• May We Die in Peace?
  • Like everyone else in this country and much of the world, we have been caught up in the firestorm of divergent opinions and strong feelings about the Terri Schiavo end of life conflict. The medical members of the PERF Board of Directors have all had extensive experience in intensive care units as well as with end of life issues...and in all the different vagaries this subject can present. Unfortunately, we all have been involved in cases like Terri's, which means we have informed opinions on this tragedy. And a tragedy it is for everyone involved. In response to the intense interest that has been expressed, we asked Dr. Petty to write something on this subject for us. As a pulmonologist, he has often worked with grieving families, been on many ethics committees and has survived personal experience with near death on several occasions. We feel he is uniquely qualified to address this subject.
  • A peaceful death is the hope of all who must die, and this includes us all. The prophecy of life for three score years and ten is offered by the 90th Psalm, with the encouragement, "If by reason of strength (life span) may be four score years." "But then the spirit dies and flies away." This is where the term "passing away" is derived. The "passing" means something different to various cultures, beliefs and religions, but no religion denies the fact of death. Indeed every society has found the need to create a "higher belief," which I believe to be a spiritual religion, at least in part, to deal with the inevitable.
  • Terri Schiavo's life was tragically shortened at the time of her cardiac arrest, which was due to a serious chemical (electetrolyte) disturbance, at a time that she was drastically dieting to lose weight. This led to a sudden and irreversible damage of the thinking and functioning part of the brain, and left her in the persistent vegetative state that became so controversial. Anyone with knowledge of her medical condition, as well as the extensive studies which showed no remaining thinking or feeling functions, knew this was so. Many self styled "experts" got involved and created a controversy which should never have happened.
  • Sadly, Terri Schiavo has been denied peace in death. But even in her vegetative state, she is denied the death of her remaining body by many because of a lack of understanding about the certainty of her never being able to recover enough to participate in her environment.
  • She is entitled to the right to self-determination, and to the right to privacy by the US Constitution and the Common Law. Her husband knew her wishes and properly acted as her surrogate decision maker. Too bad that she did not have a living will, or a durable power of attorney. But in fact, the bond and understanding between Terri and her husband was properly handled by the only person charged with this responsibility.
  • Tragically, this case got to the courthouse, and to the Florida State Legislature and amazingly, to the legislative and executive branches of our Federal Government. Even worse, it became a feeding frenzy by the press. This is particularly troublesome, because no national media, or newsprint media, that I saw ever produced a group of credible physicians, armed with her CT scan which showed little thinking cortex, if any, remaining! I finally saw her CT scans on local TV last night. Earlier electroencephalogram tests showed no significant higher brain activity. Thus the press became part of a conspiracy to maintain a contrived controversy about her life and death processes. Fortunately the judicial branch of our Government has been responsible to an extreme, and Terri and her husband have had due process. The wisdom of our Founding Fathers, who established the principle of separation of powers, continues to hold!
  • The feeding tube was a life support measure for her, just like hemodialysis or a respirator is for patients who are capable of recovery. These technologies are used to "buy time" to allow for nature's healing processes, in cases of acute organ system injuries. The respirator is connected to the airway of a patient to provide for oxygen to reach the tissues for the purpose of metabolism of food for energy production. The tube and respirator are removed when recovery has occurred. Sometimes the tube and respirator are discontinued in states of futility. This is the appropriate use of the feeding tube and respirator.
  • In Terri's case the feeding tube in her stomach provided food and water to be metabolized in the tissues for energy production. This life support kept her body going for 15 years during which there was no recovery. Respirators are only used temporally until the patient recovers. Respirators should not be used to extend death in futile situations. In Terri's case the feeding tube has been in place far too long, because of the futile situation. Terri's prolonged feeding tube use is considered "extraordinary care" in most ethical and religious circles.
  • Other principles have been violated. The principle of "distributive justice" means that everyone has a right to the financial, and legal resources that Terri has. These limited resources should not be squandered on one individual, when their use is futile. The principle of reason, i.e. common sense, was abandoned. Terri has not been alive in the normal sense for years. In this dilemma, she cannot live, because her mind and soul have gone. But she can't die finally, in the somatic sense, because of massive parental and governmental interference. The husband, family and friends cannot have a funeral. They cannot come to closure with this tragedy. What could be worse?
  • The concerns about dehydration or starvation need to be set aside. I have had many patients, and personal medical friends, choose not to drink or eat because they find pain and suffering in continued existence, and relief after they no longer eat or drink. In these cases and in other chronic states of illness, such as in advanced cancer, renal or liver failure, and failure of respiration the body pours out nature's opiates, called endorphins, and Indeed it becomes a "good death" and people can die in peace. Terri finally "died" after 15 years of struggle. May everyone learn from this sad experience.
  • Thomas L. Petty MD

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