A "Painless" Death?
Schiavo insists that dehydration is "the most natural way to die."
It's more like torture.
by Wesley J. Smith
11/12/2003 12:00:00 AM
MANY WHO SUPPORT Terri Schiavo's threatened dehydration assert that removing a
feeding tube from a profoundly cognitively disabled person results in a painless
and gentle ending. But is this really true? After all, it would be agonizing if
you or I were locked in a room for two weeks and deprived of all food and water.
So, why should we believe that cognitively disabled patients experience the
deprivation differently simply because they receive nourishment through a
feeding tube instead of by mouth?
An accurate discussion of this sensitive issue requires the making of proper and
nuanced distinctions about the consequences of removing nourishment from
incapacitated patients. This generally becomes an issue in one of the following
two diametrically differing circumstances:
(1) Depriving food and water from profoundly cognitively disabled persons like
Terri who are not otherwise dying, a process that causes death by dehydration
over a period of 10-14 days. As I will illustrate below, this may cause great
(2) Not forcing food and water upon patients who have stopped eating and
drinking as part of the natural dying process. This typically occurs, for
example, at the end stages of cancer when patients often refuse nourishment
because the disease has distorted their senses of hunger and thirst. In these
situations, being deprived of unwanted food and water when the body is already
shutting down does not cause a painful death.
Advocates who argue that it is appropriate to dehydrate cognitively disabled
people often sow confusion about the suffering such patients may experience by
inadvertently, or perhaps intentionally, blurring the difference between these
two distinct situations. For example, when Michael Schiavo, Terri's husband, and
his attorney, George Felos, appeared on the October 27, 2003 edition of
"Larry King Live" the following exchange occurred:
KING: When a feeding tube is removed, as it was planned [for Terri], is that a
terrible death? SCHIAVO: No. It's painless and probably the most natural way to
FELOS: When someone's terminally ill, let's say a cancer patient, they lose
interest in eating. And literally, they--by choice--they stop eating.
SCHIAVO: Cancer patients, they stop eating for two to three weeks. Do we force
them to eat? No, we don't. That's their choice.
Later in the interview, Schiavo reiterated the assertion in a
response to a telephoned question:
CALLER: Does it bother you that the death is so slow?
SCHIAVO: Removing somebody's feeding tube is very painless. It is a very easy
way to die. Probably the second best way to die, the first being an aneurysm.
Yes, it is true that when people are actively dying from terminal disease, they
often refuse food and water. The disease makes the food and water repulsive to
them. In such circumstances, it is medically inappropriate to force food
and water into a person who is actively rejecting it. Indeed, doing so could cause
But this isn't what is happening to Terri. She isn't dying of cancer. Her
body isn't shutting down as part of the natural dying process. Indeed,
she is not dying at all--unless her food and water is taken away.
WHAT HAPPENS to non-terminally ill people with cognitive disabilities whose
feeding tubes are removed? Do they suffer from the process?
When I conducted research on this question in preparation for writing my book
"Forced Exit," I asked
neurologist William Burke these very
questions. Here is what he told me:
A conscious [cognitively disabled] person would feel it just as you or I
would. They will go into seizures. Their skin cracks, their tongue cracks, their
lips crack. They may have nosebleeds because of the drying of the mucus
membranes, and heaving and vomiting might ensue because of the drying out of the
stomach lining. They feel the pangs of hunger and thirst. Imagine going one day
without a glass of water! Death by dehydration takes ten to fourteen days. It is
an extremely agonizing death
Dr. Burke opposes removing feeding tubes from cognitively
disabled people and so some might dismiss his opinion as biased. But
neurologist Ronald Cranford's pro-dehydration testimony in the Robert Wendland
also testified that Terri's feeding tube should be removed--supports much of
what Dr. Burke asserted. While
called seizures "rare," his detailed description of the dehydration
process reveals its gruesome reality:
seven to nine days [from commencing dehydration] they begin to lose all fluids
in the body, a lot of fluids in the body. And their blood pressure starts to go
down. When their blood pressure goes down, their heart rate goes up. . . . Their
respiration may increase and then . . . the blood is shunted to the central part
of the body from the periphery of the body. So, that usually two to three days
prior to death, sometimes four days, the hands and the feet become extremely
cold. They become mottled. That is you look at the hands and they have a bluish
appearance. And the mouth dries a great deal, and the eyes dry a great deal and
other parts of the body become mottled. And that is because the blood is now so
low in the system it's shunted to the heart and other visceral organs and away
from the periphery of the body . .
