Of Vincent Lambert and Ethical Rubicons

This article was published by National Review online on July 12, 2019.

Wesley Smith

By Wesley J Smith

Vincent Lambert is dead.

The forty-two-year-old Frenchman, who breathed his last yesterday in Reims, didn’t die by accident. It wasn’t “his time.” He died slowly, over nine days, by forced dehydration—a demise that causes radical drying of tissues, cracking membranes, potential seizures, and slow organ failure.

This was not a case of euthanasia, per se—even though taking away a person's sustenance can only have one outcome. Rather, Lambert’s forced dehydration was deemed simply a matter of bioethics carried out in law, an emotionally difficult but routine matter of removing the “medical treatment” of “artificial nutrition and hydration”—because his wife wanted it and the courts judged it to be in his best interests.

How was this in his best interests? Lambert was profoundly disabled with a catastrophic brain injury that left him diagnosed as permanently unconscious (although his parents insisted that he was minimally aware). But he did not require mechanical breathing assistance or kidney dialysis. All the poor man needed to survive was what every human requires: food and water.

Lambert’s case made huge news in Europe because it was the subject of a bitter court fight between his wife and his parents (both his mother and father wanted Lambert to live). The story was less discussed in the United States, partly because of distance, but also because we crossed the dehydration Rubicon in 2005 with the death of Terri Schiavo, when courts ordered her tube-feeding halted.

Lambert's case closely paralleled Schiavo's. Both were profoundly disabled with a severe brain injury. Neither had left formal written instructions about their desires if they became seriously incapacitated. Both deaths were preceded by bitter intra-family legal disputes. Schiavo’s two siblings opposed her dehydration; Lambert’s full-siblings supported it, but his half-siblings sided with his parents. Both Schiavo and Lambert were Catholic patients, and in both cases pro-dehydrators accused family members opposed to dehydration of being motivated merely by religion, and not by true concern for the patients.

Some argue that these cases demonstrate a bias against the equal worth of cognitively disabled patients. That argument went nowhere in the Schiavo case. But in the Lambert case, the Committee on the Rights of Persons with Disabilities at the United Nations intervened, requesting that his dehydration be delayed while it investigated whether removing his food and water would be a discriminatory act. That request gave Lambert a temporary reprieve when a French Court of Appeals reversed a trial court’s approval of the dehydration. But the victory was short-lived, as the French Supreme Court later reversed the decision.

I hope the U.N. Committee continues its investigation. Lambert (and Schiavo) were not terminally ill. They only died because those with the power to decide deemed their lives not worth living. Is it not discrimination based on disability to decide that death is in a patient’s best interests because a patient is cognitively incapacitated? Is it discrimination based on disability to remove food and water from people because they are cognitively incapacitated, when we would not (yet) starve incompetent patients who willingly eat?

In the U.S., popular support for Schiavo’s dehydration was a Rubicon. Before the national imbroglio about her dehydration, many Americans were unaware that the cognitively disabled could die in this way. Post-Schiavo, polls showed that most Americans supported the approach, and that settled the “food and fluid” issue. Today, unconscious and minimally conscious patients are dehydrated in all fifty states as a matter of medical routine, usually with the family's acquiescence. If there is a family dispute, the law will usually give the benefit of doubt to death instead of life, unless the patient made it abundantly clear before injury or illness that they wanted care to continue. I suspect that Lambert will be such a Rubicon throughout much of Europe.

But that will not be the end of it. Bioethics is never static. The mainstream movement’s utilitarian reasoning is based on a “quality of life” ethic, instead of a “sanctity/equality of life” approach. That philosophy, embraced by the medical establishment, will lead the country to view induced death as the proper response to serious illness and injury. Prepare for the following trends:

• Advocacy to withhold spoon feeding from people with advanced dementia: The euthanasia movement wants the law to allow advance medical directives to instruct caregivers to starve the signer—even if they willingly eat and drink—once their dementia reaches a predetermined level of decline. If adopted, it would force nursing homes and family members to starve and dehydrate these patients to death—perhaps even if they ask for food. 
• Increase in “futile care” laws: Texas, Virginia, and other states permit doctors and/or hospital bioethics committees to refuse wanted life-sustaining treatment based on their views about the quality of the patient’s life and/or costs of care. In the future, such laws could permit doctors to order tube-feeding withheld over the objections of family.  
• Healthcare rationing: With the increased crisis in medical costs, we could one day see laws placing time limits on coverage for the cost of care of profoundly disabled patients like Lambert and Schiavo.  
• Lethal injection instead of dehydration: If euthanasia/assisted suicide spreads, at some point people will conclude that lethally injecting these patients is more humane than dehydration—which it undoubtedly would be. One of the advocacy points behind these dehydration cases has been to acclimate us to eliminating suffering by eliminating the sufferer. Once that premise is accepted, lethal injection becomes the logical choice.  
• Harvesting the organs of profoundly disabled patients: Dehydrating patients to death renders their organs unusable for transplantation. But if we ever allow their euthanasia killings, that paradigm would change. Belgium, Netherlands, and Canada already conjoin euthanasia with organ harvesting and some bioethicists have opined in professional journals that the cognitively disabled (and others) should be organ harvested as the means of euthanasia.
  

