Why do people insist that Mrs. Schiavo doesn't feel pain?

[Xithras]

I've seen it posted here and mentioned in the media that the process of starvation for Terri Schiavo will be "painless" because her brain is gone. Even the debunking and fact checking threads repeat this meme. If there's anyone here who knows anything about neuroscience, I'd like them to explain this to me:

Terri Schiavo has lost about 70% of her cerebrum, the part of her brain that controls higher thought, to hypoxia...I'm not disputing that. But I've always been taught that the receptors for pain and discomfort are located in the medulla? The medulla then activates parts of the cerebrum to identify and react to the pain (related to the visual cortex, IIRC). Neither side is claiming that the brainstem or medulla is injured (which would make her legally braindead), so there is no reason to beleive that her medulla isn't fully active and functional.

If this is correct, then the statement that she's feeling no pain is simply false. She can't make the mental connections to figure out WHY she's feeling pain or HOW to deal with it, but she certainly experiences every twang, cramp, and pain associated with the process of starvation.

Am I wrong?

[NMDemDist2]

1. you may be interested to read this post

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=104&topic_id=3346554&mesg_id=3346726

[mirandaod]

2. I don't know

if she can feel pain or not. However, I do know that she's in a hospice, and there are drugs available to make damn sure she isn't suffering.

[BlueEyedSon]

3. She will feel no pain because she will be tanked up on morphine

the moment she appears to be in any distress.

[Xithras]

8. Ah, yes, morphine. I haven't seen any mention of it in the press.

I wonder if they're already giving it to her?

[jayfish]

18. My Understanding Is...

that it's will be available if needed. It's probably more for the family then Terri as I'm sure it can be difficult watching the human body fight for it's survival.

Jay

[MrNiceGuyDied]

15. I hate subject lines

she is receiving pain medication just in case there is a possibility she might feel discomfort.

[LynneSin]

4. I'm sure she's not feeling pain because I'm sure she's getting painkillers

Just in case...

[mmonk]

5. With the brain that is no longer functioning

there is no awareness of pain, thus rendering any impulses mute.

[Name removed]

11. Deleted message

Message removed by moderator. Click here to review the message board rules.

[mmonk]

14. No

but there is no conscious awareness. It's based primarily on logic.

[mmonk]

24. Also,

I heard a Doctor on NPR familiar (expert actually) with persistive vegetative states say there would be no suffering on her part should the tube be removed.

[CottonBear]

25. One does not need a medical degree to learn about

human neuroscience and physiology from basic medical texts, research studies and medical journals. I would assume that anyone with a high school or college degree is capable of doing this research for themselves.

However, if one was home schooled or studied at a fundamentalist parochial school, where basic scientific theories and critical analysis were not taught, then this research could be difficult.

[Xithras]

16. But the brain IS functioning.

A lot of people here seem to be under the impression that she's braindead, which she isn't.

She's missing a big chunk of her cerebrum (aka the "upper-brain"), but her lower brain is still working fine. The lower brain is what controls pain and sensation. If her lower brain was dead, I doubt we'd be having this discussion...her plug would have been pulled years ago.

[mmonk]

20. Does anything you aren't aware of

bother you?

[Xithras]

34. See, here's the technical problem with that answer.

It's already been brought up in this thread even.

Mrs. Schiavo's cerebrum is not gone. It's MOSTLY gone. 70% gone. The question is, what's in that 30% that's still functioning? As I said in another post, the part of the brain that controls vision is probably working because her eyes track people around the room (not a signal of intelligence, but of brain functionality). It's also possible that she may have some kind of awareness. She almost certainly isn't self-aware, has no idea who or what she is, who any people are, or even that she's dying, but depending on which 30% is still functioning there is no reason to believe that there might not be some glimmer of existence in her mind. She may feel the sheets, but not know their sheets. She may feel hunger, but not know what do do about it. She may feel temperature, but not know whether it's hot or cold.

There's a big difference between existence and intelligence. I don't think she has any intelligence, but I don't see any basis for the statements that the lights are completely out upstairs. The last decades discoveries about brain elasticity alone should give pause to doctors who so blithely dismiss her. Nearly a third of her cerebrum exists...what is it doing?

For the record, I think she should be allowed to die, I just believe that it should be done in a more humane manner. Shoot her up with a few thousand cc's of morphine and let her go in bliss.

