What’s Wrong with the World

What Mr Smith said was that her feeding tube had not been removed.

Not quite the equivalent of saying that ANH had NOT been stopped.

There is no need to "remove" the tube in order to stop its use. But it is good that you have assumed that the parents were in agreement with your views and your values. If that is what is required for you to leave them alone at this point and wish them well for the future then your assumption serves a greater good in this particular instance.

Lydia, when a commenter imputes venal motives to someone (you) for merely expressing the wish that disabled people like Javona Peters not, out of Christian love, be murdered, I must assume that TRUTH's real name is LIAR; and should this pro-tube pulling troll's comment disappear, I (at least) would think you had done a good thing.

Well, Mr. Truth's comment is unpleasant, but I will answer it: I'm not a party to the email WJS got. While it's true that you can simply stop giving a person food and water using a tube and dehydrate him to death while the tube remains in place, WJS _clearly_ is taking it from whatever his source told him that she received food and water until the end and was not dehydrated to death. As for "leaving people alone," of course even when I feared that the mother had succeeded, and the father had finally consented, in dehydrating their daughter to death, which I regard as murder, there was not a single thing I could do about it except publicize it. That was only right. Mr. Truth's comments will be watched, certainly.

The problem with "not murdering" disabled persons is that forcing them to stay alive through invasive artificial means (for our own moral placation) violates a right just as fundamental as the right to life: the right to refuse unwanted bodily invasions and medical treatment -- even if well intended.

I would wish that disabled persons who cannot refuse or decline treatments in the direct first person NOT be subjected to what would -- in any other circumstance -- be an extreme form of aggravated assault and battery.

I see no assertion from Wesley Smith that Javona did not dehydrate to death. In fact, he states that he does not know the mechanism of death. I am unclear how one concludes that ANH was continued til the end, therefore. In the large majority of cases where ANH is stopped, the feeding tube is not removed.

It's possible that WSJ is being cagey with words, although that would be contrary to all my previous experience with him. He says in the main post that "she was given every medical chance to survive." Given especially Wesley's own strong fight against dehydrating people to death, he would never say that if he believed it to be remotely plausible, given what his source told him, that she was dehydrated to death. Also, though it's not a strictly accurate usage, the phrase "remove a feeding tube" often is used to mean "stop ANH," and he may well have reason to believe his source is speaking in these terms. Again, I didn't see the e-mail, of course, but I think it's quite clear what WJS is trying to say himself.

Buster, it's absurd to the point of being disgusting to imply that giving food and water is (would be under "any other circumstances"??) assault and battery. (And above and beyond your deserts, I wish for you that you may never be dehydrated to death.) Bag it.

I repectfully disagree, Lydia. You are equating food and water (as the term is commonly used) with ANH. This is a common misperception, but the two are qualitatively different. If they were one and the same, then there would be no controversy. I was referring to implementation and maintenance of ANH -- an invasive medical procedure -- when I referred to the concept of assault and battery. Your equating food and water with ANH is no less "absurd" than my equating ANH with aggravated assault and battery, depending upon one's POV.

Food and water supply a basic biological need, but ANH delivered through a PEG tube connected to an IVAC machine goes beyond this. It is life support just as a mechanical ventilator or dialysis machine is. Certainly if a person were forcibly compelled to undergo those medical procedures, even with beneficent intent, it would be viewed as violative and assaultive.

ANH replaces and circumvents a lost vital physiologic function through invasive means just like a ventilator or dialysis. It can only be done with informed consent, by highly trained and specialized medical practitioners working under controlled conditions, requires a doctor's order, requires specialized medical technologies and devices, and then skilled nursing to maintain. ANH has myriad complications, and has well established risks. It is NOT the same as food and water from legal, ethical, and medical stances. Of course you may feel differently on a moral level, and I respect such, but that is not what I am referring to. If one were to give a PVS patient food and water (as opposed to infuse tube feeds directly into the gut), the result would be death through aspiration.

I would encourage you to research the term "medical battery" and read the section of the 5th edition of the Physicians' Ethics Manual (published in the Annals of Internal Medicine in April of 2005, and endorsed by the Amercian Medical Association and American College of Physicians) that deals with artificial nutrition and hydration if you doubt the veracity of my claim. You are more than free to disagree of course, but I am NOT asserting a personal POV. I am iterating what is codified in professional canons.

Think of it this way, Lydia. If someone shoved a tube down my throat and into my stomach, pierced my stomach from the inside out, pierced my abdominal wall, sewed a tube into the aperture, tied me down or sedated me to prevent me from resisting such, and then connected me to a machine that infused manufactured nutrients and hydration into me to forcibly keep me alive -- all against my previously expressed wishes, but I can no longer directly object because of the chemical and physical restraints used on me -- clearly such would be extreme assault and battery.

I do agree, though, that the medical, legal, and ethical zeitgeists cannot be ignored, which is why I explicated as I did "in any other circumstance."

Bustertheboa--
Don't waste your time.

Walking up to someone on the street and cutting them with a knife is assault and battery.

Walking up to someone on the street and cutting them with a knife after asking them first and being told "NO, that is not something I would want" is still assault and battery, but in this example the assaulter has demonstrated intent and demonstrated clear disregard for the victim.

Changing the knife to a scalpel and the location to a operating room doesn't change a thing.

This example clearly illustrates the difference between wanted and unwanted medical treatment.

"I am iterating what is codified in professional canons."

And your point is? That the the zeitgeist trumps Christian ethics? Or, that it is better to err on the side of death than that of providing
extraordinary care? Based on what has been written so far, I fear more will be killed in the name of compassion than we could ever have imagined just a short time ago.

"If they were one and the same, then there would be no controversy."

That's, um, an interesting assertion. There's never controversy over anything there shouldn't be controversy about? How about tearing unborn infants to pieces or sucking out their brains? Gee, it's controversial, so that means it can't be qualitatively the same as murder. How about lethal injections for disabled newborns? That's "controversial"--in other words, an open question--in some medical ethics circles. Does that mean it's qualitatively different from murder?

"If one were to give a PVS patient food and water (as opposed to infuse tube feeds directly into the gut), the result would be death through aspiration."

This is not true in general. Being "PVS" is not the same thing as having one's swallowing muscles non-functional but rather refers to a certain level of mental function. Some (many?) PVS people can be spoon fed and can suck on (for example) a wet washcloth. Of course if they are not in fact fed by mouth, the swallowing muscles will atrophy eventually and stop working, but that is not a result per se of the PVS state. PEG tubes are usually inserted in PVS people both for ease of care and also because it is so difficult to give a person of adult or near-adult size enough food and water by the slow method of spoon feeding.

If you tried to commit suicide by taking poison, it would not be "assault and battery" to pump your stomach to get the poison out. "Sticking a tube in" a person who has nothing wrong with him is obviously a poor analogue for inserting either a PEG or an NG tube in a person unable to feed himself who is likely to die otherwise. Moreover, the procedures you so graphically describe have already been done before all the debate arose on the people whose deaths you are so solicitous to obtain by dehydration. At that point it is merely a matter of giving the food and water. Plenty of parental and spousal care-givers learn to and do give tube feedings at home as part of basic care. The giving of the food and water at that point cannot be described as "invasive" even by your bizarre standards and are by no means extraordinary. In fact, in some cases a further surgical procedure has even been done to _remove_ the tube (this was done to Terri Schiavo, without anesthetic) in order to make it harder for feeding to be resumed.

Really, I don't think Boa and his "friend" Mr. Truth know nearly as much about this as they imply.

She was not dehydrated.

So in the example of the knife wielding person you figure the end justifies the means in the absence of consent? In other words, your words, it makes sense to be a cheerleader on the sideline chanting "the guy with the knife is doing it for your own good so its okay"?

The absence of a diagnosis and prognosis is an entirely different circumstance from the circumstance that exists once a diagnosis and prognosis exists.

The point being that care directives aren't written to exclude treatment in the absence of a diagnosis and prognosis. The trigger for a care directive is not the absence of medical facts but the presence of medical facts. Therefore a person with an advanced directive is given all necessary life preserving and sustaining treatment until facts are in hand that can be used to evaluate whether the advanced directive is applicable given the KNOWN facts.

That a respirator, IV medications and even an NG is established and used during the interim between KNOWN and UNKNOWN doesn't negate the persons rights including their right to declare that treatments NOT be continued under described circumstances.

Wesley, thank you so much for stopping by and for the clarification. It shouldn't have been necessary, but I appreciate it very much.

Sorry, "Truth," I don't think you have a right to have people stop giving you food and water. But I appreciate your clarification, because it makes it quite clear that all of this has _nothing_ to do with "sticking knives in people" but rather with the idea that it's "harming" people just to keep pouring bags of food/hydration into the _already set up_ feeding set-up if one concludes that they "wouldn't want it."

Not to mention the fact that (if this matters to you--it doesn't to me) this girl was underage and isn't even claimed to have expressed any desire on the matter.

Before you condemn me to hell know this: I didn't want Javona Peters to die. In an ideal world people don't suffer, don't need to be healed, don't need to make decisions or choices that boil down to choosing between the lesser of two evils.

Government will award to itself any authority that is not specifically restricted from it and reserved by the people. The 9th amendement addresses this specific issue.

While I don't necessarily agree with every CHOICE or the availability of every CHOICE I do believe that we must exercise extreme caution in tampering with the rights reserved to and for the people.

Even when preserving such rights can lead to the ability of the people to make self destructive choices. The right of people to refuse medical treatments is a prime example. A certain religion prohibits blood transfusions and under the right circumstances blood transfusions are certainly life saving or potentially life saving treatment.

The scales are set right now to weigh religious freedom as having priority over other considerations including the interest of society to preserve life. My personal religious belief doesn't prohibit blood transfusions, I may even think refusal of blood transfusions is nonsensical and tantamount to suicide.

Chip away at the rights reserved to the people and pretty soon you will find yourself unable to make ANY decision without someone elses approval.

The clarification is this: it doesn't matter whether YOU think it isn't harming the person. It doesn't matter whether I think it harms the person.

What matters is that the person have their choice respected.

Maybe we, as a society, have a bad way of determining what the persons choice is. Maybe the method in law for determining the persons choice is flawed.

My concern is that the person have the right to make a choice and that the right not be infringed or minimized.

Thank you for allowing me the opportunity to present my point of view. I appreciate your respect and civility. I hope I have not offended you.

Right now there is a case in Canada where the person and his family is not being afforded ANY consideration or respect for their choice and treatment directive.

The power and authority to make the decision was, supposedly, presumptively placed in the hands of the hospital rather than presumptively being placed in the hands of the patient.

The court has stepped in to say there is no basis in canadian law for the presumption that the authority and the power of decision rests with the hospital. The court has acted to preserve the status quo until the court has an opportunity to fully hear the case being made by both sides.

Hopefully, and by the will of God, the court will eventually preserve the right of the patient to make treatment decisions.

Yes, where I differ from "Truth" and his friend/brother/twin/whatever, Boa, is that I do not regard all private decisions to be symmetrical. That is, the decision not to have food and water until one dies is not symmetrical with the decision _to_ have it. Thus I don't regard patient autonomy as the highest value, though in some cases (as in Canada) the application of that principle can save lives. But sometimes it kills, as it could have done in Javona's case and has done in many another case. Ironically, in many of the cases where "choice" is being trumpeted, there is no evidence at all that the "choice" in question even was or would have been the patient's own, and sometimes it is being exercised for minor children and people who have never expressed any such wish. In the case of elderly Marjorie Nighbert, she _asked_ for food and water but nonetheless was dehydrated to death, in the name of "her choice." Things are totally screwed up, and it's a strange thing that people begin shouting "patient choice" whenever we're talking about dehydrating someone to death. Be that as it may, yes, I would not dehydrate someone to death even if he had expressed a desire for it at some earlier time in his life. I would consider it facilitating suicide. I also do not regard food and water, even "artificially" administered, to be treatment. There is a continuum from feeding oneself with one's hands to feeding a baby with a bottle to feeding by way of an NG or PEG tube. They are just different means of getting the food and water into the system.

If you tried to commit suicide by taking poison, it would not be "assault and battery" to pump your stomach to get the poison out. "Sticking a tube in" a person who has nothing wrong with him is obviously a poor analogue for inserting either a PEG or an NG tube in a person unable to feed himself who is likely to die otherwise.

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I agree, which is why I clarified that the medical and legal and ethical zeitgeists cannot be ignored, and why I specified "in any other circumstance." You are correct that different metrics and standards apply to medical scenarios. However, the logic also runs the other direction with equal facility. Just as you correctly point out that pumping the person's stomach would not be assault and battery, failure to do so would not be murder or facilitating suicide.

Your statements regarding PVS are inaccurate, as is your comparison to a person who cannot feed himself. PVS patients can no longer volitionally swallow, which is qualitatively different vfrom inability to feed, and that is why they are tube fed. It is not for convenience issues, as you erroneously assert.

I do agree that negative rights trump affirmative rights -- or as you put it, not all private decisions are symmetrical. Your point about Javona's age is well taken, but all that does is change the legal metric applied. Rather than substituted judgment, best interests would be the applicable standard. Otherwise, however, the medical and legal and ethical landscapes would be unchanged.

"I am iterating what is codified in professional canons."

And your point is? That the the zeitgeist trumps Christian ethics? Or, that it is better to err on the side of death than that of providing extraordinary care? Based on what has been written so far, I fear more will be killed in the name of compassion than we could ever have imagined just a short time ago.

My point was that I would be explicating the EXACT same information irrespective of how I feel personally. What I am relating to you is not my personal opinion. That is all. Can you honestly say the same???

Generally speaking, the tendency is to err on the side of intervention when either the default scenario (ethical vernacular) or the emergency exception (legal vernacular) occurs. However, those instances refer to settings when diagnosis is unknown, prognosis is unknown, and there is no evidence one way or the other about the person's wishes. When such is NOT the case, there is a general tendency to err on the side of lesser intervention. The rationale is that it is better to withhold potentially wanted treatment (non-beneficence) and allow natural death to occur, than it is to inflict potentially unwanted treatment (maleficence) and force artificially sustained life. In modern bioethics, respect for autonomy -- in the way of upholding negative rights -- trumps affirmative preservation of life. This is as per Beauchamps and Childress, if you're interested.

I am not saying that such is right or wrong, bad or good, moral or immoral. I am merely saying that it is. Whether I agree or not is simply not germane.

Think of it this way, Lydia. If someone shoved a tube down my throat and into my stomach, pierced my stomach from the inside out, pierced my abdominal wall, sewed a tube into the aperture, tied me down or sedated me to prevent me from resisting such, and then connected me to a machine that infused manufactured nutrients and hydration into me to forcibly keep me alive -- all against my previously expressed wishes, but I can no longer directly object because of the chemical and physical restraints used on me -- clearly such would be extreme assault and battery.
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I can see why you might have misunderstood, Lydia. I should have been more clear. In the example above, I was referring to a situation where tube feeds are medically indicated, but I have expressly refused such. In other words, I am not perfectly fine and the tube feeds are needed to keep me alive. To say that once the procedure is done all I require is administration of tube feeds would be inaccurate... and also irrelevant. The site would need to be maintained, and you seem to be ignoring the invasive and assaultive nature of the procedure itself, as well as the ongoing nature of the bodily invasion of having ANH infused directly into my gut against my will.

Do you advocate forcing other forms of life support on people who cannot directly refuse in the direct first person simply to keep them alive? Or is it tube feeds that have some special significance for you? While it is true that artificially administered fluids and nutrition are not readily distinguishable from other forms of medical treatment (speaking about medical, ethical, and legal planes), I have found that many do ascribe special moral and emotional significance to such that they do not ascribe to respiration, waste elimination, hematopoiesis, etc. -- even though all of these functions are necessary for biological maintenance.

Is it the lack of wishes in writing that you find disturbing? I can tell you that even today, even in people over age 60, even in the post-Quinlan post-Cruzan post-Schiavo era, the majority of patients do NOT put their wishes in writing. Perhaps that is the take home message: to have some sort of tangible documentation of one's wishes.

Or is it that you simply feel ANH can never be withheld or withdrawn, even in writing??

That's, um, an interesting assertion. There's never controversy over anything there shouldn't be controversy about? How about tearing unborn infants to pieces or sucking out their brains? Gee, it's controversial, so that means it can't be qualitatively the same as murder. How about lethal injections for disabled newborns? That's "controversial"--in other words, an open question--in some medical ethics circles. Does that mean it's qualitatively different from murder?
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No Lydia. I think you misunderstood me. Let me clarfiy.

If ANH were viewed as being the EXACT same thing as food and water, with absolutely no differences AT ALL, no dissent or debate from anyone, then there would be no controversy. Obviously, therefore, ANH and food and water do differ from each other -- at least in some ways, to some people.

