Wednesday, March 23, 2005
Don't Feed Me, I'm Fat!
Eating disorders and inscrutable actions
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Unless a court orders that her feeding tube be reinserted, Terri Schiavo will probably die in the next three weeks of a fatal heart rhythm brought on by the chemical imbalances that arise from extreme dehydration, according to several experts on end-of-life medical care.
But, they are quick to add, that is just a guess. Very little is known about the timing and mechanism of death when food and water are withheld from people with severe brain damage who are otherwise in fairly good health. Not many people have that experience. Studying their deaths is an extremely low priority.
With advanced dehydration, the functioning of many vital organs -- heart, brain, kidneys, lungs -- worsens. But it is difficult to say which is first to fail, tipping a person irreversibly toward death, said Porter Storey, a leader of the American Academy of Hospice and Palliative Medicine who was the medical director of a hospice in Houston for 18 years. [...]
[...] "Their breathing slows down, and then their next breath doesn't come," he said yesterday. "Does that mean the brain, which sends a signal to the lungs, goes first? Or does it mean the lungs failed? We do not precisely know why people die, and it is not something that can be answered by scientific experiment."
Each day the body produces waste (such as acid, potassium and a nitrogen-containing compound called urea) that must be excreted in urine to prevent it from accumulating to toxic levels. To do that, the kidneys require a minimum volume of water, which they extract from the blood, in which to dissolve those substances.
When dehydration becomes severe, the kidneys essentially run out of water to make urine. As production of urine falls, the concentration of toxins rises.
In the Senate, Republicans circulated a “talking points” memo last week discussing Ms. Schiavo’s fate in terms that emphasized political opportunism. “This is an important moral issue and the pro-life base will be excited that the Senate is debating this important issue,” that memo explained. “This is a great political issue, because Senator [Ben] Nelson of Florida has already refused to become a cosponsor [of the Schiavo bill] and this is a tough issue for Democrats.”
In the House, Majority Leader Tom DeLay rightly denounced that Senate memo as “disgusting.” But then a recording surfaced of remarks he’d delivered the other day to the Family Research Council, a powerful religious-right group that backs Republicans. There Mr. DeLay declared that the Almighty—working as always in the most mysterious ways—intended that Ms. Schiavo should relieve him of his mounting legal and ethical problems.
“One thing that God has brought to us is Terri Schiavo, to help elevate the visibility of what is going on in America,” Mr. DeLay explained, according to
The New York Times. “This is exactly the issue that is going on in America, of attacks against the conservative movement, against me and against many others.” (He also mentioned “a huge, nationwide, concerted effort to destroy everything we believe in”—a category that clearly includes free golf vacations provided by casino lobbyists.)
And in the White House, George W. Bush rose from his bed the other night to sign the bill that provides a special privilege of federal legal appeal solely to Ms. Schiavo’s parents. For dramatic effect, he had rushed back to the capital from Texas. Perhaps he didn’t want to sign that awful legislation in his home state, thus recalling another law he signed as Governor in 1999.
So why did Congress intervene? Mr Bush says that in cases like Mrs Schiavo's, it is wise to “always err on the side of life”. That is surely correct: in the absence of a living will, the presumption ought to be that someone would prefer to live rather than to die. But such a right cannot be unqualified: should she be kept alive in the minuscule hope of a recovery for 20 years, 50 years? In the end doctors, governed by the law and the judicial system, do have to take such decisions. Furthermore, Mr Bush and Congress need to take account of the costs of their intervention, particularly when it comes to setting all sorts of unfortunate constitutional precedents.
The Schiavo bill is an extraordinary piece of federal interference in the judicial system. In order to get it passed, the Republicans had to limit their bill to Mrs Schiavo; but it will surely justify a surge of similar heart-breaking requests. The bill also specifically tells the federal judge to examine the case “notwithstanding any prior state-court determination”. The Republicans, who are usually stern defenders of states' rights, may come to rue the day when they urged the federal system to ignore them.
Sen. Bill Frist last week watched a videotape of Terri Schiavo made in 2001. He did this in his capacity as Senate majority leader and as a renowned physician. In both roles, he performed miserably. As a senator, he showed himself to be an unscrupulous opportunist. As a physician, he was guilty of practicing medicine without a brain. After viewing the tape, Frist (R-Tenn.) felt confident to question the several courts and many doctors who - apparently handicapped by firsthand examinations - had erroneously concluded that Terri Schiavo was in a "persistent vegetative state."
"I question it based on a review of the video footage," he told the Senate. "She certainly seems to respond to visual stimuli." Doubtful. Frist and his colleagues were responding to political stimuli - the so-called right-to-life crowd. Frist and his (mostly) GOP colleagues were operating under such pressure that they sometimes did not know which subterfuge to adopt. It should not matter - it must not matter - if Terri Schiavo is really in a vegetative state or not. What should matter - under right-to-life reasoning - is that she is alive. Life is life, Frist. Get with the program.
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