- Hello, Jeff - If it is such a natural way to die and
so painless then maybe we should like Michael Schiavo in a room for 10
days, no food, and no water and see if he thinks it is such a "gentle
- By Wesley J. Smith
- First Published 11-12-3
- Many who support Terri Schiavo's threatened dehydration
assert that removing a feeding tube from a profoundly cognitively disabled
person results in a painless and gentle ending. But is this really true?
After all, it would be agonizing if you or I were locked in a room for
two weeks and deprived of all food and water. So, why should we believe
that cognitively disabled patients experience the deprivation differently
simply because they receive nourishment through a feeding tube instead
of by mouth?
- An accurate discussion of this sensitive issue requires
the making of proper and nuanced distinctions about the consequences of
removing nourishment from incapacitated patients. This generally becomes
an issue in one of the following two diametrically differing circumstances:
- (1) Depriving food and water from profoundly cognitively
disabled persons like Terri who are not otherwise dying, a process that
causes death by dehydration over a period of 10-14 days. As I will illustrate
below, this may cause great suffering.
- (2) Not forcing food and water upon patients who have
stopped eating and drinking as part of the natural dying process. This
typically occurs, for example, at the end stages of cancer when patients
often refuse nourishment because the disease has distorted their senses
of hunger and thirst. In these situations, being deprived of unwanted food
and water when the body is already shutting down does not cause a painful
- Advocates who argue that it is appropriate to dehydrate
cognitively disabled people often sow confusion about the suffering such
patients may experience by inadvertently, or perhaps intentionally, blurring
the difference between these two distinct situations. For example, when
Michael Schiavo, Terri's husband, and his attorney, George Felos, appeared
on the October 27, 2003 edition of "Larry King Live" the following
- KING: When a feeding tube is removed, as it was planned
[for Terri], is that a terrible death?
- SCHIAVO: No. It's painless and probably the most natural
way to die.
- FELOS: When someone's terminally ill, let's say a cancer
patient, they lose interest in eating. And literally, they--by choice--they
- SCHIAVO: Cancer patients, they stop eating for two to
three weeks. Do we force them to eat? No, we don't. That's their choice.
- Later in the interview, Schiavo reiterated the assertion
in a response to a telephoned question:
- CALLER: Does it bother you that the death is so slow?
- SCHIAVO: Removing somebody's feeding tube is very painless.
It is a very easy way to die. Probably the second best way to die, the
first being an aneurysm.
- Yes, it is true that when people are actively dying from
terminal disease, they often refuse food and water. The disease makes the
food and water repulsive to them. In such circumstances, it is medically
inappropriate to force food and water into a person who is actively rejecting
it. Indeed, doing so could cause suffering.
- But this isn't what is happening to Terri. She isn't
dying of cancer. Her body isn't shutting down as part of the natural dying
process. Indeed, she is not dying at all--unless her food and water is
- What happens to non-terminally ill people with cognitive
disabilities whose feeding tubes are removed? Do they suffer from the process?
- When I conducted research on this question in preparation
for writing my book "Forced Exit," I asked St. Louis neurologist
William Burke these very questions. Here is what he told me:
- A conscious [cognitively disabled] person would feel
it just as you or I would. They will go into seizures. Their skin cracks,
their tongue cracks, their lips crack. They may have nosebleeds because
of the drying of the mucus membranes, and heaving and vomiting might ensue
because of the drying out of the stomach lining. They feel the pangs of
hunger and thirst. Imagine going one day without a glass of water! Death
by dehydration takes ten to fourteen days. It is an extremely agonizing
- Dr. Burke opposes removing feeding tubes from cognitively
disabled people and so some might dismiss his opinion as biased. But Minnesota
neurologist Ronald Cranford's pro-dehydration testimony in the Robert Wendland
case--Cranford also testified that Terri's feeding tube should be removed--supports
much of what Dr. Burke asserted. While Cranford called seizures "rare,"
his detailed description of the dehydration process reveals its gruesome
- After seven to nine days [from commencing dehydration]
they begin to lose all fluids in the body, a lot of fluids in the body.
And their blood pressure starts to go down. When their blood pressure goes
down, their heart rate goes up. . . . Their respiration may increase and
then . . .
- the blood is shunted to the central part of the body
from the periphery of the body. So, that usually two to three days prior
to death, sometimes four days, the hands and the feet become extremely
cold. They become mottled. That is you look at the hands and they have
a bluish appearance. And the mouth dries a great deal, and the eyes dry
a great deal and other parts of the body become mottled. And that is because
the blood is now so low in the system it's shunted to the heart and other
visceral organs and away from the periphery of the body . . .
- Most of the time, we never know for sure what a starved
or dehydrated person experiences. But in at least one case--that of a young
woman who had her tube feeding stopped for eight days and lived to tell
the tale--we have direct evidence of the agony that forced dehydration
- At age 33, Kate Adamson collapsed from a devastating
and incapacitating stroke. She was utterly unresponsive and was diagnosed
as being in a persistent vegetative state (PVS). Because of a bowel obstruction
she developed, her nourishment was stopped so that doctors could perform
- Adamson eventually recovered sufficiently to author "Kate's
Journey: Triumph Over Adversity," in which she tells the terrifying
tale. Rather than being unconscious with no chance of recovery as her doctors
believed, she was actually awake and aware but unable to move any part
of her body voluntarily. (This is known as a "locked-in state.")
