The Case of Terri Shiavo

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DMO

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I'm sure most of you heard of or discussed of the situation involving the government, a husband, a family, and of course Terri Shiavo.

If you didn't, here's a link of it.

http://www.miami.com/mld/miamiherald/7068761.htm

I'd like to know your views.

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Life is only of instrumental value, relevent only as determined by oneself.
 
I think the doctor that declared her as being a vegetable should be charged with malpractice. He was smoking some sort of crack.
 
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I could see there being a debate if the woman's wishes were ambiguous. However, it appears she clearly stated she never wanted something like this. I think the family is being selfish, and I know that sounds harsh, but when it comes down to it that's what it is. They are justifying it by clinging onto false hope... this woman's brain is gone.
 
I have a differnet view of the whole case, mainly because it is a local thing here in the Tampa area, and I went to a Grand Rounds lecture with one of the ethics professors/physicians at USF here. He told me lots of facts about Schaivo that the press does NOT get a hold of. Things like:

Her CT scan of her head shows a severely atrophied cortex, about the size of the mouse in your right hand. The intracranial contents are now mostly CSF.

There are reports of Terri responding to a Mickey Mouse balloon. Several tests have been run, including using the balloons as well as flashing lights and what not... she responded to about 1 in 1000 of those tests. Pure luck that she was smiling at the time the balloon went by. Its like saying to a comatose patient as they are bucking the vent "COUGH! COUGH I SAY! (as they're coughing).

The money that the husband won has been used to pay for her rehab. He will likely see very little of it.

I think it is a sad sad case, but thankfully it has gotten America talking about what they want happened to them. Which makes my job easier as a physciian.

Q, DO
 
Megalofyia
In waitlist hell

Registered: Oct 2002
Location: Land of Applications
Posts: 604

I think the doctor that declared her as being a vegetable should be charged with malpractice. He was smoking some sort of crack.



HUH???? You must have never seen what someone in a persistent vegetative state looks like.... In any case, Jeb Bush should really get a clue. His recent declaration is clearly unconstitutional as per the Nancy Cruzan case... Let her die! I can't imagine this ever happening (and being strung out for 13 years) at any other reputable hospital in the US!
 
The woman collapsed under questionable circumstances. Now, the husband is living with a different woman. They even have kids. Why is he going to such lengths to terminate his wife's life? Couldn't he just divorce her and move on?

The evidence that Terri wanted life support to be terminated is anecdotal at best.

Euthanasia by starvation over 14 days is perhaps the most inhumane way to go about it.

No matter what your views on the "right-to-die" issue are, those three facts should give you pause in this case
 
Originally posted by QuinnNSU
I have a differnet view of the whole case, mainly because it is a local thing here in the Tampa area, and I went to a Grand Rounds lecture with one of the ethics professors/physicians at USF here. He told me lots of facts about Schaivo that the press does NOT get a hold of. Things like:

Her CT scan of her head shows a severely atrophied cortex, about the size of the mouse in your right hand. The intracranial contents are now mostly CSF.

There are reports of Terri responding to a Mickey Mouse balloon. Several tests have been run, including using the balloons as well as flashing lights and what not... she responded to about 1 in 1000 of those tests. Pure luck that she was smiling at the time the balloon went by. Its like saying to a comatose patient as they are bucking the vent "COUGH! COUGH I SAY! (as they're coughing).

The money that the husband won has been used to pay for her rehab. He will likely see very little of it.

I think it is a sad sad case, but thankfully it has gotten America talking about what they want happened to them. Which makes my job easier as a physciian.

Q, DO

Valid points, but what about the fact that it would take >14 days for her to die if the tube was pulled? If they are so adamant about terminating support, couldn't they came up with something to expedite her death?
 
idq1i
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Registered: Apr 2003
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Posts: 209

The woman collapsed under questionable circumstances. Now, the husband is living with a different woman. They even have kids. Why is he going to such lengths to terminate his wife's life? Couldn't he just divorce her and move on?

The evidence that Terri wanted life support to be terminated is anecdotal at best.

Euthanasia by starvation over 14 days is perhaps the most inhumane way to go about it.

