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I just read a great article in the L.A TImes that put to rest a LOT of the uncomfortable feelings I had when talking about this issue. I, and many people I talked with said something along the following lines: She should be allowed to die, but geez, do they have to starve her to death?"

This article put that thought away for good. On a scale of 0-10, 0 being a bad death and 10 being hte best, starving to death is an 8.
Here is the L.A Times Story and I post it below the fold for you as well. I apologize if this was already posted, I hunted and didn't see it.

This needs to get out for I think that the vast majority of people that are somewhat against the trend on this case, are feeling that way because they feel that starving to death is cruel. It's just not so.

After suffering through cancer, the middle-age woman decided her illness was too much to bear. Everything she ate, she painfully vomited back up. The prospect of surgery and a colostomy bag held no appeal.

And so, against the advice of her doctors, the patient decided to stop eating and drinking.

Over the next 40 days in 1993, Dr. Robert Sullivan of Duke University Medical Center observed her gradual decline, providing one of the most detailed clinical accounts of starvation and dehydration.

Instead of feeling pain, the patient experienced the characteristic sense of euphoria that accompanies a complete lack of food and water. She was cogent for weeks, chatting with her caregivers in the nursing home and writing letters to family and friends. As her organs finally failed, she slipped painlessly into a coma and died.

In the evolving saga of Terri Schiavo, the prospect of the 41-year-old Florida woman suffering a slow and painful death from starvation has been a galvanizing force.

But medical experts say going without food and water in the last days and weeks of life is as natural as death itself. The body is equipped with its own resources to adjust to death, they say.

In fact, eating and drinking during severe illness can be painful because of the demands it places on weakened organs.

"What my patients have told me over the last 25 years is that when they stop eating and drinking, there's nothing unpleasant about it -- in fact it can be quite blissful and euphoric," said Dr. Perry G. Fine, vice president of medical affairs at the National Hospice and Palliative Care Organization in Arlington, Va. "It's a very smooth, graceful and elegant way to go."

Schiavo, who hasn't had any food or water since Friday, has been in a persistent vegetative state for 15 years that makes it impossible for her brain to recognize pain, doctors say.

"Her reflexes with respect to thirst or hunger are as broken as her ability to think thoughts or dream dreams or do anything a normal, healthy brain does," Fine said.

But even if her brain were functioning normally and she were aware of her condition, she would be comfortable, doctors say.

"The word `starve' is so emotionally loaded," Fine said. "People equate that with the hunger pains they feel or the thirst they feel after a long, hot day of hiking. To jump from that to a person who has an end-stage illness is a gigantic leap."

Contrary to the visceral fears of humans, death by starvation is the norm in nature -- and the body is prepared for it.

"The cessation of eating and drinking is the dominant way that mammals die," said Dr. Ira Byock, director of palliative medicine at Dartmouth Hitchcock Medical Center in New Hampshire. "It is a very gentle way that nature has provided for animals to leave this life."

In a 2003 study published in the New England Journal of Medicine, 102 hospice nurses caring for terminally ill patients who refused food and drink described their patients' final days as peaceful, with less pain and suffering than those who had elected to die through physician-assisted suicide.

The average rating given by the nurses for the patients' quality of death was an 8 on a scale where 9 represented a "very good death" and 0 was a "very bad death."

Patients deprived of food and water will die of dehydration rather than starvation, unless they succumb to their underlying illness first.

Without fluids, the body loses its ability to maintain the proper balance of potassium, sodium, calcium and other electrolytes in the bloodstream and inside cells.

The kidneys react to the fluid shortage by conserving as many bodily liquids as possible.

The brain, which relies on chemical signals to function properly, begins to deteriorate. So do the heart and other muscles, causing patients to feel tired and lethargic.

"Everything in the body is geared toward trying to maintain that normal balance," Fine said. "The body will do everything it can to maintain this balance if it's working well."

Meanwhile, the body begins mining its stores of fat and muscle to get the carbohydrates and proteins it needs to make energy.

"If you mine too many proteins in the heart, it gets unstable," Sullivan said. That can give rise to an irregular heartbeat, which can cause the patient to die of cardiac arrest. Or, if the muscles in the chest wall become weak, the patient can end up with pneumonia, he said.

Patients already weakened by disease begin feeling the impact after a few days, Fine said.

They eventually descend into a coma and finally death. The entire process usually takes one to two weeks, although a patient who is otherwise healthy -- such as Schiavo -- could hold on much longer.

Throughout the process, the body strives to suppress the normal feelings of pain associated with deprivation.

That pain of hunger is only felt by those who subsist on small amounts of food and water -- victims of famine, for instance, or concentration-camp inmates. They become ravenous as their bodies crave more fuel, said Sullivan, a senior fellow at Duke's Center for the Study of Aging.