Just as the procedures you describe differ from murder -- in some way, to some people, at least -- as well... hence the controversy. They MAY be qualitatively the same as murder... or NOT.

From the Physicians' Ethics Manual:

Withdrawing or Withholding Treatment

Withdrawing and withholding treatment are equally justifiable, ethically and legally. Treatments should not be withheld because of the mistaken fear that if they are started, they cannot be withdrawn. This practice would deny patients potentially beneficial therapies. Instead, a time-limited trial of therapy could be used to clarify the patient's prognosis. At the end of the trial, a conference to review and revise the treatment plan should be held. Some health care workers or family members may be reluctant to withdraw treatments even when they believe that the patient would not have wanted them continued. The physician should prevent or resolve these situations by addressing with families feelings of guilt, fears, and concerns that patients may suffer as life support is withdrawn.

Irreversible Loss of Consciousness

Persons who are in a persistent vegetative state are unconscious [39, 40] but are not brain dead. Because their condition is not progressive, patients in a persistent vegetative state are not terminally ill. They lack awareness of their surroundings and the ability to respond purposefully to them. The prognosis for these patients varies with cause. Some physicians and medical societies believe that there are no medical indications for life-prolonging treatment or access to intensive care or respirators when patients are confirmed to be in a persistent vegetative state [41]. They conclude that these patients cannot experience any benefits or suffer any discomfort and that all interventions should therefore be withdrawn. However, many patients or families value life in and of itself regardless of neurologic state. For these reasons, goals of care should guide decisions about life-prolonging treatment for patients in a persistent vegetative state in the same manner as for other patients without decision-making capacity.

Intravenous Fluids and Artificial Feedings

Artificial administration of nutrition and fluids is a life-prolonging treatment. As such, it is subject to the same principles for decisions as other treatments. Some states require high levels of proof before previous statements or advance directives can be accepted as firm evidence that a patient would not want these treatments in the setting of terminal illness, permanent unconsciousness, or advanced dementia. For this reason, physicians should counsel patients to establish advance care directives and complete these parts of living wills especially carefully. Clinically, there is unfounded concern that discontinuing use of feeding tubes will cause suffering from hunger or thirst despite research findings to the contrary. Physicians should carefully address this issue with family and caregivers.

Are you asserting, Buster, that people in a PVS cannot swallow at all, or are you making some difference between "volitional swallowing" and other kinds of swallowing? If the former, I am quite confident that you are wrong. They do swallow their saliva, for instance. And nurses who worked with Terri Schiavo years ago (before all spoon feeding was stopped and the relevant muscles allowed to atrophy) did give her spoon feedings of jello and such and have said as much in writing. I'm confident it would be possible to come up with other examples. I'm guessing perhaps you are saying that "non-volitional swallowing" is of such a different sort that it makes it too hard to feed people enough/effectively (a little jello on a spoon isn't going to keep anyone alive), but that is very similar to what I had said already. In fact, I recall reading one physician's testimony in favor of dehydrating people to death who actually admitted that syringe feeding, for example, would be possible but he opposed it for his own ideological reasons. Again, though, I'm not asserting that it wd. be possible to get all necessary nutrition and hydration in that way.

Of course "if ANH were viewed as being the EXACT same thing as food and water," and were viewed so by a sufficient number of people, there would be no controversy. In fact, there was little controversy even thirty years ago. Feeding tubes aren't exactly a super-recent invention. The parents of the famous Karen Ann Quinlan (sp?) expressly stated that they would never have thought of having her feeding tube withdrawn, despite the fact that they fought a famous case to withdraw her ventilator. And the whole significance of the Cruzan case arose because the hospital refused to stop her ANH. Times have changed.

But I was talking about what is the case, not what is "viewed" as being the case. Yes, I believe that food and water, however administered, are basic care and not treatment, contra the physicians' manual that you quote. I understand that you may consider such quotations to be decisive. I don't. These things aren't relative. There's a truth of the matter.

You missed the point Lydia was making.

The point was that the "how" of delivering food and water is irrelevant from her perspective.

Everyone should eat and drink and therefore everyone should be in agreement that no one should concern themself with how they get the food and water.

She is only willing to have people consider what the end result is. To have people consider how the end result is acheived and what is required along the way doesn't help her argument and can only undermine it. Therefore it is best to limit and simplify the argument. You have to narrow the discussion. You have to limit what you put before the people in order to limit the dissent. To get at black and white you have to eliminate every shade of gray.

The idea forwarded is that food and water are never bad and therefore ANY process that delivers food and water can't be judged as bad. Using this logic there is no room for argument or discussion. Food and water are not a choice. Therefore the means of delivery can not be subject to refusal. Food and water are compulsory care and therefore any means necessary to deliver them MUST be compulsory as well. The means of delivery cannot be considered or classified "surgical" or "treatment" by medical, moral or legal standards. This represents common knowlege. This represents common sense.

Patient autonomy is a bad thing because that opens the door to individualism and diverging opinions and ideas, ideas and opinions not necessarily in agreement with the opinions and ideas that Lydia holds most dear and most sacred.

There is no symmetry, only opposites.

Allowing the patient to decide is a bad thing unless the patient decides in a manner agreeable to Lydia. If everyone is in agreement with Lydia then there is no need for patient autonomy because everyone would be of the same opinion and everyone would have the same sacred ideas and beliefs.

The only way for the world to make sense, the only way for there to be nothing wrong with the world, is to make sure the world is a place where everyone is in agreement with Lydia.

I assume you are not medically trained and therefore your perspective on swallowing makes sense to you. If a person can swallow saliva that seems to indicate something. You did mention "volitional swallowing". Interesting since safely swallowing, swallowing with minimal risk of aspiration, requires volitional effort.

You mentioned Terri Schiavo. The three barium swallow tests performed in that case established she did not initiate volitional swallowing, the substance was placed in her mouth and she made no effort to swallow it. Without the connection the message cannot travel. Without the nerve impulse the muscle doesn't act. Yes the muscles can weaken from disuse. In the case where the muscle doesn't recieve nerve impulses to act upon the muscle is useless.

Perhaps you heard the phrase "contractures". This phrase came up in the Schiavo case. Normally the nervous system balances the forces of opposing muscle pairs. Normally the pathways are intact for feedback. Normally the pathways are intact to both muscle pairs. Contractures are the result when the nervous system- for whatever reason- is unable to balance the forces of opposing muscle pairs.

You might have heard that Terri Schiavo didn't recieve dental care- it was one of the many complaints made to Florida DCF. In the course of the investigation into this complaint the DCF investigator was informed that normal dental examines could not be performed because Mrs Schiavo would clench and grind her teeth because she didn't react "normally" to the manipulations of her jaw.

"What I am relating to you is not my personal opinion. That is all. Can you honestly say the same???"

You are trying to put emotional and spiritual distance between yourself and the viewpoint you hold. I can't say I blame you. After all, how can one really maintain; "I am not saying that such is right or wrong, bad or good, moral or immoral...", and hope to build a genuinely moral health-care system?

Please, ditch the faux neutrality and take a stand, but seek a source greater than the prevailing zeitgeist . Try to view the matter from the perspective of Eternity.

The crux of the need for PEG or NG, beyond meeting nutritional requirements (of course) is that if the person cannot effectively direct the "swallowed" material to the esophagus then material is aspirated to the lungs. NG and PEG bypasses the need for the body to properly direct the material since the material is carried directly and safely.

Injecting the material under pressure into the mouth or back of the throat with a syringe is no better than forcing material into the mouth. If the person is incapable of initiating a proper swallowing effort then you are likely forcing material into the lungs.

Eating and digesting is also not solely a "mechanical" process. Saliva and stomache acid production is stimulated via nuerological process. The body prepares itself for a meal via stimulus response. No doubt you have experienced this.

Placing material on a cloth, or introducing water soluable materials is not necessarily medically advisable either. Anything introduced to the lungs can initiate an irritation and inflamation response. Not everything that is acceptable as a food is necessarily biologically compatible with lung tissue. Not every patient has the capacity to fend off infection from organisms introduced into the warm moist environment of the lungs.

Dr Thogmartin addressed the behavior of the trio of nurses that confessed behaviors that were not in keeping with the medical instruction of Terri Schiavos doctors, not in keeping with the notations and directives in Terri Schiavos medical chart and not in keeping with policy and procedure and not in accord of the training and education that the nurses recieved. These nurses are held to a higher standard of behavior in keeping with the trust given them, their experience in a medical environment and in keeping with their specialized knowlege above and beyond the knowlege of the average person.

Mr. Truth, I was merely stating that Terri Schiavo was able to be fed small amounts of jello on a spoon. This was testified to by nurses. This was quite some years before the controversy arose, but the difference in ability to swallow between that time and later appears to have been a result of the gradual atrophy of the muscles needed for swallowing. My point was simply that if she "was PVS" (if indeed this is a fully objective diagnosis) at the time that nurses were giving her small amounts of jello by spoon, then it is possible for PVS patients to receive small amounts of nutrition and hydration by spoon. That's all. I can well imagine that if there is no volitional swallowing but only involuntary swallowing, that would raise the risk of aspiration and would make any spoon or syringe feeding a slow and careful business. I acknowledge all of that. Still, you know, the question of how much to moisten the mouth of such a person, whether to give ice chips or small amounts of fluid, and so forth is not so cut and dried as you seem to think. Worries about aspiration can be exaggerated, and physicians differ on how much spoon and syringe feeding to give with people in various states of cognitive impairment, etc.

I have a small amount of experience of something perhaps related in having fed baby formula with a syringe to a premature infant who kept falling very deeply asleep, ceasing to suck, head lolling, etc. The tendency is for the liquid simply to run back out of the mouth. You can coax swallowing very carefully and slowly by head positioning and even by stroking the throat to induce swallowing. You get somewhat skilled at it after a while, but it's very slow, and this baby probably should have had an NG tube, but she never choked. No, I am not medically trained. It was my own child, and I was working under the direction of the nurses. But mostly it was something you had to teach yourself by practice. A feeding tube would have been much better, and trying to do that for an adult would be nigh impossible because of the sheer quantities involved. The person would become too dehydrated even if you did it for a long time each day. But that doesn't bother me, as I have no problem with feeding tubes. My point, however, is that we are really talking about delivery systems here, not about an inability to take in and ingest food.

By the way, both "Truth" and "Buster Boa" seem to be posting rather lengthily, and "Truth" is getting a little aggressive. I advise backing off on the sarc., "Truth." Perhaps you aren't used to talking to people who actually believe in objective truth about ethical matters, but guess what--you've fallen among some of them. So take it easy.

I might add that I have good friends who have a child who has Down's Syndrome. He eats by mouth during the day and also had PEG tube feedings at night, because he wasn't getting enough calories otherwise. He had reflux and was (they gradually discovered) aspirating food *for years*, until they discovered that he had a chronic low-level lung infection as a result. But he didn't go into convulsive choking and die in a drowning-like state. He is, in fact, fine. There was never any question of that. What they have now done is to move the tube further along the digestive tract to avoid the reflux problem with the nighttime feedings, and this has alleviated many of the lung problems as well. But the whole notion that _any_ amount of aspiration is automatically going to kill a person suddenly and dramatically is something of an exaggeration.

In fact, it's one of those odd and twisted things: First we say that some person is going to _die_ if he's given small amounts of food and water by mouth, even for comfort's sake. Then we say that he therefore _must_ have tube feeding and absolutely nothing else. Then we say that tube feeding is "unnatural" and define it as an "extraordinary measure." So then we leave the person to die *of necessity* without food and water after 10-14 days, without even attempting small amounts of natural hydration, because we have convinced ourselves that the person will surely...die if we do even that much. And that's called ethical behavior. If this makes moral sense to anybody else, then I suggest such a person has a messed-up moral sense.

but seek a source greater than the prevailing zeitgeist

I fail to see how one can find the carefully considered standards of medical ethicists "the prevailing zeitgeist." These questions arise at this time because medical technology is now able to keep the bodies of persons, who until very recently would have merely died and received their eternal reward, "alive" after their cognitive functions have ceased. In fact, their "person" is no more, although their heart continues to beat so long as their body is serviced by machines. The real question here is how to define "death."

I advise backing off on the sarc., "Truth."

The ground rule, Truth, is that they (meaning the blog authors and their sycophants) can use sarcasm, and/or insulting and belittling language, on you, but you cannot reciprocate. As Zippy would say, "You get used to it."

"These questions arise at this time because medical technology is now able..."

Rodak, that's actually not true. Feeding tubes were around for a while before people even thought of tube feeding as "extraordinary" and as something to be withdrawn to leave an otherwise non-dying person to die in 10-14 days (just as you would without food or water). It isn't the sheer existence of the comparatively speaking low-tech feeding tube that has prompted all this soul-searching but an entirely different set of ideas connected with "quality of life" and "personhood." Ideas which I'm pretty sure you share, but still not ideas that somehow arise of necessity from the sheer "unnaturalness" of tube feeding.

Doctors are not ethical experts. Sorry.

Nor are biomedical ethicists. God help us, these "ethicists" are just philosophers (who went into a potentially more lucrative sub-specialty of telling doctors how ethically to bump off Grandma), and speaking as a philosopher, I hold no brief for the ethical insight and expert-ness of philosophers!

WJS talks about a Hastings Report article seriously considering the Groningen Protocol for active killing of newborns. If that one gets accepted by the "carefully considered standards of medical ethicists," are you going to buy that, too, Rodak? If so, I've got a death camp to sell you. Zeitgeist is an _excellent_ word.

You may notice, Rodak, how long-suffering I've been in this thread. Even against some advice right near the beginning from Bill. I've not edited, deleted, nor touched a single one of Boa's or Truth's very long posts, including "Truth's" most recent one all about me and how everyone has to agree with me, blah, blah. Nor have I ever touched a single comment of yours, ever. Not once. We all have our different limits, approaches, and lines. But you should be a lot less smart-alecky on this particular point given that I'm the post author and I'm letting this conversation go on this long and in this way.

Lydia--
I have never heard you--or any of the others--caution a commenter who is agreeing with your position,no matter how rudely, to tone it down "or else." That's all I'm saying.

Rodak, I have to admit that I think the truth of one's position makes a difference to how hard-hitting or humorous (at another commentator's expense) one can legitimately be on a blog. I realize that may strike you as unfair, but that fact doesn't worry me unduly. In any event, I take major responsibility on this matter--watching everybody's tone or statements, deciding who gets censored, censured, or warned about their tone or statements, etc.--in ordinary cases only for my own posts and threads.

I think the truth of one's position makes a difference to how hard-hitting or humorous (at another commentator's expense) one can legitimately be on a blog.

Well, that's an interesting position to take:

But I say to you, that whosoever is angry with his brother, shall be in danger of the judgment. And whosoever shall say to his brother, Raca, shall be in danger of the council. And whosoever shall say, Thou Fool, shall be in danger of hell fire.

Another absolute standard?

I apologize for my overly aggressive post and being overly sarcastic. As a guest here I appreciate your hospitality. I appreciate the discussion and your patience.

"The real question here is how to define "death.""

The real question is how to protect human life from being degraded and diminished by technologies that
artificially create, extend or extinquish it. Given
the Darwinist impulse emanating much of our culture, the truly decent response is to; "Rage, rage against the dying of the light."

May this serve as a footnote to my previous comment;

"We'll have intelligent nanobots go into our brains through the capillaries and interact directly with our biological neurons," he told BBC News.
http://news.bbc.co.uk/2/hi/americas/7248875.stm

"We'll have intelligent nanobots go into our brains through the capillaries and interact directly with our biological neurons"

Kevin--

Yes, it is proven once again that life imitates art.

"... until they discovered that he had a chronic low-level lung infection as a result. But he didn't go into convulsive choking and die in a drowning-like state. He is, in fact, fine. There was never any question of that." -Lydia

First, I am glad this child is fine. Second, I don't think it can be said that aspiration didn't have any negative impact on this child, even if the impact wasn't the immediate and aptly graphic depiction "convulsive choking and dying in a drowning- like state".

I can only assume you might have been trying to respond to my criticism of the nurses in the Schiavo case and perhaps you were trying to mitigate and imply "no harm, no foul". SOmething along the lines of "Terri Schiavo didn't crash so what is the big deal?" The big deal is that she suffered many episodes of pneumonia. Since these nurses never documented their acts- because they knew their acts were wrong and could get them fired for endangering the patient- the doctors couldn't address the cause but were left to deal with the effects. I spoke to the issue of professionalism. Dr Thogmartin also addressed the issue of professionalism and addressed the issue of patient endangerment.

AT the time Mrs Schiavo was under the care of those nurses (PRIOR to the 2000 hearing that started everything...) Mrs Schiavo was no celebrity, she was a not a "noteworthy" patient, she was one of many patients these nurses cared for.

