What if it was 100% certain that Terri was PVS?

To be honest, if there had been no evidence Terri Schiavo was not in a PVS it wouldn't have been quite as disturbing, but I still would have disagreed with removing her feeding tube.

For one thing, whether someone has consciousness/awareness or not is really impossible to determine with 100% certainty. We don't have the ability to determine what someone else is experiencing, thinking and feeling and we know for a fact that it is possible for someone to be aware of and internally responding to their environment with absolutely no outward indication of consciousness. Awareness and consciousness are not things we can measure accurately if at all.

Look at the case of patient B in the study we've been discussing at http://bmj.bmjjournals.com/cgi/content/full/313/7048/13 --it took researchers 25 weeks (175 days!) of intense efforts trying to find any kind of non-reflexive response before they realized that if they sat him in the chair just right he could communicate with 100% accuracy by a small twitch of his shoulder. This is a guy who was thought to be completely unaware and unresponsive for about two years, but when they were finally able to communicate with him they found that he had been aware and able to process and mentally respond to his environment all that time. If they hadn't just happened to find the one way in which he was reliably able to communicate, after 25 weeks of intense efforts trying things that didn't work, he would still be being treated as and considered PVS to this day.

For another thing, the right to refuse medical treatment for ourselves or on behalf of a ward is not absolute. So when we give someone the right to withdraw a feeding tube in the case of a non-terminal patient with PVS, but not in the case of a patient with MCS or who is locked-in or quadriplegic, or a myriad of other conditions, that is making a judgement on the relative value and worth of a life. Frankly, I think that's wrong.

Finally, I am against removing feeding tubes as a way to bring about someone's death for a number of reasons. For one thing, a feeding tube does not replace or bypass any major organ or bodily function. As CBB pointed out, it's no more artificial or "life support" than a catheter or many other procedures which, along with PEG tubes, are used routinely both temporarily and long-term with patients who are fully-functioning in many other ways.

The main problem I have with removing a feeding tube, though, is that it does not "allow" a person to die from the course of their disease when they were going to die soon anyway. It literally causes them to die of dehydration. Dying of dehydration when your swallowing mechanism is weak may be "natural", and yes a feeding tube is artificial--but according to that argument my otherwise healthy mother should have been allowed to die of kidney failure instead of receiving dialysis when her kidneys shut down in her 40's (a congenital condition which I also have probably at least a 50% chance of experiencing as well).

To me, allowing someone to die simply because they can't swallow when the rest of their body (or at least the integral systems) functions fine is right on par with standing there watching a child suffocate to death in an athsma attack when you have a bottle of medicine in your hand that could open their air passages, or letting someone remain completely immobile when their legs don't work adequately by themselves because leg braces or a wheelchair are "artifical."

I am seriously considering signing a document that I don't want medical care or body organs removed until I experience both brain and cardiac death (I am an organ donor but I don't want my heart removed while it's still beating unless my head is completely smashed), but it appears that if I did sign such a document there is very little likelihood it would be honored.

(cross-posted on codeblueblog)