After 24 hours without any food, "the body goes into a different mode and you're not hungry anymore," he said. "Total starvation is not painful or uncomfortable at all. When we were hunting rabbits millions of years ago, we had to have a back-up mode because we didn't always get a rabbit. You can't go hunting if you're hungry."

After a few days without food, chemicals known as ketones build up in the blood. These chemicals cause a mild euphoria that serves as a natural anesthetic.

The weakening brain releases a surge of feel-good hormones called endorphins.

Doctors also have a host of treatments to ameliorate acute problems, such as sprays and swabs to moisten dry mouths and creams to moisturize flaky skin. They can also administer morphine or other powerful painkillers.

Sullivan said doctors are likely to give some to Schiavo, although, "frankly, I think they might as well give it to each other, because it will probably be more painful for them than it will be for her."

Originally posted to librarianman on Wed Mar 23, 2005 at 05:46 PM PST.

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Comment Preferences

  •  Thank you for this (4.00)
    I watched my father go this way - his body just shut down. It was preceded by a long period of indescribable agony from cancer pain, so the dénoument was a reprieve from his suffering. People just don't know what they're talking about, but it doesn't keep them from weighing in with all kinds of useless bullshit.

    Useful diary, and it's recommended.

    Let the great world spin for ever down the ringing grooves of change. - Tennyson

    by bumblebums on Wed Mar 23, 2005 at 05:53:58 PM PST

    •  Ditto (4.00)
      Both my father and grandfather have died recently and doctors recommended removing their feeding tubes after it became clear there was nothing more they could do to save them.

      Even though I knew it was for the best, I worried that they were uncomfortable from not eating and drinking-even though they were on massive amounts of pain killing drugs.

      I am relieved to know this info.

    •  My father-in-law chose to die this way (4.00)
      at the age of 94. He was failing physically, though not mentally, and had become very frail. When he contracted a respiratory infection, he refused medication, as well as food and drink. He, and our family and the nursing home had, fortunately, discussed and made plans and signed the important agreements, and he was not put on any type of life support or feeding tubes. He slipped into a coma after about a week and passed away very peacefully, amazingly, only a few minutes after all the family had arrived. (We were alerted by the nursing home that his death was imminent). None of us felt he was in any discomfort at all, and we all agreed that it was quite apparent he had chosen this.
  •  I'm still bothered (3.66)
    legal euthanasia would be far more gentle.
    •  I agree (none)
      with you wholeheartedly. What is wrong with a heart stopping injection? I believe that Florida does not have a law that would allow that however, thus, having to resort to this.
    •  Phyrro (3.66)
      I'm inclined to agree, but this is a one-step-at-a-time thing.  People just aren't ready for the idea of euthanasia.

      Try looking at it this way:  It's just slower than what we traditionally think of as euthanasia.  As long as there is no suffering on the part of the patient (see notes about morphine etc.) it accomplishes the same end state.

      Proverb: War does not determine who is right, war determines who is left.

      by kfred on Wed Mar 23, 2005 at 06:15:23 PM PST

      [ Parent ]

      •  yeah (none)
        you're right.
      •  Slower, gentler euthanasia (none)
        Exactly. I'm so glad someone said that.

        And librarianman, I'm so grateful you posted this diary. This matches completely with my experience. Both my grandmothers died this way: in their respective daughter's homes, with their families around them, with an extremely slow, gentle, natural letting go.

        My father-in-law was in an ICU after a rapid succession of heart attacks. He was on a respirator, and the time came when we had to write a DNR and remove the respirator. This was much quicker, but seemed to me to be much more painful for the patient and was certainly more painful for the family.

        Personally, I think you're not fully adult in this society until you've had to let someone you love die. That's the curse of modern medicine: you have to make the choice.

        If I can't dance, it's not my revolution. -- Emma Goldman.

        by DoctorScience on Wed Mar 23, 2005 at 08:13:56 PM PST

        [ Parent ]

  •  In this case, (none)
    the use of the word "starve" is an attempt to gain support.  People's feeding tubes are removed every day, when there is no chance of recovery.  No, it is not pretty, but neither is existing in a persistent vegetative state or dying a long, painful death from terminal, inoperable cancer.  But, no one is forced to view the last moments.  

    The only second term dubya deserves is 20 to life!

    by Street Kid on Wed Mar 23, 2005 at 05:56:55 PM PST

  •  You beat me to it! (3.50)
    I was just thinking I should do a diary on this, and feeling very tired and lazy after a long day at work--so bless you!  I have recommended this.