As Fr. Richard John Neuhaus once wrote, bioethicists “professionally guide the unthinkable on its passage through the debatable on its way to becoming the justifiable until it is established as unexceptional.” With the Schiavo and Lambert dehydrations, removing sustenance from the cognitively disabled has been “established as unexceptional.” Futile care is at the “justifiable” stage. Organ harvesting conjoined with euthanasia, as the means of killing patients, has become “debatable.”

Unless society collectively rejects the logic and moral premises of the “quality of life” ethic, I see few impediments—other than the weak reed of emotional revulsion—to keep us from following a dark bioethical path.

Wesley J. Smith is a senior fellow at the Discovery Institute. His latest book is Culture of Death: The Age of “Do Harm” Medicine.

Medical Experts Now Agree that Severely Brain-injured Patients are Often Misdiagnosed and May Recover

This article was written by Nancy Valko and published on her blog on August 15, 2018.

Nancy Valko

By Nancy Valko

People with severe brain injuries from accidents, strokes, illness, etc. are often in comas at first. If they don’t die or spontaneously wake up, they can progress to a “persistent vegetative state” (PVS) described as “awake but unaware” and/or a “minimally conscious state” (MCS) described as “definite, but extremely limited, awareness of self or environment, and limited means of communication”. People with both conditions have had court battles over removing their feeding tubes such as the 1988 Nancy Cruzan and the 2001 Robert Wendland “right to die” cases.

Now, an August 9, 2018 Medscape article “New Guideline for Minimally Conscious, Vegetative States Released” reveals that 3 specialty societies including the American Academy of Neurology have just published a new guideline with 15 recommendations for “accurate diagnosis, prognosis and treatment for these conditions”.

The reason for the new guidelines, according to Dr. Joseph Giacino, who was one of the authors of the study, is because:

“Misdiagnosis of DoC (“disorders of consciousness”) is common because underlying impairments can mask awareness — in fact, there is a 40% rate of misdiagnosis, leading to inappropriate care decisions as well as poor health outcomes.” (Emphasis added)

The 223 page new guideline titled “Practice guideline update: Disorders of consciousness” states that:

“Clinicians should refer patients with DoC (disorders of consciousness) who have achieved medical stability to settings staffed by multidisciplinary rehabilitation teams with specialized training to optimize diagnostic evaluation, prognostication, and subsequent management, including effective medical monitoring and rehabilitative care.” 

and 

“When discussing prognosis with caregivers of patients with DoC (disorders of consciousness) during the first 28 days after injury, avoid statements suggesting that these patents “have a universally poor prognosis”. (All emphasis added)

According to Dr. Giacino, “Approximately 20% of individuals who have disturbance in consciousness from trauma regain functional independence between 2 and 5 years post-injury, even though they may not return to work or pretrauma functioning.” (Emphasis added)

The study also cites the drug amantadine and brain imaging showing that the brain can still respond normally to stimulus even though the person seems unaware as potentially helpful.

What about the “right to die” for these people? Ominously, the guideline does mention “1 study found that hospital mortality was 31.7%, with 70.2% of those deaths associated with the withdrawal of life-sustaining therapy”. (Emphasis added)

IS THE “40% MISDIAGNOSIS” RATE REALLY NEWS?

Doctors like Dr. Keith Andrews of the UK and US doctor Mihai Dimancescu published medical journal articles in the 1990s showing that around 40% of patients in a so-called “persistent vegetative state” were misdiagnosed. And in 1987, the Royal Hospital for Neuro-Disability in the UK opened a “vegetative state” unit and later developed the “Sensory Modality Assessment and Rehabilitation Technique (SMART)” as a clinical tool for the assessment and rehabilitation of people with disorders of consciousness following severe brain injury.

Despite this, most media stories about cases like Terri Schiavo’s and “right to die”/assisted suicide groups continued to insist that “PVS” is a hopeless condition for which everyone should sign a “living will” to ensure that food and water is withheld or withdrawn to “allow” death.

This happened despite articles like the New York Times’ 1982 article “Coming Out of Coma”. about the unexpected return of consciousness of Sgt. David Mack over a year after the famous “right to die” neurologist Dr. Ron Cranford predicted ”He will never be aware of his condition nor resume any degree of meaningful voluntary conscious interaction with his family or friends” before. (Emphasis added)

There have also been articles about people like Terry Wallis who in 2003 regained consciousness after 19 years in a “minimally conscious” state. Unfortunately, such cases were often explained away as just “misdiagnosis” or a “miracle”.

MY EXPERIENCE

Just before Drs. Jennet and Plum invented the term “persistent vegetative state” in 1972, I started working with these many comatose patients as a young ICU nurse. Despite the skepticism of my colleagues, I talked to these patients as if they were awake because I believed it was worth doing it for the patient if hearing is truly the last sense to go. Because of this, I unexpectedly saw some amazing recoveries and one patient later told me that he would only respond to me at first and refused to respond to the doctor because he was angry when heard the doctor call him a “vegetable” when the doctor assumed the patient was comatose.

Over the years, I’ve written about several other patients like “Jack”, “Katie” and “Chris”in comas or “persistent vegetative states” who regained full or limited consciousness with verbal and physical stimulation. I also recommend Jane Hoyt’s wonderful pamphlet “A Gentle Approach-Interacting with a Person who is Semi-Conscious or Presumed in Coma” to help families and others stimulate healing of the brain. Personally, I have only seen one person who did not improve from the so-called “vegetative” state during the approximately two years I saw him.

