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Feeding tubes: and now, for something completely different

Kentucky gov. Ernie Fletcher has been in the hospital for gallbladder surgery. Last week he was put on a feeding tube.

But don't start counting the days until the guv is removed from life support and shuffles off this mortal coil. Instead, take a look at the stories (here and here).

Yes, they have a completely different tone from the many who report on people who are considered "better off dead," don't they? Yes, indeedy. In this case, they're using the same kind of language that -- gasp! -- disability rights activists used back when Terri Schiavo was on a feeding tube. Fletcher's doctor matter-of-factly referred to it simply as an "alternative method of [delivering] nourishment."

"Bypassing the pancreas with a feeding tube .... allows a patient to receive needed nutrition," the guv's doctor told reporters.

Imagine that.

The use of a feeding tube is not considered a setback, officials said.

In fact, it's a common measure in situations like these, said Dr. Richard A. Wright, chief of gastroenterology at the University of Louisville.

"It's standard procedure," said Wright....

When a patient has pancreatitis, Wright said, it can be painful and difficult to eat certain things, such as fatty foods and those containing protein. ...

"You want to rest the pancreas as it's recovering," he said.

He added that this usually shortens rather than lengthens a hospital stay, and that patients can continue to receive tube feeding at home if necessary. ( Read story from the Courier-Journal.)

What are we to make of all this? That Terri Schiavo's and Haleigh Poutre's feeding tubes were different from the guv's? Or does it have something to do with the kind of person using it -- the guv is a normal person with a pancreatic problem, whereas the other two are "vegetables" (or Terri was a vegetable, and the jury's still out on Haleigh)?

It also has to do with the fact that Fletcher will recover, a.k.a. return to normal. In fact, his feeding tube was removed on Monday.

So it's OK.

Still, I'm going to save this story for the next time one of those "take her off the feeding tube and let her die" stories crops up. And maybe send it to the reporter. Along with a link to this press release.


Feeding tubes are overrated. My family is a 3 tube family: both of my kids and I have feeding tubes. If the average parent wracking her(his) brain trying to come up with a new and innovative dinner idea that the family will eat without complaining knew how easy tube feedings are, there might be a run on feeding tubes. (And if drunken college students knew how easy it is to pour in a large quantity of cheap potent alcohol into a tube -- I know there would be people clamoring for them.) I say this only partly tongue in cheek. It really is plug and pour to feed with a g-tube (gastrostomy).

The governor actually had a j-tube (jejunostomy) that is far more invasive, and difficult to use than a g-tube like my kids have, or like what Terri Schiavo had.

I am oxygen dependent so I relate to the feeding tube issue. I was horrified and heartbroken over what happened to Terri Shiavo. We have to keep the pressure on until there is justice and respect for every one of us.

What are we to make of all this? That Terri Schiavo's and Haleigh Poutre's feeding tubes were different from the guv's? Or does it have something to do with the kind of person using it -- the guv is a normal person with a pancreatic problem, whereas the other two are "vegetables" (or Terri was a vegetable, and the jury's still out on Haleigh)?

Obviously it is the patients, not the feeding tubes, that are at issue.

In the current case, the patient is conscious, alert, and retains all his qualities of personal identity or moral personhood - and presumably will continue to do so. In addition, he has - again, I presume - given his express consent for this procedure.

In the other cases you mention, the patients were not conscious or alert, and in the Schiavo case in particular clearly had lost all vestiges of personhood and would never regain them. More importantly, there was evidence that she herself had expressed a desire not to receive long-term maintenance by gastric tube. (This evidence was disputed, but found to be reliable in multiple court hearings. The court did the best job it could to find out what she really wanted, taking into account uncertainties and ambiguities, and found that she did not want that treatment. There is no better answer to be had.)

Shouldn't this make a difference? Aren't the condition of the patient and the patient's own wishes somewhat relevant considerations in determining what treatments to provide? What other factors could possibly be relevant?

So in both the Fletcher and the Schiavo cases, the patient is receiving exactly what the patient themselves requested. And in both those cases, the treatment given acknowledges the moral personhood of the patient as it is found in the case at the time in question (namely, that Fletcher is a moral person with moral interests at stake in his continued treatment, and Schiavo had ceased to be a person with the destruction and liquefaction of her brain, and had no personal interests any longer at stake other than the fulfillment of her previously expressed wishes). Each is receiving the treatment that they requested and most comprehends the interests they have at stake - that is, they are being treated in exactly the same ways, albeit with different procedures as befits their differing wishes and conditions.

I would hope future cases are resolved consistently with the way both these cases have been handled. It would be a grave mistake to insist on exactly the same procedures for all patients, irrespective of their condition or wishes.

I think Mary's point was, and correct me if I'm wrong, was the tone in which the feeding tube was described by medical professionals and the media in these cases was very different.

For the guv, it has been described as a simple, helpful medical intervention. One that made his life easier, and his health easier to maintain. A simple alternative for gaining the needed nutrition.

In Schiavo's case, the feeding tube became "life support," an invasive medical intervention that no one who was conscious would possibly want. The thing is, if Schiavo were not using a feeding tube, and had the same disability but was able to eat on her own, she would not have been considered "terminal" and a feeding tube would not be a "heroic measure" to keep her alive.

The problem here is that people often see feeding tubes as an end of life heroic measure, even though there are many other life sustaining uses. It is even a direct question on advanced directives in some states. When someone says they don't want one when they are twenty years old, they may not know all the different situations that they are used, nor have a good understanding of what their quality of life would be if they became disabled and had to use one.

The problem with the Terry Schiavo case, in my mind, is that the "LINE" moved. The line between who is really terminal and who is simply severely disabled moved, even if just slightly. The feeding tube was the key to allowing this movement. The culture around those that are severely disabled and may not be able to speak for themselves directly is so prejudice, that something as simple as a feeding tube can be the difference between someone being considered disabled and someone being considered terminal.

The idea that because Terri Schiavo was severely brain damaged made her incapable of "personhood" is the most appalling thing I think I have read.

This is the stuff of eugenics--not of liberalism. Let's be honest about what motivated those who supported the killing of Terri Schiavo: Those who advocated she be killed were doing so not because they cared about her but because of the people who tended to back the Schindlers, and I am not referring to the disability rights groups.

You know, not everything in the world is political.