Posted on 12/04/2003 3:31:09 PM PST by sweetliberty
I was on another board, but didn't fare too well. There is something I'd like liberals to answer, though:
Ignoring for the moment the specific case at hand, what would prevent any guardian who wanted to be rid of a somewhat-incapacitated but clearly-somewhat-concious ward from drugging that person, having him declared to be in a persistent vegetative state, and then having him put to death? Since the death would be by state-ordered dehydration, an autopsy would likely not be required. Further, even if one were performed, it likely wouldn't show much since the state authorizes the use of drugs like morphine on persistently-vegetative patients (to avoid discomforting the staff with moaning, etc.)
Even if Michael Schiavo is in fact a saint, the fact that the state allows him certain unchecked powers suggests strongly that a dishonest guardian in his shoes would be able to have his ward killed whether or not the ward is PVS. And that IMHO is pretty scary.
I hate to think of ending up in a hospital and having to deal with Michael S. He already has removed the feeding tube from his parents and felt good about it. I hope patients can object to having him come near them.
http://www.sptimes.com/2003/12/14/photos/a-feedtube1.jpg
Dorothy Turrentine, 90, has been a resident of Palm Garden in Largo since her daughter, Norma Ramsey, at right, began working there as a nurse five years ago. Before that, Turrentine lived with Ramsey for eight years.
http://www.sptimes.com/2003/12/14/photos/a-feedtube2.jpg
Nurse Norma Ramsey speaks with Herbert and Vera Klein in the halls of Palm Garden in Largo. Vera Klein has been visiting her husband, Herbert, at the nursing home nearly every day for 12 years. "I wouldn't give up the time I spend with him for anything," said Vera.
Illustration: How a feeding tube works
Down the hallway in the Largo nursing home where 40-year-old Terri Schiavo once lived, 90-year-old Dorothy Turrentine is slowly dying.
As a young Kentucky woman, she danced on roller skates to catch the eye of her future husband. She raised two kids and ran a small farm. Now a bum heart has brought her to the end. She has stopped eating, except for occasional sips of nutrition drinks or milk.
Her condition presents a thorny challenge for the Florida Legislature, which passed a law in October enabling Gov. Jeb Bush to order Schiavo's feeding tube reconnected six days after it was removed.
Because of the Schiavo case, a move is afoot in Tallahassee to alter Florida's right-to-die laws. One bill would lead to more tube feeding for people without living wills. Another would limit decisions by family members, such as Schiavo's husband, who might have a financial stake in their loved ones' fate.
Some doctors and nursing home administrators say they are worried such changes could do more harm than good. For every Terri Schiavo, a young person who might survive decades on a feeding tube, there are thousands of Dorothy Turrentines, chronically ill elders who don't want to eat.
Tightening tube feeding laws "would have a chilling effect on current practice," said Dr. Robert Walker, a University of South Florida professor who specializes in medical ethics.
"In the dying process, people's bodies normally shut down and they lose appetite. If you put in a feeding tube, we might be able to sustain life a little longer in some cases, but ultimately they are going to succumb to the disease process."
Several lawmakers said they share these worries and are proceeding cautiously.
"The one thing we don't want to do," said Sen. Dennis Jones, R-Seminole, "is take the million people who have existing living wills and have them concerned that their instrument is not valid, because it certainly is."
However, the only bill filed so far, the "Starvation and Dehydration of Persons with Disabilities Prevention Act," illustrates the challenge.
Now, state law lets people reject "life-prolonging procedures" by signing living wills or advance directives. These directives kick in when the person becomes unable to communicate. People also can designate a "health care surrogate" to make decisions for them. Even without written instructions, family members or friends can decide what would be best.
The proposed bill would narrow these options. It would prohibit courts, doctors, health care surrogates and families from withholding tube feeding except for a few circumstances:
The patient had rejected tube feeding with specific written instructions. A living will that only rejected "life-prolonging procedures" would not kick in unless it specifically mentioned tube feeding.