No matter what your views on the "right-to-die" issue are, those three facts should give you pause in this case


__________________
NYMC '07



The circumstances surrounding her collapse is irrelevant. What is relevant, is that her husband has maintained his stand for the past 13 years... Ie.. let her die! This is what Terri would have wanted!!! The new woman and child in his life happened many many many years after this incident. His view didn't suddenly change to "let her die" after he began his new relationship w/ this woman... The point is that he is her proxy, not her parents. He knows what his wife would have wanted. Her parents (as sad as the situation is) are still clinging onto the unrealistic hope that she will recover because they do not realize that her smiles, open eyes, and grunts, are all merely reflexive movements of a person in a persistent vegetative state. As Quinn mentioned, her brain is the size of a mouse and has ZERO realistic hope of recovery. She is taking a valuable bed in the hospital and costing the state hundreds of thousands of dollars and year. Not to mention the fact that Mr Bush's new law is entirely unconstitutional!!! This is truly a tragic case, but for God's sake, let the woman go and die in peace, instead of dragging her along.
 
Originally posted by idq1i
The woman collapsed under questionable circumstances. Now, the husband is living with a different woman. They even have kids. Why is he going to such lengths to terminate his wife's life? Couldn't he just divorce her and move on?

The evidence that Terri wanted life support to be terminated is anecdotal at best.

Euthanasia by starvation over 14 days is perhaps the most inhumane way to go about it.

No matter what your views on the "right-to-die" issue are, those three facts should give you pause in this case

She collapsed becasue she was hypokalemic from her bulimia. She went into VFib and suffered prolonged hypoxia. She NEVER regained consciousness after her code.

Anectodal -> Only because no official DNR/Living Will was done. How many people in their 20's get that done? Especially when they're 100% healthy (besides her eating disorder, which she denied).

Her brain is so primitive (and gone) that she will not suffer. If they came up with another way to kill her, it would be a WHOLE other can of worms... i.e. lethal injection... very different from "pulling life support"

Q, DO
 
I'm wondering what the malpractice suit that the husband won was all about. Perhaps someone has some details.
From all I have read thus far, I think they should let her go. I also agree with some of the other posters that perhaps her death should be expedited. But, I don't think that will happen since it is bound to raise a whole bunch of new issues, not to mention the wrath of life-at-any-cost advocates. It is sad that so many resources are being spent on someone who doesn't seem to have any chance of a meaningful recovery.
 
Personally, I do believe that they should just let her go. My problem is with the time it would take for it to happen. There are just too many zealots on both sides, turning this unfortunate case into a battleground.

I based my doubts on this:
>>>>>>>
Interviewed on the Fox News Channel, Dr. Michael Baden, co-director of the Investigative Unit of New York State Police in Albany and former chief medical examiner for New York City, ruled out potassium imbalance and a heart attack as factors in Terri's mysterious collapse 13 years ago ? which left her severely incapacitated and unable to speak ? and pointed to head trauma and bone injuries as a more likely cause.

Baden explained to host Greta van Susteren it was unlikely for a woman of Terri's age at the time to have a potassium imbalance, unless she had certain types of diseases, which she didn't have.

"Too little potassium can cause the heart to stop beating properly and lead to lack of blood flow to the brain and death of brain cells by lack of oxygen, but that's very unusual, Greta, extremely unusual," he said.

That Terri's heart was healthy would rule out the likelihood of cardiac arrest, he said.

"The reason she's in the state she's in is because there was a period of time, maybe five minutes or eight minutes, when not enough oxygen was going to her brain," said Baden. "That can happen because the heart stops for 5 or 8 minutes, but she had a healthy heart, from what we can see."

Baden said he studied a bone scan made in March 1991 at a rehabilitation facility that describes her as having a head injury: "That's why she's there, that's why she's getting a bone scan."

"A head injury can cause, can lead to the vegetative state that Ms. Schiavo is in now," he continued, adding the scan showed evidence of other injuries, bone fractures
Van Susteren asked if he were suggesting a potassium imbalance caused a fall that led to a head injury, or perhaps some "pre-existing head injury [led] to her passing out."

"Something totally different," he answered. Because cardiac arrests triggered by low potassium are so rare, "the other issue is: Could it have been due to some other cause, which is raised by the family. [That] has to be looked at."
 
Her bone injuries are secondary to her bulimia... Anyone w/ a eating disorder like Terri are going to be in a persistent catabolic state that is going to cause premature osteoporosis --> fractures! You're right that it would be extremely unusual for someone of her age to be hypokalemic, but bulemia would sure as hell be a likely one!!!
 
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Actually hypokalemia is not that rare. We see it ALL THE TIME in the hospital, however, the consequences of hypokalemia are serious indeed. I have seen one hypokalemia induced V-fib go into full cardiac arrest.