CONCLUSION

It is good news that the American Academy of Neurology and other groups are finally rethinking their approach to people with severe brain injuries, especially the recommendation to start rehabilitation therapies as soon as the person is medically stable and the recommendation for periodic and thorough testing over time.

This is crucial because the often quick prognosis of “hopeless” attached to people with severe brain injuries can-and has-led to early withdrawal of feeding tubes and ventilators as well as DCD (donation after cardiac/circulatory death) for these non-brain dead people.

Dr. Joseph Fins MD and chief of Medical Ethics at Weill Cornell Medical College perhaps says it best when he praises the new guideline as “a real step forward for this population that has historically been marginalized and remains vulnerable” and “suggests that brain states are not static, but dynamic, and that people can improve over time”. (Emphasis added)

Statement from Terri Schiavo Life and Hope Network regarding the death of Jahi McMath.

Statement from Terri Schiavo Life & Hope Network Regarding the Death of Jahi McMath

Philadelphia, PA., June 29, 2018 /Standard Newswire/ — Jahi McMath, an teenager at the center of an international debate on “brain death” criteria, died earlier this week due to liver failure.

“We fought for Jahi, her family, and her rights ever since her 2013 brain injury,” said Bobby Schindler, President of the Terri Schiavo Life & Hope Network. “After Jahi was ruled to be brain dead, she and her family found themselves in an incredible situation wherein Jahi was considered legally dead in California, but legally alive in New Jersey due to that state’s religious accomodations. Nailah Winkfield and Jahi’s entire family fought for nearly five years on the grounds that Jahi exhibited behavior inconsistent with the brain death diagnosis. Jahi was not only still alive, but may haves benefited from treatment and rehabilitative care.”

Brain death, known as the neurological criterion for death, was formulated in 1968 but has been the subject of vigorous debate since its inception. The Terri Schiavo Life & Hope Network advocates for revisions to the brain death criteria that allows for patients who may be experiencing severe coma or minimal consciousness to still have a chance at treatment and care.

“At present, to be ruled brain dead means that you’re considered dead,” continued Schindler. “Jahi lived for nearly five years after being declared dead thanks to the love and care of her mother. The way that Jahi, Nailah, and her family were treated by some physicians since 2013 has been a scandal—a case study in the human cost of elitist and bureaucratic disregard for a patient who needed care.”

That NBC, the Associated Press and others are reporting this week with headlines like “Jahi McMath, Oakland Teen at Center of Brain Death Debate, Dies,” ironically underscores the reality that so many have denied for nearly five years: Jahi was alive.”

“We will continue to advocate in Jahi’s memory for revisions to the ‘brain death’ criteria to ensure that patients who don’t meet the criteria in the future won’t be denied all care.”

The Terri Schiavo Life & Hope Network upholds human dignity through service to the medically vulnerable.

Vincent Lambert given temporary clemency from death by dehydration.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Vincent Lambert with his mother.

According to Figero news Viviane Lambert, the mother of Vincent Lambert was informed on April 9, that her son would die a slow and agonizing death by dehydration, also known as euthanasia by dehydration.

Today Francetvinfo reported that Vincent Lambert will not die by dehydration, at this time, as the court approved a complete assessment of his condition by three qualified doctors. According to Francetvinfo (google translated):

A new expertise is ordered by the Administrative Court of Châlons-en-Champagne in order to be able to pronounce "definitively" on the stop of the treatments decided by the University Hospital Center of Reims. 

.. A college of three qualified doctors "in neurology, physical medicine and rehabilitation" will be appointed soon by the court. He will then have one month to draw up the real state of health.

Vincent Lambert was cognitively disabled in a motorcycle accident injury in 2008. In 2015, his wife petitioned the court to have all treatment and care ceased including food and water. His parents urged that their son be transferred to a rehabilitation center.

To intentionally kill a person by withdrawing fluids, when the person is not otherwise dying is euthanasia by dehydration since the person is directly and intentionally killed by dehydration.

• Link to previous Vincent Lambert case articles.
• We remember Terri Schiavo.

France: Vincent Lambert to die by dehydration (euthanasia).

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition.

Vincent & Viviane Lambert

On April 12, Figero news reported that Viviane Lambert announced that she was told on April 9, that her son Vincent Lambert, would have his fluids and food withdrawn and die a slow and agonizing death by dehydration, also known as euthanasia by dehydration.

Vincent Lambert was cognitively disabled in a motorcycle accident injury in 2008. His wife unsuccessfully petitioned the court to have all treatment and care ceased including food and water in 2015. His parents urged that their son be transferred to a rehabilitation center.

In the Figero news report Viviane Lambert stated (google translated):

My son was sentenced to death. His name is Vincent Lambert, he is the father of a little girl, he lives, and has committed no crime. And yet, this Monday, April 9, 2018, in France, a doctor told me that in ten days my son would begin the slow and long agony of dying of hunger and thirst. 

...Mr. President: my son did not deserve to be hungry and dehydrated. Who would dare, in this respect, to speak of "dying with dignity"? Why impose this sentence?

To intentionally kill a person by withdrawing fluids, when the person is not otherwise dying is euthanasia by dehydration since the person is directly and intentionally killed by dehydration.

• Link to previous articles about the Vincent Lambert case.
• We remember Terri Schiavo.

We remember Terri Schiavo

Alex Schadenberg

Executive Director - Euthanasia Prevention Coalition

Terri with her mother.

