The Popes casket.

[fredfighter]

procedure, and I

The predecessor to the modern feeding tube was the esophagastomy, an opening through the neck into the esophagus that allowed food and water to bypass the mouth. It was developed over a century ago to allow people with severe facial injuries to receive food and water.

The stomach tube now used is actually a simpler procedure which is one reason it has become the standard.

For Terri Schiavo seminal issue was not how difficult or expensive it was to keep her body going, the seminal issue was "What was it that was being preserved?" Most of our disagreements are disagreements as to the facts, not the principles.

[Dave Hinz]

I have. And I've looked at a _lot_ of brain scans. It's an axial view through the area where the cerebral cortex should be. The ventricles (fluid-filled spaces, kind of butterfly shaped) have expanded nearly out to the skull, showing that where previously there had been cerebral cortex, there was nothing but cerebro-spinal fluid. The cerebral cortex is what makes you you, the brain stem handles lowest level controls such as breathing, digestion, pumping of blood - the cerebellum handles voluntary motion. (oversimplified but basically accurate).

The scans I saw were CT scans. They showed the metal which precluded an MRI scan. A nuclear scan would have been very telling - since you couldn't do MRI (due to the metal), a nuclear scan would have been the next best thing to see biochemical activity in the brain. The radio- pharmacuticals will tag areas of biological activity. Holes in a brain nuclear scan are a dramatic way to see damage in fuction, which is useful in addition to damage in structure as a CT will show.

Not having been in that situation, I can't say, but I would think I would have insisted on a nuclear scan to show presence or absence of activity in the very damaged parts of the brain.

Dave Hinz (worked in engineering on medical scanners for about a decade)

[Dave Hinz]

Well, fluid isn't brain, Doug.

[Doug Miller]

Of course I understand that. The medical question is the degree of cognitive function that she had remaining. Then there's the ethical question: is it right to deprive a living human being of sustenance, based on that person's level of cognitive function?

-- Regards, Doug Miller (alphageek at milmac dot com)

Nobody ever left footprints in the sands of time by sitting on his butt. And who wants to leave buttprints in the sands of time?

[fredfighter]

Agreed it was not immediately fatal. But absent invasive life support, like a feeding tube (although a stomach tube is less traumatic than one might at first suppose) it was ultimately fatal.

[Joe AutoDrill]

Don't tell fishermen that... They've been using lead for decades...

[Jason Quick]

While there is certainly some room for debate, when the overwhelming majority of one's cerebral cortex is missing, including most all of the relevant bits that handle speech, thought processes, etc., it would not be at all unreasonable to conclude that there's nothing going on up there, correct?

Certainly, if they express a wish to not exist in that state. I would argue that we have a duty, in fact, to honor a person's wishes inasmuch as possible. That of course is the crux of the issue, really - what did she want, and when did she want it? If her wishes were not in fact expressed while she was, uh, interactive, should the spouse be allowed to determine the course of action in any case? My take is that in the absence of any reasons to restrict spousal rights in this situation (i.e. evidence of abuse, pending divorce, etc), the spouse should have a nearly absolute right to decide what goes.

And as for the abuse suggestions that have been made - the sort of physical trauma that it would take to put someone into the state Terri Schiavo was in would be immediately evident to a doctor, I'd think, and Michael Schiavo would've had his rights restricted long ago.

Jason

[Doug Miller]

"Invasive life support." That kinda says it all.

I'm glad that you'll never be in the position of making health-care decisions that affect me or my family.

-- Regards, Doug Miller (alphageek at milmac dot com)

Nobody ever left footprints in the sands of time by sitting on his butt. And who wants to leave buttprints in the sands of time?

[Doug Miller]

Perhaps; but then we come to the second question:

Apparently you don't consider shacking up with another woman for seven years, fathering two children by her, to be sufficient reason to restrict the husband from making such decisions? Doesn't seem to me that he was too interested in behaving like a spouse.

-- Regards, Doug Miller (alphageek at milmac dot com)

Nobody ever left footprints in the sands of time by sitting on his butt. And who wants to leave buttprints in the sands of time?

