Yesterday, as I was performing an endoscopy here in Montgomery, Ala., I walked over to the physicians’ lounge to dictate my report. While I was dictating the report, I heard a report on CNN that the federal judge for the middle district of Florida had refused to intervene in the case of Terri Schiavo and that her family’s attorney was seeking relief at the 11th Circuit Court of Appeals in Atlanta.
I was then paged to come to the radiology department to perform a percutaneous jejunostomy tube placement in an elderly patient I had seen before that had had problems with feeding tolerance with her gastrostomy tube. As I looked at the patient, I was struck by the fact that this patient was non-communicative and bed-bound, much like Terri Schiavo, but was aware of pain and discomfort, could hear my voice and make facial movement to let me know that she could hear me, and has a sense of her surroundings, much as appears to be the case with Ms. Schiavo.
Yet, this patient was near the end of her life and we were “extending” her life by intervening in feeding her when she was unable to feed herself. There was no question among my colleagues that this was the right thing to do and would diminish suffering as well as unneeded hospitalization. Unfortunately, this same level of medical care is not being extended to Ms Schiavo who is much younger and in no immediate danger of dying except for removal of nourishment.
I have seen video of Ms Schiavo, and like Sen Frist, I agree there is no obvious evidence that this patient is in a persistent vegetative state. This is a clinical diagnosis and is usually reserved for patients totally unaware of their surroundings and unable to respond. Her nursing caregivers have given evidence that this is not the case. Her actions appear to be similar to patients with global cerebral dysfunction, but that in no way suggests that she is unaware of her surroundings.
Over the past 20 years, I have treated thousands of patients in need of gastrostomy tubes and nutritional support. At no time did the question of recovery enter into the decision to feed the patient unless their underlying illness would be fatal without mechanical or pharmacological support or they were brain-dead, neither of which applies to Ms Schiavo. If recovery became the criterion to feed patients, which is a basic function of humanity, then we would be subjecting children with Downs syndrome, mental retardation and other chronic neurologic impairment to a premature death.
As a practicing nutritional specialist, my first responsibility is to the welfare of my patient. A feeding tube is not an extraordinary means to maintain life by just about any medical standard. Any physician who would knowingly starve a patient to death, court order or not, is in my opinion violating the Hippocratic Oath and is in effect guilty of malpractice. I implore our nation and courts to intervene in this landmark case and restore the potential for life to Ms Schiavo and her family. I fear in the absence of intervention and disregard for life, our nation and our people may regret forever this moment in the life of our country.
Dr. R. Randolph Brinson is a practicing gastroenterologist specializing in nutritional support in critically ill patients and the effect of nutritional intervention on chronic long-term patients. Over the past 15 years, he has placed over 2,000 gastrostomy, jejunostomy or nasojejunal feeding tubes. Brinson is a clinical assistant professor of medicine at the University of Alabama School of Medicine and founder and chairman of Redeem the Vote.