THE TERRI SCHIAVO CASE: THE 'TUBE DOCTORS': Device's inventors never foresaw ethical dilemma

Atlanta Journal-Constitution ^ | 3/26/05 | Joe Milicia (AP)

[madprof98]

Cleveland --- The doctors who created the current technique for inserting feeding tubes into patients say there are no easy answers in the case of Terri Schiavo and use of the procedure has gone far beyond its original purpose.

The insertion of feeding tubes required major surgery until Dr. Michael Gauderer, now director of surgery at Greenville Children's Hospital in South Carolina, and Dr. Jeffrey Ponsky developed a technique in 1979 intended to help infants and children who couldn't swallow.

Today, it's used more than 250,000 times a year and has become an integral part of end-of-life care.

Feeding tubes are too often used in patients with no potential for recovery, said Ponsky, chairman of the department of surgery at Case Western Reserve University.

''Once they're in, it's so emotionally difficult to take it out and let someone die,'' he said.

Ponsky believes that Schiavo, the brain-damaged Florida woman whose care has become the subject of a legal battle, should remain connected to a feeding tube if her family wants to care for her.

The tube was removed a week ago.

Gauderer said it wouldn't be appropriate for him to give an opinion on the Schiavo case, but he believes the government shouldn't intervene.

''This is something that needs to be decided at the family level,'' he said.

Gauderer and Ponsky first performed their technique --- percutaneous endoscopic gastrostomy, or PEG --- in 1979 on a 4-month-old boy at Rainbow Babies & Children's Hospital in Cleveland.

They inserted a needle into the baby's stomach and passed a thread through that was pulled out the mouth by an endoscope. A feeding tube was attached to the thread then drawn through the throat, into the stomach and pulled out through the belly.

Doctors soon began performing the procedure on adult patients, and it is now used 99 percent of the time feeding tubes are required, Ponsky said. Some nursing homes require feeding tubes be inserted that way, because they're less likely to come loose than an IV or a tube through the nose.

Gauderer and Ponsky say they didn't envision PEG being used for end-of-life care. ''It never entered our minds this would produce such a massive ethical dilemma,'' Ponsky said.

Gauderer hopes the Schiavo case will cause people to decide with their families what they would want done.

Ponsky believes the country needs to examine the most humane way to remove a feeding tube and end life.

''We take convicted murderers and give them a gentle death by injection, and we take someone like Terri Schiavo and decide she has to die and make her suffer weeks of dehydration and malnutrition and loss of dignity rather than provide a rapid euthanasia,'' Ponsky said. ''It's a paradox.''

[madprof98]

Very thoughtful, informative answer. I think many people with similar experiences fail to distinguish between those who are terminally ill and those whose lives are merely inconvenient for others.

[Cboldt]

From the point of view of the elites, this really the point of the Terri Schiavo case: RAPID EUTHANASIA for the unwanted.

Yes, it is. The manner of death will become the issue, and sanctity of life and patient's wisehs are being overshadowed.

[codercpc]

Three years ago, my Grandfather became seriously ill. He was in an out of consciousness, and fading fast. He had a living will that declared DNR, and included no feeding tubes. He had been very adamant about this fact, because during Grandpa loved life more than anyone I have ever met. His favorite activity was travel, and the eating associated with it. In fact many of his vacations revolved around restaurants he had heard of and wanted to try out. He loved good culinary experiences more than anything else. He stated that if he couldn't enjoy the food he was getting then it wasn't worth it (hence the no feeding tube decision he made).

Towards the end, he was unable to swallow, and began choking on even the most pureed foods. One day, in the presence of my Grandma, and the doctor, he stated that he wanted a feeding tube put in. The doctor was unsure of his mental capabilities at this time, and took Grandma aside and explained to her, that he would transfer decisions to her (she was listed as Health care POA). The doctor explained to her that it was easy to put in a feeding tube, but legally, and morally much harder to remove it. Grandma had just heard her husband say "put it in", and of course followed his wishes (this conflicted her).

For the next two months, she went through a living hell. Due to the feeding tubes Grandpa became diabetic, in fact at times his blood sugars went up into the 600 range, the doctors would then stabilize his insulin, and he would go in and out of diabetic comas. Grandpa had never been a diabetic before the tube was inserted.

Two months later he died, but now Grandma remembers those last days with horror, not with the wonderful memories that she should have of the life they shared together.