[xpunkisneatx]

38. no tracking

her eyes don't track around the room...her eyes do the primitive reflex that mimics tracking..she basically stares into space and her eyes move randomly.

[Xithras]

43. Where was that stated?

I've seen it repeaded several times that her eyes track movement. It's an autonomic response and doesn't mean much, but it does mean that whatever part of the brain her optic nerves are connected to is functioning properly.

You know, all of this discussion could have been avoided with a simple MRI. A basic map of which parts of her brain are actually working would go a long way towards telling everyone exactly what she's capable of feeling and experiencing. The CT scan that's on the web showing the "holes" is inconclusive because there's no way to know how her brain adapted to the missing matter.

[Lindacooks]

49. Her Guardian ad litem said her eyes do NOT track.

He is the court appointed person (a doctor and lawyer both) who spent hours and hours with Ms. Schiavo trying to elicit some kind of response. He's the best source for any unbiased information about her.

[mmonk]

44. I was primarily going on information

from a physician that was discussing persistive vegetative states and this case. She said there would be no discomfort to Terri in this process and to none in this state. I defer to experts. I don't know personally from any studies on my part. I do know that neurons have to fire properly. Disruption in this process from neuron and receptors I'm sure are affected.

[Just Me]

23. Did God grant you some special insight into knowing she DOES feel pain?

n/t

[Xithras]

30. No, my college professors did that.

Human biology was a requirement.

[Morose]

37. Ever been put to sleep during surgery?

Do you know which part of your brain is turned off while they operate? Would you call what you experience vs what some "part" of your brain might process, pain? Do you distinguish sensations you process but are not "aware" of differently from those which you don't process at all?

Last I heard btw, they monitor Teri for basic physical symptoms associated with pain, such as changes in heart beat, etc.

[Just Me]

41. Then, why are you rejecting the overwhelming scientific evidence,...

,...and the overwhelming documentation of patients with fully functioning brains demonstrating that, under the conditions Terri Shiavo is existing, there is no indication that she feels pain.

Moreover, why are you denying that she is being medicated just in case there is any possibility she is feeling pain?

Moreover, why aren't you focusing on the repugnant abuse of her situation by radical repukes and extremist religious nuts rather than obsessing over this PERSONAL situation which isn't ANY OF OUR DAMNED BUSINESS?!?!?! :grr:

[K-W]

31. Your argument is fatally flawed.

The fact that the lower portion of the brain handles pain does not mean that someone can feel pain without other parts of the brain anymore than it means someone with an eyeball but not brain can see.

I dont know myself exactly what her condition is, but your logic is faulty.

[Xithras]

36. see #20

[smoogatz]

6. When a feeding tube is removed

and the patient is likely to die, it's standard practice to keep them twilighted on morphine. So no, she's not feeling any pain. She's floating into the next world on a warm fluffy cloud.

[KansDem]

22. You got that right!

In August of 2003, I suffered a heart attack and was taken by ambulance to the hospital where I was immediately admitted. A cardiologist was brought in to insert two stints; I was given morphine (or a drug that was morphine based) for the operation.

During the entire operation, I remember being at peace without a care in the world. Nothing, I mean nothing concerned or bothered me during that time. It was a feeling of wonderment and rest that I never felt before or since...

Man, that morphine is goooooood stuff!

[xpunkisneatx]

40. you recieved versed

versed is a sedation medication that is given to patients that recieve cardiac catheterizations...by that way, you got 2 stents...not stints. Anyway, Versed and morphine are very different, but morphine does give a sense of euphoria. Not only that, it depresses the respiratory system and will thus cause terri's death long before she would die of dehydration or starvation.

[KansDem]

50. Well, whatever it was, I wish it came as a desert topping!

Although, as I laid there waiting for my "stents," I remember hearing the word "morphine" mentioned to me as the technician was describing the procedure. Perhaps he was just using that word as a comparison to what I was getting. Or I might have thought he said the word, afterall, I had already been given some kind of sedative and the situation was getting woozy...:boring:

[Bluebear]

7. You are wrong because she is receiving "comfort care"

In other words enough morphine to put her nerves in la-la land. Hospice care is very compassionate.

[Gold Metal Flake]

9. No brain, no pain.

There's not "there" there. That is, no one is home. No person resides in that living shell.

