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Tube Feeding

PREVIEW ~ includes a list of recent books by Wesley J. Smith

THIS SERIES WILL ADDRESS QUESTIONS SUCH AS: "WHEN NUTRITION AND HYDRATION ARE FED TO PATIENTS VIA A TUBE, AND NOT AN ORDINARY SPOON, DO WE CALL IT 'MEDICAL TREATMENT' OR BASIC CARE?"

I. FEEDING AND CARING OF THE SICK, DISABLED AND INFIRM HUMAN BEINGS

II. CREATING A DISPOSABLE CASTE  - (Caring for Robert Wendland) BY WESLEY J. SMITH

III. KILLING IN THE SHADOWS -  (The Robert Wendland) story BY WESLEY J. SMITH

For updated information on Robert Wendland see: http://www.raggededgemagazine.com/extra/wendland012201.htm and http://www.cnn.com/TRANSCRIPTS/0101/15/bp.00.html

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I. FEEDING AND CARING OF THE SICK, DISABLED AND INFIRM HUMAN BEINGS

?? QUESTION: When doctors, and nurses go out for breakfast, lunch, and dinner, do they say "I'm real hungry, let's go to the cafeteria and get some medical treatment"?

The following excerpts which address such questions is taken from "REPORT OF THE SELECT COMMITTEE ON MEDICAL ETHICS" House of Lords Session 1993 94, London: HMSO: Vol. II.

"My Lord Chairman . . .Having been tube fed myself on numerous occasions I know that it is in fact a very simple thing to do and is not problematical. The main reason that we think it is different from things that are purely medical treatment is that food is a requirement of every human being and we do not call it medical treatment when we go out for lunch. It is just a question of the delivery of something that is a basic human necessity. The body itself will absorb the food in the normal way, delivering it to tissues which will cope with it in the normal way." [Ms Alison Davis, SUCP Handicap Division, HL Vol.II, 2.11.93:259]

Question: "[W]hat would be your response to an individual who expressed a sincere, considered and consistent wish to die?

"(Ms Davis) My Lord Chairman . . .Some years ago I did actually satisfy all the, as the euthanasia advocates call it, strict criteria for euthanasia. I was in severe pain which was not at that time being properly controlled, I have an incurable disability and some doctors at that time though I did not have long to live. I did repeatedly, consistently and sincerely want to die over a period of probably three years. The important thing that you need to know, I think, is that the cause of my misery was nothing to do with any of those things which satisfied the strict criteria. 

The reason for my misery was unrelated traumasone was the breakdown of y marriage, and there were various other traumas that had occurred at that time. What I needed and what I eventually got was people to say that my life was precious whatever I thought of it and that my feelings of hopelessness and worthlessness while sincere were not the correct way of looking at my life. What I did not need and what I am eternally grateful did not happen was for someone to say, "yes, you are right, let me help you die," because if they had said that in a sense they would have been encouraging and validating that very hopelessness that was causing my wish to die. 

Therefore, I think that what we should offer people in that same position as I was is that we should stay with them, we should not collude with their despair and hopelessness and that is what we feel if the correct response to people who are so distressed and despairing. . .the point is that I also had severe pain due to twisting of the spine which at that time was not being properly controlled and as a result of that it was felt that I did not have long to live, so quite apart from my having spina bifida which, as you rightly say, would not necessarily mean premature death, there were additional factors that did appear to threaten my life."

Question: "[I]n a different situation in someone with a progressive and incurable disease in its terminal stages who implored the individual doctor to terminate his or her life, or implored a relative to do it, simply because they said they could no longer bear the suffering, would you still take the same view? 

"(Ms Davis) . . . no doubt you have heard from hospice doctors that pain and suffering of that type can be resolved, so our answer would be the same. We should stay with the person, we should in a sense involve ourselves in their suffering, which is sometimes very much harder to do than actually giving the quick answer and walking away from them. [. . .] I was taking part in a television programme in February speaking against a Dutch doctor who said that he did offer euthanasia for individuals with my degree of spina bifida." [ . . .] (Lord McColl of Dulwich) The problem is that if she were in Holland she might well have been bumped off. [. . .] (Ms Davis) . . . In this country [Great Britain] in fact babies who would grow up to be like me are sedated and starved to death in some hospitals; so sadly some doctors in this country would also take similar action to those in Holland." [HL Vol.II, 2.11.93: 259-262]

bullet CREATING A DISPOSABLE CASTE by Wesley J. Smith E-MAIL: wesleyjs@MINDSPRING.COM

"Robert  [Wendland] will need to learn to adjust to no stimulation," reads the sign above the cognitively and physically disabled man's bed at Lodi Memorial Hospital West. This means that for much of the time, Robert lies in bed, without lights, music or television. He may only have visitors for 1 1/2 hour per day.

