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Michael Schiavo insists that dehydration is "the most natural way to die."
It's more like torture.
by Wesley J. Smith
11/12/2003 12:00:00 AM
An accurate discussion of this sensitive issue requires the making of proper and nuanced distinctions about the consequences of removing nourishment from incapacitated patients. This generally becomes an issue in one of the following two diametrically differing circumstances:
(1) Depriving food and water from profoundly cognitively disabled persons like Terri who are not otherwise dying, a process that causes death by dehydration over a period of 10-14 days. As I will illustrate below, this may cause great suffering.
(2) Not forcing food and water upon patients who have stopped eating and drinking as part of the natural dying process. This typically occurs, for example, at the end stages of cancer when patients often refuse nourishment because the disease has distorted their senses of hunger and thirst. In these situations, being deprived of unwanted food and water when the body is already shutting down does not cause a painful death.
Advocates who argue that it is appropriate to dehydrate cognitively disabled people often sow confusion about the suffering such patients may experience by inadvertently, or perhaps intentionally, blurring the difference between these two distinct situations. For example, when Michael Schiavo, Terri's husband, and his attorney, George Felos, appeared on the October 27, 2003 edition of "Larry King Live" the following exchange occurred:
KING: When a feeding tube is removed, as it was planned [for Terri], is that a terrible death?
SCHIAVO: No. It's painless and probably the most natural way to die.
FELOS: When someone's terminally ill, let's say a cancer patient, they lose interest in eating. And literally, they--by choice--they stop eating.
SCHIAVO: Cancer patients, they stop eating for two to three weeks. Do we force them to eat? No, we don't. That's their choice.
Later in the interview, Schiavo reiterated the assertion in a response to a telephoned question:
CALLER: Does it bother you that the death is so slow?
SCHIAVO: Removing somebody's feeding tube is very painless. It is a very easy way to die. Probably the second best way to die, the first being an aneurysm.
Yes, it is true that when people are actively dying from terminal disease, they often refuse food and water. The disease makes the food and water repulsive to them. In such circumstances, it is medically inappropriate to force food and water into a person who is actively rejecting it. Indeed, doing so could cause suffering.
But this isn't what is happening to Terri. She isn't dying of cancer. Her body isn't shutting down as part of the natural dying process. Indeed, she is not dying at all--unless her food and water is taken away.
WHAT HAPPENS to non-terminally ill people with cognitive disabilities whose feeding tubes are removed? Do they suffer from the process?
When I conducted research on this question in preparation for writing my book "Forced Exit," I asked St. Louis neurologist William Burke these very questions. Here is what he told me:
A conscious [cognitively disabled] person would feel it just as you or I would. They will go into seizures. Their skin cracks, their tongue cracks, their lips crack. They may have nosebleeds because of the drying of the mucus membranes, and heaving and vomiting might ensue because of the drying out of the stomach lining. They feel the pangs of hunger and thirst. Imagine going one day without a glass of water! Death by dehydration takes ten to fourteen days. It is an extremely agonizing death.
Dr. Burke opposes removing feeding tubes from cognitively disabled people and so some might dismiss his opinion as biased. But Minnesota neurologist Ronald Cranford's pro-dehydration testimony in the Robert Wendland case--Cranford also testified that Terri's feeding tube should be removed--supports much of what Dr. Burke asserted. While Cranford called seizures "rare," his detailed description of the dehydration process reveals its gruesome reality:After seven to nine days [from commencing dehydration] they begin to lose all fluids in the body, a lot of fluids in the body. And their blood pressure starts to go down. When their blood pressure goes down, their heart rate goes up. . . . Their respiration may increase and then . . . the blood is shunted to the central part of the body from the periphery of the body. So, that usually two to three days prior to death, sometimes four days, the hands and the feet become extremely cold. They become mottled. That is you look at the hands and they have a bluish appearance. And the mouth dries a great deal, and the eyes dry a great deal and other parts of the body become mottled. And that is because the blood is now so low in the system it's shunted to the heart and other visceral organs and away from the periphery of the body . . .
MOST OF THE TIME, we never know for sure what a starved or dehydrated person experiences. But in at least one case--that of a young woman who had her tube feeding stopped for eight days and lived to tell the tale--we have direct evidence of the agony that forced dehydration may cause.
At age 33, Kate Adamson collapsed from a devastating and incapacitating stroke. She was utterly unresponsive and was diagnosed as being in a persistent vegetative state (PVS). Because of a bowel obstruction she developed, her nourishment was stopped so that doctors could perform surgery.
Adamson eventually recovered sufficiently to author "Kate's Journey: Triumph Over Adversity," in which she tells the terrifying tale. Rather than being unconscious with no chance of recovery as her doctors believed, she was actually awake and aware but unable to move any part of her body voluntarily. (This is known as a "locked-in state.") When she appeared recently on "The O'Reilly Factor," host Bill O'Reilly asked Adamson about the dehydration experience:
O'REILLY: When they took the feeding tube out, what went through your mind?
