Monday, February 21, 2005
On Death by Dehydration
A Potentially Painful Death
Advocates for dehydrating the neurologically disabled assert that it is a painless end. But there are substantial reasons for doubt. St. Louis neurologist Dr. William Burke told me:
A conscious person would feel it [dehydration] 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.
Minnesota neurologist Dr. Ronald Cranford, an avid supporter of dehydration, who has often appeared as an "expert witness" in litigation over withholding food and water, testified in the Robert Wendland case about the effect of dehydration on cognitively disabled patients:
After 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. . . .
Since the people to whom this is done generally can't communicate, we mostly don't know what they actually experience. But in at least one case we do: that of a young woman who had her tube feeding stopped for eight days and lived to tell the tale.
At age 33, Kate Adamson collapsed from a devastating stroke. She was diagnosed as likely to develop a persistent vegetative state (PVS) but was actually "locked in"-that is, she was completely awake and aware but unable to communicate. Even after the doctors realized that Adamson was entirely conscious, they urged her husband to "let her go." He refused, and indeed, when she developed a bowel obstruction, he authorized surgery. However, to clean the bowel enough to permit surgery, her nourishment was stopped. When, eventually, she recovered her ability to communicate, she wrote Kate's Journey: Triumph over Adversity. Appearing on The O'Reilly Factor, Adamson described the experience of being denied nourishment.
When the feeding tube was turned off for eight days, I thought I was going 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.
In preparation for an article in the Daily Standard, I asked Adamson to provide more details about what she experienced while being deprived of tube-supplied nourishment. As an illustration, she told me that she was administered inadequate anesthesia during her bowel-obstruction surgery. Yet, as painful as that was, it was not as bad as the suffering caused by being denied nourishment:
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."
Moreover, although Adamson was not deliberately dehydrated-she was constantly on an IV saline solution-she 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 slake my desperate thirst.Doctors who withhold nourishment and hydration with the purpose of causing death may prescribe morphine or other narcotics to alleviate the pain. But who knows whether this is sufficient? For example, when Cranford was asked during his Wendland testimony what level of morphine would have to be given to prevent the patient from suffering, he testified 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." He added that he would probably put Robert Wendland back into a coma to ensure that he did not feel pain!