It seemed from your post that you were implying that since Mrs Schiavo was going to be killed by the removal of the PEG that it shouldn't matter or be a big deal that she was subjected to the unprofessional conduct of her caregivers. Wrong on 2 counts. #1.The PEG removal was not at issue when the nurses committed their crimes. #2. Caregivers are always accountable for their own actions and inactions.

But getting back to your example:

"What they have now done is to move the tube further along the digestive tract to avoid the reflux problem with the nighttime feedings, and this has alleviated many of the lung problems as well."- Lydia

This has alleviated many of the lung problems: Obviously having chronic infection within the lungs, and not KNOWING this patient or having evaluated the medical history so I will say possibly, resulted in unexplained elevated white cell counts, unexplained fevers, productive or unproductive cough, increased susceptibility to other infection and opportunistic infection, lung scarring, incidents of pneumonia, increased fatigue and increased irritability, etc.

Maybe the signs were masked by other KNOWN and IDENTIFIED medical issues, maybe the symptoms weren't so easy to get at. Perhaps the lung scarring isn't a huge issue today but it might be in the future, the human body has marvelous compensation mechanisms and built in over capacity- if you don't run sprints and you aren't a professional athlete the effects may never be apparent. On the other hand if you are stricken with pneumonia it might suddenly become a very important issue. This not

I didn't imply or state that silent aspiration automatically caused immediate life threatening respiratory collapse or sudden death. I didn't paint graphic or inflammatory mental images.

I said some things considered food are not necessarily biologically compatible with lung tissue and can cause irritation and inflammation reactions. Some material are of a consistency that they can cause mechanical obstruction. The passages get very narrow as you go deeper in the lungs. Some materials can carry organisms that might be harmless 99% of the time but when introduced to the right dark, warm, moist, nutrient filled environment...

Everyone is entitled to quality, competent, professional medical care. Caregivers should always be held accountable. You look and you say there were greater and lesser acts that did harm to Mrs Schiavo. Agreed. I look and I say there were 3 nurses that weren't prosecuted because the statute of limitations had expired when they came forward and confessed their crimes. My understanding is that 2 have since left the state of Florida and likely are no longer in the profession. If you don't know the name of third, and you or someone you love is being cared for by nurses in Florida, you might want to do a little honest research into the Schiavo case.

I'm saying that the question of mouth feeding in very small amounts is not open and shut, even for people "in a PVS." I'm also saying that it's simply ethically and professionally crazy to endorse dehydrating people to death on the grounds that they need to receive hydration through a feeding tube and at the same time to insist that they are in an "unnatural" state such they must have a feeding tube on the grounds that it would be _risky_ to give them small amounts of hydration by! I think such people _should_ have feeding tubes, and shouldn't have them removed. But it's a bizarre set of professional ethics that pretends to take the high ground by ruling out as "criminal" giving somebody a little mouth-moistening jello or ice chips because it might cause lung inflammation over time but endorses the cessation of _all_ food and fluids until the person expires of dehydration inevitably in two weeks. That, to my mind, is simply no professional ethics at all. It's twisted thinking.

Are you asserting, Buster, that people in a PVS cannot swallow at all, or are you making some difference between "volitional swallowing" and other kinds of swallowing? If the former, I am quite confident that you are wrong. They do swallow their saliva, for instance. And nurses who worked with Terri Schiavo years ago (before all spoon feeding was stopped and the relevant muscles allowed to atrophy) did give her spoon feedings of jello and such and have said as much in writing. I'm confident it would be possible to come up with other examples. I'm guessing perhaps you are saying that "non-volitional swallowing" is of such a different sort that it makes it too hard to feed people enough/effectively (a little jello on a spoon isn't going to keep anyone alive), but that is very similar to what I had said already. In fact, I recall reading one physician's testimony in favor of dehydrating people to death who actually admitted that syringe feeding, for example, would be possible but he opposed it for his own ideological reasons. Again, though, I'm not asserting that it wd. be possible to get all necessary nutrition and hydration in that way.

______________________________________________________________________________________________________

Then on this we are in agreement. I never stated or meant to suggest that PVS patients cannot swallow AT ALL. As you correctly pointed out, they can swallow their own saliva; although not necessarily with absolute safety. Even when PVS patients are not fed by mouth, aspiration pneumonias can and do occur from their mishandled saliva. That was clearly the case with the late Terri Schiavo.

If a PVS patient is SOLELY given nutrition and hydration by mouth, then far and away the result will be death through aspiration. However, it could also be death through dehydration. You concede this as well in your last sentence above.

I am unclear what you mean by "faux neutrality." There is nothing apocryphal about my ability to segregate professional detachment from my personal feelings. However, I do recognize that such is an acquired skill, and not everyone has it. Are you suggesting that sharing information from a professional stance should be done with personal bias and prejudice, supporting only one POV, rather than dispassionate objectivity?

I'm saying that the question of mouth feeding in very small amounts is not open and shut, even for people "in a PVS." I'm also saying that it's simply ethically and professionally crazy to endorse dehydrating people to death on the grounds that they need to receive hydration through a feeding tube and at the same time to insist that they are in an "unnatural" state such they must have a feeding tube on the grounds that it would be _risky_ to give them small amounts of hydration by! I think such people _should_ have feeding tubes, and shouldn't have them removed. But it's a bizarre set of professional ethics that pretends to take the high ground by ruling out as "criminal" giving somebody a little mouth-moistening jello or ice chips because it might cause lung inflammation over time but endorses the cessation of _all_ food and fluids until the person expires of dehydration inevitably in two weeks. That, to my mind, is simply no professional ethics at all. It's twisted thinking.
______________________________________________________________________________________________________

You may be unfamiliar with the terms "medical battery" and medical malpractice." An example of the former would be to inflict unwanted treatment on an unconscious person -- when emergency exception and default scenario do not apply -- who has refused such previously. An example of the latter would be PO feeding of a pateint who cannot safely and volitionally swallow.

From your posts, it seems that you are making assertions based on your personal feeelings and beliefs, rather than any actual formal medical training and experience (as a professional). Nothing wrong with that, but it does call into question your objectivity nad ability to analyze in a detached manner.

If you object to withholding and withdrawing of feeding tubes, then by all means let your legal guardian know and/or have it documented in writing. That is your choice. I respect that.

But that is not everyone's choice. Not everyone shares your beliefs. What applies to you may or may not to others. You seem to hold that preservation of life is the highest good, and that preserving life is its own end. You are certainly entitled to such.

But for better and for worse, preservation of organic existence is not the highest goal or ideal of modern medicine. Respect for autonomy, in the way of upholding negative rights, is the highest goal and ideal, even if the expected outcome is death. That's just how it is (demonstrating my "faux neutrality"). That is why my father-in-law was able to refuse blood transfusions, why my late grandfather was able to refuse tube feeds, and why my late father was able to refuse a ventilator. Perhaps that is "twisted" to your way of thinking, but I suspect my relatives would have found your sentiment to be just as "twisted."

BTW, you are correct that feeding tubes have been around for decades. About as long as mechanical ventilators and dialysis machines. All are recognized as life support measures that were intended to act as bridges to recovery, not indefinite maintenance therapies. Perhaps you were unaware of this.

It seems that you have your mind made up, Lydia. I realize that any information I present to you may -- at most -- make you change your argument or rationale, but will certainly not change your mind. Such is the reality of such debates. People frequently have a visceral reaction that is independent of information and data. But my willingness to dispassionately share information from a professional stance is not IMO "faux neutrality." It is being professional.

I wish you the best, and certainly hope you never have wanted therapy withheld from you. Even more, I hope you never have unwanted treatment inflicted on you. Take care.

Actually, it was Kevin who used the phrase "faux neutrality," not I. I can't tell if you think I used it or if your comment is addressing each of us in a different part.

Kevin and I don't always agree on everything, but here I do see his point fairly clearly: Ethics get intertwined with medicine quite tightly. There is an odd idea that I really believe many doctors _do have_--that is, I don't think they are being dishonest, though I think they are mistaken--that everything they tell you is neutral as regards moral issues. But this is not true. Here's an example: Advice to a woman as to whether to get an amniocentesis will inevitably include what philosophers call "decision-theoretic" aspects as well as sheer information. Decision theory involves plugging in how important this or that is to you. So, for example, it might be more important to one person than to another to avoid accidentally causing a miscarriage (which there is a small risk of with an amnio), whereas a different person might consider it more important to find out if a child has Down's Syndrome so as to have an abortion. Even the tolerance for false positives and false negatives will reflect moral values; pre-natal screenings tend to have a rather eyebrow-raising false positive rate. This is tolerated because one major purpose of prenatal screening is not "missing" children with birth defects--that is, not missing the opportunity to have a termination. The unnecessary anxiety to parents of false positives (even if they are corrected by later tests) is treated as of less importance.

So, here: Doctors imply that it is somehow a strictly _medical_ opinion that dehydrating a person to death by ceasing to give ANH is acceptable, but actually of course that is a strongly _moral_ opinion. Even to treat it as an option "on the table" is in effect to take a moral position.

I don't mean to imply that moral positions are irrational. Nor do I at all concur with what I suspect, Boa, is your position--that moral opinions are "feelings." Far from it. What I do mean to imply is that medical ethics is not itself a physical science, that doctors really can't do without some moral opinions of their own, and that they should realize and admit this rather than treating their "professional opinion" as entirely value-free. In fact, it _shouldn't_ be value-free, because healing people is not a value-free art. Unfortunately, I all too often disagree with the implicit moral opinions that underlie much of contemporary medical practice. It's therefore all the more annoying to me to get the impression that some people don't think of these as moral opinions at all. That, I take it, was part of Kevin's point when he referred to "faux neutrality."

"All are recognized as life support measures that were intended to act as bridges to recovery, not indefinite maintenance therapies. Perhaps you were unaware of this."

I don't quite get the point of this. Is the claim that the inventor of feeding tubes would have been horrified at the idea of people's being on them for years? Is this something we actually know? And even if so, so what? So my friends with the little kid who just needs some extra calories by night tube feeds, runs around during the day, and isn't dying but rather growing up, are somehow _abusing_ feeding tubes by using one as part of his long-term maintenance? And so are the large numbers of other people in the world who live for years with tube feeding? Is this a neutral judgement, if so? And it seems to me rather strange to imply that tube feeding as many-years' maintenance for people who cannot feed themselves is some sort of new-fangled idea, contrary to some "originalist meaning" of feeding tubes, when in point of fact it's _withholding_ tube feedings until death by dehydration that was itself a new idea just seventeen years ago at the time of the Cruzan case, before which plenty of hospitals and doctors simply refused to do such a thing. Actually, deliberate death by dehydration can pretty clearly be traced to a number of relatively recent (past twenty years) changes in the ethical views of the cognitive elite, filtering thence down to ordinary people, probably most strongly the combined notions that a) autonomy is the highest medical value, b) it is likely that most (or at least very many) people autonomously would prefer to be dehydrated to death rather than receive tube feedings when they are mentally incompetent and in and "undignified state," and therefore c) it is an important priority that we set up a legal mechanism whereby even people who never put any such wish in writing can have the wish thus to die enacted via hearsay reports of their conversations.

So strong has this combination of notions become that actually #1, patient autonomy, is often treated rather questionably in the rush to assume #2 and in the high priority granted to #3.

but it does call into question your objectivity and ability to analyze in a detached manner.

It is an objective fact that withholding food and water for the purpose of causing death is murder.

That is your choice. I respect that. But that is not everyone's choice

The fact that one chooses it does not change murder into not-murder.

In order to get at black and white you have to eliminate every shade of gray.

Apparently the distance between being a street thug with a knife and being a doctor with a knife just got very much shorter.

Apparently you can tell the street thug "stay away from me with that knife!" and people will accept that you mean what you say and take you seriously.

But they won't beleive you are serious or mean exactly what you say if you say it to your doctor.

Doctors, in order to not "murder" you, you will have to turn a deaf ear when you tell them not to cut you up with the knife.

"c) it is an important priority that we set up a legal mechanism whereby even people who never put any such wish in writing can have the wish thus to die enacted via hearsay reports of their conversations."-Lydia

Probate law has existed how many years? More than 20? More than 40? More than 100?

Courts in this country for the past 200+ years and courts in other countries for centuries have been the adjudicator of disputes involving oral declarations of intent (oral contracts).

So what is it you are thinking or proposing is new and in need of being "set up"?

There is no priority to "set up" legal mechanisms to hear testimony, review evidence and consider the law. The legal system is not new nor is the law.

The only new twist is special interest groups created since 1973 with evolving and changing agendas, media willing to showcase lifestyles of the bizzare and highly dysfunctional, groups willing to lay seige to hospice, hospital and even funeral homes if it serves their purpose, media willing to showcase fractured families and family members who exhibit bizzare pathological behaviors, and - finally - the fact that there is a small but very vocal segment of the population that doesn't care about the facts or the truth of the matter and that will repeat anything or make up something just to be a part of it all because it appeals to their particular form of mental health problem.

You're telling me probate courts ordered tube feeding stopped on patients before circa 1990? Find a single case. One.

Apparently the distance between being a street thug with a knife and being a doctor with a knife just got very much shorter.

Yes, it has, but it wasn't my doing. A court ruling in 1990 probably got the ball rolling.

But they won't beleive you are serious or mean exactly what you say if you say it to your doctor.

You're begging the question. Let me repeat: The fact that one chooses it does not change murder into not-murder.

I'll come back to case law if there is any point to it.

But I'm not sure there is a point to providing it because you have built this scenario:

1. Oral declarations made in close proximity in time have no value. This is because either the court is incompetent to adjudicate disputes arising from oral declarations or because you can never be satisfied that the only source available to report on those declarations is untrustworthy and unreliable. Either reason is sufficent in your way of thinking to disqualify oral declarations.

2. According to what you have said written declarations have no value except maybe on the day they are made. With the passing of each day the written declaration becomes less valuable as evidence to you.

You haven't specified exactly how old the written directive would have to be in order to have completely lost its value as evidence but it is clear that the door to dispute will remain open regardless of the format.

The possibility of fraud with written instruments is well established and so speculation on that aspect can provide endless fodder for the cannon. There are as many ways to attack the written as there are to attack the oral.

So you automatically devalue the oral declaration and you demand there be a written directive. Then you go on to build a case against accepting the more valuable and acceptable written directives also. The bottom line is that nothing is acceptable that is not in agreement with your values and opinions

There are only two options for communicating a persons intent and decision and you have excluded both options.

But getting back to the demand for pre 1990 case law.
_____________________________________________________________________

First indication that PVS treatment was becoming an issue for nuerologists:

http://www.aan.com/globals/axon/assets/2326.pdf

Position statement of AMERICAN ACADEMY OF NEUROLOGY pre 1990:

"In 1988, the AAN issued a position statement, Certain Aspects of the Care and Management of the Persistent Vegetative State Patient, that set medical and ethical principles for physicians to consider when treating patients in PVS or similar states."

I regret that I don't have a link handy to the 1988 AAN position statement in its entirety, I only have a reference to it from the more modern statement they have made from the link above.
____________________________________________________________________

Case law:

--Claire Conroy, New Jersey Supreme Court, 1985. Although Ms. Conroy died before the feeding tube was removed, the NJSC ruled in favor of her right (through a surrogate) to refuse ANH. This case is particularly significant because it was the first (to my knowledge) determination (articulated) by a court that there was no difference between ANH and any other form of life-sustaining treatment.

--Helen Corbett, Florida, 1986.

--Paul Brophy, Massachusetts, 1986.

--Hector Rodas, Colorado, 1987. Probably most significant because Mr. Rodas was competent to make his own health care decisions, including the decision to refuse ANH (which he did, but the hospital refused to do so, so Rodas filed suit and won). ANH was removed, and Rodas died 15 days later, still in the care of the same hospital.

--Nancy Jobes, New Jersey, 1987.

--Marcia Gray, Rhode Island, 1987 (or 1988...litigation was in 1987, but if I recall correctly, it took a while for the ruling to be applied).

--Nancy Cruzan, Missouri, litigation began in 1988; Ms. Cruzan died in late 1990.

I'm assuming you won't be satisfied with my answer because it is an ANSWER and it demonstrates that the courts do in fact have a history of adjudicating in favor of the right of American citizens to make their own choices about medical treatments regardless of how disagreeable those choices might be to third person bystanders. This history in the courts most certainly predates Cruzan in 1990. Certainly these difficult decisions being in the hands of human beings have not always been without controversy and without dispute. Did you really think there was anything "new" about the Schiavo case? Humans have been dealing with disease and death for how long?

Of course no family prior to the Schindlers was nearly as publicity seeking about these matters and very few of the early cases were publicized at all- certainly the pre 1990 world would never have witnessed anything close to the circus that the Schindlers created out of the tragedy that befell their daughter. Acceptable public behavior changes over time I guess. No other hospice seige comes to mind. Although there is a church group that has been protesting at funeral homes when services are held for fallen American soldiers. ~shrug~

You're telling me probate courts ordered tube feeding stopped on patients before circa 1990? Find a single case. One.

