From a Medical Perspective, Should Terri Schiavo's Feeding Tube Have Been Removed?

General Reference (not clearly pro or con)
The British Broadcasting Corporation (BBC), in its Mar. 31, 2005 "Timeline: Terri Schiavo case," gave the basic background of Terri Schiavo's medical condition:

"Terri Schiavo had been brain damaged since 1990 when, aged 26, her heart stopped beating temporarily and oxygen was cut off to her brain."

Mar. 31, 2005 - BBC (British Broadcasting Corporation) 

PRO (yes)

Joshua Perry, JD, Assistant Professor at the Center for Biomedical Ethics and Society at the Vanderbilt University Medical Center; Larry Churchill, PhD, the Ann Geddes Stahlman Professor of Medical Ethics at Vanderbilt University Medical Center; and Howard Kirshner, MD, Professor of Neurology, Psychiatry, and Hearing and Speech Sciences and Vice-Chairman of Neurology at Vanderbilt University, explained in their article "The Terri Schiavo Case: Legal, Ethical, and Medical Perspectives" published in the Nov. 15, 2005 Annals of Internal Medicine:

"The Schiavo case rests critically on the concept of the persistent vegetative state and the certainty of the prediction that a patient in this state will have no meaningful recovery...

The American Academy of Neurology, along with representatives of the American Neurological Association, the Child Neurology Society, the American Association of Neurological Surgeons, and the American Academy of Pediatrics, set up a Multi-Society Task Force to establish criteria for diagnosing the persistent vegetative state...

The Task Force reviewed case series from the literature... Of the patients in the persistent vegetative state for more than 3 months after nontraumatic injuries, the probability of moderate disability or good recovery was 1%...but for patients still in the persistent vegetative state at 6 months, this probability was 0%. No patient, even those with traumatic brain injury, has been reported to recover after a full year of being in the persistent vegetative state... Certainly no patient has recovered after 15 years, the period during which Terri Schiavo survived in this state. The criteria make clear that the patient can have periods of sleep alternating with periods of an awake-like state, in which his or her eyes are open and may move about, and the patient may breathe, yawn, and open his or her mouth, but not interact meaningfully with others...

On April 1, 2005, an autopsy was performed, revealing that Mrs. Schiavo's brain was 'grossly abnormal and weighed only 615 grams'--less than half of the expected weight for an adult her age...

In our opinion, the law did not fail Terri Schiavo."

Nov. 15, 2005 - Larry Churchill, PhD 
Howard Kirshner, MD 
Joshua Perry, JD 

Sean Morrison, MD, Professor of Geriatrics and Palliative Care at Mount Sinai School of Medicine in New York, in an interview with The New York Times for a Mar. 25, 2005 article entitled "Neither 'Starvation' Nor the Suffering It Connotes Applies to Schiavo, Doctors Say," explained:

"Evoking concepts like starvation is especially powerful...[because] we are so familiar with what it feels like to be hungry and have experienced the heartbreak of images from famine-ravaged regions...

Removing a feeding tube for a patient in a persistent vegetative state, which the courts have determined Ms. Schiavo is in, based on scientific evidence, is vastly different from a conscious person's being refused meals...

No one is denying this woman food and water... People in a persistent vegetative state...have no knowledge of food.

They don't recognize food... If you put food in their mouth, it would sit there until they took a breath, and then that food would go down into the lungs...

Withdrawal of nutrition is a common method for ending life, and many terminally ill patients choose that course...

I have never had a patient who has stopped eating and drinking who has expressed that they are hungry."

Mar. 25, 2005 - Sean Morrison, MD 

Joseph Fins, MD, Chief of the Medical Ethics Division of New York-Presbyterian Hospital/Weill Cornell Hospital, in an interview with The New York Times for a Mar. 25, 2005 article entitled "Neither 'Starvation' Nor the Suffering It Connotes Applies to Schiavo, Doctors Say," commented:

"The window of opportunity to be diagnosed as even minimally conscious closes within three months of oxygen-deprivation brain damage…

Based on evidence accepted by the courts that Ms. Schiavo is in a persistent vegetative state and not in a more conscious state…the part of brain that allows one to suffer is not functioning…and that should be reassuring to people who are concerned."

