THE FINAL DAYS
Death from dehydration common, placid, doctors say
Removing a feeding tube from a patient who has no hope of recovery is a common practice that leads to a peaceful death, doctors say.
BY JACOB GOLDSTEIN
jgoldstein@herald.com
Unless an order is given to reinsert her feeding tube, Terri Schiavo will soon begin a peaceful decline that will lead to death in about two weeks, experts said Saturday.
She won't be aware of thirst, hunger or suffering, because the parts of her brain that create awareness were destroyed 15 years ago, according to the doctors who have examined her.
Schiavo will die of dehydration -- a common end for patients with no reasonable hope of recovery, and one widely believed to be essentially painless.
Patients who, unlike Schiavo, are conscious to begin with, lose consciousness about a week after the tube is removed. The body's systems fail in the following days, leading to ''a sort of peaceful slipping away,'' said Dr. John Kuluz, a University of Miami expert in pediatric critical care and brain injury.
Removing feeding tubes ''happens all the time,'' said Dr. Douglas Katz, a Boston University neurologist. ``It's a common procedure in people who have hopeless medical conditions, among them people in vegetative states.''
According to doctors, Schiavo is in a persistent vegetative state -- a condition of unconsciousness that persists endlessly, even though basic brain functions continue to cycle the body through periods of sleep and waking.
NO 'SENSE' OF PAIN
Vegetative patients can feel pain in a primitive sense -- reflexes might make them flinch when poked, for example. But they are not conscious of feeling pain or discomfort.
''Even though some of the pathways for sensation are intact up to a point, the part of the brain that processes information about sensation and feeling is not working,'' Katz said. ``A person who is unconscious or in a vegetative state cannot have any sense of discomfort or suffering.''
Even for patients who are conscious to begin with, death by dehydration appears peaceful, according to a study published in 2003 in the New England Journal of Medicine.
A survey of 107 hospice nurses who cared for terminally ill patients who chose to die by refusing food and water found that ``most deaths . . . were peaceful, with little suffering.''
The study asked nurses to rate the patients' deaths on a zero-to-nine scale, with nine being the best possible death; the median rating was eight.
Christine Exposito, a registered nurse at HospiceCare of Southeast Florida, said in about half of the cases in which one of her terminal patients loses the ability to survive without a feeding tube, the patient's family will allow the patient to die of dehydration.
ORGAN FAILURE
Dehydration is a gradual process. The body loses water through urination, perspiration and breath. After several days, the volume of blood in the body begins to decline because of the lack of water.
The concentration of toxins and carbon dioxide in the blood increases. All of the body's systems gradually become weaker.
After about 10 days, organ systems begin to fail. The kidneys and liver may stop filtering toxins from the blood. The muscles that drive breathing begin to fail.
Barring an intervention, Terri Schiavo will die in about two weeks when her heart, deprived of oxygen, stops beating.
You or I would be arrested if we starved our dogs to death. I can not justify why it's OK with a functional human being.
I will never allow any family member to be placed under the care of any hospice whatsoever. They are Hitler's goons dressed as caregivers. Any one who works for them must be crazy or the devil incarnate.