LETTERS  PCR #186      (October 13--19, 2003)

Chery Ford, RPN, on Terry Schiavo
Phil Frank and the right to life
Jason Liquori defends Montecore
Mack's absolutely, positively last, final, word on Terence

Letters to the EditorWe welcome your feedback.
A REGISTERED NURSE COMMENTS ON TERRY SCHIAVO

Nolan,
I am a Registered Nurse with 25 years of medical training. I voice my opinion from viewing similar patient situations as Mrs. Schiavo's. I've also been involved in several seminars and discussions surrounding ethical questions related to those proposed in Mrs. Schiavo's legal debate.

In my professional and personal opinion it is too late for Mr. Schiavo to be requesting that a feeding tube be removed from his wife. In all the years of my nursing experience, our protocol was very clear, and as follows:

1. In the acute phases of a patient's trauma, should the patient present with a legal living will and DNR (DO NOT RESUSCITATE) declaring that if in the event of trauma where they were suddenly physically and mentally incapacitated and could not make decisions for themselves with regard to life support issues, i.e. ventilators, gastrointestinal and nasogastric feeding tubes, Total Parenteral Nutrition via intravenous feedings, etc., and indicated that they wanted no medical intervention whatsoever, the patient was then allowed to die in accordance to their wishes and without ANY medical intervention.

2. However, if there was no legally written DNR, living will or durable power of attorney present to indicate the patient's wishes, they were then declared a Full Code and all medical intervention was taken at that time to ensure life support measures in an effort to maintain the patient's life. This included, intravenous infusions, tube feedings, ventilators, etc.

Prior to enacting the necessary life support measures, we did not sit around by ourselves or with the patient's family discussing or debating what we "thought" the patient's "quality of life" was at the time, or what it was going to be in the future. Or furthermore, if any of us thought that because their quality of life was not acceptable, or not, we then had the right to make them a code or no code. Or to provide them with life support measures, or not. If they did not have the appropriate paperwork to declare what their wishes were, then all other discussions and or assumptions were a moot issue.

Nowhere in all of my 25 years in the medical profession has any family member, friend, health care professional, etc., been allowed to determine that after so many years of a patient being successfully sustained life via tubes of any kind, and who had maintained the same status over those years, could suddenly walk into any facility and make a random decision without justification that the patient was not worthy of such intervention any longer, and then request that the tubes be discontinued.

If, on the other hand, the patient began showing a rapid decline in health, clearly showing no signs of improvement and or ability to be maintained at the level they were and in a palliative state, then the DPOA or next of kin could open a legal case requesting that extraordinary life support measures be discontinued. However, I've seldom seen that happen. I think mainly because if the patient suddenly had a change in status and began a rapid decline, their life usually ended in a relatively short time and on their own.

I reiterate, because Mrs. Schiavo is no longer in the acute phases of her trauma and it is apparent that when her trauma had occurred she did not have a written, legal DNR or living will indicating what her choices were in the event of such a situation (verbal hear-say via spouses, friends were not admissable).........should anyone be allowed to suddenly come along and decide that it was time to terminate her or anyone's life for that matter. Dr. Kevorkian spends time in prison for assisting in voluntary suicide. In this particular case....Mrs. Schiavo isn't even allowed to verbally volunteer her own suicide. Therefore, removing Mrs. Schiavo's tube feedings at this point in her life...in my nursing opinion, would be no different than Mr. Schiavo insisting on legal assistance to enact upon a form of homicide.

The laws up until this situation were pretty clear and without question.

If Mr. Schiavo is allowed to do this at this time.....I question how many other patients who are now residing in nursing homes and who have been successfully nourished via feeding tubes will suddenly have family members appear demanding removal of them. I think that the legal system needs to remain in the courtrooms and leave the ethically and legally clear DNR/living will protocols alone. Up until now, there has never been a question as to how, when or on who medical intervention would or would not be initiated.

Mrs. Schiavo's situation should be a good lesson for people of all ages to:

1. Recognize the importance of appointing themselves a DPOA (Durable Power Of Attorney) who clearly understands and has access to the necessary paperwork to substantiate their wishes in the event of such circumstances.
2. Have a legal Living Will and DNR written. Maintain the papers in a safe place where a family member could access them. It is also a good idea to provide a copy to your family physician.

Cheryl Ford RN
Former EMT & Paramedic

   Cheryl, thanks so much for writing! Your experience in these matters bolsters the many good points you make and helps serve up a serious note of caution to all readers. It is clear Terry made no written requests relating to quality of life/death issues before she died---she was only 26 when she had her heart attack, and few people think about death at 26. Although the law wasn't designed to get involved in these matters, it's happening with greater frequency, for whatever reason. (The cost of health-care is usually reason number one, but in this case, a medical lawsuit was sustaining her feeding.) The media has found it easy to depict Michael Schiavo (the husband) as a rat, by implying keeping Terry alive in a vegetative state indefinitely is too inconvenient and he wants to move on with what remains of the lawsuit money. However, the courts, for the most part, have sympathized and sided with him.
    This case shows it's never too early or too late to make DPOA arrangements.
   Interestingly, you and the following writer bring up Dr. Kevorkian, likely because I did regarding "assisited suicide" as being more merciful than death by starvation. This was admittedly a sloppy analogy on my part and not intended to be taken literally.
   Nurses who work at a nursing home close to my job tell me that this sort of thing--removal of feeding tubes from the very elderly and incapacitated--is very commonplace, and too often there is no family around to intercede one way or the other. Of course, that is not exactly the same as Mrs. Schiavo's case, where, as you pointed out, she was not dying, there had been no change in her condition, and there were frequent family visitations. ---Nolan