Will six do? Or do you need more?

Here are just a smattering of the cases involving withdrawal (by court agreement or order) of ANH that occurred before 1990 (Cruzan). As I say, just a "smattering," because there were certainly more, and hundreds which never found their way to a courtroom. These are just the ones that come to mind for me, mostly because they were the ones that got a great deal of publicity, so most folks who were regularly reading a newspaper in the 1980s would have heard of them:

--Claire Conroy, New Jersey, 1985. Although Ms. Conroy died before the feeding tube was removed, the NJSC ruled in favor of her right (through a surrogate) to refuse ANH. This case is particularly significant because it was the first (to my knowledge) determination (articulated) by a court that there was no difference between ANH and any other form of life-sustaining treatment.

--Helen Corbett, Florida, 1986.

--Paul Brophy, Massachusetts, 1986.

--Hector Rodas, Colorado, 1987. Probably most significant because Mr. Rodas was competent to make his own health care decisions, including the decision to refuse ANH (which he did, but the hospital refused to respect his directive, so Rodas filed suit and won). ANH was removed, and Rodas died 15 days later, still in the care of the same hospital.

--Nancy Jobes, New Jersey, 1987.

--Marcia Gray, Rhode Island, 1988.

Cruzan was only unique because hers was the first (and thusfar, the only) case of this nature to be accepted for review by the U.S. Supreme Court. Of course, as most people realize, Nancy Cruzan's parents LOST their case before the USSC (5-4), and it was only upon remand to the Missouri state court that they were able to get a decision in their favor--their surrogate decision to remove artificial life support (which the state of Missouri (Ashcroft as governor), which had previously successfully challenged the Cruzans at the USSC, declined to appeal).

Hi there, Truth. I am gratified to know that someone is actually reading my posts elsewhere. LOL! Welcome to them, of course.

Of course no family prior to the Schindlers was nearly as publicity seeking about these matters and very few of the early cases were publicized at all- certainly the pre 1990 world would never have witnessed anything close to the circus that the Schindlers created out of the tragedy that befell their daughter. Acceptable public behavior changes over time I guess. No other hospice seige comes to mind. Although there is a church group that has been protesting at funeral homes when services are held for fallen American soldiers. ~shrug~

Actually, after Nancy Cruzan's ANH was removed, there was a group (led by the ubiquitous Randall Terry) who "stormed" her hospital, and was arrested (Randall Terry, himself, the publicity-seeking firebrand, was not among those making the effort he himself had encouraged, so he was not among those arrested...just as he was not among those arrested at Mrs. Schiavo's hospice "vigil." Apparently, Randall Terry prefers to shield himself behind 10-year olds and their gullible, and easily-directed, parents. If I recall correctly, it was 19 of the faithful who found themselves in jail for trespassing during Cruzan. Less than the 52 or so who were arrested during Schiavo (not including the people who issued death threats via the internet, or who attempted to rob a gun store (with a knife...heh!) to "save Terri"), but Cruzan was in a pre-internet world.

I had a feeling Lydia was making a mistake in asking for case law, since I had assumed that withdrawal of treatment had been going on quietly, and in secret, for some time, case law or no. I guess what you fellows don't understand is the irrelevance of it all to ascertaining whether this permission given by courts is right or wrong.

So you automatically devalue the oral declaration and you demand there be a written directive. Then you go on to build a case against accepting the more valuable and acceptable written directives also.

I doubt that Lydia ever indicated a need for a written directive. She's very candid about the fact that any persons's written or spoken directive asking those charged with his care to starve him to death is one that cannot be honored.

An interesting article (the author is anti-euthanasia) from 2002 covering a lot of the recent history (I haven't read it all yet, so don't know if it goes further back) is here. An excerpt that caught my attention, and which I remember reading a long time ago:

In 1997, of course, in Washington v. Glucksberg and Vacco
v. Quill, the United States Supreme Court rejected the
constitutional challenges to laws banning assisted suicide. The Court rejected the idea that there is a fundamental right to assisted suicide. In so doing, the Court refused to rely on the broad, abstract language from Casey and instead inquired whether there was any support for the view that a right to assisted suicide was deeply rooted in our Nation’s history and tradition. The Court carefully reviewed the relevant history and stated: “we are confronted with a consistent and almost universal tradition that has long rejected the asserted right, and continues explicitly to reject it today, even for terminally ill, mentally competent adults. To hold for respondents, we would have to reverse centuries of legal doctrine and practice, and strike down the considered policy choice of almost every State.” In this case (unlike in Roe v. Wade and Stenberg v. Carhart), the Court was unwilling to take that step.

And further:

The Court also rejected the equal protection argument. The Court agreed with the view that there is a difference between letting a patient die (by refusing life-saving medical treatment) and killing a patient (by assisting in the patient’s suicide). According to the Court, “Logic and contemporary practice support New York’s judgment that the two acts are different, and New York may therefore, consistent with the Constitution, treat them differently. By permitting everyone to refuse unwanted medical treatment while prohibiting anyone from assisting a suicide, New York law follows a longstanding and rational distinction.

I had a feeling Lydia was making a mistake in asking for case law, since I had assumed that withdrawal of treatment had been going on quietly, and in secret, for some time, case law or no.

Interesting characterization. As I said in my post, the cases I cited were just off the top of my head, memorable because they each received considerable publicity. There was nothing "secret" or "quiet" about any of them, and any person who regularly read a newspaper in the 1980s would have been aware of them. Had I actually taken the time to access the case law from that period "before circa 1990," rather than simply tap my personal memory bank for those which received the most publicity, I'm sure I would have come up with a hundred cases (maybe more) that occurred in the 1980s. And if a simple case law search could come up with them, there was--obviously--nothing secretive about them.

I guess what you fellows don't understand is the irrelevance of it all to ascertaining whether this permission given by courts is right or wrong.

In your opinion, of course. We probably differ there, but I absolutely respect your right to yours.

nothing secretive about them.

I didn't say that the cases were secret, but that the withdrawal of ANH probably went on mostly in secret since its legality was not universal. A case can still be made that it was Cruzan that gave your side the momentum it needed.

In your opinion, of course. We probably differ there, but I absolutely respect your right to yours.

And let me fall all over myself proclaiming how much I respect yours as well. But the right and wrong is what's at issue, in which discussion you seem not much interested, nor in my observation that the legal turn taken since the 80's amounts to a moral and legal revolution, not a reaffirmation of longstanding ethical practice regarding how we treat the most helpless among us.

"But the right and wrong is what's at issue, in which discussion you seem not much interested, nor in my observation that the legal turn taken since the 80's amounts to a moral and legal revolution, not a reaffirmation of longstanding ethical practice regarding how we treat the most helpless among us."- William Luse

For some, maybe most, the conversation has not been about we do to others.

For some, maybe most, the conversation has been about what others chose and decide for themself.

Most recently the conversation became about the history of self determination from the legal perspective.

It is apparent the controversy for you arises out of your disagreement with the choices of others and your moral dilema about what it means to be charged with respecting and carrying out the decisions of others with which you are not in agreement.

You want people to either agree or disagree with your opinion of what is right and what is wrong. As I stated in my earlier posts to get to black and white you have to eliminate every shade of gray. You aren't interested in the medical, ethical or legal perspective. You simply demand that people either agree with your narrow minded, over simplified, black and white perspective that says everything is irrelevant except whether someone agrees with you or disagrees with you.

In an effort to bolster your position against medical choice you look to the extremes, the most negative consequence, result or outcome- DEATH.

YOU say supporting medical choice equates to supporting murder, that anyone that supports medical choice is supporting murder. The only way to be against murder is to be against medical choice.

Apparently that equation makes sense to you because that is what results from extremism. Authoritarians and dictators find extremism very useful for controlling the masses. It helps to eliminate all those shades of gray that free thinking people embrace and like to explore or discuss.

Authoritarians and dictators also like to limit the availability of information because it is very useful to limiting the exchange of ideas and to limiting the ability to build on ideas and explore or broaden the horizons. Freedom starts with free thinking.

Because SOME medical choices might be life or death decisions you wish to infringe upon the right of medical choice.

I'm sure your rationale is that you only wish to interfere in the narrowest way, that you only wish to pick and chose specific items for which the right of the people should be infringed or curtailed, controlled and dictated.

You don't encourage people to decide for themselves, to do their own research and reach their own conclusions. You would prefer that discussion and debate not take place. That information not be presented. That certain questions not be asked. People might get the "wrong" ideas.

Just as an aside: the founding fathers of this country were God fearing, they were not death fearing. They most assuredly held the belief that there were fates worse than death.
___________________________________________________________________________________

http://libertyonline.hypermall.com/henry-liberty.html

Patrick Henry, March 23, 1775 (on the eve of the founding of this country):

"Is life so dear, or peace so sweet, as to be purchased at the price of chains and slavery? Forbid it, Almighty God! I know not what course others may take; but as for me, give me liberty or give me death!"
___________________________________________________________________________________

http://www.ushistory.org/declaration/document/index.htm

From the Declaration of Independence:

"And for the support of this Declaration, with a firm reliance on the protection of Divine Providence, we mutually pledge to each other our Lives, our Fortunes, and our sacred Honor."

First, I entirely agree with Bill that the truth of the matter is what it is, and I want to clarify that my mention of the sea change that took place on this in the relatively recent past was not meant to imply that if it had happened earlier, dehydrating people to death wouldn't be wrong.

My point in asking for a case "prior to circa 1990" was simply to refute the idea that this all arises _naturally_ and _inevitably_ from the intuition everywhere by all or most men that ANH is a form of life support on a par with a ventilator. I put the term "circa" in there deliberately because of the possibility that the late 80's was when it got off and running at the state level, before Cruzan, which appears to have been the case. I cite Wesley J Smith's history of this:

It wasn't always so. It used to be thought of as unthinkable to remove a feeding tube. Then, as bioethicists and others among the medical intelligentsia began to worry about the cost of caring for dependent people and the growing number of our elderly — and as personal autonomy increasingly became a driving force in medical ethics — some looked for a way to shorten the lives of the most marginal people without violating the law or radically distorting traditional medical values. Removing tubes providing food and fluids was seen as the answer. After all, it was argued, use of a feeding tube requires a relatively minor medical procedure. Moreover, the nutrition provided the patient is not steak and potatoes, but a liquid formula prepared under medical auspices so as to ease digestion. There can also be complications such as diarrhea and infection.

Having reached consensus on the matter, the bioethics movement mounted a deliberate and energetic campaign during the 1980s to change the classification of ANH from humane care, which can't be withdrawn, to medical treatment, which can. The first people targeted for potential dehydration were the persistently unconscious or elderly with pronounced morbidity. Thus, bioethics pioneer Daniel Callahan wrote in the October 1983. Hastings Center Report, "Given the increasingly large pool of superannuated, chronically ill, physically marginalized elderly it [a denial of ANH] could well become the non treatment of choice."

In March 1986, the American Medical Association Council on Ethical and Judicial Affairs, responsible for deliberating upon and issuing ethics opinions for the AMA, legitimized dehydration when it issued the following statement: Although a physician "should never intentionally cause death," it was ethical to terminate life-support treatment, even if:

"...death is not imminent but a patient's coma is beyond doubt irreversible and there are adequate safeguards to confirm the accuracy of the diagnosis and with the concurrence of those who have responsibility for the care of the patient. . . . Life-prolonging medical treatment includes medication and artificially or technologically supplied respiration, nutrition and hydration."

There it was: Food and fluids provided by a feeding tube were officially deemed a medical treatment by the nation's foremost medical association, meaning that withdrawing them was deemed the same as turning off a respirator or stopping kidney dialysis.
As often happens in bioethics, once the medical intelligentsia reached consensus, their opinion quickly became law. Thus, in 1990, the Supreme Court of the United States issued its decision in Cruzan v. Director, Missouri Department of Health, which upheld Missouri's law allowing for the removal of life-sustaining treatment from a person, provided there was "clear and convincing evidence" that the person would not have wanted to live. Unfortunately, the Court also agreed that tube-supplied food and fluids is a form of medical treatment that can be withdrawn like any other form of treatment. (This is often erroneously called the "right to die.") With the seeming imprimatur of the Supreme Court, all 50 states soon passed statutes permitting the withholding and withdrawal of tube-supplied sustenance — even when the decision was made by a third party.

With that principle established, what did unconsciousness have to do with it? Not a thing. It didn't take long for the American Medical Association to broaden the categories of dehydratable people. Thus, in 1994, a brief eight years after its first ethics opinion classifying tube feeding as medical treatment that could be withdrawn only when the patient was "beyond doubt" permanently unconscious, the AMA proclaimed it "not unethical" to withdraw ANH "even if the patient is not terminally ill or permanently unconscious."

And here's the link for the WJS quote:

http://www.catholiceducation.org/articles/medical_ethics/me0089.html

I'm just curious - why are the lists posted by Boohil and TRUTH regarding pre-1990 case law exactly the same?

I'm just curious - why are the lists posted by Boohil and TRUTH regarding pre-1990 case law exactly the same?

Because Truth and I post at another board, where this exact question ("name one case--just one--of court-ordered ANH withdrawal, pre-Cruzan") was posed just a few days ago. I responded there (with the list posted above). As it happens, Truth and I are also both here, and apparently we both simply C&P'd the response I had written on the other board...which is perfectly fine with me. No need for either of us to reinvent that particular wheel.

Boohil

I have to admit--they appear to be different people, much as I'd love to declare them to be sock puppets of one another. I could, of course, be wrong about that, but my evidence so far is that they are different posters.

I assure you that we are different people, as can be easily ascertained by our logged IP addresses.

Thanks eversomuch, though, for the expressed "sockpuppet" aspersion, and the admission of your eagerness to expose our suspected duplicity. That's precious.

The IP address is part of my evidence, Boohil. That's part of what I said what I did. Look here: You chaps sound rather suspiciously alike. I'm not the only one to notice it. You should rather commend my honesty for checking into it and advertising what the evidence I have actually shows. I didn't express a "sockpuppet aspersion." Rather, I refuted it from my position as a blog author with access to evidence that non-authors don't have.

"First, I entirely agree with Bill that the truth of the matter is what it is, and I want to clarify that my mention of the sea change that took place on this in the relatively recent past was not meant to imply that if it had happened earlier, dehydrating people to death wouldn't be wrong." -Lydia

Have you ever volunteered in hospice or hospital?

Just curious because nothing from you (Lydia) or William Luse leads me to believe you have anything more to rely on than your passionately held but purely academic ideas and beliefs. All lofty, purely theoretical, clean and unencumbered by the many, many shades of gray you would see in every unique interaction with every unique person and family for which these discussions and debates are not purely hypothetical, theoretical or academic. You know why students wear lab coats when and if they ever get in the lab? Probably not.

No, I am NOT a sock puppet but if you need a distraction- smoke and mirrors- I guess a discussion about "hey, where did he come from?" will serve a proper diversion to cover your retreat from any discussion and debate on matters of substance.

It never ceases to amaze me how vehemently some people will defend the "right" to commit flagrant murder, all in the name of bodies-as-property in the perverse modern understanding of "property".

Too bad, fellas. Your bodies are not your property. Heck, even your property is not your property. In other words, there is a God, and you are not Him.

Yes Zippy there is a God. Likely with an appreciation for honesty and truth and most assuredly very familiar with the human experience, free will and all that it entails. Render onto caesar and all that. I'll leave you unchallenged to enjoy your occupation of the moral high ground.

Lets save time and cut to core of what you feel bears repeating:

Murder is murder. Rocks are hard. Water is wet. If it walks like a duck, etc. etc. I am very familiar with the mindset that wants to influence but not inform. The inflammatory phrasing. The horrific imagery. Equating apples to oranges, straw man arguments and all the variations on the theme that murder is murder, PVS isn't an acceptable diagnosis, etc. etc. ad nauseam.

Lydia, thank you for being such a gracious host. You can call off the 2nd battalion. I don't intend to spend a lot of time rehashing and repeating for all the newcomers that think they can do a better job of representing your side of the discussion and debate than you have.

You have done a very good job and it has been refreshing to deal with someone who values free speech.

At this point things can only degenerate into meaningless noise as one side attempts to outshout and outgun the other. I'd love to stay and debate with every torch and pitchfork wielding villager that is on the way to take back the neighborhood but I'll just admit defeat and retreat before I spend far too much time trying to defend my character and my immortal soul from the coming damnation. Enjoy your religious freedoms and other freedoms while you still have them and before you surrender them in the name of all that is good and right.

