Thursday, July 24, 2008

The Janet Rivera Case: Medicalized Tyranny

I told you all this was coming, and here it is. A California woman named Janet Rivera, age 46, who we are told is unconscious, has a family who want her to continue to receive food and water. Her husband was even her guardian. But he was removed as guardian and a total stranger--the county coroner no less--was put in his place. And the doctors convinced him that the time had come for Rivera to die.

Why remove Janet's husband as decider? No abuse was alleged. Apparently he had difficulties with the technicalities. From the story:

Sanger woman Janet Rivera, 46, has been in a coma since she had a heart attack in February 2006. For more than two years, Rivera's husband, Jesus Rivera, made all of his wife's medical decisions while Rivera was under the care of the DeWitt Community Subacute Center in Fresno. A judge granted the Fresno County Public Guardian's Office conservatorship of Janet Rivera in June....The judge said the conservatorship was granted to the Public Guardian's Office because Jesus Rivera "was not able to see that [Janet Rivera's Medi-Cal] benefits had lapsed a year ago and was not able to meet with a surgeon about a surgery that needed to be performed."

Hadden said he could not offer details on why his office took conservatorship of Rivera. But, he said, "The county does not seek this position we're in." Hadden said his office reinstated Rivera's Medi-Cal benefits after it took over conservatorship. But in the meantime, he said, the Riveras racked up a $200,000 hospital bill that has yet to be paid.
When Janet began to breathe on her own, the guardian still refused to put the feeding tube back in. The life support has been restored by court order--temporarily--but who knows how much damage was caused from nearly ten days off of treatment. Also, the reporter alludes to the Terri Schiavo case as being similar. Oh no it's not. The family is united in their desire for her to live--it's the doctors who want her to die.

During Schiavo, we were told that only the husband should decide. But when this husband wants his wife to continue on--well family ties apparently have their limits. This smacks of a futile care theory case to me.

Wanna bet the media doesn't castigate the doctors and the guardian for going against the husband who wants his wife to live as they did the Schindlers when they when against a husband who wanted his wife to die.



At July 25, 2008 , Blogger JohnnyDontDoIt said...

Maybe I'm wrong, but left up to the doctors, the doctors would choose death for patients on life support a majority of the time.

At July 25, 2008 , Blogger Wesley J. Smith said...

johhnydontdoit: I hope you're wrong, but in some cases, I fear, you are right. Worse, bioethicists.

At July 25, 2008 , Blogger Heather Seierstad said...

I've worked in ICU as a nurse assistant, and I don't think that's true, that the majority of doctors would choose death for patients on life support a majority of the time. I think that most doctors enjoy seeing their patients get better. It still feels like a failure to them when they cannot save their patients. And there are many, many patients who only need life support a short period of time, and they do recover.

However, that being said, I think there is the idea in the medical community that if someone is not going to "get better," that it is better to "let that person die." It's dangerous thinking that can and has spread to different situations, as Wesley Smith has pointed out.

At July 25, 2008 , Blogger Wesley J. Smith said...

heather seirstad: Thanks for your input. You put your thumb right on the problem. Life for its own sake is no longer seen in some circles as being the main thing. It is quality of life, a cure, improvement, etc.

That is a radical change because it ceases to view life as an objective good--which would still permit people to refuse unwanted interventions, a right I support--and turns it into a subjective good or bad depending on the circumstance. Even "do no harm" is turned on its head with some arguing that maintaining life is doing harm.

The danger, of course, is that we will put others out of our misery, whether that misery is emotional (family of caregivers), financial (family or society, or ideological (personhood theory).

At July 25, 2008 , Blogger JoshBrahm said...

We're keeping a close eye on this case, and have already done a TV interview, a press release and editorial on the subject. I'm personally in touch with Janet's family. If you are interested in some of the information you're not hearing from the media, click here.

Josh Brahm
Director of Education & P.R.
Right to Life of Central CA

At July 26, 2008 , Blogger Lydia McGrew said...

Josh, what do you think the prognosis is? I don't mean for the patient's recovery. I mean for the patient not to be dehydrated to death by the state.

At July 26, 2008 , Blogger JoshBrahm said...

