- The Washington Times - Friday, March 25, 2005

ASSOCIATED PRESS

Her skin is flaky, tongue dry and eyes sunken. Doctors say Terri Schiavo could survive another week without food or water, but is the brain-damaged Florida woman suffering? On that point, expert opinion varies widely.

Mrs. Schiavo stopped receiving food or water March 18. Because she is in a persistent vegetative state, many medical authorities say she is unable to process or communicate pain and discomfort.

As her organs fail, they predict that she is likely to die peacefully, as if she were drifting off to sleep.

But other physicians strongly disagree.

Dr. David Stevens, executive director of the Christian Medical Association in Bristol, Tenn., has worked in some of Africa’s poorest nations.

He recalls watching people die of dehydration with symptoms that include thick saliva, severe cramps and dry heaving. As their mucous membranes and intestines dry out, they bleed from the mouth and nose, and begin to hallucinate.

Dr. Stevens says the quiet death that physicians often associate with dehydration comes to patients whose bodies already were shutting down from cancer or another terminal illness.

“That’s a whole different thing than someone like this, whose body is in metabolic equilibrium,” he said.

But groups representing hospices said Mrs. Schiavo’s case has raised “erroneous medical claims” that stopping food and water causes terminal patients considerable discomfort.

“Most studies show that patients nearing the end of their lives do not experience hunger,” said Ryan Walker, a spokesman for the Hospice and Palliative Nurses Association.

Other medical authorities say a case such as Mrs. Schiavo’s is more difficult to analyze because researchers don’t have a complete idea of what a vegetative patient might feel.

Mrs. Schiavo was 26 and outwardly healthy when she collapsed and her brain was temporarily starved of oxygen. The courts have ruled that the episode left her in a persistent vegetative state, and agreed that her husband has the right to disconnect her feeding tube.

“Often the issues hardest to decide are when young people who are otherwise living productive lives are struck down by an unforeseen event. They do not have a lot of other medical problems and can live for years without succumbing,” said Elaine J. Amella, associate nursing research dean at the Medical University of South Carolina at Charleston.

Currently, Mrs. Schiavo is not known to face a life-threatening infection, for which the family and doctors might agree to withhold antibiotics and let nature take its course.

Without a national euthanasia policy, physicians said nutrition is the only medical intervention over which Mrs. Schiavo’s surrogate decision-makers can exercise any individual choice.

“In this case there really isn’t any in-between,” said Dr. Michael Weissman, director of the palliative care center at the Medical College of Wisconsin in Milwaukee.

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