PHIL FRANK AND THE RIGHT TO LIFE

Nolan,
We are on the very same subject as before. The twist here is it seems that if someone murders you in the name of mercy automatically they are exempt from guilt. (Sí, señor, re: "Decisions, decisions", front page, and likely the Hell On Earth "suicide band" matter, discussed in PCR #184.---N)

As I said before, no person has the right or jurisdiction to supersede the inalienable right of life. It's preposterous to believe this could be so, legally or morally. Whether this woman is "suffering" or not does little to condemn her life as merely vegetative or useless. This woman is "alive", period. She has someone who loves and cares for her regardless of her condition or purported consciousness. We were created to live and be alive until the same fate that created our existence takes that existence away. No living thing, not one, gives up until that final light is quenched. Why, if we are so intelligent and highly evolved, do we mock the very life that the teeniest creature alive will hang on to with the tenacity of a rogue bear? Is there some spark of light left in us to help us imagine why this could be? Again, how can one inalienable right, the right to happiness? The right of liberty (freedom)? Take away another inalienable right, the right to life?

Phil [Frank]

   The subject line in your email said "suicide again". Somehow this got switched around to a suicide case. I, again, blame myself for associating Dr. Kevorkian and mercy killings in the same breath as the Schiavo case.
   The point I want to make is that IN MY OPINION "alive" is not the same as "living". "Inalienable right to life"? Sure, but insurance runs out, families go into hock, then what? Nursing homes are usually too expensive, options are perilously few.
   And, PLEASE, despite my earlier misguided attempt to equate this case with assisted suicide, refrain from concluding that I think this is at all the same thing. Someone who's suicidally depressed because s/he feels the "quality of life" is not what it should be, is a little different from a terminally ill patient with no hope of survival, but with all their faculties, and different still from a comatose patient whose condition is not expected to change.
   Side note: You're not going to like this, but yes, I believe it's more cruel to keep someone alive who's in constant agony than to pull the plug and end their suffering. Professional pain management research is, I suppose, lagging behind other fields of medicine.
   We've digressed a little from the Terry Schiavo case. It's easy to sit comfortably and tell everyone what a utopian world should be like, but until we're walking in their shoes it is impossible to know how we'd handle death as an option in dire circumstances. ---Nolan

Follow-up from Phil: Just a note: I used the subject line "suicide again" because of the idea that this is what she had supposedly told them or implied when she was alive, so in a sense she would want to commit suicide if she were able to tell us how she really feels right now. ---Phil


JASON LIQUORI DEFENDS MONTECORE THE TIGER

Hey, Nolan
As you know I am a big fan of big cats. I've been trying to keep up with this story because it will effect all types of animal shows, exhibits and reserves in the near future. You wrote: On NBC Today, Siegfried said apparently the tiger was reacting in some "protective" mode when Roy stumbled during the act, but got confused and violent. (Yep, I did. In last week's issue.---N)

I missed that interview, but saw Siegrfried on CNN's Larry King live and heard him describe how the tiger may have been trying to protect Roy. In that interview he did not refer the tiger becoming violent, but rather stated that in the confusion he may have tried to drag Roy away from Siegfried and the animal handler who were running over to see what had happened (the tiger was crouched over Roy at this time). Like picking up another tiger, Montecore, grabbed Roy around the neck. The trouble is, Roy is not a tiger.

I think one of the things the public may not take into account is that animals perceive things differently than us. A 500 pound tiger may obey a 200 pound man, but only because that man has convinced the tigers he is one of them and every bit as deserving of their respect. Whether this was an attack or a protective maneuver designed to get Roy off stage and away from the woman with the "big hairdo", I believe the severity of the wounds has to do with the fact the Montecore had no idea how relatively fragile Roy is as a human being. I witnessed a fight between two tigers a few months ago (The brother and father of the tiger I sent you a photo of a little while ago). It lasted just a few seconds and they both walked away with wounds that looked very severe, but to them seems no more bothersome than a scraped knee.

This letter is longer than my last submission of Dinosoldier (Which is finally up! Mea culpa for the delay---Nolan). I wish Roy and Montecore the best. (As do we all. Thanks for writing, my friend---N)

Jason L Liquori
Project Manager/Director
Hocus Focus Productions


MACK'S POSITIVELY, ABSOLUTELY, FINAL WORD ON TERENCE

Terence,
I read your last response about three times just to be sure that what I'm about to say fit the need. Terence, after careful consideration to all that's been discussed, I have come to realize that... you're apparently a Moron.

Mack [Beasley]



To send an email to Letters to the Editor write to: Crazedfanboy1@aol.com.  Any emails sent to this address will be assumed intended for publication unless you specifically instruct me not to. I can and do respond privately, if that is your preference. Frequently, it's both ways.---Nolan

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