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Wednesday, March 30, 2005

Painless Death?

Euthanasia (Greek euthanasi?, a good death :
eu-, eu- + thanatos, death.} ?

Christian Medical Expert Disputes Secular Views in Schiavo Case
(Editors Note: The following report contains a detailed description of death by dehydration that may be unsettling to some readers.)

( - Supporters of both euthanasia and the so-called "right to die" are being criticized for allegedly capitalizing on the case of Teri Schindler Schiavo to benefit their own cause. Schiavo is the disabled Florida woman whose feeding tube was removed under court order Wednesday at the request of her husband and over the objections of her other family members.

While some commentators have dismissed the attempts to save Terri's life, one medical ethics expert said the medical community's decision to participate in the actions meant to end Terri's life is what deserves the criticism.

The CBS Morning News featured medical ethicist Joseph Fins during its report Thursday. He echoed the claims made by Terri's husband, Michael Schiavo, his attorneys and doctors that Terri is essentially brain-dead.

"And she is in a chronic and permanent vegetative state," Fins said, "and our science indicates that, that is not a state from which one recovers."

No mention was made in the report of more than a dozen medical experts, including neurologists, who have submitted affidavits on behalf of the Schindler family, including Terri's parents, indicating that the woman is consciously attempting to interact with her environment and is a good candidate for therapy.

Marc Spindelman, an Ohio State University law professor and "expert on death issues," according to the Miami Bureau of the Washington Post, said the case has larger ramifications than just Terri's so-called "right to die."

"This case really raises in a stark form questions about quality of life, that is to say, when a life is and is not worth living anymore," Spindelman said.

Bill Allen, professor of bioethics law at the University of Florida, told the Orlando Sentinel that "the Schindlers were allowed to abuse the legal system in their quest to keep their daughter alive." Allen said the Schindlers' lawyer, who filed successive appeals in every court available, "did a magnificent job of gumming up the works."

The "removal of feeding tubes is a common practice," according to Kenneth Goodman, director of bioethics at the University of Miami School of Medicine and a co-director of the Florida Bioethics Network. He told the Tampa Tribune that there is no pain involved in dying of dehydration and/or starvation.

"Soon after nourishment is denied to the brain, it begins producing chemicals that act as a natural anesthetic," the Tribune paraphrased Goodman as telling a reporter. He directly disputed claims that Terri will suffer as a result of her lack of sustenance.

"She is not going to feel a thing," Goodman said of Terri. "The artificial pain medication that Schiavo will receive is to make sure that if there is [pain], it is adequately handled."

But at least one Christian ethicist disputes much of what these alleged experts have stated.

Dr. David Stevens, a medical doctor who also has a masters degree in bioethics, serves as executive director of the Christian Medical and Dental Associations. He began a conversation with Wednesday, addressing the claim that Terri was in a "persistent vegetative state."

"The sad thing about this situation is, she's not in a persistent vegetative state...even though that's [how she's] been labeled and that's the law they're using," Stevens argued.

"Persistent vegetative state says you're totally unable to react with your environment in any way. All you've got to do is see the pictures of her on the Internet to realize she's reacting with her environment," Stevens added. "What we have is a severely disabled woman who, her husband wants her dead. And this will do it, what they're going about right now, unfortunately."

Contrary to Spindleman's claim that the case revolves around "quality of life" issues, Stevens believes the debate over whether a terminally ill person should be allowed to refuse treatment has nothing to do with Terri's situation.

"In this situation, what they're doing is, the intent is to make her dead," said Stevens. "The intent is not to get rid of a burdensome intervention."

Stevens explained that, even when terminally ill patients near death refuse fluids or food, medical practitioners are obliged to at least offer it to the patient.

"If not, it's tantamount to murder. Because what you're trying to do is kill her, you're not trying to relieve her of a burdensome treatment," Stevens said. "Giving her fluids and nutrition by mouth is not a burdensome treatment. It never has been defined in medical care and never will be, I hope, defined that way except, perhaps, by this judge."