There has been quite a public outcry from Fresno ever since CBS started covering the story. I think most people are getting the idea that it's wrong to starve and dehydrate someone. Due to that, think there’s a good chance the court will back off and let Janet’s family take over. The court-appointed guardian doesn’t enjoy coming off as an evil guy from the news stories, so he’ll probably be glad to let the case go as well. Janet's brother Michael, who is a Muslim, has a really good understanding of how to address tough end of life issues, so that's good.

On a side note, on one of last night's CBS reports here in Fresno, they kind of pitted me against a local neurologist. I was saying that starvation and dehydration is a long painful death, based on doctors reports I read when Terri Schiavo was dying, and this neurologist is saying that Janet probably isn't feeling anything, that if her eyes are open it's just a reflex action, etc. Can you guys shed any light on this? Would Janet be feeling the discomfort of starvation or not? It seemed odd to me, since the reason the doctors first gave for pulling Janet's ventilator and feeding tube was to "end her suffering," albeit the local neurologist didn't say that... Any thoughts?

At July 26, 2008 , Blogger Lydia McGrew said...

They certainly can't have it both ways, though they always try to do so in just the way you describe. If she's suffering, then she's feeling something. If she is so incapable of feeling anything that she cannot feel the pain of dehydration, then she is not suffering. Absent some (highly implausible) argument to the effect that somehow painful muscle contractions are feel-able and dehydration isn't--which of course won't be forthcoming--that is a matter of simple logic. So you could always ask the neurologist, "If what you are saying is true, what does that tell us about the rationale given for dehydrating her to death--to end her suffering from muscle contractions?"

In any event, the local neurologist you debated presumably has not personally evaluated Janet clinically. True? In that case, he should be more cautious. Evaluating consciousness is a notoriously tricky business. There are multiple incidents of people who were said to be entirely unconscious and unable to hear or feel but who later woke up and said that they did hear what was being said of them, they were feeling, and so forth. It's highly unlikely that any evidence this neurologist had would permit him reasonably to be dogmatic on the subject. Usually in such cases it's extremely difficult to tell what the person is experiencing. It's not impossible that she is not experiencing pain and would not experience pain if dehydrated to death. But in that case the stuff about "ending her suffering" is all baloney. But it's entirely possible that she is capable of experiencing pain. Has she been tested for pain responses and extensively evaluated by neurologists with no axe to grind? I suspect that the more careful and honest neurologists would admit to the difficulty of being definite on the subject even after evaluation had failed to produce the desired responses.

My two cents. I'd be interested in what Wesley says, as he knows a lot more about this.

At July 27, 2008 , Blogger MaxedOutMama said...

Well, I am not Wesley, but I have mostly recovered from a state that at its worst was probably alternating from MCS to PVS. I was at one point blind, paralyzed and unable to speak. I vividly remember drifting in and out, and struggling to reestablish enough of a workable neural net to be able to sustain consciousness and memory. For example, I remember one day realizing that there was drool running down the left side of my chin. That went on for a bit, fading in and out. After a while, I got indignant about it. This, I decided in my entirely averbal way, was completely inappropriate! It took me quite a while of fading in and out to get firmly established in my mind that there WAS drool running down my chin and then it took me much longer to formulate a plan to deal with it. Eventually I tilted my head back and over and then managed to rub most of it off. It was a huge victory!

As far as those "muscle contractions", my comment is that this happened to me when I was recovering, and every time I have recovered function it has happened. As the nervous system is trying to connect up for a while all it is doing is jerking muscles around. Maybe it looks rough to an outsider, but that's what you have to do. Long after I was able to walk again (okay, I probably walked a bit like Frankenstein at that time), every morning I would wake up and spend a long time - from a half an hour to an hour - feeling myself back into my body. First I'd find my arms and get those to move, and then I'd start working on my legs. I'd get them to thrash around until I could control their movement a bit, and then work on it until I could flex my feet and roll my ankles on command. No wonder I was tired by mid-morning!

Eventually it got to where my arms were already with me when I woke up, and then gradually my legs did the same thing.