The patient had previously given clear and informed oral consent to withholding the feeding tube.
The tube would not sustain the patient's life anyway.
Depending on how doctors and nursing homes interpret these conditions, that could mean more feeding tubes for people like Dorothy Turrentine.
Congestive heart failure has clouded her mind. Her food intake dropped dramatically a month ago, and she has lost 28 pounds. She left decisionmaking to her health care surrogate and daughter, Norma Ramsey. But she made no living will, much less one with specific instructions about tube feeding.
Ramsey said she is certain what her mother would want.
"She and I discussed a lot of things," said Ramsey, an assistant director of nursing at Palm Gardens of Largo, where her mother has lived for five years. "She said she didn't want any heroics at all. She said, "I don't want to die more than once. Don't bring me back."'
With 38 years in nursing, Ramsey has seen hundreds of people die, including many who stopped eating. "It's a quiet death. Very quiet. They just slip away."
The bill's sponsor, Sen. Stephen Wise of Jacksonville, said he was motivated by disturbing videos of Schiavo, the Pinellas woman whose plight has sparked years of court battles. Some doctors and a judge say she lives in a persistent vegetative state. She moves her eyes, swallows saliva and makes sounds. Her husband wants to remove her feeding tube and says his wife wouldn't have wanted to live this way. Her parents want to keep their daughter alive.
"If what they did to Terri Schiavo was done to a dog, they would be put in jail," said Wise, a Republican. "If they starved a dog to death, it would be cruelty to animals."
Last year, Wise watched his 83-year-old father die after a breathing machine was removed to comply with his father's living will.
"He had no brain waves. His heart was beating artificially," Wise said. "With the issue of being in a vegetative state, I think of my dad. When I conjure up Terri Schiavo, she was not even close."
What about chronically ill old people like Turrentine, who are conscious but won't eat?
"I don't know. I hadn't even thought about that," Wise said. "That's the difficulty of something sensitive like this. You start out thinking something is a pony but it turns out to be a Clydesdale."
Wise said his bill was drafted by Right-to-Life, an advocacy group that views food and water as basic sustenance no matter how it is delivered. Florida Right-to-Life president Robin Hoffman said a companion bill would be filed in the House.
The House bill is expected to be backed by House Speaker Johnnie Byrd, R-Plant City. Byrd could not be reached for comment.
Senate President Jim King said he expects some right-to-die changes to pass the House during the next legislative session, which starts in March. But he vowed to keep such bills from reaching the Senate floor. Even ostensibly good changes can be amended in destructive ways, the Jacksonville Republican said.
When his parents died of cancer, King said, "I witnessed first-hand a lot of things that are worse than dying - some of the invasive treatments being done."
King wrote many provisions in current law that give patients and families the right to withhold procedures. That legislation "is part and parcel of my legislative legacy."
One bothersome aspect of the Schiavo case for some legislators was that her husband stood to inherit money from a medical malpractice settlement if she died early on. Court records indicate most of that money has since been spent on lawyers. But some legislators want more protection against conflicts of interest.
Reps. Frank Attkisson, R-Kissimmee, and John Stargel, R-Lakeland, were early supporters of legislative action in the Schiavo case. They now say judges should appoint guardians ad litem in some cases to make sure family members' motives are pure.
When patients can't speak for themselves and haven't left written instructions, current law allows family "proxies" to decide. A spouse gets first crack at being the proxy. Absent a spouse, it falls to adult children, then parents and on down a line of succession that even includes close friends. Proxies now make end-of-life decisions for 20 to 25 percent of nursing home patients, experts estimated.
Any family member who thinks a proxy has a conflict of interest or is acting improperly can appeal to a judge. Such appeals are rare, because doctors and nursing homes have become skilled at helping families work through guilt and hash out feelings. The Tampa Bay area's two hospice organizations, for example, have treated more than 100,000 clients and have never seen a family dispute boil over into the courts.