Thirteen years ago, today, Terri Schiavo died of euthanasia by dehydration (slow euthanasia). Terri was not terminally ill, she only needed basic care, fluids, food and love to live. Her family wanted to provide her that care but her husband wanted her to die.

We remember Terri. Terri was directly and intentionally dehydrated to death. 

We will never forgot. 

Link to Terri Schiavo Life and Hope Network.

• The cruelty of Terri Schiavo's death.
• Persistently unconscious patient (15 years) awakened.
• Texas bill is model legislation to prevent death by dehydration.
• Great news: Appeal dismissed in BC normal feeding case.
• Killing the vulnerable by dehydration.

Persistently Unconscious Patient (15 years) Awakened

This article was published on his National Review blog on September 26, 2017

Wesley Smith

By Wesley Smith

Ever since Terri Schiavo, writing about the wrongness of removing feeding tubes from patients diagnosed with persistent unconsciousness (PVS)–we should never call them “vegetables,” a term as denigrating and dehumanizing a racial epithet–is like spitting in the wind. 

But, what the heck. As mentioned above, such patients are often dehydrated to death by having their feeding tubes removed, which takes up to two weeks. 

Never mind that some 40% of such diagnoses are erroneous. Never mind that some of these people may feel the agony of not eating or drinking if so misdiagnosed. Bioethics and law treat artificial nutrition and hydration as a medical treatment, and any medical treatment can be refused or withdrawn. 

But what if scientists found a way to awaken such patients? That may be on the way after an unconscious patients seems to have been roused through nerve stimulation. From the Guardian story: 

A 35-year-old man who had been in a persistent vegetative state (PVS) for 15 years has shown signs of consciousness after receiving a pioneering therapy involving nerve stimulation. 

The treatment challenges a widely-accepted view that there is no prospect of a patient recovering consciousness if they have been in PVS for longer than 12 months. 

Since sustaining severe brain injuries in a car accident, the man had been completely unaware of the world around him. But when fitted with an implant to stimulate the vagus nerve, which travels into the brain stem, the man appeared to flicker back into a state of consciousness. 

He started to track objects with his eyes, began to stay awake while being read a story and his eyes opened wide in surprise when the examiner suddenly moved her face close to the patient’s. He could even respond to some simple requests, such as turning his head when asked – although this took about a minute. 

This should be good news that should cause us to pause in removing feeding tubes from the unconscious as this research proceeds. (Some bioethicists even want such removals to become the standard of care, say after two years.) 

But I can hear the bioethicists now–because I have read their advocacy: It is more urgent to remove the feeding tubes from the minimally conscious because they may be in horror at their impaired condition or otherwise suffering. And, in fact, people with minimal awareness are legally dehydrated in all fifty states. 

Except–a study of patients in a locked-in state–the appearance of complete unconsciousness but actually aware–shows that most are “happy,” and majorities would not want euthanasia. (Scientists can now communicate with such patients.) 

So, as this research proceeds, let’s care for these seriously disabled patients–both apparently unconscious and conscious–as full and equal members of the moral community, and think twice before removing sustaining treatment that can only have one result; a protracted and perhaps, painful death.

Killing for Organs

This article was published on Wesley Smith's blog on July 28, 2015.

Wesley Smith

By Wesley Smith

We are a society of public policy promise breakers. Advocates for radical transformations in law and culture promise their proposed changes will be constrained and regulated by strict guidelines. 

Then, when the policy becomes law, it is often Katy bar the door and the old promises are forgotten. 

That pattern has not played out with organ transplant medicine. Yet. 

Not for lack of trying. Many in bioethics and the transplant field want to break the important promise solemnly made that vital organs would only be taken from patients who are dead. This is known as the “dead donor rule.” 

But with the backlog of organs growing due to fewer catastrophic brain injuries and improvements in transplant medicine, the utilitarians want to make the dead donor rule dead (as I have written about often over recent years). 

The latest promise breaker pusher is Walter Glannon, a Canadian bioethicist, writing in the philosophical journal Aeon. First, Gannon says honoring patient choice to be killed and harvested is more important than that the patient actually be dead first. 

Glannon has a whole list of people who could be killed for their organs. First sophistry, taking kidneys before death, and pretending it doesn’t actually cause death. From the piece: 

In a protocol developed by the transplant surgeon Paul Morrissey at Brown University in Rhode Island, for instance, kidneys can be taken from patients while they are alive because doing this does not cause brain death or heart death. Death is declared after the kidneys, and then life-support, are removed. This scheme applies only to kidneys, though, and is thus limited. 

I was unaware this is happening. If so, “scheme” is the right word since it is crass sophistry that pretends that the taking of the kidneys would not cause death. Ironically, kidneys don’t deteriorate as fast as other organs. So, this seems to me a gambit to destroy the DDR. It should be stopped. 

Texas bill is model legislation to prevent Death by Dehydration.

By Dr Jacqueline Harvey

Governor Abbott signed
HB 3074 into law.

On Friday, June 12, 2015, Texas Governor Greg Abbott overturned 16 years of legal forced dehydration and starvation in Texas by signing House Bill 3074. The Euthanasia Prevention Coalition (EPC) was present for the historic moment and presented a commendation to Representative Drew Springer on his skillful passage of this landmark legislation, and EPC briefly explained the significance of this bi-partisan, unanimously-supported, model disability rights bill. HB 3074 is a critical first step in EPC’s national and worldwide efforts to restore the rights of persons with disabilities to receive nutrition and hydration (ANH). Therefore this vital win in Texas is anticipated to save lives not just within the Lone Star State but throughout the United States and even globally as EPC prepares to explore this issue with standing at the United Nations.