ADAMSON: When the feeding tube was turned off for eight days, I thought I was going insane. I was screaming out in my mind, "Don't you know I need to eat?" And even up until that point, I had been having a bagful of Ensure as my nourishment that was going through the feeding tube. At that point, it sounded pretty good. I just wanted something. The fact that I had nothing, the hunger pains overrode every thought I had.
O'REILLY: So you were feeling pain when they removed your tube?
ADAMSON: Yes. Oh, absolutely. Absolutely. To say that--especially when Michael [Schiavo] on national TV mentioned last week that it's a pretty painless thing to have the feeding tube removed--it is the exact opposite. It was sheer torture, Bill.
O'REILLY: It's just amazing.
ADAMSON: Sheer torture . . .
In preparation for this article, I contacted Adamson for more details about the torture she experienced while being dehydrated. She told me about having been operated upon (to remove the bowel obstruction) with inadequate anesthesia when doctors believed she was unconscious:
The agony of going without food was a constant pain that lasted not several hours like my operation did, but several days. You have to endure the physical pain and on top of that you have to endure the emotional pain. Your whole body cries out, "Feed me. I am alive and a person, don't let me die, for God's Sake! Somebody feed me."
Unbelievably, she described being deprived of food and water as "far worse" than experiencing the pain of abdominal surgery. Despite having been on an on an IV saline solution, Adamson still had horrible thirst:
I craved anything to drink. Anything. I obsessively visualized drinking from a huge bottle of orange Gatorade. And I hate orange Gatorade. I did receive lemon flavored mouth swabs to alleviate dryness but they did nothing to slack my desperate thirst.
Apologists for dehydrating patients like Terri might respond that Terri is not conscious and locked-in as Adamson was but in a persistent vegetative state and thus would feel nothing. Yet, the PVS diagnosis is often mistaken--as indeed it was in Adamson's case. And while the courts have all ruled that Terri is unconscious based on medical testimony, this is strongly disputed by other medical experts and Terri's family who insist that she is interactive with them. Moreover, it is undisputed that whatever her actual level of awareness, Terri does react to painful stimuli. Intriguingly, her doctor testified he prescribes pain medication for her every month during the course of her menstrual period.
BEYOND THE TERRI SCHIAVO CASE, it is undisputed that conscious cognitively disabled patients are dehydrated in nursing homes and hospitals throughout the country almost as a matter of routine. Dr. Cranford, for example, openly admitted in his Wendland testimony that he removes feeding tubes from conscious patients. Thus, many other people may also have experienced the agony described by Adamson and worse, given that dehydrating to death goes on for about a week longer than she experienced.
AT THIS POINT, defenders of removing feeding tubes from people with profound cognitive disabilities might claim that whatever painful sensations dehydration may cause, these patients receive palliating drugs to ensure that their deaths are peaceful. But note: Adamson either did not receive such medications, or if she did, they didn't work. Moreover, because these disabled people usually can't communicate, it is impossible to know precisely what they experience. Thus, when asked in a deposition what he would do to prevent Robert Wendland from suffering during his dehydration, Dr. Cranford responded that he would give morphine but that the dose would be "arbitrary" because "you don't know how much he's suffering, you don't know how much aware he is . . . You're guessing at the dose." At trial, Cranford suggested he might have to put Wendland into a coma, a bitter irony considering that he had struggled over many months to regain consciousness.
The time has come to face the gut wrenching possibility that conscious cognitively disabled people whose feeding tubes are removed--as opposed to patients who are actively dying and choose to stop eating--may die agonizing deaths. This, of course, has tremendous relevance in the Terri Schiavo case and many others like it. Indeed, the last thing anyone wants is for people to die slowly and agonizingly of thirst, desperately craving a refreshing drink of orange Gatorade they know will never come.
Wesley J. Smith is a senior fellow at the Discovery Institute and an attorney and consultant for the International Task Force on Euthanasia and Assisted Suicide. His current book is the revised and updated "Forced Exit: The Slippery Slope From Assisted Suicide to Legalized Murder."
Correction appended 11/13/03: The article originally stated that Kate Adamson had been deprived of nourishment in an attempt to end her life. In fact, the dehydration was being done in attempt to alleviate a bowel obstruction. The painful surgery Adamson refers to was originally referred to as surgery to insert a feeding tub. It was actually surgery to remove the bowel obstruction, which is a more involved procedure.
