End-of-Life Decisions: What Would You Want?
Schiavo Case Forces Americans to Think About the Unthinkable
WebMD News Archive
March 21, 2005 - What would Terri Schiavo want?
Would the brain-damaged Florida woman want doctors to remove the feeding tube that has kept her alive for 16 years? Her husband believes she would. Would she instead prefer to keep whatever life remains to her? Her siblings and parents believe so.
And what about us? Whatever we think about the Schiavo case, it forces all of us to ask ourselves a troubling question. If we were in the same situation as Terri Schiavo, what would we want?
It may be the most important decision we ever make.
To get that information, WebMD turned to two end-of-life experts.
End-of-Life Decisions: Brain Death vs. Persistent Vegetative State
Richard Demme, MD, leads the ethics committee at the University of Rochester Medical Center in New York. His group is responsible for determining what kinds of life-prolonging medical care - if any - patients want.
Schiavo, Demme notes, is not brain dead. Brain death means that there is no longer any electrical activity in any part of the brain. People who are brain dead cannot breathe on their own - and Terri Schiavo clearly can.
Most of the doctors in the Schiavo case say she is in something called a persistent vegetative state. Demme, who saw her brain scans at a medical meeting, agrees.
"It means the lower part of the brain that tells her lungs to breathe is still intact. But it doesn't mean she has any thoughts or the ability to experience anything," Demme tells WebMD. "Her brain is pretty much full of fluid. Barring some miracle, she will never get any better than she is now. There is nothing in medicine we know of that will make her able to think or experience again. To suggest there are medical therapies that can help her - that all she needs is tender loving care and she will be romping in the back yard again - is cruel."
Just because a patient will never get better doesn't mean that person wants to die, Demme notes.
"Studies find that roughly two-thirds of Americans say, 'Quality of life is really important to me.' They would rather die a little sooner if their remaining life would be better," he says. "And about a third of Americans say, 'I don't care how bad things get, I will take every little gasp of life I can get, because death lasts a long time.'"
Some 40,000 Americans, Demme says, are living in a persistent vegetative state.
"Their loved ones think they may get some satisfaction from their lives," he says. "There is no consensus on this. Some people think, 'I would not like to live like that.'"
End-of-Life Decisions: Feeding Tube Removal
Terri Schiavo can't chew or swallow. She's kept alive by a feeding tube, says William Lamers, MD, medical consultant for The Hospice Foundation of America. Lamers, one of the first doctors to develop a hospice program in the United States, has led the standards and accreditation committee of the National Hospice Organization.