Rep. Drew Springer
receives EPC award.

Under Rep. Springer’s leadership, HB 3074 moved Texas from the one state to allow healthcare providers to remove food and water in any circumstance to joining five other states that explicitly protect patients in need of ANH. The Texas law was an anomaly in that it allowed the medical community authority to remove ANH in any circumstance. In contrast, five states have passed laws to ensure that food and water is not forcibly withheld by a healthcare provider to kill a patient. Now that HB 3074 is signed into law, Texas no longer ranks as the worst state for patients in need of ANH but ranks among the best.

EPC believes that HB 3074 is model legislation. Representative Springer brokered an unprecedented compromise that cleared a 12-year stalemate on this issue. HB 3074 began in committee with opposition, but Springer was able to find language agreeable to all parties and foster unity to enable the bill to be passed in all committees and chambers of both House and Senate with no opposition.

New York Bill S4794 Promotes Involuntary Euthanasia by Dehydration

By Dr Jacqueline C. Harvey

Dr Jacqueline Harvey

While the battle rages over assisted suicide, many forget that in 1990, the United States Supreme Court allowed involuntary euthanasia by dehydration and starvation. First, by declaring artificially-administered food and water (ANH) as a form of “life support” and then, granting third parties the ability to remove ANH (feeding tubes) from persons with disabilities, it became effectively legal to deny a human being food and water against their will in the United States. While the Euthanasia Prevention Coalition (EPC) International’s efforts in the U.S. to reform this issue at the state-level are proceeding with encouraging momentum (Texas House Bill 3074, passed unanimously out of committee up for a floor vote in coming days), Senator Kemp Hannon in New York has launched an effort to make it easier to remove a feeding tube against the patient’s will and cause a death by dehydration. It appears that the euthanasia lobby, who want to kill by dehydration and starvation, are marching forward.

In spite of the Nancy Cruzan case, which granted authority to third-parties to remove food and water, ANH is pervasively considered such ordinary care that states have explicitly written into their law strict safeguards against unilateral removal. The Cruzan standard was that, in the absence of a written advance directive, the healthcare decision maker can remove life support, including food and water if they present “clear and convincing evidence” that this was the will of the patient. This was used to kill Nancy by dehydration over 12 days. In New York, Senator Hannon is attempting to flout this standard by striking the section of the law that demands an agent be aware of the patient’s desire to die by starvation and dehydration before condemning them to die that long, lingering death. Senate Bill 4794 would grant an agent decision-making authority to dehydrate a patient even when the patient’s wishes are not known and cannot be determined:

Section 3. Subdivision 2 of section 2982 of the public health law, as amended by chapter 230 of the laws of 2004, is amended to read as follows: 

2. Decision making standard. After consultation with a licensed physician, registered nurse, licensed psychologist, licensed master social worker, the agent shall make health care decisions: (a) in accordance with the principal's wishes, including the principal's religious and moral beliefs; or (b) if the principal's wishes are not reasonably known and cannot with reasonable diligence be ascertained, in accordance with the principal's best interests; provided, however, that if the principal's wishes regarding the administration of artificial nutrition and hydration are not reasonably known and cannot  with reasonable diligence be ascertained, the agent shall not have the authority to make decisions regarding these measures.

S4794 would amend the law to clarify that oral feeding is not applicable, a surprising addition. EPC has been involved with legal efforts to ensure patients with dementia are given food and water by mouth when family members object and perhaps see the person as better off dead. But it is important to note that an inability to swallow is an arbitrary standard. Several scenarios can inhibit a patient’s ability to swallow. Anyone requiring only a feeding tube is not brain dead, but often brain injured, like this man whose wife was encouraged to discontinue his feeding tube, but awakened from his coma and is recovering from his brain injury day-by-day. Even fully-conscious people may require tube feeding. In Britain, for example, a man named Leslie Burke with cerebral ataxia petitioned the court to prevent the removal of feeding tube after he lost the ability to request it, fearing an agonizing death that in another famous tragic case, Terri Schindler Schiavo, died after 13 days.

While conscious people and Mr. Burke could make their wishes known, those who do not explicitly declare their wish not to be denied food and water could be legally denied food and water. Instead of erring on the side of life, S4794 grants full life-and-death decision making capability into the hands of someone who may not know what the patient would want nor have any way to determine that information.

If S4794 passes, New York will usher in dehydration by default and all people will be at risk. Please contact Senator Kemp and declare your opposition to S4794 at: hannon@nysenate.gov

The Cruelty of Terri Schiavo’s Death.

This article was published by Wesley Smith on his blog on March 31, 2015.

Wesley Smith

By Wesley Smith

During the Terri Schiavo debacle, I would often debate bioethicists and others who claimed that Terri’s death would be gentle. 

These advocates either intentionally or ignorantly conflated two different circumstances.

1. The first, taking food and water from someone whose body readily assimilated sustenance. That is an agonizing death. 
2. The second, people dying naturally whose bodies are shutting down. In such circumstances, people stop eating and drinking on their own as part of the process of passing on. That does not cause suffering, and indeed, it is medically inappropriate–and can be cruel–to force sustenance into their bodies.

Terri was a number 1, and the advocates pretended she was a number 2.

