THE CHIPS ARE DOWN. We have had a surfeit of due process. It is now well past time to consider the facts which process has willfully ignored. There is no reason, medical, moral, or legal, to refrain from an attempt to provide Terri Schiavo with orally administered liquids.
There are only two possible explanations for having employed gastric tube feeding. Either (1) her neurologic damage has brought about a swallowing dysfunction with danger of aspiration pneumonia; or (2) it was simply a matter of convenience to avoid labor intensive hand feeding.
In either case, no medical reason now exists to refuse a trial of natural drinking. She may have impaired swallowing function, but that at its worst cannot be as bad as death by dehydration.
Allowing her to drink water would be the definitive test of swallowing function. She may be able to swallow water and other clear liquids, in which case she will avoid death by dehydration, even if she later succumbs to malnutrition. Or she may be able to swallow pureed food, which will avoid death by malnutrition. Or she may not be able to swallow water without aspiration into the lungs, and so would develop pneumonia, and have a quicker and more peaceful death.
As to legal concerns, a guardian may refuse any medical treatment, but drinking water is not such a procedure. It is not within the power of a guardian to withhold it, and not in the power of a rational court to prohibit it.
The moral case speaks for itself.
When we awaken from this queasy nightmare, people will ask how it could have been that a court could post a police officer by the bedside to insure that a dying woman succumbed to a ghastly death by thirst.
William Anderson is a lecturer at Harvard University and Senior Psychiatrist at Massachusetts General Hospital.
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