I guess my story points out that feeding tubes can be "bad" things in some situations, and I applaud your families courage through your tough times.

[dawn53]

Interesting story in the St. Pete Times about a similar situation to Terri's. In this case, the husband let the parents care for the daughter, he divorced her and moved on with his life. Too bad Michael Schiavo didn't do the same thing.

http://www.sptimes.com/2005/03/26/Tampabay/Parents_endure__cling.shtml

[thinkingman129]

Let us posit, perhaps, he wanted her to live; but when he realized her life was not going to improve beyond being in diapers, immovable, and incapable of responding beyond the barest of physical responses....he slowly made a much more realistic realization.

He may have fought against the realization of how bad off she truly was, insisting to himself that she would recover. Once he realized that was an impossible dream, he remembered her statements. I don't find it all that hard to believe.

I want to live, but if my life hung on the same threads as Terri's...I would want my wife to choose for me as Michael has for Terri.

[thinkingman129]

I think in the throes of the realization of impending death, sometimes we wish for the death not to occur.

Had your grandfather foreseen what the feeding tube would have done, had your grandmother foreseen the results, would either have chosen differently?

That's the problem with feeding tubes, IMO. They truly are medical intervention and preempt what God may have meant to happen.

Why can people not accept the natural progression? Why do we fight to have procedures that may be worse than the "cure"?

[codercpc]

I think that Grandpa was not mentally capable of making this decision, and the doctor agreed, but my Grandmother heard her husband say that, and emotion took over. For the last three years my Grandmother has suffered great episodes of depression because of Grandpas last few months, but she thought she was doing what he wanted.

I beg people to think about this when they are making out living wills, and remember that every single situation is different. I also know that the Shindlers have admitted that they would do everything to keep Terri alive, and I have to believe (given my personal experience), that even if they heard Terri say "I don't want to live like this" they would continue down this road.

I don't blame the Shindlers, just as I don't blame my Grandmother for trying to preserve their daughters life, I am just saying that many times emotion overrules common sense and that people who are screaming "murder" should think what they are doing to each and every person who has ever been in this position.

I am now going off on a different tangent, but I feel that I have the right to speak my mind. I know that my husband has said many times this past week that I am to "remove the tube", if he ever gets in Terri's position, I also know that my Mother in Law would do every thing that the Shindlers are doing to keep him alive, even to the point of demonizing me and exploiting his life on national TV. I would refuse to divorce him and fight just like Michael Shiavo is doing to keep my promise to him, and I would have thousands on Free Republic questioning my motives (we both have very large life insurance policies).

These end of life decisions are each unique, and until we walk in the others shoes we have no right to speculate.

[Earthdweller]

Nope..you can't show with your actions that she said she wanted to live in one instance and then change your mind with your actions that she didn't.

If we are dealing with clear and convincing evidence this is a flip flop pure and simple.

[thinkingman129]

My wife has demanded the same of me. Fortunately, for me, her mother knows this and agrees that she would desire the same. If her mother did not agree, I would stand for what my wife wanted, even if that meant I were demonized.

I have told my wife that I may not be willing to have dialysis (for a short period, if at all) if my kidneys were to fail (I am diabetic).

We can't figure out every answer for every situation, but we can discuss how we feel and believe regarding the basics. I don't think living wills are the complete answer, because we can and do change our minds. I would want for my guardian to make decisions based upon my best (and my future hope for heaven) rather than enabling me in a sudden fear of the unknown. We will all die at some point, won't we? I would want my family to LET ME GO when my life quality has become unbearable.

Sometimes that "LETTING GO" is as simple as TELLING the person that they are free to leave. They often do, more quickly then, for their bodies are terribly weary.

I agree with you 100%. But we are very (suprising to me, among conservatives and Christians at free republic) much in the minority here....although I think the numbers are very different nationally.

[ViLaLuz]

Wrong. There is evidence that she can eat and drink.

[thinkingman129]

Absolutely, there are statements that she has been able to eat and drink. Have you determined their veracity, accuracy and bias? Have you determined how often she has been able to this without assistance, or without choking to death on that very same sustenance?

Would you prefer that she be fed, by mouth, and given drink by mouth and die in that attempt?

Could it be, perhaps, that her throat and swallowing reflex went 'south' years (and YEARS) ago, and the next step was natural starvation which the feeding tube precluded?