Now Terri’s brother frankly discusses the terrible circumstances of his sister’s slow death by dehydration. He had an artist depict what she actually looked like. From, “I Will Never Forget the Look of Horror…” 

These are the hard facts my family and I will have to live with for the rest of my life:  

After almost two weeks without food or water, my sister’s lips were horribly cracked, to the point where they were blistering.  

Her skin became jaundiced with areas that turned different shades of blue. Her skin became markedly dehydrated from the lack of water. Terri’s breathing became rapid and uncontrollable, as if she was outside sprinting.  

Her moaning, at times, was raucous, which indicated to us the insufferable pain she was experiencing. Terri’s face became skeletal, with blood pooling in her deeply sunken eyes and her teeth protruding forward.  

Even as I write this, I can never properly describe the nightmare of having to watch my sister have to die this way. What will be forever seared in my memory is the look of utter horror on my sister’s face when my family visited her just after she died. 

The process Bobby describes is exactly what the late, pro-dehydration neurologist Dr. Ron Cranford testified happens to those being dehydrated in the Robert Wendland case. From my, “A Painless Death?” in the Weekly Standard quoting a court transcript: 

Dying of Thirst is Excruciating Agony.

By Wesley Smith, August 8, 2014 - Link to this article on his blog.

Wesley Smith

Health writer Larry Bernstein of the Washington Post has written an excruciating column about how awful and painful it is to die by thirst. The article laments–as any civilized person would–the potential mass deaths by dehydration of the Yazidi at the hand of the butchers of ISIS in Iraq.

Dying of dehydration is an awful death. From the piece:

I’m not about to start ranking the horrors visited on the human body this summer, from Ebola in West Africa to bombs and bullets in Gaza and Israel. But thousands of particularly excruciating deaths may soon be added to the list by the Sunni extremists of the Islamic State of Iraq and Syria, the terrorist group that is sweeping through parts of Iraq and establishing its own state.As this barbarism continues.

Bernstein did some research:

I asked Jeffrey Berns, president-elect of the National Kidney Foundation and a nephrologist at the University of Pennsylvania, what these children may be going through. “Thirst, as you probably know, is one of the most potent drives for behavior we have. It may be the most potent we have, more than even hunger,” he said. “People are going to be miserable.” 

The body is about 60 percent water, and under normal conditions, he said…If it’s not replaced over time and dehydration becomes severe, cells throughout the body will begin to shrink as water moves out of them and into the blood stream, part of the body’s efforts to keep the organs in fluid. “All the cells will shrink,” he said, “but the ones that count are the brain cells. They don’t operate normally when they’re’ shrinking.” 

Changes in mental status will follow, including confusion and ultimately coma, he said. As the brain becomes smaller, it takes up less room in the skull and blood vessels connecting it to the inside of the cranium can pull away and rupture. Without water, blood volume will decline and all the organs will start to fail, he said. Kidney failure will soon lead to disastrous consequences and ultimately death as blood volume continues to fall and waste products that should be eliminated from the body remain.

Yes, an awful, horrific death.

Terri Schiavo

Except when inflicted on people like Terri Schiavo? That can’t be right.

This is a biological process–yet conscious and unconscious disabled and elderly alike are made to die of thirst throughout the country and much of the Western world by thirst through removal of tube-supplied sustenance.

Yet how many times have we seen advocates for removing feeding tubes from the cognitively disabled sooooothingly assure us it is a peaceful, painless way to die? From a 2005 Chicago Tribune story about the pending death of Schiavo:

Patients diagnosed as PVS can be dehydrated to death. What if the diagnosis is wrong?

This article was written by Bobby Schindler, the brother of Terri Schiavo. Bobby and his family operate the Terri Schiavo Life and Hope Network. This article was published by LifeNews on April 21, 2014.

Bobby Schindler will be speaking at the First National Symposium on Euthanasia and Assisted Suicide on May 2 -3, 2014 in Minneapolis Minnesota.

The parents of Terri Schiavo.

By Bobby Schindler

I have written time and time again about the dangerous and dehumanizing persistent vegetative state (PVS) diagnosis. Actually, we saw in my family’s battle to save my sister, Terri Schiavo, from death by dehydration, that a tremendous amount of debate raged over whether or not she was in this condition.

In fact, this diagnosis is what allowed the court to order the removal of Terri’s food and water. Yet despite continuing research validating that the PVS diagnosis is growing in its inaccuracy, the medical community uses this diagnosis to end countless lives of our medically vulnerable patients who are allegedly in this condition.

This latest finding is one of a continuous stream of reports that have been issued on the inaccuracy of the PVS diagnosis. From the Report, Brain Scans Show Vegetative Patients May Actually Recover:

The Journal’s report, released on Feb. 3, revealed that some patients who were believed to be in a PVS were actually able to understand and communicate. Through the use of functional magnetic resonance scanning (fMRI), researchers in the United Kingdom estimated that a percentage of those patients suffering from profound brain injuries possessed the capacity to comprehend and communicate in limited ways.

Terri Schiavo

Indeed, every time these studies are published we should move to abolish the PVS diagnosis, in particularly, using it as a reason to kill. Sadly, however, despite these imaging studies and what they reveal about the human brain, the vast majority of the medical community sees nothing improper about using such an unscientific diagnosis for, what usually turns out to be, reasons almost never in the best interest of the patients.

