Monday, November 7, 2005

Schiavo & tube feeding articles in Mayo Clinical Proceedings

November's Mayo Clinical Proceedings has several important articles ( table of contents for the entire issue). 
First, is a lengthy summary and discussion of the, as they put it, Terri Schiavo "saga," that grew out of a grand rounds at Mayo.  It is quite thorough and a good read, and one hopes--probably unrealistically--that certain public officials and prominent opinion makers will read this with an open mind.  It ends with several pages of addressing the specific ethical questions the case raised, as well as asking "Is there a better way?"  Which brings up something I meant to blog a while back:  I attended a speech given by Michael Schiavo (at an end of life ethics conference) & he said a few interesting things.  First, given that it is often mentioned as an unclear point in the Schiavo history (including this article), Michael Schiavo stated that it was, indeed a conflict over money/the settlement that caused the rift between him and the Schindlers.  The second, and much more interesting point, is that Mr. Schiavo said it's his belief that there's nothing doctors/the medical community could have done to prevent the conflict, that it was a family/personal conflict, & not a failure of Terri Schiavo's docs or anyone else.  As a doc, that sounds reassuring to me, and on reviewing the case in this article, it seems like he's right.  Despite being touchstones for all of us, cases like Schiavo's going to the courts are rare; and while getting the courts involved is generally undesirable her case seems like a reasonable one for the courts (to establish what her wishes would be given there was intractable conflict within the family & no written evidence of her wishes).  What went tragically wrong with the case was not this but the extra-judicial involvement, the political intervention--"Terri's Law," Jeb Bush, Bill Frist's speech, Tom Delay's intimations of violence against "activist judges," President Bush flying back from Crawford, Judge Greer getting death threats and booted out of his church, etc.  That's the problem & promoting advanced directives isn't going to fix that....
I've already blogged too long tonight, but there's also a review of the medical and ethical aspects of long-term enteral tube feeding.  Thorough, and despite being written by a bunch of MD's, seems to have a distinct speech-pathologist flavor to it.  It presents much of the same material as the JAMA 2004 review of tube feeding, with more stuff on post-stroke & cancer patients. 
And finally, there's a review of adult acute lymphoblastic leukemia for those of you interested.

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