Monday, March 21, 2005

Schiavo and the Times

Tom Maguire points us to an article in the New York Times yesterday. The piece, by John Schwartz, contends that "Experts Say Ending Feeding Can Lead to a Gentle Death."

The experts Schwartz speaks to in his article include Dr. Linda Emanuel, a doctor at Northwestern University who specializes in "end-of-life care" and tells us that "From the data that is available, [be dehydrated to death] is not a horrific thing at all." One data point omitted by Dr. Emanuel, Schwartz, and the rest of the staff at the Times is Kate Adamson.

I refer readers, again, to the invaluable work of Wesley J. Smith, who detailed the case of Kate Adamson, a woman who, was diagnosed to be in a persistent vegetative state (like Terri Schiavo) and had her feeding tube removed (like Terri Schiavo). It turns out that she wasn't in a PVS and, luckily, she lived to tell us exactly what being dehydrated to death feels like.

Appearing on The O'Reilly Factor, Adamson was asked if having her feeding tube removed was painful. She replied: "Oh, absolutely. Absolutely. To say that--especially when Michael [Schiavo] on national TV mentioned last week that it's a pretty painless thing to have the feeding tube removed--it is the exact opposite. It was sheer torture."

Here is Smith's account of Adamson's story:
In preparation for this article, I contacted Adamson for more details about the torture she experienced while being dehydrated. She told me about having been operated upon (to remove the bowel obstruction) with inadequate anesthesia when doctors believed she was unconscious:

"The agony of going without food was a constant pain that lasted not several hours like my operation did, but several days. You have to endure the physical pain and on top of that you have to endure the emotional pain. Your whole body cries out, 'Feed me. I am alive and a person, don't let me die, for God's Sake! Somebody feed me.'"

Unbelievably, she described being deprived of food and water as "far worse" than experiencing the pain of abdominal surgery. Despite having been on an on an IV saline solution, Adamson still had horrible thirst:

"I craved anything to drink. Anything. I obsessively visualized drinking from a huge bottle of orange Gatorade. And I hate orange Gatorade. I did receive lemon flavored mouth swabs to alleviate dryness but they did nothing to slack my desperate thirst."

Apologists for dehydrating patients like Terri might respond that Terri is not conscious and locked-in as Adamson was but in a persistent vegetative state and thus would feel nothing. Yet, the PVS diagnosis is often mistaken--as indeed it was in Adamson's case. And while the courts have all ruled that Terri is unconscious based on medical testimony, this is strongly disputed by other medical experts and Terri's family who insist that she is interactive with them. Moreover, it is undisputed that whatever her actual level of awareness, Terri does react to painful stimuli. Intriguingly, her doctor testified he prescribes pain medication for her every month during the course of her menstrual period.

In other words, the Times did a story on what being dehydrated to death feels like, but ignored one of the only people alive with first-hand knowledge of the matter.

A Note on Dr. Linda Emanuel: Let's look at Dr. Emanuel. In the past she has done studies for the Commonwealth Fund and the Nathan Cummings Foundation, groups which work with George Soros's Project on Death in America.

She edited the 1998 book, Regulating How We Die: The Ethical, Medical, and Legal Issues Surrounding Physician-Assisted Suicide. Her own views on physician-assisted suicide are quite moderate. She thinks, for instance, that Dr. Kevorkian was too extreme. In August 1996, she said of Kevorkian, ""This exemplifies the dangers of misuse that motivate our resistance to physician-assisted suicide. His threshold has always been so far below what we consider to be appropriate for professional practice . . ."

Later in life, she took a more mainstream pose, declaring that "'We do not have a right to die, but we do have a right to be free of unwanted intervention."

And what does she think about intervention? She gave this account of how she became interested in "end-of-life care":
Dr. Linda Emanuel was shocked into participation by a chilling experience in an intensive care unit.

Emanuel, vice president for ethics standards at the American Medical Association, recalls joining emergency room doctors and nurses who sprang to the rescue and celebrated when an unconscious dying woman was revived.

"Later, I went to intensive care only to discover the woman was there in a vegetative state," said Emanuel. "We thought it was cut and dry, where success equaled resuscitation. It wasn't. We didn't know if she wanted to be resuscitated. No one talked to the family. No one even thought of it. And that was the standard of care."

So where does Emanuel stand on Terri Schiavo? In October 2003, she issued a statement saying she believed that replacing Schiavo's feeding tube was a mistake.

Update, 9:54 a.m.: I concluded my original post by saying, "Glad the Times was able to find an unbiased expert."