I think for most of these people who spend a long time in this state, the problem is less consciousness than sustained consciousness and the struggle to regain enough mental "space" (I don't know quite how to explain it) to develop volition and sustained purpose. It really helps if you have someone outside trying to work with you, because they help you through the breaks in consciousness. I think all the recent research that has been done has showed that most of these people do have partial brain function left, which is probably why the research has stopped.

I was very ill indeed and I am still surprised that I am alive, much less with normal function. But I am, and I absolutely disagree with the idea that it is merciful to dehydrate these people to death. Dehydration really hurts. I know, because I once inadvertently tried it.

My feeling is that if someone wants to sign an order to dehydrate someone, they should be locked in a jail cell for three days without water to think about it. That wouldn't kill the person, but it might give the person an idea of what they are proposing to inflict. It feels like your body is on fire. I am sure that if someone is truly dying, they don't feel it, but I sure did. The thought fills me with pure terror.

At July 27, 2008 , Blogger Wesley J. Smith said...

MaxedOutMama: Thanks very much for dropping by and sharing a perspective that many bioethicists and doctors refuse to see. They will often instead try to conflate people dying of cancer, at the last stage of the dying process, stopping eating with dehdyrating someone due to cognitive incapacity.

I wrote about the potential pain of dehydration for the Weekly Standard some time ago and referenced Kate Adams who had a similar story and wrote a book about it.

Thanks again.

At July 28, 2008 , Blogger BOB OLIVER said...

I examined Terri Schiavo's case with well over 1,000 hours of thought provoking study.

In 2007 I met Carole Austen ( Carol was eighty years old at the time. We shared amazing life experiences and had incredible conversations. Carole and I teamed to do a radio program together for three months. Then she had a stroke.

About three weeks before the stroke we briefly talked about Terri Shindler Schiavo and found that we were in different camps on the subject. Carol wanted to die if something major befell her. We were supposed to revisit the issue as she was willing to take it under additional consideration. We never got to because she had a stroke.

Two of my most painful medical experiences I can remember: Once I had a metal sliver about as thin as a hair and about 1/64th inch long in my finger; once I had hernia surgery (the recovery was very painful); I have led an active life and have many other stories to include knee surgery, shoulder separations and much more. The point I want to make follows. It appears extreme pain or suffering from a thorn or sliver can cause a lion to roar! But should it give rise to Euthanasia my the medical profession?

Carol had her stroke. The Doctors did nothing for her. Her son and daughter did nothing for her. Carol Lived for 6 days. She was not given anything other than saline drip. No food. No nutrition. No electrolytes. Virtually no medical on gong treatment.

While in bed for the first three days, Carole sat up on her own, exercised on her own at her own passe, greeted people socially, reached out to hold their hand or hug them, and occasionally spoke their name or attempted speech.

On the third day, it was apparent that there was to be "no proactive care and they were just going to let her die of malnutrition." I was left alone with her briefly and communicated with her verbally. She was totally alert and aware.

I first asked her if we could discuss her medical situation and she nodded affirmatively. I then explained to her what my concerns were. She continued to nod during the conversation as we moved forward. Ultimately I said she would have to dramatically show me that we were in fact communicating her wishes.

I asked Carole "Do you want to LIVE?" She reached up with her left hand and arm, grabbed the top of her head and gave "three" exaggerated nods in the affirmative. I then asked "Do you want to DIE?" She reached up again and this time moved her head in an exaggerated "NO" side to side three times. I asked if she wanted me to intervene on her behalf and she nodded yes.

I went to the family, Hospital, medical staff, all the agencies I could think of and then filed a Police report. "They" ultimately did nothing to save her.

It is my understanding and knowledge, that she was taken off the saline after the third day, and did not receive any food or water at all. She was put on an extreme high dosage of morphine and died on the sixth day.

I have never been contacted by any family member or agency, police or court since. I did file an eleven page affidavit statement and police report two days before she died.

I completely believe that what is happening in our times with respect to this issue needs to be made for visible. As it is , the medical community is too frequently propagating euthanasia for a variety of reasons including, political agendas and sociological and economic factoring.

I can be reached at 831 383-2676 or . I still do the radio program which was started with me by Carole. Saturday nights at 9pm. Carole's site


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