Lydia,

Don't let these people convince you otherwise. These people on this board are pro pro death and have absolutely no respect for the Schindlers or to Terri Schiavo.

It is an objective fact that withholding food and water for the purpose of causing death is murder.

But it is also an objective fact that when ANH is withheld or withdrawn, it is NOT for the purpose of causing death. You are confusing intended outcome with expected outcome, which is very common and understandable. But the fact is that these are different ethical constructs.

If a person who had ANH stopped miraculously recovered full competence and deglutition capacity, we would not wire that person's jaws shut, paralyze the peristaltic muscles, or otherwise bind the person to prevent him/her from seeking food and water. Just as we would not smother a person who had a ventilator turned off but miraculously breathed on his/her own; just as we would not poison a person whose kidneys miraculously recovered after stoppng dialysis; just as we would not slash the throat of a person whose bone marrow miraculously recovered after suffering aplastic crisis and transfusions were stopped. In all of those cases death would be the expected result from cessation of medical treatment, but that we would NOT do those various things clearly indicates that death was not the intent.

You also appear to be confusing ethics and morality when it comes to medical decision making. Those are two distinct constructs, although related and overlapping. Perhaps reading Beauchamps and Childress would be useful. Not that you will agree with the substance of the text, of course, but it would at least allow for clarification of some terms and concepts.

The fact that one chooses it does not change murder into not-murder.

And this is precisely why cessation of life support is not murder. You are correct that consent and choice are irrelevant to murder. If it's murder without my consent, then it's also murder with my consent. I cannot consent to my own murder. Nobody can. You are correct.

But with medical treatment choice does matter and is paramount, whether you agree with it or not. Treating a person against his or her will is assault and battery, for instance. If it were irrelevant as you claim, then whether a person expressly declared refusal of ANY treatment -- verbally, once or repeatedly, in writing, via video, etc. -- then we could never withhold or withdraw any form of treatment that extended life because it would be murder. Even at the apex of the Schiavo brouhaha, however, any number of persons who generally opposed cessation of her ANH admitted that they would have felt differently had she left her wishes in writing. That this was so clearly indicates that cessation of ANH was not murder, because if it were, then leaving her wishes in writing would have been immaterial.

What a surprise to find James here. The villagers must have missed you terribly. Another shining example of the mentality that associates advocating for freedom and liberty with advocating for death. Interesting to note that our founding fathers proudly proclaimed that they would sacrifice their lives in the cause of winning freedom and liberty but never once has it been suggested- until the Schiavo case- that their fight for liberty and freedom was a fight on behalf of death and to inflict death.

I only stopped back for a moment to address Zippy and his repulsive pro slavery comment. But I simply can't find the words to express my outrage.

I like Buster's rationalized explanations for eliminating the disabled. What happen to Schiavo is not unlike what the Nazi did in Germany.

The courts and bioethists have done a good job with sanitizing and rationalizing the acts that Nazi did in Germany.

People need to read about the T4 Euthanasia program on how Germany executed thounsands of disabled people calling them "Useless Eaters"

The courts and bioethists have taken this and sanitized it into some gross form of "death with dignity"

One of the methods the Germans used to kill disabled people was starvation.

Not much time here. James, golly, don't worry about me. I'm a hard-liner of the hardliners. I'd never give in on this stuff until death.

Actually, Buster, you might be surprised and even shocked to know the things that have indeed happened to people who asked for food and water. WJS has documented Marjorie Nighbert's case. She asked verbally for food but was nonetheless dehydrated to death. I have been told of a case (by a lawyer) of a woman who had had a stroke and wrote notes asking for water but was dehydrated to death. This is not unknown. I have even known personally a man who had had a stroke and tried again and again to get up from his bed to get a drink of water. He suffered terribly. He was given some IV hydration, but that didn't relieve his terrible thirst, and his children didn't authorize the placement of a PEG tube. He died within a few days.

So actually, people are in fact sometimes denied fluids until death even when they are conscious and ask for them. I don't know how much difference this makes to you. I might add that it makes hash of the assurances in the physicians' manual that being denied fluids until death does not cause suffering. But of course in my view it would be dead wrong even if the person were sufficiently unconscious as not to suffer.

What happen to Terri Schiavo and others like her was tragic. I can't imagine what the family must go through when something like that happens.

But, as tragic as something like that is, it not uncommon.

Thousands and thousands of children are born each year who just like Terri Schiavo.

They live out their lives in a wheelchair or bed being cared for 24/7.

Fortunately, they are not all killed.

Some still respect the sancity of life.

As a society, we need to care for our disabled and not kill them.

It is the courts role to protect life not destroy it.

Unfortunately, our society is drifting away from the sancity of life and to a quality of life.

If a person is deemed "Unworthy of living" it only takes some hearsay evidence from a person to condenm that person.

That person is then eliminated from society becuase they have a quality of life that is undeserving and unworthy.

Of course, the courts and bioethists try to rationlize and santize it stating that person would never want to live in that state.

But, disability is fact of life.

God is giver of life and of disability.

Just because a person becomes disabled doesn't make them any less worthy of life.

You are quite correct Lydia. Wesely Smith is quite knowledgable with the Marjorie Nighbert case.

Yes, I have heard about cases where the individual was restrained from getting to food and water and was starved and dehydrated to death. You would have to check with Wesley to be sure, but I heard in Nighbert case, she was actually restrained because trying to get to other people's food and water.

I don't think Marjorie Nighbert was strong enough to be doing that. She was pretty enfeebled at that point. But what I do recall is that she, like many people in similar cases, was drugged as the dehydration continued to alleviate the "discomfort" of the whole process.

But it is also an objective fact that when ANH is withheld or withdrawn, it is NOT for the purpose of causing death.

Excuse me? Then for what purpose would you do it?

I only stopped back for a moment to address Zippy and his repulsive pro slavery comment.

Ah yes. Opposing murder is "pro slavery". Death is freedom.

But I simply can't find the words to express my outrage.

Bye. Have a nice life, and may you meet people like Lydia rather than people like yourself at the end of it.

Mr. Truth, I was merely stating that Terri Schiavo was able to be fed small amounts of jello on a spoon. This was testified to by nurses. This was quite some years before the controversy arose, but the difference in ability to swallow between that time and later appears to have been a result of the gradual atrophy of the muscles needed for swallowing. My point was simply that if she "was PVS" (if indeed this is a fully objective diagnosis) at the time that nurses were giving her small amounts of jello by spoon, then it is possible for PVS patients to receive small amounts of nutrition and hydration by spoon. That's all. I can well imagine that if there is no volitional swallowing but only involuntary swallowing, that would raise the risk of aspiration and would make any spoon or syringe feeding a slow and careful business. I acknowledge all of that. Still, you know, the question of how much to moisten the mouth of such a person, whether to give ice chips or small amounts of fluid, and so forth is not so cut and dried as you seem to think. Worries about aspiration can be exaggerated, and physicians differ on how much spoon and syringe feeding to give with people in various states of cognitive impairment, etc.

the nurses that you are refering to were desinated in court as being not credible. in the state of florida, persons can sign an affadavit without actually swearing under oath that it is the truth. in the case of carla lyer, she signed three different affadavits in aug. sept. and nov. she swore that each of these were the truth even though they were sometimes completely different. in one of the other nurses affadavits, she claims that she saw abuse and told the schlindlers about it. were this correct, then not only the nurse but the schlindlers brokie florida law by not reporting it. it also seems real strange that the schlindlers did not mention this at any time until they needed something to jump start their case.
another example of this would be cyndi schook. she is the one that the schlindlers stated that she heard michael say"is the bit*h dead yet?" this same person stated in court under oath that she did not sign that affadavit and she did not say that. by entering that writen statement, the schlindlers attorney violated the code of ethics of the court considering that she was an officer of the court

Ron, I'm not sure I should bother responding to you, but I take it you are saying that these nurses didn't give her jello on a spoon, or that we should just discount any testimony of theirs to this effect? Is that really what you want to argue? I realize that the Schiavo case brings out the worst in the Left, but I think you're stretching it a bit here. Even those in this thread who argued that small amounts of food and fluid by spoon are "not medically indicated" had to concede that they _could_ be given; they merely implied that this is gravely inadvisable on the grounds that some of it might be aspirated and that over time this would likely cause lung inflammation. Frankly, I find this hardly an overwhelming argument, especially coming from people who evidently _don't_ think it a similarly hard and fast medical rule that people should not be left to dry up and die with no fluids over a period of 14 days. But it certainly doesn't amount even as far as it goes to a serious challenge to the possibility that a PVS person could be given small amounts of jello on a spoon without dropping dead instantly as a result. In fact, that whole idea of the instant fatality of small amounts of food and fluid was ridiculed by my opponents as more or less a strawman, despite the fact that gruesome images of Terri's instantly choking to death and dying horribly (as if dehydrating to death weren't horrible enough) _were_ invoked during her case by the anti-Schindler camp.

So, it's really not terribly implausible that these nurses did just what they said they did. In fact, one of my interlocutors has gone so far as to imply that giving a disabled woman in Terri's situation a little jello on a spoon is "criminal" because of all that lung inflammation concern. (Again, he evidently doesn't think it similarly "criminal" to leave her to die with no fluids.) I suppose the anti-Schindler camp needs to make up its mind: Does it want to argue that she was able to be fed by mouth, so gee, I guess PVS people can be fed at least a little bit by mouth, but that this was a horrible crime because she might have aspirated a little? Or does it want to argue that the nurses who cared for her earlier are just such wretched people that she was probably never given any jello by mouth at all?

Really, Ron, I don't think you have a defensible point.

Notice to "Walter in FL" and any fans who might miss him. Walter has that combination of frequency of comments, severe wrong-headedness, incoherence, lack of ability to reason, and persistent use of insult that pushes me over the line. Readers can bear witness that wrong-headedness _alone_ is not enough to do this and that I have not attempted to maintain a one-sided discussion in this thread. But his comments have been deleted.

Opposing murder is "pro slavery". - Zippy

Telling someone their body is subject to outside ownership is pro slavery.

Whatever other point you were trying to make about murder and your beliefs is an aside.

For the record no one owns me. Just because you wanna surrender yourself to some form of outside "ownership" and control thats your burden to bear. Pretty much it signals the start of absolving yourself from responsibility for your own actions. You can always blame whatever master you serve right? Or the voices in your head. Maybe it is just your predestiny to pick up the rifle and climb into the bell tower? Perhaps some directive from your owner?

Sorry you don't like body piercing. I guess if you ruled the world there would be many forms of expression prohibited, many books burned, colleges and university closed on account of a lack of non prohibited subject matter to discuss or teach.

Most assuredly to quell the dissent you would need to round up the dissenters and have them restrained, imprisoned or executed. Dictators and authoritarians don't tolerate dissent well.

One begins to understand the wisdom of this countries founding fathers in not placing absolute authority, power and control into the hands of one man.

"We the people" might find that one mans ideas and opinions oppressive and insufferable.

Sorry Lydia, I probably crossed the line. I'm a little outspoken and unrestrained when it comes to certain values and ideals.

Yes, Truth, please knock it off on dissing Zippy, for whom I have the highest respect. And, though I hope this doesn't "set you off" again, God does own you whether you believe it or not. I realize that it may be angering to hear that people believe that, but it's true of all of us, on, as C.S. Lewis put it, the "prosaic grounds that he made it all." (quoting from memory)

Here is something that might interest you Lydia:

1. http://www.indybay.org/uploads/part1terriinterview.mp3
Jana Carpenter is interviewed and talks about Terri as she lay dying
in 2003. Jana Carpenter is a nurse who worked closely with the
Schindlers and actually got to read some of her medical charts.
Rating is an 8.
Dated around October 2003.
Running Time - About 28 Minutes

2. http://www.centerforajustsociety.org/uploads/terri012905.mp3
An execellent interview of Ken Connor with John Sipos. He explains
some of Terri's Law and the judicial problems with the Schiavo case.
Rating is a 10.
About 20 Mintes long.
Dated January 29,2005.

3. http://www.ewtn.com/vondemand/audio/resolve.asp?
rafile=wo_02182005.rm
David Gibbs and Bob Schindler are interviewed in February 2005. About
1 hour long. Bob and David answer questions from callers. Relays some
interesting facts.
Rating is a 9.
Dated February 18,2005.
Running Time - About 1 Hour

4. http://kgovarchives.com/bel/2005/24k/20050301-BEL042-24k.mp3
Cheryl Ford RN is interviewed in March 2005 and talks about Terri
Schiavo.
Rating is a 7.
Dated March 01,2005.
Running Time - About 28 Minutes

5. http://www.kfuo.org/mp3/Issues5/Mar_17c.mp3
Wesley Smith talks about Michael Schiavo's 2005 Nightline Interview
the day before Terri's feeding tube was removed.
Rating is an 8.
Dated March 17,2005.
Running Time - About 15 minutes.

6. http://libsyn.com/media/commarts/NGOVCNeff.mp3
Very Good interview by Chuck Neff in the media who studied the
Schiavo case. Has a very distrubing story about his mother in
hospice.
Rating is a 9.
Dated around March 18,2005
Running Time - About 15 Minutes.

7. http://www.youtube.com/watch?v=1IqoanJnk9Y
Lieberman on Terri Schiavo.
Rating is a 6.
Dated around March 18, 2005
Running Time - About 3 minutes.

8. http://libsyn.com/media/commarts/NGOVTerriLegal.mp3
A university professor tells how JEB or Bush could have saved Terri
from death.
Rating is a 7.
Dated around March 18,2005.
Running Time - About 20 Minutes

9. http://treyjackson.typepad.com/junction/files/capone.mov
Trudy Capone is interviewed and talks about Terri Schiavo in March of
2005. Trudy says Michael didn't know what to do with Terri. If
Michael didn't know what to do with Terri, he probably didn't know
her wishes.
Rating is an 8.
Dated around March 18,2005.
Running Time - About 5 Minutes.

10. http://treyjackson.typepad.com/junction/files/nurse.mov
Heidi Law is interviewed and talks about Terri Schiavo in March of
2005.
Rating is a 7.
Dated around March 18,2005.
Running Time - About 5 minutes.

11.
http://web.archive.org/web/20050403013905/http://www.msnbc.msn.com/id/
3036789/
Lawyer Bois - Believes the Federal Courts studied the Schiavo case
well. However, Bois was very suspect of Terri's so-called wishes and
was disturbed that the Federal Courts did not take a look at that
issue.

Lawyer Starr - Adds that the Schindlers did present their side on the
Clear and Convincing Standard but believes Judge Greer found
Michael's evidence to be realiable. However, Starr believes that
Legal mistakes were most likely made and was disturbed by the fact
the Terri did not have GAL consistently throughout the legal process.
Starr ends that Congress should given more clear direction to the
Federal Courts.
Rating is a 9.
Date around March 18, 2005.
Running Time - About 10 Minutes.

12. http://www.youtube.com/watch?v=nWJ3hLKO2XI
This a short interview on Scarbough Country between a bioethist and a
Right to Life Attorney. Bill Allen looks like one evil dude and does
not believe Terri Schiavo is a person.
Rating is a 6.
Dated around March 18,2005.
Running Time - About 5 Minutes.

13. http://www.kfuo.org/mp3/Issues5/Issues_Etc_Mar_21b.mp3
Rita Marker talks about what Terri's Law II was really about. Does a
good rebuttle of Rep. Debbie Wasserman's comments.
Rating is a 10.
Date March 21,2005
Running Time - About 20 Minutes

14. http://www.kfuo.org/mp3/Issues5/Issues_Etc_Mar_31b.mp3
A nurse named Cindy Provience who is writing a book on PVS talks
about Terri Schiavo. Discusses some interesting facts about the PVS
diagnosis.
Rating is an 8.
Dated March 31,2005.
Running Time - About 20 Minutes.

15. http://www.priestsforlife.org/audiosf/05-04-08schiavo.m3u
Frank Pavone Talks about Terri Schiavo's Final Hours. The Eye Witness
account by Frank Pavone.
Rating is a 9.
Dated April 05,2005.
Running Time - About 39 Minutes.

16. http://www.kfuo.org/mp3/Issues5/Issues_Etc_Apr_14b.mp3
Wesley Smith talks about the Legacy of Terri Schiavo after her death.
Relays some very interesting facts.
Rating is a 10.
Dated April 14,2005.
Running Time - About 20 Minutes

17. http://www.coralridge.org/BroadcastArchives.asp#1953
http://www.coralridge.org/BroadcastArchives.asp#1954
http://www.coralridge.org/BroadcastArchives.asp#1955
http://www.coralridge.org/BroadcastArchives.asp#1956
David Gibbs, Dr. Stevens and Joni Eareckson Tada are interviewed on
Dr. Kennedy's Truth That Tranforms radio program.
Rating is a 10.
Running Time - About 40 Minutes.