Furthermore, not only can the PVS diagnosis be used as an actual death sentence for a patient, but as a death sentence figuratively speaking, as well. And it seems both are supported under the pretext to save health care costs. You see, the PVS can also be used to cut off funds for a person in need of vital rehabilitation. Because once insurance providers receive the PVS diagnosis in regards to the patient’s condition, no longer are they willing to pay for any rehabilitative services.

French court ruling prevents death by dehydration for disabled man.

By Alex Schadenberg
International Chair, Euthanasia Prevention Coalition

A court in France ruled against the withdrawal of food and water from Vincent Lambert, a tetraplegic patient who has been in a state of minimal consciousness in hospital for five years, following a car accident.

Parents of Vincent Lambert

Lambert was incapacitated in a car accident five years ago, but the decision to cut his intravenous food and water supply has divided his family. Lambert's doctors and wife wanted to end the supply and allow Lambert to die, but his parents, who are vehemently opposed to ending his life, took his case to court.

The ruling goes against the wish of his wife and instead favours the parents’ desire to keep their son alive.
The wife and parents of Lambert have long been in opposition over the issue and in recent months his brothers and sisters have become involved on opposing sides.

The Lambert case is very similar to the Terri Schiavo case in 2005 in Florida, except that in the Schiavo case the court sided with Schiavo's estranged husband rather than her parents and siblings, who wished to care for her.

The French court has prevented Lambert from dying a horrific death by dehydration.

Links to similar articles:

Terri Schiavo: Her death marked a beginning.

More than 1000 people killed by dehydration in the UK.

Elder abuse and death by dehydration, a personal story.

Imagine the pain of knowing you are being dehydrated to death.

Hospital for Sick Children in Toronto dehydrating children with disabilities to death.

People are being wrongly diagnosed as PVS.

This article was written by Bobby Schinder and published on the Life and Hope Network website under the title: Our disdain for the Brain Injured. This article was also published by LifeNews.

By Bobby Schindler - December 23. 2013

Bobby Schindler

How many of these news reports do we need to read about patients who are wrongly diagnosed as being in a so-called persistent vegetative state (PVS) before we eliminate this dangerous, unscientific and completely subjective diagnosis? I’m getting tired writing about it.

Our brain injured are being killed because of it, not to mention the prejudices that exist against these persons by labeling them as “vegetables” as a result of this bogus and dehumanizing diagnosis.

In yet another finding, this time out of Tel Aviv University, researchers found those who were purportedly in a PVS showed some level of awareness. This contradicts the PVS definition that says a person in this condition has no awareness and/or is unable to communicate. From the story, “First-of-Its-Kind Experiment Reveals Patients in Vegetative State Might Have Emotional Connection to Familiar Faces”:

“We showed that patients in a vegetative state can react differently to different stimuli in the environment depending on their emotional value,” said Dr. Haggai Sharon with Tel Aviv University’s Functional Brain Center, according to American Friends of Tel Aviv University. “It’s not a generic thing; it’s personal and autobiographical. We engaged the person, the individual, inside the patient.”

Scott Routley

Over the past several years there has been a steady stream of research that is discovering how persons diagnosed as being in a PVS are, in fact, able to communicate at some level. It was as far back as 2006 when our organization, the Terri Schiavo Life & Hope Network issued its first press release on this deceptive PVS diagnosis and its need to be rejected, when research found similar results regarding patients wrongly diagnosed as being in a PVS.

For families who are caring for these persons, these finding are hugely significant, as it was for the family of Scott Routley when it was found that he was able to communicate with his parents as to whether or not he was in pain after physicians thought he was in PVS and unable to respond. And I recently wrote about a two-year old named L.B. who physicians believed would never improve from his PVS condition, only to be proven wrong when he responded to adult stem cell treatment, emerging from his so-called PVS condition.

All of these new brain studies and their results, particularly when it comes to catastrophic injuries to the brain, demonstrate how science is improving when it comes to understanding the brain, brain injury and subsequent treatment protocols. So much so, that one can only guess what the future holds for these persons and why there is reason to be encouraged.

Tragically, most people do not realize when a physician determines someone is in a PVS, it can become a death sentence for them – both figuratively and literally. Indeed, when diagnosed as “PVS” and therefore deemed as having no “quality of life”, funding to help them receive rehab is essentially cut-off by insurance companies and/or Medicare/Medicaid. And because families cannot afford the rehab services their family member needs, often times these persons are abandoned and warehoused with no chance to recover.

Ironically, rehabilitation and therapy is most vital to these individuals during this time so that their quality of life can be improved, otherwise the potential for their recovery will be forever compromised. However, even more disturbing is that the decision to kill these vulnerable persons (many times by starvation and dehydration) can be easily made and happens every single day. Over the years, because of the aggressive nature of those infatuated with seeing these people eliminated from existence, laws have been changed so that once they are diagnosed as PVS, these people can be legally killed; and it’s legal to kill these innocent souls in all 50 states.

Unfortunately, for these brain injured persons and the families who unconditionally love them and decide to take care of them, there really doesn’t seem to be a whole lot of passion when it comes to protecting their lives, let alone getting them the help they need and deserve.

Until the day comes when society sees the value in protecting the God given dignity of these persons, things will not change. In fact, it will get worse with the new health care system and with too many of those in the medical profession who, not only discriminate against these people, but who also loathe them.

Links to similar articles:
● Canadian research showing that some PVS people can communicate.
● Patients in Vegetative State should not be assumed to be unaware.
● Imagine the pain of knowing you are being dehydrated to death.

