Patient won't suffer, doctors say
By Maya Bell
Sentinel Staff Writer
Posted October 17 2003
A lawyer representing Terri Schiavo's parents argued Thursday that removing her feeding tube and allowing her to starve is "arguably the most brutal, inhuman, and pain-inducing way to kill any living creature."
But many doctors say he's wrong because without food, the body starts its natural defense mechanism against pain.
"It's just the opposite," said Ronald Schonwetter, the chief of medical operations at LifePath Hospice in Tampa. "I deal with a lot of patients in end-of-life care and those who died from lack of dehydration and nutrition probably died the most comfortable of any patients I've seen."
As Schiavo, 39, enters her second day today without the sustenance and hydration that has kept her alive for 13 years, doctors said she'll grow increasingly lethargic and sleepy, eventually slipping into a deep coma and dying in a week or two. The most discomfort she's likely to feel is a dry mouth -- if she feels anything at all.
In persistent vegetative state, doctors said, Schiavo has minimal brain function and is unaware of hunger, thirst or pain. But, they note, patients with most of their mental faculties intact don't feel hunger at the end of their lives, either.
"When we don't eat, we feel really hungry and it feels uncomfortable but, as far as we know, that kind of hunger mechanism isn't one that operates with people who have advanced cancer, dementia or, in this case, are in a persistent vegetative state," said Dr. Joshua Hauser, director of education at the Buehler Center on Aging at Northwestern University in Chicago.
Dr. Gary Miller, medical director of Vitas Health Care Corp., estimated that about 35 of the 650 patients receiving care from Central Florida's largest hospice have rejected artificially administered food and water and are undergoing the same dying process as Schiavo.
And like Schiavo's body, he said, their bodies have a built-in mechanism that shields them from discomfort. He described it this way:
Without nutrition, the body enters a phase known as ketosis. That's when the body draws on its alternate energy system of fat. As fat is broken down for energy, it produces a byproduct known as ketones, which are absorbed by the brain and liver, relieving pangs of hunger.
In the ketosis phase, the body also produces endorphins, a morphine-like chemical, that dulls pain.
"Patients with metastatic cancer may need extra pain medication but, for the rest, the body really does protect itself," Miller said. "It's really a very normal, natural process that, from talking to patients, is not painful."
Representing Schiavo's parents, Miami lawyer Jack Thompson disagrees. In a letter urging Gov. Jeb Bush to order the resumption of Schiavo's twice-a-day feedings, Thompson said dying by dehydration makes death in the electric chair look like an "act of compassion."
Thompson, among the lawyers who answered the governor's appeal for help, said he plans to file a writ in Pinellas Circuit Court today demanding the governor step in.
After meeting Wednesday with Schaivo's parents, Bob and Mary Schindler, Bush said he'd like to do exactly that, but his legal staff Thursday was still researching whether he has the authority.
The courts consistently have ruled that Schiavo's husband, Michael, is carrying out his wife's wishes not to be kept alive by artificial means, but her parents have fought every step of the way. They insist their daughter could be rehabilitated.
Schiavo has been in a vegetative state in Pinellas County since 1990, when she collapsed from what doctors said was a potassium imbalance.
Maya Bell can be reached at mbell@orlandosentinel.com or 305-810-5003. |