Mar. 25, 2005 - Joseph Fins, MD 

CON (no)

Wesley J. Smith, JD, Anti-Euthanasia Activist, in his Nov. 11, 2003 article, "A 'Painless' Death?," published in The Weekly Standard, argued:

"Many who support Terri Schiavo's threatened dehydration assert that removing a feeding tube from a profoundly cognitively disabled person results in a painless and gentle ending. But is this really true? After all, it would be agonizing if you or I were locked in a room for two weeks and deprived of all food and water. So, why should we believe that cognitively disabled patients experience the deprivation differently simply because they receive nourishment through a feeding tube instead of by mouth?...

Yes, it is true that when people are actively dying from terminal disease, they often refuse food and water. The disease makes the food and water repulsive to them. In such circumstances, it is medically inappropriate to force food and water into a person who is actively rejecting it. Indeed, doing so could cause suffering.

But this isn't what is happening to Terri. She isn't dying of cancer. Her body isn't shutting down as part of the natural dying process. Indeed, she is not dying at all--unless her food and water is taken away."

Nov. 11, 2003 - Wesley J. Smith, JD 

William Burke, MD, PhD, Professor at Saint Louis University Health Sciences Center, as quoted in Wesley Smith's article "A 'Painless' Death?," which appeared in the Nov. 11, 2003 Weekly Standard, explained:

"A conscious [cognitively disabled] person would feel [the removal of a feeding tube] just as you or I would. They will go into seizures. Their skin cracks, their tongue cracks, their lips crack. They may have nosebleeds because of the drying of the mucus membranes, and heaving and vomiting might ensue because of the drying out of the stomach lining. They feel the pangs of hunger and thirst. Imagine going one day without a glass of water! Death by dehydration takes ten to fourteen days. It is an extremely agonizing death."

Nov. 11, 2003 - William Burke, MD, PhD 

Jodie Gilmore, a freelance writer, in an Apr. 4, 2005 article in The New American titled "Court-ordered Euthanasia," argued:

"Terri is not 'brain dead,' as headlines and news stories describe her. In fact, 14 independent medical professionals (six of them neurologists) have given either statements or testimony that Terri is not in a persistent vegetative state. Her family foundation website notes that she 'responds to stimuli, tries to communicate verbally, follows limited commands, laughs or cries in interaction with loved ones, physically distances herself from irritating or painful stimulation, and watches loved ones as they move around her. None of these behaviors are simple reflexes and are, instead, voluntary and cognitive. Though Terri has limitations, she does interact purposely with her environment.'

Terri is not on life-support systems, such as a respirator, which could be construed as 'over-zealous' treatment, disproportionate to the expected outcome. She does have a gastric feeding tube, which is connected only at meal times. But the existence of a feeding tube does not magically metamorphose Terri from a human to a 'houseplant,' which is what Michael's lawyer and euthanasia advocate, George Felos, compared her to...

The February 8 issue of Neurology published a study that measured the brain activity of patients in a 'minimally conscious state' (MCS). The study showed that severely brain-damaged patients, although they can't follow simple instructions or even communicate, may retain at least some 'cognitive function.' According to a New York Times article, Dr. Joseph Fins, who is chief of the medical ethics division of the New York Presbyterian Hospital, Weill Cornell Medical Center, cited research indicating that nearly a third of persons diagnosed with PVS were really 'minimally conscious'...

Dr. Richard Neubauer, medical director of the Ocean Hyperbaric Neurologic Center in Ft. Lauderdale, Florida, filed an affidavit rendering his medical opinion that Terri Schiavo was neither 'brain dead' nor in a 'persistent vegetative state'... Dr. Neubauer, who has predicted that Terri could improve given proper hyperbaric therapy, has successfully treated brain-injured patients."

Apr. 4, 2005 - Jodie Gilmore