More than 1000 people killed by dehydration in the UK

By Alex Schadenberg, 
Executive Director - Euthanasia Prevention Coalition

Alex Schadenberg

For many years I have stated that once death by dehydration becomes common people will react by demanding death by lethal injection. Death by dehydration is not a compassionate death. 

The Euthanasia lobby, who first promoted death by dehydration, now use the abandonment of vulnerable people that has led to death by dehydration becoming common as a reason for legalizing euthanasia.

An article written by Ben Riley-Smith and published in the The Telegraph on December 1, 2013 states that access to information files in the UK indicate that more than 1000 people died by dehydration related to neglect and abuse over the past 10 years in the UK.

The article stated:

More than 1,000 care home residents have died of thirst or while suffering severe dehydration over the past decade. 

Elderly and vulnerable patients were left without enough water despite being under the supervision of trained staff in homes in England and Wales. 

“How can we call ourselves civilised when people are left to starve or die of thirst? … It is an utter disgrace that they are ever left without the most basic care,” said Dr Alison Cook, a director at the Alzheimer’s Society.

The article then explained the statistics:

Figures obtained by this newspaper (The Telegraph) under freedom of information laws found that 1,158 care home residents suffered dehydration-related deaths between 2003 and 2012. Dehydration was named as either the underlying cause of death or a contributory factor, according to analysis of death certificates by the Office of National Statistics. 

Some 318 care home residents were found to have died from starvation or when severely malnourished, while 2,815 deaths were linked to bed sores. 

The real figures are likely to be far higher because residents who died while in hospital were not included.

The article continues:

In 2011 a BBC Panorama investigation secretly filmed staff at Winterbourne View private hospital, near Bristol, hitting and taunting patients with learning disabilities. Six staff members were eventually jailed, while 19 patients are due to receive compensation. In October a coroner said that Orchid View care home, near Crawley, West Sussex, where 19 residents died, was riddled with “institutionalised abuse” and criticised the CQC for rating it as good in 2010. 

Last year the CQC issued 818 warning notices to adult social care services in England – around two thirds more than the preceding year.  

Norman Lamb, the care and support minister, said the deaths from thirst and starvation were “entirely unacceptable”.

The fact is that killing a person, who is not otherwise dying, by dehydration, is ethically the same as euthanasia. Killing people by dehydration is usually a form of abuse and neglect.

Imagine the pain of knowing you are being dehydrated to death.

This article was written by Wesley Smith and published on his blog on November 12, 2013.

Wesley Smith

We dehydrate to death helpless people to death in this country because they have a catastrophic cognitive impairment. Advocates for dehydration say it is just medical ethics, the withdrawal of the medical treatment of tube feeding. (Now, there is even a lawsuit to compel starvation by withholding spoon feeding–not a medical treatment!)

Dehydrating helpless people to death was once unthinkable. Then, in the 80s, bioethicists began advocating withdrawing tube-supplied food and fluids. And so it came to pass.

Advocates for dehydration started by claiming it should be reserved strictly for those who are unconscious. They have, of course, broadened the dehydration caste since. But recent scientific studies have now also shown that many supposedly unconscious patients aren’t unaware at all.

And now we learn some are paying attention to their surroundings!  From the Cambridge University report:

A patient in a seemingly vegetative state, unable to move or speak, showed signs of attentive awareness that had not been detected before, a new study reveals. This patient was able to focus on words signalled by the experimenters as auditory targets as successfully as healthy individuals. If this ability can be developed consistently in certain patients who are vegetative, it could open the door to specialised devices in the future and enable them to interact with the outside world.

And get this:

These findings suggest that some patients in a vegetative or minimally conscious state might in fact be able to direct attention to the sounds in the world around them.

If this is true of other patients, imagine the horror of hearing doctors and family discussing removing your food and water. Imagine the pain of the actual event!

Actually, we know what that is like. Kate Adamson, thought mistakenly to be unconscious after a brain stem stroke, underwent abdominal surgery with inadequate anesthesia. She was then left unfed (but hydrated via drip) during the healing process–and it was more painful than the sensation of being cut open!

I wrote about this during the Terri Schiavo fiasco. From my piece, “A Painless Death?”

In preparation for this article, I contacted Adamson for more details about the torture she experienced while being dehydrated. She told me about having been operated upon (to remove the bowel obstruction) with inadequate anesthesia when doctors believed she was unconscious: 

“The agony of going without food was a constant pain that lasted not several hours like my operation did, but several days. You have to endure the physical pain and on top of that you have to endure the emotional pain. Your whole body cries out, “Feed me. I am alive and a person, don’t let me die, for God’s Sake! Somebody feed me.” 

Unbelievably, she described being deprived of food and water as “far worse” than experiencing the pain of abdominal surgery. Despite having been on an on an IV saline solution, Adamson still had horrible thirst: 

“I craved anything to drink. Anything. I obsessively visualized drinking from a huge bottle of orange Gatorade. And I hate orange Gatorade. I did receive lemon flavored mouth swabs to alleviate dryness but they did nothing to slack my desperate thirst.”

By the way, the take away from all this? Many will say these patients are suffering by knowing of their condition, justifying doctors to lethally inject, anesthetize and dehydrate, or kill by harvesting their organs. Indeed, some bioethicists already have.

P.S: If someone you love is thought to be unconscious, assume they can still hear you. Stories of “unconscious” people recalling all that went on around them are ubiquitous.