want to live in that state.

But she is no longer that same young woman. She is greatly altered. Severely brain damaged. Infantile. Yet, feeling and aware on that infantile level. There is no way to know whether she wants to live or die.

Had they taken away life support in the first few days or weeks of her vegetative state, things would have been far less painful, I reckon. So few people are educated enough to realize prognosis.

My husband died nearly fifteen years ago when he was thirty eight. He had lymphoma and tumors proliferated throughout his brain. He had one cerebral hemorrage that left him paralyzed on the right side and he had a feeding tube and catheter. He was one miserable human being. He could not speak. Just thrashed around.

I said, "If he has another hemorrhage, do nothing. No ventilator."

He had a hemorrhage and a was intubated. Brain dead.

Fortunately, he died while still on the ventilator. I would not have maintained him in that state. He had malignant tumors throughout his brain. The night before his first hemorrhage, he had such terrific pain that he forced me to tie a handkerchief around his head and cursed me when I could not make it tight enough for some relief.

It was my duty as a wife and a friend to let him go. I was not letting him go. He was going.

I think it is very important for physicians to be frank and honest about prognosis in a crisis situation. Tough call, I know. But there does come this point when anyone with common sense knows that there is no hope for a viable life. Families don't want to accept that but they should be told bluntly.

Several years ago, my mother suffered a hole in her esophagus. Took a couple of days for the problem to be absolutely pin-pointed. Emergency surgery on a seventy nine year old woman. She had to have a feeding tube. There were no promises of a full recovery. Very difficult decision.

We opted for the surgery. Very difficult surgery. She came out of it but she was nuts for a month or so. I thought, "What have we done?"

She came home with a feeding tube and had home nursing for a month or so and with the family staying with her at night.

Once home, she regained her mind. She recovered and began to be able to eat and drink again on her own. The tube was removed.

About three months after that, she had encephalitis. Totally nuts and in a semi coma in the hospital. Another feeding tube. Accurate diagnosis and medical treatment plus about three months of rehab and she came out of it.

She is now a very healthy eighty two year old woman. Tiny - four foot eight and ninety four pounds. A dynamo. She looks better now than she did before the hole in her esophagus.

Decisions during a crisis are so difficult. I knew what to do with my husband. My mother's crisis had more grey areas.

I feel a lot of compassion for the Terri Shiavo situation. For the Shindlers and for Michael Shiavo. She is not going to get better. She is going to stay the same as she has been for about fifteen years. For whatever reason, Michael Shiavo is going with what he remembers her saying before she was in this state.

She is not now that person. She is very different. Severely brain damaged but some cognizance.

As a nurse, I know that I would have difficulty starving her. Very tough.

But, when I look at the photographs of her as a young, healthy seeming woman, I can see reason for letting her die.

Very difficult, complicated case. In a year or so, she could die of pneumonia or influenza. Quite likely. She could die from complications of a UTI. Her situation is very tenuous. Why starve her? Why not let her parents care for her until the end?

On the other hand, why prolong her misery? She could not have wanted to live like this.

But she has not been the same Terri for years. There is no way to know now what she could want.

There will be an autopsy that will show severe brain damage.

Well, duh. We know that she is severely brain damaged.

Very difficult case.

It should have been a very personal matter. Government should have never been involved. The disagreement between husband and parents brought on the intervention of government.

Just a very sad and complicated case.

I don't think that there is a right opinion. I just hate to see a personal matter politicized. The religious right involved. Yet, in polls, evangelistic Christians are split on keeping her alive and letting her die.

There is just no right or wrong for Terri. The legal aspects of her situation are as grey as the physiological.

If the parents were in agreement with the husband -- or the husband in agreement with the parents, her death would not be played out in public.

I have seen a lot of deaths. I have never seen a completely painless death. It's just hard to say whether the pain is perceived by the observer or the patient.

Very hard. Is the grimace at the suppository part of perceived pain or reflex?

Terri is two weeks out now. She is yet a young, strong woman. She could die tomorrow or she could go another two weeks.

Interesting nursing lesson for the populace. Most people -- journalists, everyone -- are ignorant of how resolutely people can cling to life; what life means; life that does not adhere completely to science.

Lichen exists on air. So can humans for a time.

I wonder how aware Michael Shiavo can be of such biological resolution? Must be hard for him. I reckon he thought that she would have succumbed by now. He is a RN.

You kind of have to wonder how his nursing experience has influenced him.

If he has never done it, he should work in long term care.

Very difficult case.

I am pulled both ways.

The decision is personal, right or wrong. So far, the courts have upheld that premise.

If the tube was re-inserted now, she would exist in an even more compromised state. I reckon it is too late now to put it back.

Faizi

I encourage everyone that brings the topic of Terri Schiavo up to make out a living will. I am GLAD the government did not decide to make legislation to rule on our right to die. People have the right to determine their quality of life, they should also have the right to determine how they want to die. Lets say that Terri did tell her Hubby to not allow her to live the life she had after several doctors say there is little chance for recovery - How would you like to live another 15 years, waking up in Terri's body? Her case was about not having a living will, not a case of "is she awake or is the body in PV State?" It was about her right to choose when to die. It was quoted in Newsweek - the parents said "Even if Terri said she wanted to die, we would not let her", how selfish is that?

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michigancna said:It was quoted in Newsweek - the parents said "Even if Terri said she wanted to die, we would not let her", how selfish is that?

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I agree, my living will is made out and very specific.

The parents desire to keep her alive seemed to be purely for their own comfort. Like a family that simply cannot let go of a dying patient.

The decision to die should be up to the patient, or closest living relative who was her spouse in this case. I find it pretty damning that the parent chose to ignore her wishes as expressed by Michael Shiavo.

Andrew Lopez, RN
http://www.4nursing.com