"A lot of times there are multiple family members, and each one has an opinion," said Dr. Fadi Saba, medical director of Bon Secours Maria Manor, a Catholic nursing home in St. Petersburg. "Typically, we get the entire family in a room and let everyone say their opinion. Ultimately they come up with a decision on doing what's best for dad or mom, but it takes quite a bit of maneuvering."
The Legislature should "stop meddling with a system that has worked nicely all along," Saba said. "In eight years, we haven't had any problems."
Schiavo was the exception.
Judges already have the option of appointing a guardian to sort out family disputes. Attkisson and Stargel say guardians should be mandatory where there's a conflict of interest.
"We need to set up a review process to make sure when families make decisions, that it's unbiased and the closest loved one is making it," Attkisson said.
Terri Schiavo's husband, Michael, "received a lump sum of cash," Attkisson said. "Would he have been incentivized if her life ended sooner? The fact that he is engaged to somebody, and by now has a child, does that create an emotional conflict?
"I'd like to consider that a guardian ad litem be present to review it. Does this person have conflicts compared to the rest of the family?"
Such suggestions make some doctors and health care providers nervous.
Right-to-die laws and court decisions have evolved over years. The Legislature made changes in 1999 and again in 2001, after a task force studied the issues and took public testimony. Until now, those changes tended to broaden legal protection for family members, facilities and doctors who withhold procedures.
The guardian idea and the Wise bill would be steps backward, said Dr. Howard Tuch, medical director for Hospice of Southwest Florida. They would "create a level of fear and anxiety in an already charged environment."
The Wise bill says an incompetent patient "shall be presumed to have directed his or her health care providers to supply him or her with the nutrition and hydration necessary to sustain life."
Families, surrogates and courts could override that presumption if the patient wouldn't benefit from tube feeding. But the problem lies in the gray areas of diagnosis, when reasonable doctors might disagree whether the tube feeding would extend the patient's life.
Tuch said he wouldn't change his practice, because he believes chronically ill people who have stopped eating never benefit from tubes. Their bodies are just shutting down, he says.
Other doctors might not take that risk, fearing lawsuits and repercussions, he said. A legal presumption in favor of tube feeding might encourage a disgruntled family member to sue for malpractice. Family members who preferred the tube might insist on a time-consuming guardian, contending that the patient's life insurance or $35 in a Medicaid account creates a financial conflict with the proxy.
Such fears are exacerbated because most nursing home patients acquire their doctors at admission, Tuch said. There is no long-standing relationship with the patient or family.
"The default position is going to be the easier one to take." Tuch said. "If there's any question, I'm going to insist that the tubes be put in. The intimidation is very real."
Attention: HHS - Office for Civil Rights - HIPPA
Question:
Does the HIPAA Privacy Rule or State law control who can act on the behalf of another person? Does the HIPAA Privacy Rule address when a person may not be the appropriate person to control an individual's protected health information?
Answer: Generally, no.
The Rule defers to State and other laws that address the fitness of a person to act on an individual's behalf.
However, a covered entity does not have to treat a personal representative as the individual when it reasonably believes, in the exercise of professional judgment, the individual is subject to domestic violence, abuse or neglect by the personal representative, or doing so would otherwise endanger the individual.
Dear Sir or Madam:
Re: Schiavo -- the Best Interests of the Patient
An impartial investigation in the Schiavo case is sorely needed to determine whether or not the best interests of the Patient (Terri Schindler Schiavo) in the Schiavo case is being improperly handled. The reasons for this are numerous. But most disturbing (and urgent), at this time, is the highly suspect irregularities evident with respect to the erratic behavior of her estranged husband Michael Schiavo.
There are many reasons to believe that (the Patient's) best interests are indeed not being properly discharged under the guardianship of Michael Schiavo (her estranged husband). And if not, then it is of paramount importance to immediately implement, and follow through with, a thorough investigation respecting the safety and protections outlined in Patient's Rights and Privacy issues.