The hospice and its staff who participate in Terri's dehydration and starvation could face civil or criminal liability, in Stevens' opinion.

"There's complicity here in taking someone's life, if you believe in the principle of 'do no harm' and beneficence. In no way or stretch of the imagination can you say this is beneficent," Stevens said. "Drinking and eating by mouth is not a burdensome intervention. That is just humanity. It's just unbelievable that they've gone that far.

"That's like telling a parent that they have the right to decide whether their child is going to get food and water. If you don't want to give it to them, that's fine?" Stevens asked. "We would be screaming our heads off if that was going on, and yet, this woman is more helpless than many children."

Doctor describes process of dehydration

"What will probably kill Terri is dehydration because it's much quicker than starvation," Stevens said. "To starve to death takes eight to 12 weeks. You can die of dehydration in anywhere from three to five days to two weeks."

Stevens said the amount of fluids in Terri's system when her gastrostomy or "feeding tube" was removed and whether she receives any fluids by mouth will determine how long she lives.

Initial effects of the lack of hydration will include:

Extreme thirst;

Nausea and cramping;

Dry skin, becoming wrinkled as fluids are drawn from the skin to hydrate the organs.

"She's likely to become dizzy and begin to have cramping in her arms and legs. That's because her electrolytes, her sodium, potassium and other electrolytes in her blood start getting out of whack because of lack of fluids."

Terri's body will experience other effects due to the forced dehydration that many might not have been considered.

"She'll see decreased secretions. If she tries to cry, she won't be able to make tears very well, if at all," Stevens said. "Her mouth will become dry and saliva thick. You can have cracking of the [mucous membranes] of the mouth and lips as they dry out."

Those external symptoms of dehydration are accompanied by internal effects, as well.

"People often get headaches, then [become] lethargic and finally go into coma," Stevens continued. "It actually can cause seizures.

"As it progressively gets worse, what happens [are] the physical signs. Her blood pressure will drop, her heart rate will pick up. She'll actually, ultimately go into shock," Stevens explained. "You just don't have enough fluid to keep your blood pressure up, and it drops so low, and that sometimes can be a terminal event, or an arrhythmia of her heart.

"Her blood will get thicker," Stevens continued. "Sometimes, people who are severely dehydrated will actually have strokes just because the blood gets so thick that it clots. It's not a pretty picture."

Which of these symptoms Terri experiences and to what degree will depend on whether the hospice staff makes any attempt to hydrate her by mouth and whether she is offered any pain medication.

"If they sedate her, she could be semi-conscious or unconscious while this is going on," Stevens said. "It's not a very pleasant experience, unlike what the Hemlock Society and other groups try to make you believe."

Stevens explained that he had "had a little bit of experience" in this particular field "since I worked in Africa for 11 years with severely dehydrated people, especially kids."

Starvation, Stevens said, is not really an issue for Terri.

"It's a long process that, depending on what condition people are in when it begins, determines how long it's going to take," Stevens said. "But if you're not getting fluids, it's academic interest. Before you starve to death, you'll die of dehydration."

Case has ramifications for pro-life movement

Tony Perkins, the new president of the Family Research Council, issued a statement Thursday citing the significance of Terri's case to the pro-life movement.

"Yesterday was truly a turning point in our battle against judicial tyranny, as Terri Schiavo became the victim of what can only be described as court-mandated euthanasia," Perkins said.

"If Terri is permitted to starve to death simply because a court ordered it to occur, we will have not only allowed this woman to perish, we will have endangered the lives of virtually every American who is deemed to be too great a burden on our society and who cannot speak for themselves," Perkins added.

"In this post-Roe v. Wade culture, the idea of 'choice' has been elevated to the extent that from the unborn to the disabled, there's seemingly always someone who is empowered to 'choose' that another person's life is no longer valuable," Perkins concluded.

( :2004

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