An Eyewitness Account
Fr. Frank Pavone
National Director, Priests for Life
President, National Pro-life Religious Council
You may have seen on the news that I was at
Terri Schiavo's bedside during the last 14 hours of her earthly
life, right up until five minutes before her death. During that
time with Terri, joined by her brother and sister, I expressed
your care, concern, and prayers. I told Terri over and over that
she had many friends around the country, many people who were
praying for her and were on her side. I had also told her the
same things during my visits to her in the months before her
feeding tube was removed, and am convinced she understood.
I've known Terri's family for about six years now and they put me on the visitor's list. Terri was in a hospice but there were police officers stationed outside her room. If I were not on that visitor's list I could not get in that room beyond the armed guard because the visitor's list was kept very, very small and very well controlled. The reason? The euthanasia advocates had to be able to say that Terri was an unresponsive person in some kind of vegetative state, coma or whatever terminology they want to use to suggest that she was completely unresponsive. The only way to prove she was responsive was to see her for yourself.
I went down to see her in September 2004 and again in February 2005.
When her mom first introduced her to me, she stared at me intently. She focused her eyes. She would focus her eyes on whoever was talking to her. If somebody spoke to her from the other part of the room she would turn her head and her eyes towards the person who was talking to her.
You know what some of the doctors have dared to say about this? "Oh, it's just reflex reactions. Unconscious reflex reactions." Interestingly, that's exactly the same thing they say about the unborn child when you look at the video The Silent Scream when the child opens his mouth and tries to move away from the instrument that is about to destroy him. They say, "Oh, that's just an automatic reflex." That's the phrase they always use to dehumanize the person.
I told Terri she has many people around the country and around the world who lover her and are praying for her. She looked at me attentively. I said, "Terri now we are going to pray together, I want to give you a blessing, let's say some prayers." So I laid my hand on her head. She closed her eyes. I said the prayer. She opened her eyes again at the end of the prayer. Her dad leaned over to her and said, "OK Terri now here comes the tickle," because he has a mustache. She would laugh and smile and after he kissed her I saw her return the kiss. Her mom asked her a question at a certain point and I heard her voice. She was trying to respond. She was making sounds in response to her mother's question, not just at odd times and meaningless moments. I heard her trying to say something but she was not, because of her disability, able to articulate the words. So she was responsive.
Now, the night before she died I was in the room for probably a total of 3-4 hours, and then for another hour the next morning -- her final hour.
Brothers and sisters to describe the way she looked as peaceful is a total distortion of what I saw. Here now was a person, who for thirteen days had no food or water. She was, as you would expect, very drawn in her appearance as opposed to when I had seen her before. Her eyes were open but they were going from one side to the next, constantly oscillating back and forth, back and forth. The look on her face (I was staring at her for three and a half-hours) I can only describe as a combination of fear and sadness … a combination of dreaded fear and sadness.
Her mouth was open the whole time. It looked like it was frozen open. She was panting rapidly. It wasn't peaceful in any sense of the word. She was panting as if she had just run a hundred miles. But a shallow panting. Her brother Bobby was sitting opposite me. He was on one side of the bed I was on the other facing him. Terri's head in between us and her sister Suzanne was on my left. We sat there and we had a very intense time of prayer. And we were talking to Terri, urging her to entrust herself completely to the Savior. I assured her repeatedly of the love and prayers and concern of so many people.
We held her hand and stroked her head. During
those hours, one of the things I did was to chant, in Latin,
some of the most ancient hymns of the Church. One of the chants
I used was the "Victimae Paschali Laudis," which is the
ancient proclamation of the resurrection of Christ. There, as I
saw before my eyes the deadly work of the Culture of Death, I
proclaimed the victory of life. "Life and death were locked in a
wondrous struggle," the hymn declares. "Life's Captain died, but
now lives and reigns forevermore!"
And then we had just times of silence … just sitting there in silence trying to absorb what was happening.
But besides Bobby and his sister and Terri herself, you know who else was in the room with us? A police officer. The whole time. At least one. Sometimes two. Sometimes three armed police officers in the room. You know why they were in the room? They wanted to make sure that we didn't do anything that we weren't supposed to do, like give her communion or maybe a glass of water. In fact, Bobby, sitting on the other side of the bed, would occasionally stand up to lean over his sister. When he stood up and did that, the officer would change position. He would move around towards the foot of the bed so that he could have a direct line of sight on what we were doing. The morning that she died we went in there fairly early and I had to go back outside in front of the hospice to do an interview. In order to go out on time I had a little timepiece in my hand and at the beginning of our visit I put it in my left hand, leaned over Terri and extended my right to bless her and we began praying. I closed my eyes and I felt a tap on my left hand. It was the police officer who said, "Father, what do you have in your hand?" I said, "Oh, officer, it's a little time piece." "I'll have to hold it while you're here," he said. We couldn't have anything in our hands. He didn't even know what it was. Maybe I was going to try to give her communion. Maybe I was going to try to moisten her lips. Who knows what terrible thing I was about to do?