MOST OF THE TIME, we never know for sure what a starved or
dehydrated person experiences. But at least in one case -- that of a young
woman who had her feeding tube removed for eight days and lived to tell the tale
-- we have direct evidence of the agony that forced dehydration may cause.
Adamson eventually recovered sufficiently to author "Kate's Journey:
Triumph over Adversity", in which she tells the terrifying tale.
Rather than being unconscious with no chabce of recovery as her doctors
believed, she was actually awake and aware but unable to move any part of her
body voluntarily. (This is known as a "locked in state.")
When she appeared recently on "The O'Reilly Factor," host Bill
O'Reilly asked Adamson about the dehydration experience:
O'REILLY: When they took the feeding tube out, what went through your mind?
ADAMSON: When the feeding tube was turned off for eight days, I thought I was
insane. I was screaming out in my mind, "Don't you know I need to
eat?" And even up until that point, I had been having a bagful of Ensure as
my nourishment that was going through the feeding tube. At that point, it
sounded pretty good. I just wanted something. The fact that I had nothing, the
hunger pains overrode every thought I had.
O'REILLY: So you were feeling pain when they removed your tube?
ADAMSON: Yes. Oh, absolutely. Absolutely. To say that--especially when Michael [Schiavo]
on national TV mentioned last week that it's a pretty painless thing to have the
feeding tube removed--it is the exact opposite. It was sheer torture, Bill.
O'REILLY: It's just amazing.
ADAMSON: Sheer torture . . .
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 have her feeding tube inserted in her
abdomen) with inadequate anesthesia when doctors believed she was unconscious.
Unbelievably, she described being deprived of food and water as "far
worse" than experiencing the pain of abdominal surgery, telling me:
“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."
But what about the thirst, I asked:
“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.”
Apologists for dehydrating patients like Terri might respond that Terri is not
conscious and locked-in as Adamson was but in a persistent vegetative state and
thus would feel nothing. Yet, the PVS diagnosis is often mistaken--as indeed it
was in Adamson's case. And while the courts have all ruled that Terri is
unconscious based on medical testimony, this is strongly disputed by other
medical experts and Terri's family who insist that she is interactive with them.
Moreover, it is undisputed that whatever her actual level of awareness, Terri
does react to painful stimuli. Intriguingly, her doctor testified he prescribes
pain medication for her every month during the course of her menstrual period.
BEYOND THE TERRI SCHIAVO CASE, it is undisputed that conscious cognitively
disabled patients are dehydrated in nursing homes and hospitals throughout the
country almost as a matter of routine. Dr. Cranford, for example, openly
admitted in his Wendland testimony that he removes feeding tubes from conscious
patients. Thus, many other people may also have experienced the agony described
by Adamson and worse, given that dehydrating to death goes on for about a week
longer than she experienced.
AT THIS POINT, defenders of removing feeding tubes from people with profound
cognitive disabilities might claim that whatever painful sensations dehydration
may cause, these patients receive palliating drugs to ensure that their deaths
are peaceful. But note: Adamson either did not receive such medications, or if
she did, they didn't work. Moreover, because these disabled people usually can't
communicate, it is impossible to know precisely what they experience. Thus, when
asked in a deposition what he would do to prevent Robert Wendland from suffering
during his dehydration, Dr. Cranford responded that he would give morphine but
that the dose would be "arbitrary" because "you don't know how
much he's suffering, you don't know how much aware he is . . . You're guessing
at the dose." At trial,
suggested he might have to put Wendland into a coma, a bitter irony considering
that he had struggled over many months to regain consciousness.
The time has come to face the gut wrenching possibility that conscious
cognitively disabled people whose feeding tubes are removed--as opposed to
patients who are actively dying and choose to stop eating--may die agonizing
deaths. This, of course, has tremendous relevance in the Terri Schiavo case and
many others like it. Indeed, the last thing anyone wants is for people to die
slowly and agonizingly of thirst, desperately craving a refreshing drink of
orange Gatorade they know will never come.
Wesley J. Smith is a senior fellow at the Discovery Institute and an attorney
and consultant for the International Task Force on Euthanasia and Assisted
Suicide. His current book is the revised and updated "Forced Exit: The
Slippery Slope From Assisted Suicide to Legalized Murder."