This is a sea change in Robert's care. After 16 months in a coma caused by injuries received in an auto accident, Robert woke up and, until recently, was receiving physical and speech therapy to rehabilitate him. Robert appeared to be slowly improving. Indeed, he progressed so far in less than a year that he can maneuver himself in a motorized wheel chair through hospital corridors.

It is claimed by Robert's doctor, that the recent change in Robert's care is required by a problem with his blood sugar. But it may not be coincidental that Robert's activities have been diminished just as a court battle rages over his right to live. You see, Robert is the subject of a bitter controversy. His wife, Rose Wendland, wants to cut off the "medical treatment" of food and fluids provided through a tube. In fact, Robert would be dead now but for his mother and sister, Florence Wendland and Rebekah Vinson, fighting to keep him alive. Despite the fact that Robert is conscious and interactive, Rose's decision to cause Robert's death is supported unanimously by the Lodi Memorial Hospital ethics committee. However, a close look at the committee's approval reveals some disturbing facts. As far as is known, no one argued on behalf of saving Robert's life. The nurses and therapists, the very people who spend the most time with Robert, were never asked to appear before the committee. (Several were upset with the decision.) Indeed, the ombudsman, whose specific job is to advocate on Robert's behalf, wasn't even aware that Robert was able to manipulate a motorized wheel chair, when she too decided to support Rose's plans.

Wait, there's more. Right after Robert's mother and sister received an anonymous tip and decided to go to court to save his life, Robert was moved from a ward where he was known by staff who truly care about him, to another, where he would be cared for by strangers. The reason given, according to court testimony, was that Robert's initial caregivers were getting too involved with his case. But disability rights activists say that one way to make cognitively- disabled persons regress, and therefore appear less conscious, is to make them depressed. One way to depress such disabled persons is to remove them from a familiar environment, which is essential to their cognitive improvement.

As if that weren't disturbing enough, it now appears that Robert may have received inadequate medical care. Board certified neurologist and psychiatrist Vincent Fortanase, who has looked into Robert's case on behalf of Robert's mother and sister, has found disturbing facts from a review of Robert's medical records and discussions with his doctors and other care givers. For example, even though Robert has been awake almost a year, an electroencephalogram (EEG), which can help diagnose problems in the brain, has not been performed. Moreover, Dr. Fortanase determined that Robert may be having seizures. Yet, he has never received neuropsychological testing, important along with the EEG, because patients with seizures often respond to medication. Given appropriate treatment, Robert might obtain a higher level of interactive capability.

Dr. Fortanase recommends that Robert be transferred to a rehabilitation center that, unlike Lodi Memorial Hospital, specializes in treating brain-injured patients. There, he would be able to receive the diagnostic and specialized care he so obviously needs.

If that is to happen, it may not be soon. At Rose's request, the hearing to determine Robert's fate was just delayed from December 18, to March 4, 1996.

Robert's case is not unique. In Florida, the brother of 83 year-old stroke patient Marjorie Nighbert, decided to cut off her tube feeding, allegedly because of the terms contained in her advanced directive. Marjorie was not unconscious. During her starvation, she specifically asked nurses for food. This was so upsetting to one nurse that she blew the whistle. Enter the court, where, after a hurried investigation, it was determined that Marjorie was not medically competent to retract her advanced directive (in other words, to ask for the "treatment" of food). Thus, even though she had asked to be fed, the starvation was allowed to continue. Ms. Nighbert died on April 5, 1995.

