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Comment by acchow | Hacker News Reader

> "staff at the Pinellas Park hospice facility disconnected the feeding tube on March 18, 2005, and Schiavo died on March 31, 2005."

So, they starved her to death over 13 days? How do they know she wasn't experiencing this as torture?

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Because it was repeatedly and conclusively shown at that point that her brain had atrophied to half its size. She was gone. The reason the situation almost devolved into an armed stand-off between the courts and the executive branch is because every judge (Florida and Federal) who looked at the case--that is, those officials presented with all the evidence from both sides--quickly understood the reality; whereas the politicians hundreds and thousands of miles away who hadn't the first clue about the facts had other objectives in mind.

The subsequent autopsy confirmed what was already known. But there was never any accountability because by then the media had moved on.

Terry Schiavo is not the case to point to when questioning the science and treatment of PVS.

It was a fight between scientists and non-scientists. The scientists saw the scans of her head that showed a void where there should have been brain. The non-scientists looked at a handful of home movies where here random movements and facial expressions occasionally lined up to make her look aware. Such debate between scientific evaluation and layperson "gut feelings" predate so many of today's debates re climate.

It was also a generational fight. Her husband, the normal go-to for medical decisions was on one side, and her parents on the other. The parents wanted control over their daughter. They could not accept the widespread default that, for most all medical/legal matters, spouses trump parents. And this was Florida. So the "rights" of the older generation were given greater play in the courts than would have happened in other states.

>"The scientists saw the scans of her head that showed a void where there should have been brain."

People with "no" (very small) brains due to hydrocephalus have been discovered who are successful mathematics students and public servants. So, not sure the scientists are right here. As long as the brain is shrinking slow enough it may not be a huge deal in terms of mental ability.

http://mentalfloss.com/article/70204/man-without-brain

https://www.theguardian.com/education/2003/oct/02/research.h...

Nope. She had a medical problem related to medication. Her brain went from normal to tiny in the course of perhaps 24 hours. This was not just a small brain, this was a normal brain in which huge areas died away due to lack of oxygen.

I don't know the details but that does sound like the medical issue killed her.

She suffered cardiac arrest from low serum potassium levels (hypokalemia) and she suffered massive brain damage as a result of the lack of oxygen to the brain. It was definitely a sudden, abnormal, and catastrophic change in brain size.

Years ago I ran across those extreme bilateral hydrocephalus cases you linked. As a neuroscientist, naturally they piqued my interest. I was skeptical then, and even moreso now. To my knowledge, in the years since those 2-3 cases popped-up, there has never been any follow-up on those original patients, and no similar bilateral cases have been found in the modern-era of brain imaging.

I will happily stand corrected if someone can provide any evidence from the last 10 years where any case like this has been documented and independently confirmed. Until then, I will continue to consider the brain important.

could you elaborate? Do you think they really didn't have the condition described? If they did then while more evidence would be helpful in establishing likelihood, it would not make a difference in establishing possibility.

I think it's possible that Lorber is misreading and misrepresenting the CT scan, and the actual state of the cortex is very different than what we are being shown.

These cases are extremely interesting, and any high-impact journal would immediately accept a quantitative MRI report or the simplest fMRI study on such a patient (if it were from a reputable source).

This would make the cover of Nature or Science mags, and would capture the attention of the entire neuroscience community. Yet as interesting as they are, none of these existing case studies conform to the standards of modern neuroscience reporting.

She'd be fine with half a brain:

https://www.cbc.ca/radio/asithappens/as-it-happens-thursday-...

False equivalence. This is like showing a story about an arm amputee living a normal life, and using that to claim that someone who had just had their arm blown off would "be fine".

What happens when life support is discontinued for someone who has a normal sized brain? Are steps taken to make the end quick, or do they also starve? If the latter, then I'm not sure that it being provably not potentially horrible for Schiavo has any relevance to the underlying ethical question.