From the physicians here at USF, that is what her diagnosis was. 13 years ago there were not AEDs all over the place like there are now. She had a significant down time. She was resuscitated...

And her heart would likely show little deleterious effects of the arrest, even now.

Q, DO
 
Originally posted by QuinnNSU
I have a differnet view of the whole case, mainly because it is a local thing here in the Tampa area, and I went to a Grand Rounds lecture with one of the ethics professors/physicians at USF here. He told me lots of facts about Schaivo that the press does NOT get a hold of. Things like:

Her CT scan of her head shows a severely atrophied cortex, about the size of the mouse in your right hand. The intracranial contents are now mostly CSF.........

Q, DO

?HIPPA:confused:
 
Its also against HIPAA to talk about a patient and their diagnosis, i.e. Terri Schiavo and PVS. It is just that the press does not discuss the minute details the lay person may not understand, or, that would desensationalize the case.

Q, DO
 
All the details of the case I believe are publically available, including her medical record. With the details given out on LKL, I'm sure Quinn is fine.

I was watching Larry King Live the other day, and her husband and lawyer were on TV. They showed what her brain looks like, or rather what the fluid looks like where her brain should be.

Not knowing the details of the case, the media was pretty convincing with the pictures of her "watching" the balloon moving. After finding out the details, and espically that picture of her brain, its really distrurbing how this case was portrayed in the media.

Really is an aweful situation.
 
Originally posted by Bridaddy
Not knowing the details of the case, the media was pretty convincing with the pictures of her "watching" the balloon moving. After finding out the details, and espically that picture of her brain, its really distrurbing how this case was portrayed in the media.

Really is an aweful situation.

:clap: Good to be on the same side with you, Bridaddy. :)

It really is a sad case. It just shows you the power of a photograph. The picture with her and her mother does seem to say "Hey, she's looking up at her mom and smiling." But I have a feeling she is always in that pose and it was just the great job of a photographjer who caught that one.

There are always two sides to a story, but unfortauntely it seems that the majority of the story is from her parents...

But it is such a sad case.

Did you know the parents have not allowed cameras in her room for the past two years?!?!

Q, DO
 
Originally posted by QuinnNSU

Did you know the parents have not allowed cameras in her room for the past two years?!?!

I thought it was the husband who hasn't allowed cameras. The parents have no legal control.
 
This case shows how important it is to have some sort of legal document specifying your wishes should the situation arise where these decisions must be made. I agree that most people in their 20's don't think this is necessary, but this doesn't negate the fact that it is still something that everyone should do. Life is tenuous, and because we never know what could happen, it is wise to make certain that our wishes are spelled out on paper just in case, no matter our age!
 
Well, I've been following this case closely too. There are a lot of ins and a lot of outs as Labowski would say. I see lots of problems in this case:

1) The system of checks and balances is now tiped, how can the legislator go back and overturn the courts. I thought the courts checked the legislator and interpreted their work.

2) It has become a media fiasco! I like listening to Glen Beck in the mornings, but he is a right wing extremeist at times. He has no medical training. He goes to visit her and then comes on his radio show and tells america she in not brain dead! WTF Glen, since when did you learn to read EEG's! This is just as wreckless as those guys up north giving out that kids address and phone number that interferred with that Yankee's game.

3) This has been battled in the corts for years. She has shown NO IMPROVEMENT for 10 years! If the husband didn't care about her he would of divorced her. He is simply seeing to it that her wishes are being crarried out.

4) Smiling is a reflex, bulbular nuclei in the spinal cord and the facial nerve control smiling. It does not require higher order processing (Cortical) to form a smile. i.e infants that smile prior to 3 months of age are doing it reflexively. Even enfants with anencephaly smile prior to their short life ending. For some reason the neural network encoding smiling is in the most primative parts of our brains, the brainstem (in the pons and medulla). Do a pubmed search on smiling and bulbular nuclei. Now I'm not saying there aren't hippocampal and amygdala pathways to these nuclei, of coarse there are! How else would we smile when something tickles us. The bottom line here is that her smiling in not definative of anything. Just look at her eyes, no one is home.

