Outside the Beltway

Are Feeding Tubes Life Support?

James Joyner
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Steven Taylor is annoyed with the continuing dishonesty of the language being used by those clammoring for the re-insertion of Terri Schiavo’s feeding tube.

Forget one̢۪s view on this topic, just be honest about what the situation is. To listen to many (many, many, many) talk it is as if Terri could eat and drink, but food and water are being withheld, just at arm̢۪s length, while she dies.

[…]

Further, to ignore that the feeding tube was medical intervention, of a type similar to, although not as dramatic as, a ventilator is to put ideological blinders on. At a fundamental level it ignores the fact that for the vast preponerance of human history, Terri would have died 15 years ago, which adds yet another layer of complexity to the situation, if one now wants to call removal of the tube “playing God†or otherwise trying to evaluate her state.

Yep.

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11 responses to “Are Feeding Tubes Life Support?”

  1. Just Me Avatar
    Just Me

    But how far are you going to go in declaring it life support.

    I have a son that was born with severe reflux, and through him have met lots of kids on feeding tubes. Are we arguing that because they have to have a feeding tube that their parents should be able to remove it and let them starve/dehydrate?

    My nephew has a pretty severe disability, he spent almost two years of his life on a feeding tube. He is able to eat and swallow fine now, but he was close to death on several occiasions, has a normal IQ and functions and looks like any other child, now that he is correctly diagnosed and on the right kind of medication.

    I just think there is a fine line between declaring a feeding tube life support in the sense of being able to withdraw it. There have to be more factors involved in these decisions, than just whether or not it gets pulled.

    So while in some sense, it is life support, it just isn’t the same as a venilator, no matter how much you want to argue it is.

  2. bryan Avatar
    bryan

    Care to reply, James?

  3. Bill Avatar
    Bill

    It’s important to remember this is not a child, but an adult.

    With the right to make their own decisions on whether or not to continue life-sustaining medical treatments.

    Multiple witnesses testified that her prior, expressed wishes were not to have a feeding tube in her condition.

    PVS, with no hope of recovery, is one of the limited conditions that life-sustaining procedures may be refused by an adult.

    Opposed to her right to make her own decisions are her birth family, who testified under oath that they would NEVER remove the feeding tube even did they know beyond a doubt it were her wish.

    Their position is clearly unethical, as it completely ignores Terri’s own wishes.

    Feeding tubes are clearly a medical intervention; they share many of the same complications as a central line, the most common being infection.

    Justice O’Connor, in her concurring opinion in Cruzan v. Missouri (1990), specifically noted Cruzan’s FEDERAL right to refuse a feeding tube:

    “Artificial feeding cannot readily be distinguished from other forms of medical treatment. Whether or not the techniques used to pass food and water into the patient’s alimentary tract are termed ‘medical treatment,’ it is clear they all involve some degree of intrusion and restraint. …

    A gastrostomy tube (as was used to provide food and water to Nancy Cruzan) or jejunostomy tube must be surgically implanted into the stomach or small intestine.

    Requiring a competent adult to endure such procedures against her will burdens the patient’s liberty, dignity, and freedom to determine the course of her own treatment.

    Accordingly, the liberty guaranteed by the Due Process Clause must protect, if it protects anything, an individual’s deeply personal decision to reject medical treatment, including the artificial delivery of food and water.”

    http://abstractappeal.com/archives/2005_03_01_abstractappeal_archive.html#111158613257156180

  4. whatever Avatar
    whatever

    Bill, by your reasoning suicide should be legalized.

    And by James’s reasoning “would have been dead through the preponderance of history” would require us to off quite a few people. Christopher Reeve is one person who comes to mind, and I do believe he did wish to die in the early months of his condition.

    Look, if you support euthenasia, just say so.

  5. Bill Avatar
    Bill

    I merely quoted the justice.

    You may disagree with her, but somehow you will have to deal with her legal opinion.

    It carries substantially more weight than yours or mine. 🙂

    By the way, discontinuing life-sustaining medical treatment and allowing the underlying medical condition to cause the death of a person is in no way active euthanasia.