Also, brains are overrated [1]. :-)

[1] https://www.iflscience.com/brain/man-tiny-brain-lived-normal...

Quick Googling suggests that it's widely understood that starvation isn't, per se, painful. Presumably what might be painful is prolonged malnutrition.

As someone who has fasted for a week, I can attest that much of the physical discomfort disappears rather quickly. Though, I can't speak directly to near-death starvation, nor to dehydration.

I agree that it's ridiculous that doctors (in the U.S., at least) rarely have a way to quickly and legally dispatch people (or the shells of people). It happens informally, though. Being such a high-profile case, advocates for Terry Schiavo's parents all but ensured the doctors would follow the book--starvation.

>As someone who has fasted for a week, I can attest that much of the physical discomfort disappears rather quickly. Though, I can't speak directly to near-death starvation, nor to dehydration.

There are quite alot of reports from prisoners on hunger strikes, some of whom died. The ones I read about agreed with you. The discomfort disappears after the first week of so, after that you just get weaker and weaker to the point were you are no longer able to eat normal food.

Dehydration is much more problematic with slipping into a delirium and going into spasm. Sadly there are also examples of prisoners experiencing this, as some countries have had the concept of "dry cells". They were first used as punishment and later to break hunger strikers. Baader of the German Baader-Meinhof group for example retained kidney damage from his stay in such a cell during a hunger strike.

So, torture cells.

It doesn’t matter. Starving a bedridden patient to death is a passive activity, and is hence defined as “moral.” In contrast, giving them a morphine overdose so they die quickly and painlessly is an active measure and thus defined as “immoral.”

> giving them a morphine overdose so they die quickly and painfully ?

wait. is a morphine overdose painful?

No, that was surely a typo

More like a sudden brain malfunction, but yeah.

I think you meant "painlessly".

Uh, yeah, I kinda did. Thanks.

I'm not taking a position on this or trying to argue. I'm truly somewhat confused by it all. I'm not sure I agree with this, as I find it, honestly, rather frightening in practice, but it seems like painkiller administration is a kind of euthanasia loophole, even in places where euthanasia is not legal:

Passive euthanasia is the withholding of treatments necessary for the continuance of life. Whether the administration of increasingly necessary, albeit toxic doses of opioid analgesia is regarded as active or passive euthanasia is a matter of moral interpretation, but in order to pacify doctors’ consciences, it is usually regarded as a passive measure. Many people, therefore, regard it as an acceptable facet of good professional practice.

https://jramc.bmj.com/content/147/3/367

I have heard of that sort of thing as well. It seems to be a sort of a wink and a nudge situation, where you up their painkiller dose and say, gee, that’s a lot of drugs, I sure hope it doesn’t have any bad effect on them, wink wink nudge nudge! And then: oh no, they died, how completely unforeseen!

The facade of what I said is maintained, but the reality is more complex, as usual.

This strange denial means things can get difficult in unusual circumstances, such as when your patient is making the national news. It’s hard to wink and nudge when not everyone is playing along.

Depends on intent.

If patient is in pain (and we know because they tell us or because we think they look like they are in pain), we treat the pain. If treating that pain results in them having a shorter life, that's acceptable morally and legally. And I do not consider this active or passive euthanasia since there is a legitimate medical purpose for that medication.

If we gave someone an overdose for the purpose of ending their life, that is active euthanasia in the United States (I am unclear if it is different elsewhere and I agree it isn't so clear at the end of that abstract from a British author.)

As caregiver for my grandfather, who had end-stage dementia and then pancreatic cancer, I can say this is true. In home hospice care basically instructed us to OD him on morphine to end his suffering.

> it seems like painkiller administration is a kind of euthanasia

It absolutely is. A relative of mine had a stroke and was on the way out. The nursing home staff told us they couldn't give him anything to help hasten the end but if you think he's in pain...? [expectant stare]

It took a few rounds of this before we twigged and completed the ritual. "Yes, I think he's in pain."