There are reasons (and examples) to, not only justify, demand such an impartial investigation. The zeal with which Michael Schiavo has sought to have his wife 'put down', as soon as possible, without even affording her the slightest opportunity to receive any therapy, or even simple humane medical care (such as treating a life-threatening infection).
In anticipating her death (once he succeeded in having her feeding tube removed from her), he suddenly demanded that her body be immediately cremated. He further demanded that her parents (and siblings) not be allowed to see (not even to say goodbye to) her.
Ever since he became the sole beneficiary to his wife's medical account, for which he repeatedly lied to (and duped) a jury to obtain, Michael Schiavo has repeatedly fought to have his wife's feeding tube removed so (in his own words) he "could get on with [his] life". Medical personnel have testified that he would frequently call up to inquire: "is the bitch dead yet?"; and "when is that bitch gonna die?"
There is also testimony that, when Terri had taken a turn for the worse, he rejoiced and exulted: "I'm gonna be rich!"; and he would brag about what he was going to purchase with the money he would inherit as a result of Terri's death.
There is also documented evidence that Terri had numerous (bone) breaks and fractures (some in the process of healing) that suggested trauma (that could be a result of abuse). There were also indications that she had been strangled, and that that may have been a contributing factor (in the loss of oxygen to her brain) that was the cause of her brain damage. Michael saw to it that no one (especially not her family who cares for and loves her) would have access to her medical records, in order to determine what could have caused such a young healthy woman's heart to suddenly stop.
Michael had girlfriends, while married to Terri, and is presently living with his latest girlfriend (with whom he has sired two children). He repeatedly lied to (and duped) a jury, in order to obtain a special fund for Terri's medical and physical therapy. He swore, under oath that he was planning to use the money to "take care of" his beloved wife for the rest of her life, if necessary. The jury believed him and awarded Terri (not Michael) over $1-million (for the specific purpose of caring for her medical and therapeutic expenses).
However, as soon as the hefty award was placed in Terri's medical account, he then changed, from the 'loving' husband who wanted his wife to get well, to one who demanded that no therapy (or even the slightest medical treatment or humane care) be given to Terri. He also instituted a "DNR" order. He was now the sole beneficiary of Terri's medical account, and instead of using it for her benefit, he spent a substantial amount of it on legal fees trying to end his wife's life.
And, although he never mentioned it in all the opportunities he had to do so, during court proceedings, yet (years later), he 'suddenly' remembered that his wife had specifically expressed her wishes to him, that, if she were ever to have to be fed through a feeding tube, she would want it removed.
No question about it: it's time for a thorough (criminal) investigation into whether or not Michael Schiavo needs to be immediately removed as guardian for Terri; and replaced by a member of her family (who will look out for her best interests).
Until there is a thorough (and impartial) investigation into the question of the "fitness" of Michael "to act on" Terri's "behalf", I strongly urge HIPAA to take immediate precautions to protect the life and well-being of Terri. Thank you for your cooperation.
(name removed for web posting by msmagoo)
Senate President Jim King said he expects some right-to-die changes to pass the House during the next legislative session, which starts in March. But he vowed to keep such bills from reaching the Senate floor. Even ostensibly good changes can be amended in destructive ways, the Jacksonville Republican said. When his parents died of cancer, King said, "I witnessed first-hand a lot of things that are worse than dying - some of the invasive treatments being done." King wrote many provisions in current law that give patients and families the right to withhold procedures. That legislation "is part and parcel of my legislative legacy."
See the statute below, courtesy of Doc Knox, out of JAX.
Then send on to Floridians for further action, please.
