The Feeding Tube May Be Removed from Disabled Terri Schiavo 23Feb05
New Therapy Helps Patients To Swallow
New Signs of Awareness Seen With Imaging in Some Brain-Injured Patients
Groningen Protocol Can Be Used for Children And Retarded Adults
Supreme Court’s Acceptance of Oregon’s Assisted Suicide Case Gives Court Opportunity to Restore Legal Protection for Patients
DISABLED TERRI SCHIAVO, set be starved and dehydrated to death when her feeding tube was to be removed 22Feb05, has gained a stay until 23Feb05. Terri Schindler Schiavo is a 41-yr-old woman in FL who has been disabled for several years after a mysterious “incident” in her home caused a lack of oxygen.
She is not comatose; she is aware of people around her and recognizes family & friends although she cannot speak; she breathes on her own; she can swallow but has been kept on a feeding tube.
Her parents have tried for years to obtain legal guardianship; her husband has refused.
At least 17 Disability groups have also been fighting for her life; they know that Terri’s death will affect the security of their own lives.
Terri’s parents want only to care for her and provide needed therapy; but her husband has been determined for years to work through the court system to remove her feeding tube so that she will starve and dehydrate to death.
NEW THERAPY HELPS PATIENTS SWALLOW — Called VitalStim, the approach was approved by the US FDA (2002) as an option for patients who might not regain their ability to eat any other way & is designed to help patients recover more quickly. For many patients, their ability to swallow was lost after a stroke or brain injury, or other disorder. Using 4 electrodes on the neck, a series of currents are sent to the throat muscles, increasing intensity over the course of an hour. “The first sensation of it is a tingling,” therapist Schwartz said. “What you’re after is [the feeling] like someone’s reaching out & grabbing your throat. That means those muscles are reacting and working well. [Eliz Davies, Rockford Register Star, 815-987-1341, [email protected]]
[NOTE: Dr. Hammesfahr, noted neurologist, wrote after examining Terri Schiavo, that he does not believe she needs a feeding tube. (she can swallow her saliva)]
NEW SIGNS OF AWARENESS SEEN IN SOME BRAIN-INJURED PATIENTS Thousands of brain-damaged people who are treated as if they are almost completely unaware may in fact hear and register what is going on around them but be unable to respond, a new brain-imaging study suggests.
Some experts said the study, which appeared 7Feb05 in the journal Neurology, could have consequences for legal cases in which parties dispute the mental state of an unresponsive patient.
The research showed that the MRI can be a powerful tool to help doctors and family members determine whether a person has lost all awareness or is still somewhat mentally engaged.
“This study gave me goose bumps, because it shows this possibility of this profound isolation, that these people are there, that they’ve been there all along, even though we’ve been treating them as if they’re not,” said Dr. Joseph Fins [chief, medical ethics division, New York Presbyterian Hospital-Weill Cornell Med Ctr].
“This is an extremely important work, for that reason alone,” said Dr. J. Bernat [Dartmouth neurology prof} Dartmouth], who said findings from studies like these would be relevant to cases like that of Terri Schiavo, the FL woman with brain damage [on a feeding tube only, no other medical equipment].
In Terris case, which drew the attention of Gov. Jeb Bush and the Legislature, a brain-imaging test once standardized – could help determine awareness levels. Three million to 6 million Americans live with the consequences of serious brain injuries. An estimated 100,000 to 300,000 of them are in a minimally conscious state [bedridden, cannot communicate and unable to feed or care for themselves, but breathe on their own].
In the study, a team of neuroscientists in NY, NJ, & D.C., used imaging technology to compare brain activity in 2 young men determined to be minimally conscious with that of 7 healthy men and women
Researchers also recorded an audiotape for each of the 9 subjects in which a relative or loved one reminisced, told familiar stories/recalled shared experiences.
In the brain-damaged patients, the sound of the voice prompted a pattern of brain activity similar to that of the healthy participants. The 2 men showed near-normal patterns in the language-processing areas of their brains, Dr. Schiff said.
Since the study was completed, Dr. Hirsch said the team has tested 7 similar brain-injury patients, with similar results: the language processing networks in their brains display normal patterns upon their hearing the voice of a loved one.
The government has provided financing for the team to conduct a larger study of mental activity in minimally conscious people. Dr. Fins said one study found that up to 30% of patients identified as being unaware, in PVS, were not; they were minimally conscious.
we have found an objective voice for these patients, which tells us they have some cognitive ability in a way they cannot tell us themselves.” They are: “more human than we imagined in the past, and it is unconscionable not to aggressively pursue research efforts to evaluate them and develop therapeutic techniques.”
[http://www.nytimes.com/2005/02/08/science/08coma.html, The New York Times 8Feb05, Benedict Carey; N Valko, R.N. 8Feb05]
GRONINGEN PROTOCOL FOR CHILDREN AND RETARDED — Recent news of Dutch euthanasia of infants masks a larger agenda. Under the newly proposed Dutch rules for “life ending without request,” called the Groningen Protocol, a lethal injection could be given to mentally retarded adults as well as to infants and children. The death decision would be made by a medical committee. [Intl Anti-Euthanasia Task Force, www.iaetf.org]
DOCTORS WILL PRESCRIBE PAIN DRUGS EVEN IF THEY HASTEN DEATH — Two new studies indicate doctors are willing to administer drugs to ease pain — even if it means hastening the dying process.
