Sunday, March 20, 2005

Allow Terri Schiavo A Gentle Death

Assuming the feeding tube remains out, I imagined we would need some scientific data to counter charges from the right regarding the inhumanity of starving Terri Schiavo. I have read literature from hospices in the past regarding this, including advice that those on the verge of death (who are more aware than Terri Schiavo currently is) are often more comfortable without being fed.

I was planning to attempt to dig up such information from a medical or nursing journal. The New York Times saved me from going to the trouble. I often complain about the inaccurate information on medical issues contained in stories in the news media. In this case the New York Times did a fine job:

Experts Say Ending Feeding Can Lead to a Gentle Death

By John Schwartz

To many people, death by removing a feeding tube brings to mind the agony of starvation. But medical experts say that the process of dying that begins when food and fluids cease is relatively straightforward, and can cause little discomfort.

"From the data that is available, it is not a horrific thing at all," said Dr. Linda Emanuel, the founder of the Education for Physicians in End-of-Life Care Project at Northwestern University.

In fact, declining food and water is a common way that terminally ill patients end their lives, because it is less painful than violent suicide and requires no help from doctors.

Terri Schiavo, who is in a persistent vegetative state, is "probably not experiencing anything at all subjectively," said Dr. Emanuel, and so the question of discomfort, from a scientific point of view, is not in dispute.

Patients who are terminally ill and conscious and refuse food and drink at the end of life say that they do not generally experience pangs of hunger, since their bodies do not need much food. But they can suffer from dry mouth and other symptoms of dehydration that can be treated effectively.

Once food and water stop, death usually comes in about two weeks, and is caused by effects of dehydration, not the loss of nutrition, said Dr. Sean Morrison, a professor of geriatrics and palliative care at Mount Sinai School of Medicine in New York. "They generally slip into a peaceful coma," he said. "It's very quiet, it's very dignified - it's very gentle."

The process of dying begins in the kidneys, which filter toxins from the body's fluids. Without new fluids entering the body, the kidneys produce less and less urine, and the urine becomes darker and more concentrated until production stops entirely.

Toxins build up in the body, and the delicate balance of chemicals like potassium, sodium and calcium is disrupted, said Deborah Volker, an assistant professor of nursing at the University of Texas who has written extensively on end-of-life issues.

This electrolyte imbalance disrupts the electrical system that triggers the action of muscles, including the heart, and eventually the heart stops beating.


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