All over the country, in hospitals, nursing homes, and other facilities, conscious but cognitively disabled and aged people are being denied adequate care and/or are being starved and dehydrated to death in the name of patient autonomy, "quality of life", and "best interests of the patient" determinations. But what is really going on is the creation of a disposable caste of people, whom we, the healthy, find too emotionally painful, too expensive or too inconvenient to care for, and whose intentional killing we increasingly find all too easy to rationalize. 

 
bulletKILLING IN THE SHADOWS by Wesley J. Smith
 

Killing is not appropriate to the light. It is easiest done in the shadows, behind closed curtains, under cover of darkness, where nobody can see. To verify the truth of this, we only have to look to California's Central Valley, to Stockton, where attorneys for the Lodi Memorial Hospital and attorneys for Rose Wendland, are attempting to impose court-ordered secrecy to hide problems with the medical care received by Rose's husband Robert, whose death Rose seeks to cause by dehydration.

Robert Wendland is brain damaged and physically disabled because of an auto accident. After a 16 month coma, he woke up last January. Since then, he has improved to the point where he can successfully maneuver a motorized wheelchair and act upon to simple requests. Despite this, Rose, with the support of the hospital, wants to end Robert's life by removing his tube-supplied food and fluids. Robert would already be dead but for the intervention of his sister and mother, Rebekah Vinson and Florence Wendland, who went to court to stop the killing.

As reported in these pages (Creating a Disposable Caste, December 8, 1995), a neurologist who reviewed Robert's care on behalf of Florence and Rebekah, charged that as of his examination, there were serious deficiencies in his treatment, including the failure of doctors to order an encephalogram (EEG), a standard brain test, for Robert despite his being awake for almost a year. (EEGs were performed after this was made public.) Concerns also have been raised about Robert having his room moved, and being forced to lie without television, lights, or visitors for more than 16 hours a day, an important issue because cognitively disabled people often benefit from stimulation and personal interaction.

Stung by the serious questions about the quality of Robert's care, attorneys for the hospital wrote letters to Rebekah and Florence's attorneys, demanding that public discussion of Robert's care stop. The hospital has also imposed restrictions to prevent further facts about Robert's health from being made public. The hospital attorneys are even trying to influence court decisions about Robert. Despite the fact that the hospital is not a party to the Wendland lawsuit, its attorneys forwarded copies of their letters demanding secrecy to Stockton Superior Court Judge Bob W. McNatt, who will rule on the secrecy issue on January 16, 1996 (and on Robert's ultimate fate on March 4, 1996). Hospital attorneys have also personally appeared before the judge and have even filed an amicus brief, arguing in support of secrecy.

At the same time, Rose's attorney, Stephen Scott, has formally asked Judge McNatt for an injunction preventing further dissemination of facts about Robert's medical care. This is ironic since Rose, Mr. Scott, Robert's doctors, and a hospital representative have repeatedly spoken with the media in an attempt to convince reporters that Robert's dehydration is somehow appropriate. Indeed, the hospital representative falsely denied on KRON TV that Robert is able to maneuver a wheel chair and Rose even wheeled Robert outside the hospital so he could be video taped for television.

As long as the stories were sympathetic, Rose and the hospital didn't mind the publicity. But when KRON aired a video showing Robert successfully responding to therapy, and the substantive criticisms about the deficiencies in his medical care published in the Chronicle made them look bad, Rose and the hospital suddenly decided that Robert's privacy was being invaded by all the media attention.

The attempts to keep the lid on Robert's condition and care go hand-in-hand with their intention to cause his death. What they don't want you to know is that Robert is a conscious, feeling human being, who deserves quality medical treatment and rehabilitation, not the cruelty of intentional starvation and dehydration.

Recent books by Wesley J. Smith

Culture of Death: The Assault on Medical Ethics in America by Wesley J. Smith

Hardcover - 250 pages (February 2001) Encounter Books; ISBN 1893554066

Forced Exit: The Slippery Slope from Assisted Suicide to Legalized Murder by Wesley J. Smith

 Hardcover - (May 1997) 304 pages

You can order these and other books by Wesley J. Smith online at:

http://www.amazon.com/exec/obidos/search-handle-url/index=books&field-author=Smith, Wesley J./107-0298254-0427701

Amazon.com also provides reviews of Wesley J. Smith's books

CHN INFO SERIES
is researched and edited by Cheryl Eckstein, president of CHN and is copyright of the Compassionate Healthcare Network

E-MAIL: chn@intergate.ca


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