[fredfighter]

support,

It's a simple matter of defintion. If it breaks the skin, it's invasive.

I've nothing against invasive life support on principle. I'd want it for any ill family member who has any chance for recovery. No one in my immediate family who has expresed a preference wants it if their conditon is like that of Terri Schiavo. You won't see us in court over that.

I certainly will not be making decisions for you or your family. Nor, if I have my druthers, will my Senators or Congressman, nor yours, nor any judges either. I hope that no disputes arise in your family either.

I have a friend who had a feeding tube put into his wife, contrary to her wishes, when it was discovered that her coma had been brought on by an infection, not the normal progress of her illness. She made a meaningful, though limited recovery. Several years later, when she clearly was in the end stages of her disease she was allowed to die from a secondary infection as by then she was beyond any return to consciousness.

The right decision depends on the circumstances especially the patient's condition.

[fredfighter]

Were these the scans from 1996?

activity

I too am troubled by the lack of more recent or more thorough imagery. (assuming that indeed the most recent scans are nearly 10 years old)

[Fly-by-Night CC]

I believe over the last few years lead for fishing has been transitioning over to some other conglomeration of metals. There was concern over personal safety - how many adults and kids bite down on the split shot to fix it to the line? - as well as wildlife ingestion... as I recall those were the reasons.

[Dave Hinz]

Not to mention - Bohr's model of the atom is wrong, and very much so. But, it's perfect for understanding chemical reactions at a basic level.

[Dave Hinz]

Yup. Welcome to Usenet, Matthew. Thread drift happens.

[Dave Hinz]

I've got more important issues to decide my vote on, rather than this one.

[Dave Hinz]

Well, centuries. But, besides, it's not going to hurt the pope any. Lead caskets have been in use since at least Roman times.

[Dave Hinz]

You should be aware that some of those "concerns" were a back-door attempt by the anti-hunting folks at a roundabout gun-control scheme.

[Jason Quick]

Are you aware of how feeding tubes of the type Mrs. Schiavo had work? They essentially require a hole to be drilled into the stomach from outside. It's invasive by any definition of the word.

Jason

[Jason Quick]

No. Think about it for a second - why on earth wouldn't the man just have divorced her, and left her to the care of her deranged parents?

Well, you know, if I were in his position, I'd be dating at least. Maybe he's a shit-heel, I dunno, but AIUI he *did* spend a few years trying to get her in better shape, and when the attempts failed to bear fruit, he moved on. From what I read, it's not like he was out whoring around four nights a week. He simply had let go emoitionally, and was being thwarted in his attempts to carry out what he believed her wishes to be. I think it's a hideous position to be in, really.

Consider the scenario - your wife, after some massive brain hemorrage thing, has checked out. The doctors are telling you that she'll never recover to any state of consciousness, but that with a feeding tube she could live for decades - to use a callous phrase I read, she'll essentially be "organic furniture.". You're in your late 20s, just entering the prime of life.

Ask yourself this: if her mom and/or dad were possessed of some character flaw - say, Dad had a gambling addiction - would that be grounds to *not* give them control? What if Mom was an alcoholic, or Dad was a philanderer?

Jason

[fredfighter]

outside.

No one should fear having a feeding tube inserted into themself or a family member.

Yes, it is invasive by definition but it is far less unpleasant that you might imagine. The procedure is normally done on an outpatient basis with a local anesthetic.

Once completed, it is not uncomfortable. Indeed for someone with disphagia and who is still cognitively intact it is a godsend. It does not just extend their life, it extends it while relieving them of the discomfort of choking on ever sip of liquid they try to swallow. Patients with the feeding tube may even continue to eat solid food, relying on the tube mostly for hydration.

Ther reversal of the process is even simpler. The tube enters the abdomen though a fitting that resembles a bulkhead fitting used for electrical conduit. To reverse the procedure it is simply removed and in most cases the incisions heal without incident. In fact, the incision in the stomach heals so fast that if the tube accidentally comes out (that does happen) it must be reiniserted (a routine ER procedure) within about 90 minutes else a new incision must be made.