    ...the White House will be adorned by a downright moron...H.L. Mencken

    by bibble on Wed Mar 23, 2005 at 05:57:03 PM PST

  •  it is rhetoric (none)

    and nothing more, after all--that's what they do best, right?

    we sat with my gramma around the clock in a nursing home for several days a couple years back as she was allowed to "starve" to death, a decision both of her grown children were allowed (at that time) to make for her, despite there being no advanced directive and her not being all  THAT old (she'd been in there for several years, and had begun to suffer strokes with greater frequency until essentially she could do nothing but squeeze your hand, and firmly clamp her mouth SHUT & try to turn her head away, when the nurses tried to feed her. then she slipped into the now all-too-well-know PVS.)

    as one of those who sat by her through this, i am CERTAIN she was NOT in any pain. besides, they gave her tiny tiny amounts of just enough water to keep her comfortable, and a generous amount of morphine just in case. she slept. and then she quietly died.

    thank god The State didn't stick their big ugly noses into my family's experience! i can't even imagine what that would have been like.

    -L.

  •  GOP: Loves Vegetables, Hates Fruits (4.00)
    We need a big blog ad that says that.  I saw it on a yahoo! message board.

    good stuff...

    GOP: Loves Vegetables, Hates Fruits

    by pacified on Wed Mar 23, 2005 at 06:08:41 PM PST

  •  Excellent (4.00)
    I have been trying to call into some of the local winger radio shows to talk about my mother's recent experience with my grandpa.

    My g'pa has a very clear Medical Directive - no hydration, no nutrition.  It even uses the word "abhorent" when describing such uses to prolong his life.  Oh yea, he put the D in Devout Catholic.  

    He also has suffered from extreme dimentia in the last seven years.  It is a heartbreaker - anyone who has expereinced it knows what I am talking about.  

    About three weeks ago he broke his hip.  A virtual death-knell for anyone in their 90s.  He developed kidney problems while in the hospital.  At that point, they usually stick a tube in you so you can rehydrate.  BUT his medical directive prohibits the action.  My poor mother.  She is so distraught about her father.  But the doctor reassures her that g'pa is not feeling the pain of dehyrdation like we would.  She even talks to another doctor & he tells her the same.

    So in the past five days, she has had to endure the wingers talking about Terrie's lips cracking, etc. . . .  Bastards.

    Anyway, thanks for the info.  I sent the article to my mom.

    ag

    p.s.  My g'pa has made a recovery & is in a nursing home.  So sad because he just wants to go home & it will never happen.

    The truth is found when men are free to pursue it. FDR, 1936 Go fuck yourself. Dick Cheney, 2004

    by aimeeinkc on Wed Mar 23, 2005 at 06:10:39 PM PST

  •  Aimee (4.00)
    Thanks so much for sharing. Give your grandpa a big hug from me and all of us here at Dkos.

    "There are other worlds than this"

  •  stopping eating and drinking natural (none)
    Hi,
      I just sat by my 95-year-old great aunt's side while she died. (Lung cancer, broken leg that kept her in bed for 3 months, pneumonia, then congestive heart failure.)
      We were apprehensive about bringing her home, but it's what she wanted, so we did. I asked the hospice nurse what we could expect, and she said if her irregular heartbeat didn't get her, she would eventually stop eating and drinking, all on her own, and her body would gradually shut down, probably within a week, and she would likely die very peacefully.
      See that. This report is exactly right. When your body's shutting down anyway, it's normal to reach a point where you no longer care to eat or drink. You will probably force yourself to eat and drink for a while, and then you'll simply stop.
      And then your body slowly shuts down.
      My aunt's passing could not have been more peaceful. It was a great relief to all of us. She had been barely breathing for days, but she didn't even seem panicked about that. 98 percent of the time, she seemed perfectly comfortable. Every now and then, she'd start trying to cough, but couldn't because she didn't have enough breath, and her lungs were congested. A little liquid morphine and ativan, prescribed by the wonderful people at hospice, did the trick. She was comfortable again in moments.
       I think every idiot politician claiming to know what's best for anyone who's dying or stuck in a body without brain activity should have to sit by that person's side for a solid week and then tell us what they think about the quality of their life.  
  •  The body has a right to shut down. (none)
    Dozens of families face this dilemma everyday:  should we put grandpa on a feeding tube, as he is not able to eat anymore?  And dozens of families ask themselves whether grandpa's quality of life will be improved by such intervention.  Today's LA Times article on this topic mentioned something I'd read a while ago about "interventions" that prevent the body's natural shut-down mechanisms:  feeding tubes may in fact inhibit the body's natural endorphin-producing capabilities, so that the patient lingers and experiences pain.  

    Of course, "quality of life" means nothing to this administration.  

  •  thank you for posting this (none)
    My grandmother went this way, and she looked very peaceful, with a hint of a smile on her face, as though she were having a long good dream. I only wish all the reality-based posts on dkos could be broadcast on the news shows for the rest of the country to hear.

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