When she appeared recently on "The O'Reilly Factor,"host Bill
O'Reilly asked Adamson about the dehydration experience:
- O'REILLY: When they took the feeding tube out, what went
through your mind?
- ADAMSON: When the feeding tube was turned off for eight
days, I thought I was going insane. I was screaming out in my mind, "Don't
you know I need to eat?" And even up until that point, I had been
having a bagful of Ensure as my nourishment that was going through the
feeding tube. At that point, it sounded pretty good. I just wanted something.
The fact that I had nothing, the hunger pains overrode every thought I
- O'REILLY: So you were feeling pain when they removed
- ADAMSON: Yes. Oh, absolutely. Absolutely. To say that--especially
when Michael [Schiavo] on national TV mentioned last week that it's a pretty
painless thing to have the feeding tube removed--it is the exact opposite.
It was sheer torture, Bill.
- O'REILLY: It's just amazing.
- ADAMSON: Sheer torture . . .
- In preparation for this article, I contacted Adamson
for more details about the torture she experienced while being dehydrated.
She told me about having been operated upon (to remove the bowel obstruction)
with inadequate anesthesia when doctors believed she was unconscious:
- The agony of going without food was a constant pain that
lasted not several hours like my operation did, but several days. You have
to endure the physical pain and on top of that you have to endure the emotional
pain. Your whole body cries out, "Feed me. I am alive and a person,
don't let me die, for God's Sake! Somebody feed me."
- Unbelievably, she described being deprived of food and
water as "far worse" than experiencing the pain of abdominal
surgery. Despite having been on an on an IV saline solution, Adamson still
had horrible thirst:
- I craved anything to drink. Anything. I obsessively visualized
drinking from a huge bottle of orange Gatorade. And I hate orange Gatorade.
I did receive lemon flavored mouth swabs to alleviate dryness but they
did nothing to slack my desperate thirst.
- Apologists for dehydrating patients like Terri might
respond that Terri is not conscious and locked-in as Adamson was but in
a persistent vegetative state and thus would feel nothing. Yet, the PVS
diagnosis is often mistaken--as indeed it was in Adamson's case. And while
the courts have all ruled that Terri is unconscious based on medical testimony,
this is strongly disputed by other medical experts and Terri's family who
insist that she is interactive with them. Moreover, it is undisputed that
whatever her actual level of awareness, Terri does react to painful stimuli.
Intriguingly, her doctor testified he prescribes pain medication for her
every month during the course of her menstrual period.
- Beyond the Terri Schiavo Case, it is undisputed that
conscious cognitively disabled patients are dehydrated in nursing homes
and hospitals throughout the country almost as a matter of routine. Dr.
Cranford, for example, openly admitted in his Wendland testimony that he
removes feeding tubes from conscious patients. Thus, many other people
may also have experienced the agony described by Adamson and worse, given
that dehydrating to death goes on for about a week longer than she experienced.
- At this point, defenders of removing feeding tubes from
people with profound cognitive disabilities might claim that whatever painful
sensations dehydration may cause, these patients receive palliating drugs
to ensure that their deaths are peaceful. But note: Adamson either did
not receive such medications, or if she did, they didn't work. Moreover,
because these disabled people usually can't communicate, it is impossible
to know precisely what they experience. Thus, when asked in a deposition
what he would do to prevent Robert Wendland from suffering during his dehydration,
Dr. Cranford responded that he would give morphine but that the dose would
be "arbitrary" because "you don't know how much he's suffering,
you don't know how much aware he is . . . You're guessing at the dose."
At trial, Cranford suggested he might have to put Wendland into a coma,
a bitter irony considering that he had struggled over many months to regain
- The time has come to face the gut wrenching possibility
that conscious cognitively disabled people whose feeding tubes are removed--as
opposed to patients who are actively dying and choose to stop eating--may
die agonizing deaths. This, of course, has tremendous relevance in the
Terri Schiavo case and many others like it. Indeed, the last thing anyone
wants is for people to die slowly and agonizingly of thirst, desperately
craving a refreshing drink of orange Gatorade they know will never come.
- Wesley J. Smith is a senior fellow at the Discovery Institute
and an attorney and consultant for the International Task Force on Euthanasia
and Assisted Suicide. His current book is the revised and updated "Forced
Exit: The Slippery Slope From Assisted Suicide to Legalized Murder."
- Correction appended 11/13/03: The article originally
stated that Kate Adamson had been deprived of nourishment in an attempt
to end her life. In fact, the dehydration was being done in attempt to
alleviate a bowel obstruction. The painful surgery Adamson refers to was
originally referred to as surgery to insert a feeding tub. It was actually
surgery to remove the bowel obstruction, which is a more involved procedure.
- Patricia A. Doyle, PhD
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