You know what the most ironic thing was? There was a little night table in the room. I could put my hand on the table and on Terri's head all within arms reach. You know what was on that table? A vase of flowers filled with water. And I looked at the flowers. They were beautiful. There were roses their and other types of flowers and there was another one on the other side of the room at the foot of the bed. Two beautiful bouquets of flowers filled with water. Fully nourished, living, beautiful. And I said to myself, this is absurd. This is absurd. These flowers are being treated better than this woman. She has not had a drop of water for almost two weeks. Why are those flowers there? What type of hypocrisy is this? The flowers were watered. Terri wasn't. The other irony is - had I dipped my hand in that water and put it on her tongue - the officer would have led me out probably under arrest. He would have certainly led me out of the room. Something is wrong here.
As you may have also seen, those who killed Terri were quite angry that I said so. The night before she died, I said to the media that her estranged husband Michael, his attorney Mr. Felos, and Judge Greer were murderers. I also pointed out, that night and the next morning, that contrary to Felos' description, Terri's death was not at all peaceful and beautiful. It was, on the contrary, quite horrifying. In my 16 years as a priest, I never saw anything like it before.
After I said these things, Mr. Felos and
others in sympathy with him began attacking me in the press and
before the cameras. Some news outlets began making a story out
of their attacks and said I was "fanning the flames" of enmity
Actually, there's a simple reason why they are so angry with me. They had hoped that they could present Terri's death as a merciful and gentle act. My words took the veil of euphemism away, calling this a killing, and giving eyewitness testimony to the fact that it was anything but gentle. Mr. Felos is a euthanasia advocate, and like all such advocates, he needs to manipulate the language, to sell death in an attractive package. Here he and his friends had a great opportunity to do so. But a priest, seeing their work close-up and then telling the world about it, just didn't fit into their plans.
One of the attacks they made was that a "spiritual person" like a priest should be speaking words of compassion and understanding, instead of venom. But compassion demands truth. A priest is also a prophet, and if he cannot cry out against evil, then he cannot bring about reconciliation. If there is going to be any healing between these families or in this nation, it must start with repentance on the part of those who murdered Terri and now try to cover it up with flowery language.
Another aspect of the Terri Schiavo tragedy is that many people misunderstand its cause and therefore its solution. They think the problem was that Terri did not leave any written instructions about whether she wanted to be kept alive. In order to avoid any such problem in their own lives, they are now told that they have to draw up a "living will." This is both erroneous and dangerous.
Terri's case is not about the withdrawal of life-saving medical treatment, but rather about the killing of a healthy person whose life some regarded as worthless. Terri was not dying, was not on life support, and did not have any terminal illness. Because some thought she would not want to live with her disability, they insisted on introducing the cause of death, namely, dehydration.
So what good is a living will supposed to accomplish, aside from saying, "Please don't argue about killing me, just kill me?"
The danger in our culture is not that we will be over-treated, but rather that we will be under-treated. We already have the right to refuse medical treatment. What we run the risk of losing is the right to receive the most basic humane care — like food and water ââ€” in the event we have a disability.
Our culture also promotes the idea that as long as we say we want to die, we have the right to do so. But we have a basic obligation to preserve our own life. A person who leaves clear instructions that they donâ€™t want to be fed is breaking the moral law by requesting suicide.
If you want to make plans for your future
health care, do not do so by trying to predict the future. The
reason you cannot indicate today what medical treatments you do
or don't want tomorrow is that you don't know what medical
condition you will have tomorrow, nor what treatments will be
available to give you the help you need. Living wills try to
predict the future, and people can argue over the interpretation
of a piece of paper just as much as they argue about what they
claim someone said in private.
The better solution is to appoint a health care proxy, who is authorized to speak for you if you are in a condition in which you cannot speak for yourself. This should be a person who knows your beliefs and values, and with whom you discuss these matters in detail. In case you cannot speak for yourself, your proxy can ask all the necessary questions of your doctors and clergy, and make an assessment when all the details of your condition and medical needs are actually known. That's much safer than predicting the future. Appointing a health care proxy in a way that safeguards your right to life is easy. In fact, the National Right to Life Committee has designed a "Will to Live," which can be found at www.nrlc.org and which I recommend highly.
I am in regular contact with Terri's parents, Bob and Mary Schindler, and her siblings, Bobby and Suzanne. They are strong Christians with a beautiful, gentle spirit. If you wish to relay a personal message to them, you can send it to firstname.lastname@example.org and I will pass it along to them myself.
Meanwhile, let us continue to commend Terri to the Lord, mindful of the equal value of every life, no matter how prominent or obscure, healthy or sick.
Priests for Life
PO Box 141172
Staten Island, NY 10314
Tel. 888-PFL-3448, (718) 980-4400
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