Chicago526
<font color=red>Any dream will do...<br><font colo
- Joined
- May 6, 2003
- Messages
- 11,024
I read this article on Chicago Tribune's website. I thought I'd share, since a lot of DISer's are following the Terri Schiavo case.
Is starvation a painful way to die?
Suffering is uncommon, experts say
By Jeremy Manier
Tribune staff reporter
Published March 22, 2005
http://www.chicagotribune.com/news/...2starvation,1,6855148.story?coll=chi-news-hed
One of the main rationales of religious advocates and lawmakers seeking to keep Terri Schiavo alive through a feeding tube has been that removing her only source of nutrition and liquid would be cruel, leading to a "horrible and painful death," in the words of one activist.
But many of the doctors and nurses who witness the consequences of removing such treatment from patients say withholding nourishment is a commonand largely painlessway of letting nature take its course for ill patients. They say many people near death actually choose to have their feeding tubes removed, which typically leads to a calm, peaceful death.
Most of the experience comes from patients whose cases may differ from that of Schiavo, who has survived for 15 years in a persistent vegetative state. But experts say Schiavo, who is in a Florida hospice, likely would be given the same simple care that makes feeding tube removal an easy way out for many patients and their families.
The most common problem is a dry mouth and thirstiness, which caregivers treat with moist swabs and ice chips, if a patient is able to swallow. Those are steps Schiavo would have needed for some time, since she hasn't taken food or drink through her mouth since the 1990 heart stoppage that left her permanently brain damaged.
None of the doctors, nurses and hospice employees interviewed for this article said they have ever seen removal of a feeding tube increase suffering of a hospice patient.
"I've helped thousands of people be comfortable at the end of life," said Dr. Michael Marschke, medical director for Horizon Hospice in Chicago. "Most stop eating on their own, and they're very comfortable doing it."
Some hospice workers said they feel the controversy over Schiavo has placed their mission in question. They also criticized what they described as bad information put out by lawmakers who over the weekend moved to allow a federal court to decide Schiavo's fate.
Rep. Jim Ryun (R-Kan.) said that Michael Schiavo, by testifying that his wife would have wanted the tube removed, "sentenced her to a most excruciating death."
'They're wrong'
"I listened to those representatives, and I was appalled," Marschke said. "They're wrong. To talk like that is an injustice to the public."
A 2003 survey of Oregon hospice nurses whose patients had chosen to speed death by refusing food or fluids found that those patients experienced relatively little apparent pain or suffering. About one-third of the nurses contacted had at least one patient who chose that course in the previous four years, according to the study, published in the New England Journal of Medicine.
Most of the deaths "were peaceful, with little suffering, although 8 percent of patients were thought to have had a relatively poor quality of death," the authors wrote.
Advocates for Terri Schiavo's survival insist the dehydration process is painful, and they have cited the experience of one former patient, Kate Adamson, who had her feeding tube removed and has described it as "torture." But most people who provide end-of-life care said her story is not typical.
Some patients feel hungry for two or three days after the withdrawal of food, but experts said it's a surprisingly short-lived sensation. After that the body begins a process called ketosis, getting energy from fat stores.
Many experts believe that chemicals released in the process have the effect of relieving hunger and may even give rise to a feeling of euphoria. Oddly, having even a little food at such times may create more hunger than complete starvation.
"Within a few days, you're not very hungry," said Dr. Jeff Frank, a neurologist at the University of Chicago who has watched many patients die after having feeding tubes removed. "When you eat something, you actually feel uncomfortable."
Studies have shown that feeding tubes do not produce the same feeling of satiety that normal eating produces. Therefore, removing a tube probably does not result in the same sort of hunger that a normal fast would, Frank said.
Patients become sleepy
Lack of water makes the body stop producing urine in an effort to conserve fluid. The body retains more sodium and waste products, some of which tend to make patients sleepy.
"You get a level of sedation that enhances comfort," said Nancy Harte, a registered nurse and director of the Rainbow Hospice LIFE Institute for Learning in Park Ridge.
After a week or so, the patient's blood pressure decreases, and eventually blood carbon dioxide levels increase, starting a terminal spiral. More carbon dioxide lowers blood pressure further, making it harder for the body to get enough oxygen. The increase in carbon dioxide has a separate sedative effect, often called "CO2 narcosis." Most patients die of an infection or from cardiac arrest.
Many experts said it's only natural to assume that withholding water and food would be painful. Susan Dolan, executive director of Des Plaines-based Seasons Hospice, said her staff has a name for such reactions: "The out-of-towner syndrome."
"The family at the bedside has accepted what's happening, then sister Sue shows up, sees that Mom has lost 50 pounds, and she has a knee-jerk reaction," Dolan said. "It's the same thing with Terri Schiavo; if you're hearing about this for the first time, it's like, 'Oh my gosh, they're starving her, do something.'"
Doctors said one risk of the crisis may be to cast suspicion on the practice of removing feeding tubes. One bill that passed the U.S. House last week but failed in the Senate would have given federal courts broad power to review the removal of feeding tubes.
Marschke of Horizon Hospice said such measures would take away what is, for many families, the best option.