18. http://video.aol.com/video-search/id/2939381526
http://video.aol.com/video-search/id/3369036850
Mark Fuhrman and Suzanne Vitadamo are interviewed about Terri's
collapse after Terri's death.
Rating is an 8.
Dated May 2005.
Running Time - About 20 Minutes.

19. http://www.ewtn.com/vondemand/audio/resolve.asp?
rafile=wo_06172005.rm
Bobby Schindler and Lawyer Michael Gaynor discuss Terri after she
dies and the legalities and problems with the Schiavo case. Gaynor
present an excellent Due process argument (fundemental fairness).
Callers phone in. 1 hour long.
Rating is a 10.
Dated June 17,2005.
Running Time - About 1 Hour.

20. http://www.priestsforlife.org/audiose/gol025-05.mp3
Bobby Schindler talks to Frank Pavone about Terri shortly after
Terri's autopsy results. Bobby relays some interesting facts.
Rating is a 9.
Dated around June 2005.
Running Time - About 15 Minutes.

21. http://www.pfltv.com/bobby/
Bobby Schindler interviews on Priest's For Life with Janet Morana. He talks about the facts
of the Schiavo case. You can actually see Bobby Schindler in this interview.
9:00 minutes long.
Rating is a 9.
Dated 2006.
Running Time - About 15 Minutes.

22. http://www.christianradiomagazine.com/audio/crm20061202.m3u
David Gibbs talks about The Schiavo case on Christian Radio. He
presents a good due process (fundamental fairness) argument.
Rating is a 10.
Dated February 12, 2006.
Running Time - About 20 Minutes.

23. http://www.familynetradio.com/mornings/mp3/050306Schindler.mp3
Bob and Mary Schindler are interviewed on Lori and Friends in May
2006 about the Schiavo case. Bob relays the facts.
Rating is an 8.
Dated March 05, 2006.
Running Time - About 30 Minutes.

24.
http://www.theamericanview.com/dictator/media/595/TheAmericanViewProg5
1.mp3
Bobby Schindler is interviewed on the American View Radio program
about Michael Schiavo's 2006 interview with Matt Ladeur.
Rating is an 8.
Dated around March 30, 2006.
Running Time - About 30 Minutes.

25. http://www.ewtn.com/vondemand/audio/resolve.asp?
rafile=wo_04072006.rm
Bobby Schindler is interviewed on ETWN a year after Terri's death.
Bobby relays some interesting facts.
Rating is a 9.
Dated April 07,2006.
Running Time - About 1 Hour.

26. http://www.kfuo.org/mp3/Issues6/Issues_Etc_Jun_04a.mp3
http://www.kfuo.org/mp3/Issues6/Issues_Etc_Jun_04b.mp3
Excellent 2 hour interview of Bobby Schindler on Issues, Etc.
Rating is a 10.
Dated June 04,2006.
Running Time - Over an Hour.

27. http://www.ncfpc.org/Podcast/NCFPC-070127-Gibbs.mp3
David Gibbs is interviewed on January 27, 2007 about the Schiavo
case. Gibbs presents his case.
Rating is a 7.
Dated January 27,2007.
Running Time - About 15 Minutes.

28. http://www.somervillebaptist.org/audio/4-8-07_evening_service.mp3
David Gibb's Sermon on Terri Schiavo given on April 8, 2007 in
Alabama. Gibbs spreads his word.
Rating is a 9.
Dated April 08,2007.
Running Time - About 50 Minutes.

29. http://www.christianlaw.org/pdf/FFDL.wmv?PHPSESSID=44d0400635a57b47e342e6a3966595aa
David Gibbs tells the untold story of Terri Schiavo.
Rating is an 8. Dated May 2007.
Running Time - About 30 Minutes

30. The Good Interviews of Rita Marker
Dated at different times. Rita talks about different aspects of Terri's case through the

later end of the Schiavo Saga.
http://kfuoam.org/mp3/Issues4/Sep_1c.mp3
http://kfuoam.org/mp3/Issues4/Oct_21c.mp3
http://kfuoam.org/mp3/Issues5/Jan_24a.mp3
http://kfuoam.org/mp3/Issues5/Feb_22c.mp3
http://kfuoam.org/mp3/Issues5/Feb_23c.mp3

31. http://kfuoam.org/mp3/Issues6/Issues_Etc_Apr_27a.mp3
Bob and Mary Schindler are interviewed.
Rating is an 8.
Dated April 27, 2006.
Running Time - About 20 Minutes.

32. The Glenn Beck Interview of Bobby Schindler
These are interviews with Bobby Schindler interviewing with Glenn Beck. They occurred

during the time Terri was starving and dehydrating to death. Bobby relays his feeling and

the events of the Schiavo Saga are discussed as they manifested themselves. Rating is 9.

http://mfile.akamai.com/6713/wma/glennbeck.download.akamai.com/6713/preview/05/03/interview-

bschindler.asx

http://mfile.akamai.com/6713/wma/glennbeck.download.akamai.com/6713/preview/05/03/interview-

sschindler.asx

http://mfile.akamai.com/6713/wma/glennbeck.download.akamai.com/6713/preview/05/03/interview-

0324.asx

http://mfile.akamai.com/6713/wma/glennbeck.download.akamai.com/6713/preview/05/03/interview-

0325.asx

http://mfile.akamai.com/6713/wma/glennbeck.download.akamai.com/6713/preview/05/03/interview-

0328.asx

http://mfile.akamai.com/6713/wma/glennbeck.download.akamai.com/6713/preview/05/03/interview-

0329.asx

http://mfile.akamai.com/6713/wma/glennbeck.download.akamai.com/6713/preview/05/03/interview-

0330.asx

For the record no one owns me.

Including you: that is, you also don't 'own' you, in the sense that the word 'own' has come to represent to secular moderns.

And you needn't worry about me assuming dictatorial powers. Even if 'we the people' wanted me to do so by an overwhelming majority I would refuse the job, and retire to my own Mount Vernon.

I never got an answer to my question.

i see that censorship runs rampant on this board

James, I published your comment, but I should just warn that the automatic spam filter for the site catches stuff with that many links, so I had to rescue it. Also, of course, you're preaching to the choir when it comes to me and Terri. :-)

I am familiar with the Marjorie Neibert case, Lydia. I'll have to check, but I believe that is how her name is spelled. If you look at my original explanation, which you responded to by citing the Neibert case, I specifically stated if a patient recovered full competence and deglutition capacity. The reason I stated such was exactly because I figured you might bring up the Neibert case. If you recall, Ms. Neibert was denied food and water because she could not swallow safely. Giving her food and water would have been malpractice unless her NPO order was rescinded. And she did not have her tube feedings resumed because she lacked capacity/competence to consent to such (competence technically is a strictly legal term and finding, whereas capacity is a medical). Had Ms. Neibert been able to swallow safely she would have been fed. Had she been capable of consenting to or refusing medical treatment, she would have had ANH restarted.

Ergo, your example in no way contravenes my original post, which clearly delineated the difference between an intended outcome and an expected outcome. I do agree, though, that life saving and life sustaining medical treatments are commonly withheld at the behest on a legal guardian; but that does not perforce indicate death as intent.

James, I appreciate the compliment you gave me. But to be fair, the "rationalized arguments" you have seen me made over the years are not "mine." I am simply iterating what is already out there.

But it is also an objective fact that when ANH is withheld or withdrawn, it is NOT for the purpose of causing death.

Excuse me? Then for what purpose would you do it?
______________________________________________________________________________________________________________________

Mr. Luse, I would respectfully suggest that you read Beauchamps and Childress. It is considered the premier text on biomedical ethics. But I will try to capitulate.

There are four contextual elements in examining the ethical licitness of an action or inaction. They are in descending order of importance: intent, motive, aim, and goal. They are all related, but nonetheless distinct.

In the case of stopping tube feeds when a person has expressly declined them beyond a certain point, the intent (what I am equating with the term purpose) behind stopping the tube feeds would be to respect the patient's autonomy. Intent actually has nothing to do with life OR death. After all, tube feeds are stopped all the time if/when people recover enough to eat on their own. So obviously death was not intended in those cases. The motive would be to comply with standards of medical care, applicable legal statutes, and pertinent bioethical principles. The aim is to adhere to canonized and codified professional standards of conduct. The goal is to be a patient advocate.

You may not see it that way, but the point is that tube feeds are stopped for reasons OTHER than bringing about death. Respect for patient autonomy is the underlying intent; although such could represent motive as well, depending on how niggling one is. Death may be the expected outcome -- just as when a Christian Scientist refuses insulin to treat diabetic ketoacidosis -- but that is distinct from being the intended outcome.

Hope that helps.

"Respect for patient autonomy is the underlying intent"--even when the old lady asks timidly if she could please have a little food, because, shucks, she hasn't recovered "legal competence" to revoke the DPA she gave to her brother, who has ordered her dehydration despite the fact that she isn't terminally ill. So the highest value here is "respect for the autonomy of people who are legally competent, even to the point of refusing _requested_ food and fluids to their later, not legally competent selves." That's pretty astonishing. That you would even defend what was done in that case. (WJS spells it "Nighbert," but whatever.) Even my old argumentative sparring partner on this issue, Step2, draws the line at dehydrating people who are able to ask for food and water.

Mr. Luse, I would respectfully suggest that you read Beauchamps and Childress. It is considered the premier text on biomedical ethics.

Well, hot dog. The premier text. Do Beauchamps and Childress say it's all right to dehydrate people to death? If so, do I still have to read it?

...the intent...behind stopping the tube feeds would be to respect the patient's autonomy.

Which you can't do without removing her nutrition which you know very well will kill her. You're still trying to make autonomy, or consent, the arbiter of an act's morality.

After all, tube feeds are stopped all the time if/when people recover enough to eat on their own. So obviously death was not intended in those cases.

Irrelevant. The tube is being stopped for an entirely different reason to an entirely different end.

Death may be the expected outcome...but that is distinct from being the intended outcome.

So the doctor who pulled Terri Schiavo's tube didn't intend for her to die? Maybe he thought that by removing her food and water she'd get better? In the ethical tomes I've read, this is sometimes referred to as "kidding oneself." In other articles (by premier biomedical ethicists, I should add) I've heard it called "wishful thinking." In layman's terms (the sort you might find in a blog comments thread) it is sometimes described as "lying to oneself in order to justify what one wishes to do."

Anyway, she ended up dead. She died because her food and water was taken away. At a press conference afterwards a doctor confirmed that that's exactly why she died. He didn't seem surprised, but maybe he didn't know it would turn out that way. Or maybe he didn't want it to turn out that way, even though he knew it would. Or maybe he blamed it on the judge who ordered it. He was "just following orders."

Mr. Luse, like I said: expected outcome and intended outcome are not one and the same. Your last paragraph above seems to concede this. You are trying to equate the two, which very common misperception, but that makes it no less incorrect. Death is never the intent (purpose) when life support is removed. Knwoing it will occur (short of a miracle and intending for it to occur are two different things. So no, the doctor who pulled her tube did not intend for her to die. Death was clearly expected and hastened, but not intended.

You are also equating morality and ethics, which are different constructs. But yes... from a professional stance, autonomy trumps life. That doesn't make it a "moral arbiter." It simply is. That is why people can refuse life saving or sustaining treatments, irrespective of the treatment's complexity, and be perfectly condign in doing so. For many, preservation of organic existence is not the highest good or ideal.

I agree that the issue of stopping tube feeds when people are able to eat on their own is a different situation. You are correct. However, maintaining tube feeds in a healthy and cognizant child who has Down's Syndrome is also an entirely different situation as well. Strange that you did not criticize that when it was brought up. Since people seemed to feel that such was apropos, as nobody to my knowledge castigated it as being irrelevant, I saw no reason why the factual statement I made should be any less relevant.

I agree, Lydia, that giving food and water to a person asking for such should be the thing to do... PROVIDED the person is not NPO for medical reasons. That, however, was not the case with Ms. Neibert. You and Mr. Luse seem to focus on the end result using your personal moral paradigms, rather than a dispassionate analysis of the relevant contextual elements.

In any case, expectation and intent are clearly not the same, even if the end result is. This can be clearly seen in the dichotomy between commission of a suicidal act, versus actively committing suicide. An example of the former would be if I ran out to defend my child against two game bred pit bulls. I am bearing no weapons, wearing no protective clothing, and have no specialized fighting skills. An example of the latter would be if I threw myself off of a ten story building because I am sick of living.

End result is the same in both cases, but in one case the intent was death; in the other case there was no such no intent. There would be other differences as well between the two scenarios, but the expected outcome in both cases is my death being caused/hastened by my actions. Expectation is therefore no different. Clearly this illustrates the dichotomy between expected outcome and intended outcome.

Of course you might then argue that the scenarios I disucssed above are "different." But if expected outcome and intended outcome were really one and the same, with no meaningful differences between the two, then the scenarios should not matter. Intended outcome and expected outcome would be the same regardless.

So the highest value here is "respect for the autonomy of people who are legally competent, even to the point of refusing _requested_ food and fluids to their later, not legally competent selves." That's pretty astonishing.
_________________________________________________________________________________________________________________________

Not quite, although I can see why you would construe the situation as such.

The underlying premise is that medical self determinism -- in the way of refusing unwanted interventions, a fundamental negative right -- is a basic entitlement for all competent adults, and that this right is not abrogated by loss of competence. The right of refusal is retained. This is why a surgeon cannot just do whatever he or she thinks is indicated, even if it is to save your life, after you are under anesthesia, if you have refused specific interventions (blood transfusion would be the classic example). If a patient has refused dialysis, we cannot ethically just wait for the person to lose competence, and then dialyze because of what the patient says while delirious.

Reverse the situation. Suppose a competent person said that he or she wanted to be fed artificially, but then later on -- under the influence of mind altering drugs -- reneged on the insertion of the feeding tube. If the doctor felt that the patient was incapacitated, such that he/she could not make medical decisions, then the doctor would be entirely justified in complying with the patient's prior request when he/she was competent, and insert the feeding tube.

Of course if the patient remains competent all along, then he or she can change his/her mind at anytime.

But as I already said, I do agree that a person who is directly asking for food and water should be given such... so long as there is no medical contraindication to such.

I have enjoyed the brief stint I spent here, and wish you all the best. Once again, I would recommend Beauchamps and Childress, the Physicians' Ethics Manual, the position statement from the American Academy of Neurology, and the New England Journal article on "apprpopriate usage of ANH."

I bid you all adieu!!

In case anyone finds this confusing

But as I already said, I do agree that a person who is directly asking for food and water should be given such... so long as there is no medical contraindication to such.

it might be clarifying for me to point out expressly that Buster the Boa considers it a "contraindication" if a person cannot swallow and needs a feeding tube, and that he uses the phrase "food and fluids" only to refer to food and fluids by mouth, whereas I use it to refer to food and fluids however given. So it's a "counterindication" to give "food and fluids" in Buster's terminology if you can't swallow, or can't swallow with absolutely full and perfect safety from any aspiration, because "food and fluids" in his terminology does not include ANH!

I reject entirely the attempted parallel between a person who requests ANH while competent and then rejects it under the influence of mind-altering drugs and Mrs. Nighbert, who requested "a little food" when she was not legally competent after having given her brother a power of attorney for healthcare while legally competent. (Her brother was ordering her dehydration based on statements she had made to him about what she didn't want if she were terminally ill, which wasn't the case here in any event.)

The most important absence of parallel is that the desire for food and fluids (in my sense--the desire just to _have_ food and fluids in your stomach, not to be hungry and thirsty) is a natural and normal desire, whereas the desire to be dehydrated to death is not. This asymmetry, of course, is what Buster emphatically denies.

Interestingly, though, most doctors _do_ admit some asymmetries. For example, if a person wrote in a statement that, if he became legally incompetent and helpless, he didn't ever want his bed linen or his adult diaper changed, or to be turned in the bed to avoid bed sores, I think (I certainly hope) it would not be considered a professional requirement to go along with these requests!

What we're dealing with here is the dogma that ANH is "treatment" rather than minimal, basic care on a par with keeping the patient warm, clean, and dry. That, of course, is what I deny. In fact, that seems quite morally insane to me.

What we're dealing with here is the dogma that ANH is "treatment" rather than minimal, basic care on a par with keeping the patient warm, clean, and dry. That, of course, is what I deny. In fact, that seems quite morally insane to me.- Lydia

When it requires that you be cut into through the skin, fascia, muscle wall and into the stomache to create a new, unnatural opening into your body and the placement of a medical device into the newly created opening/tunnel into your body with the inherent risk of surgery/anesthesia/infection it most assuredly is a "treatment" and a "surgery" whether you wish to deny the reality of that or not. When the surgical site requires frequent inspection for signs of infection or reaction to the unnatural material left in place then it most assuredly requires medical care. When professional medical judgement must be excerised to determine how to react to "issues" and "problems" at the surgical site or "issues" and "problems" that arise from the use of the device then it most assuredly is not basic care. Basic care is something that a untrained bystander can provide.

