Email from Cheryl:
I wrote the following back when Terri's tube was pulled. I am sending it on again as a reminder to the issues at hand and to remind everyone if they have not written their Advance Directives, to take the time to do so now. Feel free to post or forward on as you desire.
Cheryl
Fight4Terri@aol.com I am a Registered Nurse with 25 years of medical training.
I voice my opinion from viewing similar patient situations as Mrs. Schiavo's. I've also been involved in several seminars and discussions surrounding ethical questions related to those proposed in Mrs. Schiavo's legal debate.
In my professional and personal opinion, it is too late for Mr. Schiavo to be requesting a feeding tube be removed from his wife. In all the years of my nursing experience, our protocol was very clear, and as follows:
1. In the acute phases of a patient's trauma, should a patient present with a legal living will and DNR (DO NOT RESUSCITATE) declaring that if in the event of trauma, where they were suddenly physically and or mentally incapacitated; not capable of making decisions for themselves with regard to life support issues, i.e. ventilators, gastrointestinal and nasogastric feeding tubes, Total Parenteral Nutrition via intravenous feedings, etc., and had indicated that they wanted no medical intervention whatsoever, the patient was then allowed to die in accordance to their wishes and without ANY medical intervention.
2. However, if there was not a legally written DNR, living will, or durable power of attorney present to indicate the patient's wishes;
the patient was then declared a Full Code and all medical interventions were taken at the time to ensure life support measures. All implemented in an effort to maintain the patient's life. This included, intravenous infusions, tube feedings, ventilators, etc.
Prior to enacting the necessary life support measures, we did not sit around with each other, or with the patient's family, discussing or debating what we "thought" the patient's "quality of life" was at the time.
Or, what we "thought" it was going to be in the future.
Or furthermore, if any of us thought that because the patient's quality of life was acceptable, or not, we then had the right to declare them a code, or no code, providing them with life support measures, or not.
The FACT is, and was,.... if they did not have the appropriate paperwork to declare what their wishes were at time of admission, then all other discussions, and or assumptions, were a moot issue.
No where in all of my 25 years in the medical profession has any family member, friend, adinistrator, lawyer, health care professional, etc., been allowed to determine that after so many years of a patient successfully sustained life via tubes of any kind, and who had maintained the same status over those years, could anyone suddenly walk into a facility and make a random decision without justification, that the patient was not worthy of such intervention any longer. To then request that the tubes be discontinued.
If, on the other hand, the patient began showing a rapid decline in health, clearly showing no signs of improvement, and or ability to be maintained at the same palliative level of care, then the DPOA or next of kin could open a legal case requesting that extraordinary life support measures be discontinued.
However, I've seldom seen that happen. I think mainly because if the patient suddenly had a change in status and began a rapid decline, their life usually ended in a relatively short time, and on their own.
I reiterate, because Terri Schiavo is no longer in the acute phases of her trauma and it is apparent that when her trauma had occurred she did not have a written, legal DNR or living will indicating what her choices were in the event of such a situation (verbal hear say via spouses, friends were not admissable).........should anyone now be allowed to suddenly come along and decide that it is time to terminate her, or anyone's life for that matter.
Dr. Kvorkian spends time in prison for assisting in voluntary suicide.
The irony in this particular case is....Mrs. Schiavo isn't even allowed to verbally volunteer her own suicide. Therefore, removing Mrs. Schiavo's tube feedings at this point in her life...in my nursing opinion, would
be no different from Mr. Schiavo insisting on legal assistance to enact upon a form of homicide.
The laws up until this situation were pretty clear and without question.
If Mr. Schiavo is allowed to do this at this time.....I question how many
other patients who are now residing in nursing homes and who have been successfully nourished via feeding tubes will suddenly have family members appear demanding removal of them. I think that the legal system needs to remain in the courtrooms and leave the ethically and legally clear DNR/living will protocols alone. Up until now, there has never been a question as to how, when, or on who, medical intervention would, or would not, be initiated.
Mrs. Schiavo's situation should be a good lesson for people of all ages to:
1. Recognize the importance of appointing themselves a DPOA (Durable power
of attorney) who clearly understands and has access to the necessary paperwork to substantiate their wishes in the event of such circumstances.
2. Have a legal Living Will and DNR written. Maintain the papers in a safe place where a family member could access them. It is also a good idea to provide a copy to your family physician.
At the very least, Michael Schiavo and the judge have violated Terri's "Patient's Rights." Terri deserves a swallow evaluation to see if she indeed can consume any form of nutrition on her own. If you take the time to read the affidavits from her previous caregivers, prior to removing her tube, they had been slipping her Jell-O, sips of juice, ice chips (without Michael's knowledge) and she managed to swallow.
Michael NOR the obvious demented judge has the right to disregard or violate Terri's patients rights. And this is exactly what they are doing!!!
It is SAD! For a supposedly intelligent nation, we sure have a lot of apathy in this country. We allow things like this to happen, DO NOTHING about it..and then wonder how it happened to us when we find ourselves in such predicaments. One cannot help but wonder why thousands were led into gas chambers and no one did anything to stop it!
Americans become proactive when you know something is blatantly wrong! You will never know when a situation like Terri's may be in your lap.
This is not a matter of your feelings as to whether you agree, or disagree, with her quality of life. It is a matter of advanced directives, patient rights and laws that are being broken and violated by a judge and a crazed spouse who obviously has some ulterior motive other than what he states his wife supposedly wanted.
If Michael truly believed Terri had wanted this...... then why did he allow them several years ago to place the tube in her???
He indeed had to sign a pre-op consent to allow the tube to be placed.
Why didn't he adamently voice his opinion back then about what Terri's wishes were????? Perhaps, because he at that time needed her for evidence until the court case was settled!
Does it not seem peculiar that he motioned the court to remove her tube several days after he won a 1.2 million dollar settlement?????
I have written the Governor, the judge...and various forums. We must unite and find a way to over rule the judge. He is not GOD!
Geesh!
Cheryl F. RN
Former EMT & Paramedic