Glenn W. Knox, MD, FACS, PSC
Ear, Nose and Throat
Otology and Neurotology
Diplomate, American Board of Otolaryngology
Courtesy Clinical Associate Professor, University of Florida
3663 Crown Point Court
Jacksonville, Florida 32257
(904)292-9777
fax 292-1313
June 24th, 2003
Dear Governor Bush:
I have enclosed a petition for your consideration. We are urgently requesting that the Republican Caucus in the Florida Senate vote to remove State Senator Jim King from his leadership positions. We are also urgently requesting you to consider the suspension of Senator King as per Article 4, Section 7 of the Florida Constitution. The reasons for suspension are malfeasance, misfeasance, incompetence and neglect of duty. Finally, we are asking you to consider introducing legislation to provide for the recall of state senators and representatives to avoid situations like this in the future.
Senator King has endangered the health and well-being of all Floridians by his failure to act in reasonable good faith to resolve the medical liability crisis. He has thus been instrumental in creating a public health crisis in the state. I respectfully ask that you consider these measures. I fully understand the gravity and the extraordinary nature of this situation. Thus I have presented a petition with as many signatures from Senator King's district as possible.
Sincerely,
Glenn W. Knox MD
Memo to: Florida Physicians and Patients
Cc: Duval County Medical Society
Re: Petition to suspend Senator Jim King
I have enclosed a petition for your consideration. If you and/or others wish to sign it, please either mail it to my office or drop it off. I am sorry that I cannot accept faxes or electronic submissions; original signatures are necessary. If the July 9th [2003] special session does not yield meaningful tort reform, the petition and signatures will be delivered to Governor Bush?s office. Please have each person who signs the petition provide their home address and indicate if they live in Senator King's district or work there. They must be registered to vote in the State of Florida. Thank you for your time and consideration.
BACKGROUND INFO
1) Last Acts' new mobilization
In view of Last Act's new mobilization (see article 1 with comments by Ron Panzer), it's important to know the background of it's leaders.
The decidedly right-to-die oriented agenda of Last Acts and Partnership for Caring is steaming right ahead with conscious cooperation from all the hospices, hospice organizations and other members of the groups... working together to lobby for changes in the laws of our states and the federal government, and work to change society's attitudes toward "choice" in dying to include assistance in dying, hastening death, as part of the end-of-life mission. The actions of these groups, while helping in many ways to promote better end-of-life care, threaten to sabotage the very best of end-of-life care, because "aid in dying" (killing the patient) is incompatible with dedication to provide the very best care till a NATURAL death occurs in its own timing! - Ron P.
[from LastActs.org]
LAST ACTS PARTNER CALL: HONORING OUR ACHIEVEMENTS, CHARTING OUR FUTURE TOGETHER
[excerpts only]
We are proud to announce the upcoming merger of Last Acts and Partnership for Caring. This new, national, nonprofit organization-Last Acts Partnership- presents many exciting opportunities for all its organizational partners. For example, Last Acts Partnership will engage in vigorous advocacy efforts in which all partners can participate. Last Acts Partnership's power to promote social change will be vastly increased as it coordinates, assists, and mobilizes Last Acts' 1,200 national, state and local Partners; Rallying Points' 360 local and state coalitions; and Partnership for Caring's 20,000 individual members. Through Last Acts Partnership, these individuals, organizations, and coalitions are already forming a powerful voice working to improve how people die in our society.
Together, we are empowering and engaging consumers, informing medical and health professionals, and acting as advocates for quality end-of-life care through policy reform.
http://www.lastacts.org/files/resources/declaxpcall.pdf
2) 2001 article by Rita Marker gives background information about such groups and their funding.
http://www.philanthropyroundtable.org/magazines/2001/january/marker.html
Terri's award was put in a trust fund, overseen by at least one bank, to be used for her rehabilitation, but was instead spent on legal fees, with the court's permission, to have her starved and dehydrated. The terms of the trust fund payouts should have been limited to rehabilitation only - but MS, as Terri's legal guardian, was able to do an end run around the court-ordered rehabilition by getting the court's permission to spend the award money on legal fees - under the pretense he was fulfilling her wishes.
This process would have stalled if MS had to go through an impartial GAL, who could have blocked use of her own rehab money for lawyers fees. In that case, MS would have had to use his own funds for legal fees to see her purported "wishes" realized.
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