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    End-of-Life Decisions: What Would You Want?

    Schiavo Case Forces Americans to Think About the Unthinkable

    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.

    "She has a clear plastic tube that enters the middle of her abdomen," Lamers tells WebMD. "Food is prepared in a blender and poured into a spout and gravity-drained into her stomach. That can provide sufficient calories to keep her alive year after year. It is a wet mixture, so it provides hydration as well."

    What would happen if the tube were removed? Schiavo would die of dehydration and malnutrition. That sounds terrible.

    "When the feeding tube is discontinued, she goes into a negative protein balance," Lamers says. "Her body begins to metabolize her reservoirs of fat and muscle tissue. That - or, if she doesn't get water, dehydration -- will probably be the thing that causes her kidneys and liver to stop functioning. Then she will go from kidney and liver failure to heart or brain dysfunction and die."

    Surprisingly, Lamers says, it's a gentle death - and one chosen by many terminally ill patients. Lamers has attended many patients who have chosen to die this way.

    "That kind of a death is not very painful," he says. "We know this from a tremendous amount of observations in patients who voluntarily stopped eating. They didn't experience a great deal of pain or discomfort."

    Most of the pain, Lamers says, is felt by the patient's family.

    "It is usually more difficult for the family," he says. "And it is difficult to let go. You have to sit there and listen to the family, and encourage discussion between the patient and the family so they get their reasoning out in front of everybody. I have done this with people who wanted to discontinue dialysis, disconnect the respirator, remove the feeding tube - there comes a time when people want to say enough is enough. The determination the family needs to make is this: "Is this a reasonable conclusion to make right now, to say I will die a natural death from lack of oxygen or food or water?"

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