5) As my grandfather would say, It's a giant $hit sandwhich and no one wants a bite. Starving her to death is NOT a humane way to die. The ethical arguments behind living wills, not to mention the moral back ground, is to allow someone to die with dignity. Starving to death is not dying with dignity, its HELL! So what does this bring up, her quality of life. And thanks to our insurance health care system, yes there is a price on life. It's done all the time on indigent cancer patients. So this is now an argument for euthanasia. The writers of the bible (keep in mind the only literate people during this time were monks, maybe there is a little bias in the writings) could have never imagined a situation of euthasia, but we do it to our animals all the time. We are more humane with our Pets than we are with our family. If you say no, then animal euthanasia is totally a finacial decison on your part. Now we come to the fact she is not suffering, just not fuctioning. She is able to maintain her own life status, as long as she is watered and turned, like a frickin plant.

I don't know what the answer her is. She is not in pain that they can tell, she is not miserable (brain dead!) or should I say she isn't aware of her status, her GCS is like a 10, so she realy is not conscious. Consciousness is the fact you are aware you were awake monents ago. She is able to breath on her own, and other than needing G-tube feedings and turning to prevent decubitus ulcers, she is "independent."

With our current laws, societal standards (they'll change soon, they are so plastic) and moral beliefs, I think the right answer is to let her live (only with this logic, my gut tells me to let her go). But, we must honor her autonomy. She expressed to her husband she would never want to live like that, then we must follow her wishes.

This was long winded. I know I would not want to die of starvation, but I also know I would not want to live like her. Lesson learned here is to have a living will and make sure EVERYONE in you family will honor your wishes.
 
It's just outrageous that a governor and state legislators can overrule what judges have consistently ruled to be that woman's end of life wishes. She clearly did not want to go on like this and made her wishes clear prior to this event occuring. I can understand her family being upset about this as they are emotionally attached, but the physicians and the justice system have all determined that have the feeding tube removed is what the pt would have wanted if she had any say in it. Even if she is not in any active physical pain, being trapped in a physically brain dead body could be torturous for her as is the idea of being kept alive for many years artificially for many.
 
Part of the problem is the public's perception of what withholding tube feedings would actually entail. We automatically picture it as "starving to death" -- something torturous, cruel, and painful. And maybe it would be so for any of us, who are fully awake, aware, and (mostly) healthy.

From my very limited experience, however, "starving to death" for the infirm is something altogether different. I've known a few folks (some patients, some relatives) who were very ill and either refused or became physically unable to eat. In all cases, the family made a decision just to "let them go". And what really surprised me was just how peaceful their deaths seemed. There was no perceptible anguish (and they weren't sedated, either); they all sort of drifted off, becoming less and less responsive to external stimuli, and then sometime in the middle of the night their hearts stopped.

Which is not to say that it is a peaceful way to go, but it certainly appears to be so. In fact, a few of the residents and attendings I worked with argued that an even kinder way of allowing death was to withhold IV fluids. To me, death by dehydration sounds worse than death by starvation, but they were quite convinced it wasn't. They did concede, however, that you could almost never convince families of this, so even those who were content with withholding tube feeds would still insist upon IVF.

In my opinion (for what it's worth), Ms. Schiavo's tube feeds should be stopped. The more time I spend on the wards, the more I feel that we have to reconsider our notion that life should be preserved at all costs. So often I feel that what motivates it is a fear of letting go of loved ones combined with a fear of our own mortality (forgive the amateur psychiatry). As a society we're totally uncomfortable with the notion of dying -- we regard it as something inherently unpleasant rather than something inevitable and potentially peaceful.
 
TheTerri Shiavo Info Page is a great resource for understanding the legal issues and history of the case.

Some things I was not aware of:

Michael Schiavo, as Terri's husband, had the complete legal right to dictate her care, but he chose in May 1998 to excercise a special portion of the Florida law, presumably because he knew that Terri's parents disagreed so vehemently with his wish that Terri be allowed to die. The law removes the decision making responsibility from Michael Shiavo and sets up a trial to decide. Again, he did this voluntarily. A trial was held to determine if Terri was in PVS and if she had expressed a wish to not live in such a state. The court concluded that she was in PVS and that there was "clear and convincing evidence" that she had expressed a wish not to live in such a state. There were witnesses other than Michael Schiavo who also testified that Terri had expressed such a wish. Also, "clear and convincing evidence" is considered the highest standard of proof in Florida civil law. The trial court's verdict was upheld several times.