I'm baffled that disconnection of a feeding tube seems like a reasonable way to interrupt life-sustaining processes

Euthanasia is illegal in the US. The only thing you can do is remove artificial means of life support. It’s in humane. People should be able to die with dignity. We treat our pets better.

I don't disagree, but this recent assisted suicide story certainly has added some complexity to the debate: https://www.theguardian.com/society/2018/mar/17/assisted-dyi...

TL;DR: Assisted suicide approved and performed for woman suffering from depression and psychosis.

Actually, it wasn't the first non-terminal assisted suicide. I remember a 2009 story involving a man who decided to die with his wife. The wife had terminal cancer, he was healthy, albeit 80 years old. https://www.theguardian.com/society/2009/jul/14/assisted-sui...

That article also discusses another couple suffering from non-terminal but chronic illness and chronic pain. I don't remember reading about that couple at the time.

Yeah, but you know what? That's was their choice

Yes. I don't mean to be critical of those decisions. But assisted suicide is often pitched to the public as a compassionate treatment to terminal illness. Being narrowly circumscribed is supposed to minimize the potential for abuse and coercion. So when I say those stories add complexity, I mean to say they create fodder for those opposing assisted suicide.

Not really, you just have to write the law to allow what you think should be allowed.

Some countries allow assisted suicide in non critical conditions, some allow it only for critical conditions, and some never allow it.

I don't see why it would give any weight to those opposing assisted suicide.

And TBH I don't understand what is the problem with assisted suicide for non critical conditions in the first place. People get to chose their life, and should be able to end it if they want to. The only alternative as I see it would be to put on the state the responsibility to make everyone so happy they would never want to die, which does not sound like something those opposing assisted suicide would want either.

Why would we force people to live miserable lives?

Please at least try to see the other side of the argument. Or we could replace a large chunk of depression treatment with firing squads and it would be fine your argument above.

After all, they wanted to die.

You would prefer suicide by cop?

As someone who suffers from depression for almost 20 years I would like to provide some thought:

Sometimes if you really just want to die and can not move out of bed, it would be REALLY(!) helpful if you would just be allowed to. If I could just go to my parents or my friends and say "hey, I love you all, but I have enough, I want to die" and if then nobody would be like "oh! you feel that bad? how can we help you? We are there for you" but just accept what I just said "I want to die", make an appointment at a doctor's office, give me some overdose and let me like. Act the same way as if I told them I want to move to another country, talk about it if you need, accept it and accept it as a life choice. If that would be really socially accepted–and I mean really accepted, not just some imaginary accepted by everyone just in order to treat the depressed–then I suspect a lot of depression would go away, because everyone who is depressed and fights to get out of bed everyday would have a real new choice, a real new option that is not looked down upon like "I want to die but everybody I love will be mad or sad". And having real options and choices you are free to take helps a lot if you are depressed. It's the feeling of having a lot of choices but being not allowed/accepted/able to take them that often stops one from finding the strength to fight back.

The way I see it is this: Suffering matters, and options to rid yourself of suffering should exist, including dying.

Dying wouldn't be the first course of action for most doctors (and it'd be doctors that would need to document). It is kind of like being in physical pain: You might think death is better right now, but when you heal a bit, you would rather not die, thank-you-very-much.

But for some folks, that healing doesn't really happen. Some folks go for years suffering and/or wanting to die. Same with physical pain. And if you've tried the cures available and have suffered, why wouldn't this be an option for folks? The same with any major, persistent mental illness honestly. Or any major illness that causes grief, pain, and/or disability. It isn't replacing mental health treatment, but it is adding another tool that replaces suicide that is hidden away. And honestly, I'm guessing it would give a few folks a light at the end of the tunnel. "If treatments don't work, I can eventually die painlessly if I choose".

You can have death available for non-critical patients alongside standards for getting such a thing.

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