You can't seriously mean that you think you- without training as a surgeon or training in surgical technique- could provide the PEG?

You can't seriously mean that you think you could remove the PEG?

Arguing that it is simply a "different" way of feeding ignores basic facts such as the fact that it requires a "new" opening to be cut into the body and something left protruding to the outside of the body that you were not born with.

You want to redefine "basic care" to include surgery?

You want to redefine "basic care" to include the creation and maintenance of new openings into the body?

It is obvious what you want to deny but wanting to deny that rocks are hard and water is wet hardly changes the reality.

Wanting to call it "basic care" certainly helps forward your arguments but at what cost? Is it possible that you honestly believe you can provide such a "basic care"?

Is it possible that you honestly believe that cutting into a person, placing a tube and connecting that tube to a pump is really the equal of approaching them with a spoon and a bowl of food or a glass of water?

You demand symmetry, demonstrate please the symmetry of equating approaching a person with a spoon and a bowl of food with approaching them on an operating table with a knife?

Lab experiment: Walk up to someone you don't know with a spoon and a bowl of food and ask them if you can feed them.

Now walk up to someone with a scalpel and ask them if you can feed them by cutting into them, placing a tube from the outside of their body directly into their stomache, and connecting the tube to a pump that will provide them with a slurry of their RDA of vitamins, minerals, and a little something to keep their bowels in good working order.

I suspect you would get very different reactions from the people you propose to "help" by "just" and "only" feeding them.

If you told them you were going to feed them like you would feed any baby (not that we cut open babies to feed them...) the persons being offered the knife/tube/pump combo would likely strongly disagree.

I suspect you would hear that people being offered the knife/tube/pump combo don't consider it ordinary or basic to be cut into or to get their "meal" in the form of a slurry. I suspect they wouldn't be calling that "eating", that they would likely call that a medical treatment because they wouldn't recognize the slurry as "food" or the pump as something they have ever seen at the dinner table and, worth noting, they would probably tell you it wouldn't be a welcome or invited alternative for them, that they wouldn't enjoy it and would prefer not to have your "help".

Now walk up to someone with a scalpel and ask them if you can feed them by cutting into them, placing a tube from the outside of their body directly into their stomache, and connecting the tube to a pump that will provide them with a slurry of their RDA of vitamins, minerals, and a little something to keep their bowels in good working order.

I suspect you would get very different reactions from the people you propose to "help" by "just" and "only" feeding them.

If you told them you were going to feed them like you would feed any baby (not that we cut open babies to feed them...) the persons being offered the knife/tube/pump combo would likely strongly disagree.

I suspect you would hear that people being offered the knife/tube/pump combo don't consider it ordinary or basic to be cut into or to get their "meal" in the form of a slurry. I suspect they wouldn't be calling that "eating", that they would likely call that a medical treatment because they wouldn't recognize the slurry as "food" or the pump as something they have ever seen at the dinner table and, worth noting, they would probably tell you it wouldn't be a welcome or invited alternative for them, that they wouldn't enjoy it and would prefer not to have your "help".

TRUTH,

Are you not even aware of the fact that there are those hospitalized folks who due to some tragic accident are incapable of nutrition via ordinary means (and, fyi, I am not referring strictly to coma patients)?

Are you then suggesting that these individuals, rather than being fed intravenously, be literally starved to death?

If so, there are several hundreds of people living today (including a college friend of mine) who would be a victim of your risible logic here.

Actually, a nurse could place an NG tube, which is simpler and non-surgical. But it is less efficient, and sometimes for people with a stroke it is (for some reason) considered less advisable than a PEG tube. And plenty of babies do indeed have NG tubes, even if they are born just a few weeks early and are too sleepy to get enough nutrition and hydration by sucking a bottle.

In any event, if you asked a person whether he'd rather lie in a bed with no fluids until his eyes fill up with blood from broken blood vessels caused by dryness, until his tongue turned black, until his kidneys shut down for lack of water, and he finally died of thirst, or whether he'd rather have a _minor_ surgical procedure to place a PEG tube, if he's sane and really understands what you are talking about, and believes you, he'll opt for the latter. If not, he's plenty doggoned confused and shouldn't be left to die of thirst anyway.

"A slurry." I love that. Yeah, and baby formula has all kinds of sophisticated vitamins in it, is made in a factory, and doesn't look very appetizing to us or like ordinary food, either. Maybe that means we shouldn't call it "food and water," even though babies live on it for a year or so. And some people don't think Ensure (which can also be put through a feeding tube) looks much like ordinary food, either. And I even know a lady who saved money by making her own material for her child's feeding tube *in a blender* from plain food. Very mucy like you would process it for a baby just learning to eat solids. Bet you didn't even know that was possible, didja? Gosh, it's "a slurry"! _There's_ a morally relevant point! What a totally ridiculous thing to try to use to argue that there is something oh-so-very-weird, unnatural, and treatment-like about receiving ANH.

Don't forget, too, "Truth," what I've already tried to emphasize to you--that the controversy often arises after that minor surgical procedure about which you make such a big song and dance has already been done. So in plenty of cases in which _you_ would defend dehydrating the person to death, we really are just talking about giving or not giving the nutrition and hydration. You just don't seem to get the point of this, so let me spell it out for you at a little more length: Suppose that you regard the placement of the PEG tube as some sort of horrible crime against the person, if he wouldn't have wanted it, but suppose that's already been done by the time the controversy arises. Then that "horrible crime" is in the past already, and you really are talking about the idea that a person "wouldn't have wanted" merely to _receive_ the nutrition and hydration. Which is pretty darned crazy, even _waiving_ the point about the minor nature of the surgery involved. Perhaps you want to say that we need to wipe out the terrible guilt of having implanted the PEG tube by ceasing to use it. So dehydrating the person to death becomes a sort of bizarre penance for the sin of having performed minor surgery to place the tube in the first place. Wiping out the stain, as it were. Or suppose you wish to tell us that the person _would_ have wanted the PEG tube placed and used until doctors could discover whether he was "PVS." Then why make such a song and dance about the surgery? In that case, the surgery was in accordance with the patient's wishes, and, once more, we're back to the idea that what's the real crime is just _administering_ the food and water, which yes, indeed, a layman can learn to do, which really is just _giving_ the nutrition and hydration.

Are you not even aware of the fact that there are those hospitalized folks who due to some tragic accident are incapable of nutrition via ordinary means (and, fyi, I am not referring strictly to coma patients)?

Are you then suggesting that these individuals, rather than being fed intravenously, be literally starved to death?-Aristocles
_______

Yes I am well aware, more aware than most who post messages here for whom these discussions are purely academic excercises, hobby activism or otherwise less "real" than for those who have a professional and ongoing interest in these matters. Some people a very late comers to these discussions.

You are talking about welcome, invited and expected (by the patient) medical care, the most common circumstance. A path, given the acute nature of the injuries, where the prognosis is unknown.

I am talking about a different circumstance entirely- the circumstance under which a person has specifically directed that treatment be witheld or stopped.

Lydia, it is fun having you twist my words in order to add your own horrific imagery and inflammatory word choices. Your reaction toward points you cannot refute is amazing.

Apparently you actually entertain the notion that it is criminal to cut someone who has stated they don't wish to be cut.

But you are having trouble reconciling the dualism of actually entertaining that notion while trying to support the whole "the end justifies the means" perspective.

If it makes it easier for you to grapple with the dualism by minimizing as much as possible that we are in fact talking about a surgery (I love how easily you label it "minor" just because you demand that it be "minor" for the purpose of supporting your argument) then so be it.

Again please do answer: are you claiming that the surgery to implant a PEG is so easy and minor that any simpleton could do it?

Are you claiming it is just that "basic" of care?

By the way please tell what hospital has it as a common practice for nurses to place NG tubes? Would that be a practice reserved for RN's or would any nurse at any level of training be doing that?

Medicine has nearly become childs play it is so simple...

I am talking about a different circumstance entirely- the circumstance under which a person has specifically directed that treatment be witheld or stopped.

So, if I may ask, in the case of a person who has not "specifically directed that treatment be witheld or stopped" - should ANH be intitiated? And if so, is there a point at which should ever be stopped?

So, if I may ask, in the case of a person who has not "specifically directed that treatment be witheld or stopped" - should ANH be intitiated? And if so, is there a point at which should ever be stopped? - William

Yes (Whenever necessary and possible IMHO)
No (unless there is a medical reason IMHO)

I worry about the room to maneuver given in the phrase "a medical reason."

Anyway, in the case of a disabled someone (e.g., a Terri Schiavo) who has left such instructions (which I would define rather strictly as written, not merely "taking a relative's word for it"), you would be in favor of removing ANH. If our Schiavo-like patient had not left such instructions, you would be against such removal. Is this correct?

Lydia, by the way, is not being unresponsive. For some reason she cannot access the W4 website today. She'll be back as soon as the cyber synapses reconnect.

Volunteering tonight so I only have my smartphone to read web pages and type on but yes I think you have stated my position correctly.

Then it would appear that you are prepared to describe the same act perpetrated under two different circumstances - with instructions and without - as different kinds of acts, even though they are identical in form and result. The second kind you might call murder. I don't know what you would call the first, but it definitely won't be murder. Do you see my difficulty?

I'm afraid I don't follow.
Are you referring to the accident victim scenario?

Are you arguing that it might be better NOT to initiate any treatment at all based on the premise that initiating treatment -including life support- while many answers are unknown

could, possibly, buy enough time and keep the patient alive long enough to get facts and information in hand

that would THEN be recognized as the "triggers" or basis of medical directives contained in written documents?
__________

Are you saying that life support should never be inititiated because it might lead to the circumstance where some part or all of it would need to be removed or discontinued in order to comply with a directive from the patient or the patients proxy or even a court order?

Would you agree that patients, even with advanced directives against life support, would want to have all best efforts expended until enough medical information was in hand to make an informed decision?

Are you arguing that it might be better NOT to initiate any treatment at all...?

No,no. I think doctors are obligated to initiate treatment. I'm trying to discover why you would permit removal of ANH in one circumstance (with written instructions) but not in the other (without instructions).

"Truth"--as Bill says, I'm having some connectivity problems, and now that I'm back at W4, I have to be quick. Am I saying that I could do the PEG surgery? !! Please. No, of course not. I made that very clear. If you want to make it into "major" surgery, then you aren't being honest. And I'm not by any means the only one who refers to it as "minor" surgery.

Can any nurse drop an NG tube? As in, is a LPN allowed to do so in the American medical system or only an RN? I don't know. I would't presume to say without researching it. My point was that it isn't surgical and is a lot simpler than a PEG tube. That was my only point. One of my children had an NG tube for a week as a newborn. It was a very simple device, though of course I didn't have the training to put it down her throat in the first instance. I do know _for a fact_ that the nurses did that. But you literally put the baby formula into a thing on the end of it and held it up in your fingers so that it ran down into her tummy. Gravity fed. I was able to do that part.

You still don't seem to get the significance of the fact that you're justifying simply stopping putting the feeds after the "cutting" that you are so exercised about is long, long over. Feeds that any layman can do and many, many do.

But, yes, I do think it's okay to "cut" a person, using anesthetic to the extent necessary, for the surgery to implant a PEG tube in order to administer nutrition and hydration without which he will inevitably die, as all of us will die without nutrition and hydration. And I think it's not only okay, but also required, for those who are responsible for the person and who are able to do this terrible "cutting" (that being the proxy or DPA for healthcare and the attending doctor) to authorize it and to do it even if the person once said, "I don't want any _tubes_ in me if I'm helpless someday." So sue me.

And if you think more "natural" ways are so much better, and if you are so worried about surgery, then authorize an NG tube. And if that still isn't "natural" enough for you, then stop obsessing about aspiration and at least permit small amounts of fluid to be given so the poor person doesn't die like a dog in a ditch with a blackened tongue and no moisture in his mouth. But don't, don't get on a professional high horse about how horrible it is to give fluids PO because the person might aspirate and develop lung irritation and scarring, rule out an NG tube (on the grounds that a layman can't drop one? Or what? Would it make you feel better if some laymen learned?) while at the same time getting hysterical about the evil of the "cutting" involved in inserting a PEG tube. What you are basically doing is ruling out the more "natural" ways, the non-surgical ways, of administering nutrition and hydration and then trying to make us all horrified at the idea that someone might be "cut" for a PEG tube. That is _so_ unimpressive. It's the most blatant special pleading to try to make us feel like it's imperative to dehydrate some people to death. It ain't gonna fly.

Where you're getting "the end justifies the means" about _me_, of all people, I can't say for sure. I'm the last person most people would describe that way. Or one of the last. I'm privileged to co-blog with others on this board. But I don't acknowledge that the "means" of implanting a PEG tube is some intrinsically wrong thing that I have to try hard to "justify." I'm totally unimpressed by your aversion to it, which seems to me exaggerated almost to the point of being irrational. If you are (as you imply) a medical person, then that irrationality is all the more surprising. Phobias like that are unworthy of people who work with this stuff. But maybe they are training it into y'all these days on purpose. "Oooo, yuck, cutting to insert it and tubes and a pump and a port in the muscle tissue and icky-looking slurry food! Gross!"

Where you're getting "the end justifies the means" about _me_, of all people, I can't say for sure.

That was definitely one of the more amusing implications in the thread.

Patients refuse treatment. I have no aversion to doing my job or any aspect of my job. I do have an aversion to running rough shod over a persons expressed directive. From a certain perspective- the perspective you easily discard- consent is required. Consent is assumed under certain circumstances, in particular the circumstance where the patients directive is unknown or unavailable and/or the diagnosis and prognosis is unknown and therefore it is impossible to ascertain whether conditions specified by the patient exist or do not exist. I believe this meets the requirement to "err on the side of life". But you are stating even allowing for that much error doesn't go far enough.

Affirmative consent is one thing.

What you are saying is that it should be okay to proceed even when the patient has stated they do not consent. I'm not talking about the circumstance where they haven't given permission or can't give permission, I am talking about the circumstance where they have withdrawn their permission and consent, where they have denied their permission and consent.

Whether you accept it or not you advocate for the position that the end justifies the means when you argue that permission and consent shouldn't be relevant and what is done to the patient shouldn't be relevant and whether the patient would accept or reject the proposed treatment shouldn't matter.

Whats the phrase of the day? "Its all good"? Essentially saying the only thing that matters is preserving life at all costs and by any means necessary.

Essentially saying the only thing that matters is preserving life at all costs and by any means necessary.

Certainly, it is more than self-evident that this is much preferable to its contrary: the destruction of life at all costs and by any means necessary (even without consent).

But, "Truth," there are some things you don't think consent is required for, and that I'm pretty sure you would not withhold even if the patient said he didn't want them. I've given examples above. Your whole argument that ANH is not basic care and must be refusable is based on all manner of stuff about how some versions of ANH require surgery (which you describe as "cutting" to make it sound like a big deal) to set up, how the food used looks like "slurry," and various other things meant to make ANH sound strange and unnatural rather than like the basic provision of nutrition and hydration. I say those are very poor arguments.

I'm getting nowhere, I realize. At some point I'm just going to stop responding. At least it can't be said that I let your statements go without response or that the pro-life position is overwhelmed by superior knowledge. If anything, it's the other side that has to exaggerate risks, exaggerate strangeness, induce aversions, hide or avoid information--such as that some forms of ANH do not require surgery, that tube feedings can be given by a layman once the tube is set up, that the nutrition and hydration can be prepared from real food, that when doctors say small amounts of fluid by mouth are "contraindicated" this doesn't actually mean the person is going to choke to death, that dehydrating a non-dying person to death can indeed be very painful if the person is capable of experiencing pain, that it is in any event a gruesome and quite unnatural way to die, and the like. So I think I've shown that the pro-lifer can know what he's talking about and not be overwhelmed by the supposedly greater wisdom of the "pros."

Thanks for responding Lydia. You absolutely avoid speaking to the direct issue at hand so honestly your responses aren't really responses are they?

Consent and permission. That was the subject.

You changed the subject to a rant about who is superior to whom and whether information has been hidden, whether things have been minimized or exagerated by one side or the other, and something about how okay it is to proceed against medical advice or proceeding when a given act is clearly specified to be contraindicated or not medically advisable, etc etc. It appears you were trying to add all the wonderful shades of gray in order to not have to speak to a black or white fact set.

Consent and permission.

These are the scenarios:

#1. consent and permission are given and known.

#2. The person has not yet given consent or permission but it is assumed they would- something that has sometimes been described as "err on the side of life".

#3. The person has refused consent and denied permission.

Are you honestly telling me that in all 3 scenarios you expect and demand that medical professionals proceed without hesitation???