Galley Reader arrScott writes, "By the standards implicit in your statement, only an expert in a field who held no opinions about her field would qualify as 'unbiased.' But such a person would, by definition, not be an expert. If she is biased, then so is every human, and therefore the word, by describing all people at all times, is meaningless."

That's a good point. In retrospect, my complaint against the Times is: (1) They present a woefully incomplete report; and (2) They present Dr. Emanuel as an expert without giving us any indication of her disposition on the issues which lie upstream from Terri Schiavo, and which place her opinion in context. Anyway, my thanks to arrScott and apologies to Emanuel and the Times.

14 comments:

arrScott said...

Good reporting.

But calling Dr. Emanuel "biased" in the context you do is ridiculous. By the standards implicit in your statement, only an expert in a field who held no opinions about her field would qualify as "unbiased." But such a person would, by definition, not be an expert. If she is biased, then so is every human, and therefore the word, by describing all people at all times, is meaningless. If that's really what you mean when you say "biased," your objections to bias are as nonsensical as objecting to Dr. Emanuel's inclusion in the story because she breathes oxygen.

The Times story's problem is that it is incomplete, not that the expert it quotes happens to have an opinion about a public case at the heart of her field of expertise.

Anonymous said...

I'm sorry. But I can't find any information any where on the web that indicates Ms. Adamson's condition was anything remotely similar to Ms. Schiavos.

As far as I can tell, you are comparing apples to oranges.

Anonymous said...

is this your first time on the web anonymous?? I googled kate adamson and came up immediately with an article that says her condition was far worse than Terri Schiavo and goes on to explain how they removed her feeding tube and then how she came out of it. I will give you one point that is different, Kate Adamson had a husband that was willing to fight for her and take care of her, not give in and kill her.

mark marshall said...

The only experts on how dehydration "feels" are those that have experienced it. Period. Everyone else is merely shilling for the Reaper.

actus said...

Why don't they just give morphine?

Rich said...

Removing Terri's feeding tube is a death sentence, quite literally. How many of the "right to die" advocates in this case would stand for the starvation/dehydration death of a convicted death row inmate, even one with limited mentation? Cruel and unusual? You bet and very wrong. If Terri is no longer fit for "life" by their standard, why do they not advocate a painless death, say by lethal injection? In just about any place in this country, you would commit a crime to treat an animal the way the system is now treating Terri. Those with disabilities, those who are "imperfect" in some way, should be afraid, very afraid they their person-hood may someday be denied.

TCD said...

I do admit that this is already an old argument, but it bears repeating. If I starve my dog, will I not be arrested for cruel and unusual punishemnt? What puts Terri below my beloved pooch?

Fr. David said...

The single most striking aspect of the deluge of commentary on the Schiavo matter is the absolutely wicked descent into the mire of the logical fallacies. I can't hear or read a piece without being pummeled by ad hominems, slippery slope reasoning, malicious labeling, appeals to emotion, fear and pity, appeals to authority, red herrings, straw men and irrelevant analogies. Good God, hasn't anyone a reasoned argument to make without reliance on these miserable devices? Hewitt - that wonderfully incisive and ordinarily wise opiner - has become a chief offender.
And then I find this piece on Gallery Slaves, wherein one expert is savaged by another putative expert. The problem is, the physician is in fact a nationally recognized expert in palliative care, and indeed a moderate. Her accuser, Wesley Smith, is a layman and arch-vitalist by his own acknowledgement, well known for incendiary tirades against even the mere discussion of such important subjects as medical futility, self-determination and surrogate decision making. A mroe fair review would have properly and accurately spelled out Smith's credentials and record as well as Dr. Emanuel's. But you only examined her background, implying that Smith's was beyond reproach. A most fair review would have separately, critically assayed the comments of each, without employing one to bludgeon the reasoning of the other.
If anyone who dares say Mrs. Schiavo should be allowed to die is branded a "murderer," and if this amounts to "starving and torturing her to death" then we have outlived the age of reason. That language leaves no room for reasoned argument.
Bonus dolor.

Fr. David

Anonymous said...

Fr. David hasn't read enough if he hasn't located some reasoned arguments regarding Terri Schiavo's plight (See National Review Online's the Corner for some of them), but his protestations regarding the "logical fallacies" of the criticism is in itself a fallacy of generalization, since it pretends no reasoned arguments have been made.