    Especially given the very limited circumstances where refusing life-sustaining medical treatment is legally allowed.

  6. davod Avatar
    davod

    A nurse in a notarized statement said that Terri could take food and water by mouth, but her husband stipulated the feeding tubes.

    Somewhere in all this there has to be a question about the level of MEDICAL supervison involved at the hospice.

    Oh. By the way. The multiple witnesses to Terri’s wishes were all the husband’s relatives. The judge discounted claims to the contrary by friends of Terri.

  7. James Joyner Avatar
    James Joyner

    Bryan and Just Me:

    Feeding tubes, like respirators, exist as a means of patient care to help people in critical condition recover. Are they artificial means? Even extraordinary? Sure. But if there’s some reasonable hope for meaningful recovery, we do it. If, on the other hand, people continue to exist only because they’re on the machine, then we tend to disconnect them after some period of time.

    And, “whatever,” nobody is talking about a “requirement” to “off” anybody. Here, we have a court-ordered judgment as to the patient’s wishes and her spouse’s.

  8. Bill Avatar
    Bill

    An LPN, who was never medically qualified to evaluate Terri’s swallow reflex.

    From 1990-1992 Terri failed 3 modified barium swallow tests, performed by those qualifed to do such evaluations.

    The LPN was specifically told not to attempt such feeding by mouth by the facility’s physician, given of the high risk of silent aspiration (no cough/gag reflex) and subsequent pneumonia.

    The LPN lacked the medical background/training to be able to distinguish whether what she was giving Terri was going into her stomach or more likely, going into her lungs.

    She admits in her affidavit she chose to do so anyway.

    She only filed her affidavit after she was fired by the facility (not by the husband) because of her willful choice to recklessly endanger her own patient, in direct contravention of the attending physician’s medical orders.

    >A nurse in a notarized statement said that Terri could take food and water by mouth

  9. denise Avatar
    denise

    I’m a lawyer, and I have been saying for a while that under the law, the Schindlers lose.

    However, I think the Florida law that allows outside testimony to control where there is no living will, is a lousy one. It is too subject to abuse and error. I don’t think J. Greer is evil, but it is virtually certain that this case could have randomly been assigned to a different judge who would have come to the opposite conclusion. Life and death decisions are too important to leave in the hands of one man, which is why in the criminal context we have to have 12 people unanimously decide (and then that is reviewed by the trial judge, and so on and so on.)

    I agree with J. O’Connor on the law, but I don’t approve of the statutory scheme whereby the facts were determined in this case.

    And it is as a factual issue, not a legal one, where the idea that a feeding tube is not extraordinary measures comes in. That is the teaching of the Catholic Church. To ask for your feeding tube to be removed is a mortal sin. That is why a whole lot of Catholics, including the Schindlers, have trouble believing this is really what Terri Schiavo would want. It doesn’t make sense to jeopardize your mortal soul to save yourself temporary suffering. I know most of the others here aren’t Catholic, but that doesn’t matter; Terri’s religion, not yours, would influence her wishes.

    And I don’t doubt that she said “I wouldn’t want to live that way,” or some such statement, but I don’t think that should take the place of a carefully drawn living will, any more than “I would want the Humane Society to have my bank accounts” would control if a person died intestate.

  10. Danny Carlton Avatar
    Danny Carlton

    The judge has ordered no food or drink by mouth, therefore she is being starved to death. It is not just a matter of pulling the feeding tube. Numerous nurses have signed affadavits testifying that they have fed Terri by mouth, and she can swallow — but Judge Greer ordered her not to be given food or water, even by mouth.

    If it were just about the tube, then let her family try to feed her by mouth. But that won’t happen, because Greer wants her dead. It’s his career at stake.

  11. Bill Avatar
    Bill

    None of the “nurses” (one LPN, CNA), NONE, are qualified to assess whether Terri can swallow.

    NONE of them have ever had the necessary training to tell whether she swallowed or whether she silently
    aspirated into her lungs (more likely).

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