In which of these scenarios do you expect the medical professional to have immunity from civil or criminal prosecution?

Here is a less relevant question but still interesting- can the hospital hold the patient accountable and responsible for paying the bill on services that were refused? Maybe they have health insurance and the HMO will gladly pay?

How much force is allowed to compel the patients compliance with treatment under the circumstance that the treatment has been refused, there is no consent and there is no permission?

How much are we allowed to "rough them up"?

I know- we can just automatically declare the patient incompetent or assume they are incompetent by default if they refuse what we know to be "good for them".

If they argue, if they resist we will meet force with force. They will submit one way or the other.

Four point restraints. Chemical restraints! Thats the ticket! We could just drug them out of their minds or induce a coma.

Of course if the person is PVS we don't have to drug them out of their mind or induce a coma. We can just ignore everything about them and how they lived their life and what they had to say when they were able to speak. Any of their history, their words, their thoughts and ideas, anything they shared and made known to others- all of it is devalued, discarded and discounted- Gone. Poof. Whats the popular phrase? "FORGET ABOUT IT..."

We'll just carry on as if they never had a mind and a will of their own. We'll just pretend they want to fall in line behind us and march to the beat of our drummer. We'll just strip them of their individuality and uniqueness. They can become a part of the collective. Keep that heart beating. Fates worse than death? No human has ever entertained such a notion.

Your responses confuse me, but I don't have time to explain why. I'd just like to ask a simple question and see if I can get a concise response. If our Schiavo-like hypothetical patient had not requested withdrawal of ANH should she ever fall into a PVS, would you consider it murder to withdraw it?

Lydia has admitted to at least one consequence of her position, hospitals will be put out of business from willfully violating patient directives. When she writes, "So sue me," that is exactly what will occur, except it will be aimed at the hospital administrators who allow this to happen.

If our Schiavo-like hypothetical patient had not requested withdrawal of ANH should she ever fall into a PVS, would you consider it murder to withdraw it? -William Luse

Fair question. I've overstayed my welcome here and annoyed Lydia to no end. But I'm interested so I find myself returning against my better judgement.

I will answer your question if you answer mine.

There are three possible scenarios and the patient is assumed to be competent in scenario #1 and #3:

#1. consent and permission are given and known.

#2. The person has not yet given consent or permission or is unable to give consent or permission but it is assumed they would- something that has sometimes been described as "err on the side of life".

#3. The person has refused consent and denied permission.

My question: Is it a crime for the doctor to ignore #3 and continue anyway?

Bonus optional question: Does the process used to determine #3 have to be different from the process used to determine #1? If so please explain your answer.

I ask because I've always been curious why some people think it should be harder to refuse a treatment than it is to give approval for one.

Step2, I know this may seem to be sort of a trivial point (in a way), but it was a contingent fact that the case law and some statutory laws (where these exist) went the direction they did on whether ANH should be regarded as treatment, hence "refusable," or basic care. The very fact that for a time some hospitals were able to stand out and refuse to stop tube feedings, and that it was various court decisions that set the legal trend from there on, shows that this was legally "up in the air" for a while. Even many people adamantly on the other side from me on this issue would agree with this sheerly historical point; they point to what they call the bad, old "days of forced feeding" as having been a reality in the past, which certainly indicates that the present legal state of affairs was not a necessary event by any means.

In my ideal world, of course, patients don't bother writing directives that tell hospitals and doctors to stop tube feeding, anymore than patients write directives now trying to refuse being washed and clothed. Nobody has set up this whole idea that ANH is something you should think hard about refusing and that hospitals are obligated to stop or not to start based on your advance directive. It's just not set up that way in the first place. Therefore, in my ideal world, hospitals don't lose lawsuits for initiating or refusing to stop ANH.

I ask for a concise answer to what you describe as a "fair question", and you refuse by proferring one of your own. Looks like dancing to me. I think that'll do for now, Mr. Truth.

Lydia has admitted to at least one consequence of her position, hospitals will be put out of business from willfully violating patient directives. When she writes, "So sue me," that is exactly what will occur, except it will be aimed at the hospital administrators who allow this to happen.- step2

Also explains why they won't go anywhere near answering my question about scenario #3.

Lawsuits against the hospital are concern enough. But criminal prosecution is an equal concern.

The point is lost on some people that it is no different for a street thug to attack you with a knife against your will and without your permission and a doctor doing the same thing with a scalpel in an operating room.

It is funny in a way- the dancing that William Luse refers to. One of the major differences of opinion I have with Lydia is the "ain't no big deal, just a minor surgery" dance.

I guess if a street thug cuts you superficially or in a "minor" way then the street thug hasn't really committed a crime.

"Cuts you with a knife" isn't specific enough to be morally interesting. If a street thug cuts you, his act is not directed toward your own well-being. When a doctor cuts you to insert a feeding tube, that act is directed toward your own well-being. That such a trivial and obvious truth actually needs to be stated explicitly no doubt implies something about the level of this discussion.

"Cuts you with a knife" isn't specific enough to be morally interesting. If a street thug cuts you, his act is not directed toward your own well-being. When a doctor cuts you to insert a feeding tube, that act is directed toward your own well-being. That such a trivial and obvious truth actually needs to be stated explicitly no doubt implies something about the level of this discussion.

Ditto what Zippy said --

I mean, I could not believe that TRUTH actually resorted to this example!

To compare a knife attack, which is life-threatening to the subject victim, with that of a doctor's treatment (i.e., insertion of a feeding tube), which is life-saving to the patient; already speaks volumes about the type of person we're dealing with here.

A nurse might also *take all your clothes off*. If a street thug did this... :-)

I've got a question after perusing this thread. Why is anybody taking the ironically named "TRUTH" seriously?

I know we are conditioned by the normal rules of civil discourse to treat other people's positions with respect, and give them the benefit of the doubt that they are arguing in good faith, and so forth. This is a good rule when engaging with other gentlemen (or ladies).

However, when you're dealing with an two-bit intellectual barbarian with an axe to grind, your debater's idealism can be used as a tool against you. Sometimes, you just gotta call bullshit.

So, let me point out the obvious thing that everybody knows, but nobody seems to want to say directly: TRUTH isn't really against ANH for the reason that it involves cutting the patient with a knife. He knows it, and we all know it, so why pretend otherwise? I know that he isn't, because it's such a blatantly preposterous position that nobody would really believe it. If he does really believe it, then he's got less brain activity than a PVS patient, and arguing with him is an act of mental thuggery, akin to a chessmaster playing against a toddler, so it's a pointless debate either way.

TRUTH is actually just a euthanasia-supporter, and his real reasons are no doubt the same as any run-of-the-mill euthanasia-supporter's. They probably aren't very convincing, otherwise he wouldn't have resorted to this "ANH is cutting" nonsense. Given that, it's folly to spend your precious time debunking this red herring.

You don't need to convince him that it's not a good reason, because he doesn't really believe it himself. It's just some rationalization he conjured to trip you up, and his position won't be affected one iota by having it knocked down. You don't need to convince anyone else, because nobody else would ever take it seriously in the first place, except for other pro-euthanasia trolls fishing for spaghetti to throw against the wall in other forums. It's a silly "position" that doesn't need debunking.

Deuce, I can't disagree with you. That's why you see me winding down.

#3. The person has refused consent and denied permission.

My question: Is it a crime for the doctor to ignore #3 and continue anyway?

Must be an impossible question for any of you to answer. How many posts and yet not one that is responsive.

Lots of disparaging remarks about me and yet nothing responsive to the question. The elephant in the room must be ignored eh?

Really hate that comparison between a street thug attacking with a knife (which would be met with resistance or flight) and a doctor doing the same thing because in medicine you can always prevent or overcome resistance or flight so it wouldn't get so messy and somehow the person wouldn't react so strongly (I guess, I have no idea what you people think happens I just know what does happen in the world outside of academic thought and speculation).

Oh wait- someone did claim that cutting someone without their consent and when they have denied permission and refused is okay because doctors would only do that for someones own good- it really doesn't matter that the person agrees or disagrees.

Once you need medical help you can just take whatever is dished out to you and like it.

The intellectual honesty award goes to this group. (APPLAUSE)

“Sorry, 'Truth,' I don't think you have a right to have people stop giving you food and water.“ Posted by Lydia | February 16, 2008 12:49 PM

Lydia
You believe that one’s life and death issues are the rights of a committee ruling and not the patient individual's.

What happen to one’s Constitutional Right of Self-Determination to wish to have treatments or not to have treatment?

With a with a written or oral “Living Will” and/or Health Surrogate.

Each one of us have the Constitutional right of self-determination that one’s dying not be artificially prolonged under the circumstances set forth as the individual has declared that, if at any time they are mentally or physically incapacitated and by any or all of the following: terminal condition, end-stage condition, persistent or vegetative state, and it is determined that there is no reasonable medical probability of their recovery from such condition, The individual has the right to direct that life-prolonging procedures be withheld or withdrawn when the application of such procedures would serve only to prolong artificially the process of dying, and that they be permitted to die naturally with only the administration of medication or the performance of any medical procedure deemed necessary to provide her with comfort care or to alleviate pain.

Lydia you don't have a say in others' rights.

Okay, Gen'l'men--(I use the term advisedly.)

Now, listen: I have given you a nice, long, run for your money. I have answered question after question. So far from dodging or ducking, I have said some fairly radical things in order to make myself clear. That, of course, is part of the problem, because you are just outraged at my position.

Further, let's just say I know about your charming little discussion group thread elsewhere in which you engage in juvenile commentary and mockery about our thread here and about some of the participants, including at least one of my fellow-bloggers, for whose good treatment I am even more jealous than for my own. I suppose I should be grateful that, with the exception of those comments by Mr. Walter that I deleted earlier, you have kept your more outrageous nastiness and childishness to the discussion within your own little clique. I have now made it clear in multiple comments that I am winding down the pseudo-discussion on this thread with y'all, now that everything has been said--what?--three times or so already. My own supporters are, as you can see, advising me not to waste my time with you. I've tried the "let them know it's coming to an end, start ignoring their baiting, and maybe they'll go away" stuff for a while today. It doesn't seem to be working yet.

We're done now. I really hate to start deleting stuff and have restrained myself a good deal heretofore. But if you're just going to go on saying stuff--including Walter's barely coherent comments--long after you have been more than adequately answered and taken more seriously than your level of discourse deserves, I'm going to have to stop letting you lower the tone around here. I hope that's clear enough.

Walter,
Your eagerness to establish a fictional right to die, coupled with your Florida address are a cause for concern. Hang in there. Life beats all known alternatives.

Kevin
Those are real Constitutional Rights!!!
This site is not a open forum format.
I’ve had two biased censorships of two of my replies on the first day I posted.
This site must be only for display of biased religious cult’s rhetoric and propaganda.
Enjoy yourselves!!!! I’m out of here……………………………

What happen to one’s Constitutional Right of Self-Determination

Each one of us have the Constitutional right

This site is not a open forum format.

Please, God, don't let him take my Comp class.

I’ve had two biased censorships of two of my replies on the first day I posted.

Sorry. Censorship is by its nature biased.

Lydia said
Actually, a nurse could place an NG tube, which is simpler and non-surgical.

I beg to differ. My Dad had one done and it required a doctor using an x-ray procedure to do it.
And even then they placed it in his lung and released some fluid.

http://findarticles.com/p/articles/mi_gGENH/is_/ai_2699003530

"To insert a nasogastric tube, the nurse or other health care professional should..."

And here:

http://www.enotes.com/nursing-encyclopedia/nasogastric-intubation-feeding

"Nasogastric intubation is usually performed by a licensed nurse or physician in the medical setting. Paramedics or other emergency personnel may receive special training to insert NG tubes as appropriate in the field. Patients' families may be trained to insert or change nasogastric tubes in the home setting if a patient is discharged with a NG tube in place."

As I said, Patti, I'm quite sure that nurses placed one for my baby nine years ago.

There might have been a special reason for your dad to have a doctor do it.

There may have been Lydia.

He was comatose and I believe it is harder to do in one who cannot respond. They used a fluoroscope to place it.

Skilled labor I'd say :-)

Yes, but nurses are indeed skilled. Or are supposed to be. I would hesitate to say that every comatose person requires a doctor's involvement to place an NG tube, though I wouldn't insist to the contrary unless I knew more, and it might depend not only on the individual patient's situation but also on the protocols at a given hospital or hospice facility. In any event, it is a non-surgical procedure, quite reversible, and it does not involve anything that could be called "a machine." Those who laud the late Pope for not having "extraordinary means" used to prolong his life sometimes do not know that they are unwittingly admitting that an NG tube is not extraordinary mean, for he had one at the end of his life.

It varies by state. Some states allow LPNs, most allow RNs but I wouldn't be surprised that a few don't. Don't ask me why I know this but I'm about 99% certain that display of ability to insert an NG tube is required for RN certification in Wyoming.

And I know a lot of doctors, my wife knows many, many more, and in general, procedures like that... you're often better off having a nurse do it! (Try having a doctor draw blood sometime -- way off topic though.)

Not necessarily off-topic... :-)

Lydia said

In any event, it is a non-surgical procedure, quite reversible, and it does not involve anything that could be called "a machine.

True. Not like a PEG which requires surgery and often uses a machine to regulate the flow of the vitamin enriched goop they use to feed. That kind of feed can take 10 to 12 hours to complete. And should definitely be called extraordinary care.

I disagree, Patti. Food is food, however administered and certainly whether it's "goopy" or not. (I cannot for the life of me understand why that is considered relevant.) But again, my position is that people should get nutrition and hydration. If somebody is much more comfortable with an NG tube than with a PEG tube, then go for it. But if the doctors then start making noises to the effect that they refuse to use an NG tube as opposed to a PEG tube over a long term, for some reason or other, this is *not* an excuse for saying, "Oh, well, then in that case we'll just have to discontinue nutrition and hydration altogether. The doctors say we can't just keep on forever with the NG tube, and a PEG tube would be extraordinary, so we'll just leave him here with nothing for two weeks until he dies." People just astonish me. They absolutely astonish me. Ruling out the easier, simpler, or more "natural" things (sometimes on fairly weak grounds) and then insisting on dehydrating people to death because the preferred method for long-term care requires a surgically implanted port.

If we insist on calling any kind of nutrtion and hydration "extraordinary care", then we are probably just looking for an excuse to take it away.

It is not just artificial nutrition that is the point here. It is the ability to make one's own medical choices. This includes ventilators, dialysis, transfusions, and such.

You have the right to decide for yourself if they want them or not, and for your next of kin to make these decisions according to what they feel you would have wanted if you no longer can speak for yourself.

The highest respect you can give someone is to respect and follow their wishes. Even if it hurts to do so. Even if you would want differently for yourself.

No, Patti. That's just so old and tired a way of being wrong. And so sadly shallow. I could try to argue with you. In fact, I have. I've pointed out above things that people still wouldn't do or refrain from doing for a patient (washing them, changing them) because it was "following someone else's wishes." Here's another one: There is a "clinic" in England where they cut off people's healthy limbs. Because that is the person's wish. I'd like to think some of the right to die crowd might draw the line there, though I suppose I shouldn't count on it. It's a horrible and perverse form of abandonment to follow people's self-destructive, pathological, and confused wishes in the name of their autonomy.

I don't know, Patti, if you are the new and nicer face of our bunch from that among-themselves-nasty bulletin board discussion. But I think this has probably gone on as long as is profitable. I'll just leave you with the point that you are merely giving cliches. Cliches that cannot with any remnant of sanity, even in other areas, be carried to their logical conclusion. (There was a man in Germany who killed another guy and ate him. His defense at his trial was that that was the other guy's "wish." Is that incumbent upon us too?) That is not reason. That is not argument. And that is not enlightenment. It's crazy 21st century groupthink. Try thinking outside the box.

James wrote:
We only hope that between then and now, people have been able to truly understand the background of Congress's involvment in the Schiavo matter and to find that it had nothing to do with intruding within a private family matter.

Yes, James, the majority of citizens of the nation are fully aware of the violations to the U.S. Constitution these congressmen that voted in support of the legislation in Congress relating to Terri Schiavo.

These congress members also violated their Oath of Office to support and protect the U.S. Constitution. They ignor it and violate it just to pander votes so they could be and stay in power of this nation. Well did stay in power for 8 years and look where their control has lead us.

You and your co-supporters of the Pro-Life organizations claim the country was founded by Christians. These same Christians created our U.S. Constitution and the Bill of Rights and for you, James and your co-supporters of the Pro-Life organizations to honor the violators display by you and Pro-Life is the greatest and higher level of hypocrisy of beliefs.

Where are these congress members now, James? Is Terri Schiavo the only person they wished to save?

The congress members were not there for Terri . They were there for control and power over this nations. They and the leadership of the these organizations were using each other.

That is ALL!