Regarding Michael Schiavo's character, the court found that:

"Theresa has been blessed with loving parents and a loving husband. Many patients in this condition would have been abandoned by friends and family within the first year. Michael has continued to care for her and to visit her all these years. He has never divorced her. He has become a professional respiratory therapist and works in a nearby hospital. As a guardian, he has always attempted to provide optimum treatment for his wife. He has been a diligent watch guard of Theresa's care, never hesitating to annoy the nursing staff in order to assure that she receives the proper treatment."

Anyway, I think the legislature was wrong to get involved. If you want the other side of the story, Terri's parents have a
website . The infamous video can be found there. I tend to think that they are mistaken to believe that Terri will regain consciousness, especially since her cerebral cortex is gone, but I also feel very sorry for them.
 
Newsweek has a good story http://www.msnbc.com/news/985278.asp .

"As he later told Richard Pearse, another of Terri?s guardians ad litem, Michael had lost hope for her recovery. But, says Pearse, ?I had a great problem with the idea that Michael could... get the money and then basically change his position... I was rather struck by the coincidence of that.?
 
Originally posted by QuinnNSU
:clap: Good to be on the same side with you, Bridaddy. :)

It really is a sad case. It just shows you the power of a photograph. The picture with her and her mother does seem to say "Hey, she's looking up at her mom and smiling." But I have a feeling she is always in that pose and it was just the great job of a photographjer who caught that one.

There are always two sides to a story, but unfortauntely it seems that the majority of the story is from her parents...

But it is such a sad case.

Did you know the parents have not allowed cameras in her room for the past two years?!?!

Q, DO

:)

It really is upsetting to me the way the media has portrayed this case. At first I thought it bordered on irresponsible journalism, but after thinking about it more throughly, I believe its absoluetely irresponsible. Seeing how much of her brain is gone, and finding out about the eye following the balloon is just a reflex, and happens 1 in 1000 tries really sums up the case for me.

This was never mentioned in any media (except LKL, which I normally don't watch), and to me is pivotal in the case.

A great point I hadn't considered was that she wouldn't even be aware of "starving" to death. The idea of such a slow death in my mind was cruel, but if she isn't aware of it, does it really matter?

(this was a rhetorical question, it seems subsquent posters thought I was really asking)
 
Actually, withdrawal of feeding tubes is very commonly done in severely demented patients and considered by many physicians to be one of the most humane ways to go. With this level of neurologic impairment, withdrawing feeding is thought to cause little discomfort. Demented elderly patients, most of whom can express pain and discomfort almost uniformly do not complain if the feeding tube is removed. They mention no suffering and pass away slowly but peacefully. They don't wither away to nothing. Usually after a week to several weeks they slowly begin sleeping more and eventually do not wake up. I see no reason why this should be any different in a younger person with such profound neurologic impairment.
 
Then why do not we just give her lethal injection. It is much faster and she obviously "could not feel anything". Heck, Tim McVeigh did not look painful when he received the injection.

From My piont of view, starving to death is one of the most unhuman things ever. Why we can not choose a quick way to execute the poor woman?
 
Originally posted by pxz
Then why do not we just give her lethal injection. It is much faster and she obviously "could not feel anything". Heck, Tim McVeigh did not look painful when he received the injection.

From My piont of view, starving to death is one of the most unhuman things ever. Why we can not choose a quick way to execute the poor woman?

because that would be active euthanasia, whereas taking the feeding tube is considered passive euthanasia.

this was all covered in my undergrad med ethics class. very interesting.
 
I admit I don't own a tv and I barely listen to NPR, so I am pretty oblivious of most of the torent of media cr*p that is thrown at us everyday.

But, I definitely have heard about this and this story is an example of why I can't stand to follow the media.

Quinn's explanations are about as clear as a bell for this reader and I'm satisfied with the shrunken cortex, pvs descriptions. It does seem like 1) Bush is being intrusive and inappropriate and 2) the parents' are being intrusive and inappropriate.

Does the wedding vow have something about 'cleave unto your partner and leave behind your family'? and isn't your spouse considered your next of kin, by law, and then your parents secondarily?

Both of my grandmothers decided that they'd had a good life but they were ready to go at a certain time, and so they just declined food and liquids and BOTH quietly just stayed in bed sleeping and that was about it. Incredbily peaceful and full of dignity. I was glad to see how supportive the hospitals were and it made me feel good to think that I could decide to go that way, someday too. I think we all deserve the right to determine the way we die. Her parents are being incredbily selfish and denying the most obvious reality.

I wonder why she had that eating disorder in the first place? Did she learn that from her husband's or from her childhood home? :rolleyes:
 
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