"There are lots of patients dying this way," Marschke said, "and now their family members will be concerned they're doing the wrong thing. All for the sport of politics."
Is starvation a painful way to die?
Suffering is uncommon, experts say
By Jeremy Manier
Tribune staff reporter
Published March 22, 2005
http://www.chicagotribune.com/news/...2starvation,1,6855148.story?coll=chi-news-hed
One of the main rationales of religious advocates and lawmakers seeking to keep Terri Schiavo alive through a feeding tube has been that removing her only source of nutrition and liquid would be cruel, leading to a "horrible and painful death," in the words of one activist.
But many of the doctors and nurses who witness the consequences of removing such treatment from patients say withholding nourishment is a commonand largely painlessway of letting nature take its course for ill patients. They say many people near death actually choose to have their feeding tubes removed, which typically leads to a calm, peaceful death.
Most of the experience comes from patients whose cases may differ from that of Schiavo, who has survived for 15 years in a persistent vegetative state. But experts say Schiavo, who is in a Florida hospice, likely would be given the same simple care that makes feeding tube removal an easy way out for many patients and their families.
The most common problem is a dry mouth and thirstiness, which caregivers treat with moist swabs and ice chips, if a patient is able to swallow. Those are steps Schiavo would have needed for some time, since she hasn't taken food or drink through her mouth since the 1990 heart stoppage that left her permanently brain damaged.
None of the doctors, nurses and hospice employees interviewed for this article said they have ever seen removal of a feeding tube increase suffering of a hospice patient.
"I've helped thousands of people be comfortable at the end of life," said Dr. Michael Marschke, medical director for Horizon Hospice in Chicago. "Most stop eating on their own, and they're very comfortable doing it."
Some hospice workers said they feel the controversy over Schiavo has placed their mission in question. They also criticized what they described as bad information put out by lawmakers who over the weekend moved to allow a federal court to decide Schiavo's fate.
Rep. Jim Ryun (R-Kan.) said that Michael Schiavo, by testifying that his wife would have wanted the tube removed, "sentenced her to a most excruciating death."
'They're wrong'
"I listened to those representatives, and I was appalled," Marschke said. "They're wrong. To talk like that is an injustice to the public."
A 2003 survey of Oregon hospice nurses whose patients had chosen to speed death by refusing food or fluids found that those patients experienced relatively little apparent pain or suffering. About one-third of the nurses contacted had at least one patient who chose that course in the previous four years, according to the study, published in the New England Journal of Medicine.
Most of the deaths "were peaceful, with little suffering, although 8 percent of patients were thought to have had a relatively poor quality of death," the authors wrote.
Advocates for Terri Schiavo's survival insist the dehydration process is painful, and they have cited the experience of one former patient, Kate Adamson, who had her feeding tube removed and has described it as "torture." But most people who provide end-of-life care said her story is not typical.
Some patients feel hungry for two or three days after the withdrawal of food, but experts said it's a surprisingly short-lived sensation. After that the body begins a process called ketosis, getting energy from fat stores.
Many experts believe that chemicals released in the process have the effect of relieving hunger and may even give rise to a feeling of euphoria. Oddly, having even a little food at such times may create more hunger than complete starvation.
"Within a few days, you're not very hungry," said Dr. Jeff Frank, a neurologist at the University of Chicago who has watched many patients die after having feeding tubes removed. "When you eat something, you actually feel uncomfortable."
Studies have shown that feeding tubes do not produce the same feeling of satiety that normal eating produces. Therefore, removing a tube probably does not result in the same sort of hunger that a normal fast would, Frank said.
Patients become sleepy
Lack of water makes the body stop producing urine in an effort to conserve fluid. The body retains more sodium and waste products, some of which tend to make patients sleepy.
"You get a level of sedation that enhances comfort," said Nancy Harte, a registered nurse and director of the Rainbow Hospice LIFE Institute for Learning in Park Ridge.
After a week or so, the patient's blood pressure decreases, and eventually blood carbon dioxide levels increase, starting a terminal spiral. More carbon dioxide lowers blood pressure further, making it harder for the body to get enough oxygen. The increase in carbon dioxide has a separate sedative effect, often called "CO2 narcosis." Most patients die of an infection or from cardiac arrest.
Many experts said it's only natural to assume that withholding water and food would be painful. Susan Dolan, executive director of Des Plaines-based Seasons Hospice, said her staff has a name for such reactions: "The out-of-towner syndrome."
"The family at the bedside has accepted what's happening, then sister Sue shows up, sees that Mom has lost 50 pounds, and she has a knee-jerk reaction," Dolan said. "It's the same thing with Terri Schiavo; if you're hearing about this for the first time, it's like, 'Oh my gosh, they're starving her, do something.'"
Doctors said one risk of the crisis may be to cast suspicion on the practice of removing feeding tubes. One bill that passed the U.S. House last week but failed in the Senate would have given federal courts broad power to review the removal of feeding tubes.
Marschke of Horizon Hospice said such measures would take away what is, for many families, the best option.
"There are lots of patients dying this way," Marschke said, "and now their family members will be concerned they're doing the wrong thing. All for the sport of politics."
