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A "Painless" Death?
WESLEY J. SMITH
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?
An accurate discussion of this sensitive issue requires the making of proper and nuanced distinctions about the consequences of removing nourishment from incapacitated patients. This generally becomes an issue in one of the following two diametrically differing circumstances:
Advocates who argue that it is appropriate to dehydrate cognitively disabled people often sow confusion about the suffering such patients may experience by inadvertently, or perhaps intentionally, blurring the difference between these two distinct situations. For example, when Michael Schiavo, Terri's husband, and his attorney, George Felos, appeared on the October 27, 2003 edition of "Larry King Live" the following exchange occurred:
Later in the interview, Schiavo reiterated the assertion in a response to a telephoned question:
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.
What happens to non-terminally ill people with cognitive disabilities whose feeding tubes are removed? Do they suffer from the process?
When I conducted research on this question in preparation for writing my book Forced Exit, I asked St. Louis neurologist William Burke these very questions. Here is what he told me:
Dr. Burke opposes removing feeding tubes from cognitively disabled
people and so some might dismiss his opinion as biased. But Minnesota
neurologist Ronald Cranford's pro-dehydration testimony in the Robert
Wendland case — Cranford also testified that Terri's feeding tube should
be removed — supports much of what Dr. Burke asserted. While Cranford
called seizures "rare," his detailed description of the dehydration
process reveals its gruesome reality:
Most of the time, we never know for sure what a starved
or dehydrated person experiences. But in at least one case — that of a
young woman who had her feeding tube removed for eight days and lived to
tell the tale — we have direct evidence of the agony that forced
dehydration may cause.
In preparation for this article, I contacted Adamson for more details about the torture she experienced while being dehydrated. She told me about having been operated upon (to have her feeding tube inserted in her abdomen) with inadequate anesthesia when doctors believed she was unconscious. Unbelievably, she described being deprived of food and water as "far worse" than experiencing the pain of abdominal surgery, telling me:
But what about the thirst, I asked:
Apologists for dehydrating patients like Terri might respond that Terri is not conscious and locked-in as Adamson was but in a persistent vegetative state and thus would feel nothing. Yet, the PVS diagnosis is often mistaken — as indeed it was in Adamson's case. And while the courts have all ruled that Terri is unconscious based on medical testimony, this is strongly disputed by other medical experts and Terri's family who insist that she is interactive with them. Moreover, it is undisputed that whatever her actual level of awareness, Terri does react to painful stimuli. Intriguingly, her doctor testified he prescribes pain medication for her every month during the course of her menstrual period.
Beyond the Terri Schiavo case, it is undisputed that conscious cognitively disabled patients are dehydrated in nursing homes and hospitals throughout the country almost as a matter of routine. Dr. Cranford, for example, openly admitted in his Wendland testimony that he removes feeding tubes from conscious patients. Thus, many other people may also have experienced the agony described by Adamson and worse, given that dehydrating to death goes on for about a week longer than she experienced.
At this point, defenders of removing feeding tubes from people with profound cognitive disabilities might claim that whatever painful sensations dehydration may cause, these patients receive palliating drugs to ensure that their deaths are peaceful. But note: Adamson either did not receive such medications, or if she did, they didn't work. Moreover, because these disabled people usually can't communicate, it is impossible to know precisely what they experience. Thus, when asked in a deposition what he would do to prevent Robert Wendland from suffering during his dehydration, Dr. Cranford responded that he would give morphine but that the dose would be "arbitrary" because "you don't know how much he's suffering, you don't know how much aware he is . . . You're guessing at the dose." At trial, Cranford suggested he might have to put Wendland into a coma, a bitter irony considering that he had struggled over many months to regain consciousness.
The time has come to face the gut wrenching possibility that conscious cognitively disabled people whose feeding tubes are removed — as opposed to patients who are actively dying and choose to stop eating — may die agonizing deaths. This, of course, has tremendous relevance in the Terri Schiavo case and many others like it. Indeed, the last thing anyone wants is for people to die slowly and agonizingly of thirst, desperately craving a refreshing drink of orange Gatorade they know will never come.
Wesley J. Smith "A "Painless" Death?" Daily Standard (November 13, 2003).
Will permission from Wesley J. Smith.
Wesley J. Smith, a senior fellow at the Discovery Institute, is an attorney and consultant for the International Task Force on Euthanasia and Assisted Suicide and a special consultant to the Center for Bioethics and Culture. He is an international lecturer and public speaker, appearing at political, university, medical, legal, bioethics, and community gatherings across the United States, Canada, Europe, South Africa, and Australia.
In May 2004, National Journal named Smith one of the nation's top expert thinkers in bioengineering because of his work in bioethics.
Attorney Wesley J. Smith is the author or co/author of 10 books. His most recent book Consumer's Guide to a Brave New World, ponders the dangers and potential benefits of human cloning, stem cell therapies, and genetic engineering. Among his other books are Culture of Death: The Assault on Medical Ethics in America, Power Over Pain: How to Get the Pain Control You Need, and Forced Exit: the Slippery Slope from Assisted Suicide to Legalized Murder. He is currently conducting research for a book he will write on the animal rights/liberation movement.
Wesley J Smith's writing and opinion columns have appeared in such national and regional news publications as Newsweek, the New York Times, the Weekly Standard magazine, National Review, the Wall Street Journal, USA Today, the New York Post, First Things, Forbes magazine, the San Francisco Chronicle, and the Detroit News among many others. Smith has appeared internationally on the electronic media, including such programs as CNN Crossfire, Larry King Live, Good Morning America, Nightline, and the Sunday Program on BBC 4 radio. Wesley J. Smith is on the advisory board of the Catholic Educator's Resource Center.
Copyright © 2005 Wesley J. Smith