The studies, conducted at the University of Iowa and at Yale, involve terminal sedation, in which sedatives are used to control a patient’s symptoms even if they result in a loss of consciousness. In fact, most of the doctors in the studies saw a clear difference between assisted suicide and terminal sedation.
Other medical experts worry terminal sedation could be a “creative” approach to the controversy surrounding assisted suicide. Lauris Kaldjian, M.D. [assist prof, internal medicine] conducted both studies.
“We studied the specific ethical issues of treatments that control symptoms versus interventions that intend to cause or hasten death”.; 78% of the internal medicine physicians surveyed supported the use of terminal sedation, while 66 percent of the doctors in training, or residents, agreed with the practice.
However, a surprising 1 in 3 doctors/residents supported PAS, which is legal only in OR. The studies showed that doctors were more likely to support terminal sedation but oppose assisted suicide if they had had much experience with termin
ill patients or if they frequently attend religious services [68% who had cared for 50+ terminally ill patients in the past year opposed assisted suicide & 76% who attended weekly religious services oppose assisted suicide.
Some medical professionals say terminal sedation itself can be ethically problematic. They note that, in some cases, such sedation is accomplished, in part, by withholding food and water — the nutrition and hydration necessary for survival.
In an article entitled, “Sedated to Death?” nurse Nancy Valko stated, “As a former hospice nurse and now as an ICU nurse caring for some patients who turn out to be dying, I support the appropriate use of pain and sedating medications as ethical comfort care. However, even in circumstances where such medications are necessary, I have never seen a case where a patient ‘needed’ to be made permanently unconscious.” Valko, a spokeswoman for Nurses for Life, a national pro-life nurses groups, added, “The euthanasia movement is nothing if not creative and persistent. Many people now mistakenly believe that tolerating just a little bit of deliberate death — with safeguards, of course — will give them control at the end of their own lives But as the ‘culture of death’ keeps seducing even well-meaning patients, families and medical professionals into making death decisions based on fear of suffering or diminished quality of life rather than following the traditional principles of not causing or hastening death, ultimately we are all at risk of being ‘compassionately’ rationalized to death.”
[The first study [10/04 issue, Journal of Medical Ethics], involved a survey of CT internal medicine doctors (677 members of the American College of Physicians); the other study, focused on 236 doctors in internal med training in CT, [September/October issue, American Journal of Hospice and Palliative Medicine]Maria Gallagher, 10Dec04 Iowa City, LifeNews.com, http://www.lifenews.com/bio606.html, NV, 12Dec04]
SUPREME COURT’S ACCEPTANCE OF OREGON’S ASSISTED SUICIDE CASE GIVES COURT OPPORTUNITY TO RESTORE LEGAL PROTECTION FOR PATIENTS – Today [22FEB05] the Supreme Court decided to hear the case of Gonzales v. Oregon, the case where Oregon is challenging the Federal government’s authority to regulate prescription drugs for use in assisted suicides. This presents an opportunity for the Court to clearly re-establish the right of the Federal government to determine and enforce the proper uses of prescription drugs and other controlled substances said Americans United for Life.
The case is being heard by the Supreme Court after two lower court decisions undercut the authority of the Controlled Substances Act, a Federal law that has been in effect for decades and gives the Federal government to determine the medical use of prescription drugs it regulates.
“A state may have power to exempt physicians from liability under state law, but it cannot exempt physicians from federal law,” said Denise Burke, Senior Litigation Counsel at Americans United for Life. “Lower court rulings to the contrary appear to go out of their way to override traditional Federal drug controls allowing the misuse of drugs in Oregon’s unique policy that allows physicians to kill patients. The Supreme Court now has the chance to fix this problem.”
“Killing, either by consent or not, is never therapeutic,” Burke continued.
AUL attorneys pointed out that the question before the Court is not the validity of Oregon’s assisted suicide law, but whether physicians can use drugs regulated under Federal law for the purpose of killing patients.
“The Court is not being asked to invalidate Oregon’s assisted suicide law. Even if the Supreme Court upholds the authority of the Controlled Substances Act, it would simply mean that Oregon physicians cannot use Federally-controlled drugs to kill their patients,” said Clarke Forsythe, Esq., Director of AUL’s Project in Law and Bioethics.
“Just as the Supreme Court decided that California cannot override Federal law and allow medical marijuana, Oregon cannot ignore Federal law and allow Federally-controlled substances to be used in assisted suicide.”
On the lower court rulings, Forsythe commented,
“These lower court rulings allow states to evade federal law. The Federal government clearly has had the authority to regulate drugs in the United States for decades. The lower courts have made an arbitrary exception to this. By taking the case, the Court has the opportunity to remove all doubt around this critical area of drug law.”
[Americans United for Life, CHICAGO, February 22, 2005
Daniel McConchie at 312-492-7234 x213]