There have been a number of board certified neurologists who have questioned the diagnosis given Mrs. Schiavo, especially in light that she has yet to receive an MRI, which according to these neurologists is standard operating procedure in such cases. There have been several contentions that Judge Greer directly violated Florida law in the way he handled some of the legal issues, and other suggestions that his interpretation of Florida law was broad, to use a nice term. Unfortunately, most of these issues have been ignored by the courts, including the district judge who in his verdict, after acknowledging the DE NOVO status of the congressional law and the instructions that the evidentiary aspects of the Florida trials were not to be considered, directly referred to them in rendering his verdict, instead of taking steps to begin the evidentiary process required by the statute. According to the law, the judge was not allowed to consider any evidence from the Florida trials. How then can he make a reasoned assertion into the likelyhood of success of the Schindlers' petition? He can't, and he is therefore required, as he acknowledged in his decision, to do the least harm and order the tube reinserted. Instead, he did make a judgement on the likelyhood of success, something he legally had no factual basis for doing without a fair body of evidence. He simply inferred the Florida courts evidence into the case by default.

While I agree that the nature of Smith's affiliation should have been deliniated more carefully, it is ironic that you should use language such as "incendiary tirades"...etc after making the logical criticisms you proffered. The simple fact though is that there is a certain level of emotion that comes with this case, one you and I are not going to be immune from. Please learn to differentiate between the emotion and the logical fallacies. It may be ad hominem to attack Michael Schiavo's character based on the fact that I disagree with his course of action. It is not ad hominem though to call into question his motives, based on the statements of family friends as to his treatment of Terri, or their relationship. It would be similarly logical to assume that those statements are automatically false, simply because they may have been aired in the previous trials (I do not know if this is the case, only that Florida services investigated and found no evidence on which to base a charge.) One of the chief accusations levelled against Judge Greer is partial behavior of a prejudicial nature.

Nonetheless, the emotion remains. The point Galley Slaves makes about the Times not being forthcoming about Dr. Emmanuel's position on this case is a valid one (I await your letter to the Times). Terri Schiavo is still being slowly starved to death and all the logical platitudes in the world won't change the fact that there are many of us who strongly believe that this cannot be determined to be her will, nor that such a course of action is either humane or for that matter Constitutional. "Torture" is a term that is very carefully defined in many cases. If Terri's condition is as agonizing as the witness Smith quotes, I would have to say that I can logically reason the word to be appropriate, whether you appreciate that reasoning or not, or whether it makes you comfortable or not (which I suspect, not via logic, but experience, might be the case). The same goes for the term "murder". If Michael Schiavo knows that this end is not Terri's actual wishes, then what should we call it? What other term fits knowingly sending someone to their death against their wishes?

Anonymous said...

Why hasn't Michael Schiavo been subjected to a Lie Detector Test?

The court records regarding his alleged spouse abuse must be unsealed.

It's Florida let the Sunshine in.

Jim said...

tcd wrote, "If I starve my dog, will I not be arrested for cruel and unusual punishemnt? What puts Terri below my beloved pooch?"

Actually, you can have your dog "put down" if it becomes feeble and infirm, or if it bites a small child, or for whatever reason you deem fit, and no one will charge you with "animal cruelty." Bad analogy.

Bryan said...

jim, I think that's part of his point. You can legally "put down" your animals anytime you want, but there's a certain way you're expected to do it. You take it to the vet and have it given an lethal injection. Or, if you're the rough-and-ready type, shoot it with a gun. Either way it's quick and relatively painless when done right.

But you probably don't tie it up and refuse to give it food or water until it dies. Starving an animal really is a punishable offense, and the police really don't look kindly on it. Watch one of those "Animal Cops" shows if you doubt it.

George said...

Drop the comments on Dr. Emanuel please, it detracts from the informative nature of the first part. The 4 second video segment I saw on Fox this morning where Terri followed a hellium balloon with her eyes is a good sign that she might not be PVS or at least with therapy might be coachable out of PVS. According to Here eye tracking is one of the first signs of recovery. If, as has been claimed, she can say words such as "Hi", "Mommy" and "pain" it can be infered, especially from the last that Terri's experience would be no less uncomfortable than Mrs. Adamson's. With all the miracles unknowns and progress in modern medicine surrounding the human brain, especially it's uncanny ability to heal and reroute over time how could we ever say for certain that an individual was beyond hope unless they were certifiably brain dead?

Anonymous said...

I am curious. I wonder if some person walked into Terri Schiavos room and shot her with a pistol would they be indicted for murder? This is a far cry from rational I know but what will keep people from making those decisions in the future. Decency? Morality? A belief that human life is valuable?
I think that Terri Schiavos case should merit some closer scrutiny about what our country allows and how our court system is a runawy train. By the way I see the Ms. in place of the Mrs. for Terri. Is this her HUSBANDS doing? hmmm?