Besides, Hospice workers know how to ease folks into a painless death. If there were someone livving inside Mrs. Schiavo's body, they would feel no pain.

[DELUSIONAL]

28. Isn't it amazing how ignorant so many people are about the brain

Brain function -- physiology should be taught as part of high school biology.

Oh but that might deal with EVOLUTION.

There is so much ignorance about pain and drugs.

I was once dating a guy whose mother was dying of cancer. She wasn't going to be cured and leave the hospital. The family refused to allow her to be given morphine "because she might become addicted". They were using the pain equivalent of band-aids to hold a gaping wound closed.

From the research I've done -- when morphine is used to treat pain it doesn't cause addiction. The whole study of pain and addiction is fascinating.

Could it be that many of the nut cases we are seeing are in denial that death is part of life? We are born, we life and we die. These "born again" fundamentalists believe that they will never die, that Jesus will come and "take them to heaven".

At the same time their "dear" bushie is causing the death of thousands -- but these people don't count, they won't be in the fundie's heaven anyway.

Hell I wouldn't want to be in a fundie heaven! That would be hell.

[Warpy]

10. She may feel it, but she can't interpret it as either pain or pleasure

because that part of her brain isn't there any more.

However, hospice nurses know their stuff, and if there's any rise in blood pressure and/or heart rate, they will know that there's some discomfort being registered by her autonomic nervous system and they will treat it accordingly, with opiates and sedatives.

An overdose of pentothal the day the tube was pulled would have been preferable to this drawn out process. However, since the fundies have managed to keep that illegal, we'll have to settle for extreme damage preventing knowledge of discomfort and the medications available to hospice teams to prevent discomfort from being registered cardiovascularly.

[Xithras]

27. I agree with that, she should just be drugged to death.

When my dog was hit by a car several years ago, the vet administered drugs so that it could die peacefully and painlessly. When my horse broke its legs a few years ago, we shot it to put it out of its misery. The law and common decency tell us that when something is suffering, we should help its suffering to end.

So why are we so different with humans? Personally, my understanding of biology prevents me from just buying the belief that she doesn't feel pain. I've read in several places that her eyes track people around the room. This may not be a signal of intelligence, but it indicates that her visual cortex may be among the 30% of her cerebrum that's still intact...and the portion of the cerebrum that translates pain overlaps the visual cortex. Since her medulla is functioning, there's a good chance that she does feel pain of some sort.

My argument isn't that she should be kept alive, but that she should be given a more humane death. If I had an injured dog and I let it die by starving it to death, people on this board would be howling for my prosecution. If we wouldn't accept it for our pets, then why should we accept it for humans?

[SidDithers]

12. If that's the case...

then she's been in pain for the last 15 years. Maybe it's time for her pain to end.

Sid

[Richard D]

13. I think . . .

. . . it's more that there is no one there to feel anything. I have mixed feelings about this, as I'm sure many do. It all hinges on who or what is perceiving. Is it possible for a creature with no higher cerebral functions to be present and conscious. What is the function of the huge amounts of nerves in the heart and in the belly. Some think that these are two additional "brains". Out there, but something that will be looked into much in the future.

The location of the 'self', in fact what the "self" is is simply not scientifically known. Is the self created in the brain, or is the brain simply a tool for the self to use while it has a body.

My personaly feeling is that death by starvation and dehydration isn't all that bad. Beats a slow death from an accident, burns, cancer, etc. Plus, with Terri's case there is nothing (no one?0left to interpret the sensations.

[HockeyMom]

17. Doctors? Nurses?

I heard one doctor put it this way: that she may (he emphasized MAY)feel the pain, but doesn't have the capacity to process that it hurts. A touch, a kiss, a tickle would all feel the same. Any medical people around?

[Warpy]

19. Yes, I'm a nurse

Read my post above...

[roguevalley]

21. there aren't words to describe how careful and decent and kind

and professional hospice people are. they are angels. People who are dying are treated beyond well and they will help her. The idea is to ease people into their deaths with the most love and the least suffering possible. Bless them. Bless Terri. Someone said with her injuries, the center of the brain that processes and feels pain is gone. I believe the doctors and pray for Terri and the people who matter in this. Nothing else matters. No one else matters.

[KaliTracy]

26. some medical opinions

From San Francisco Chronicle: http://sfgate.com/cgi-bin/article.cgi?f=/c/a/2005/03/23/MNGGABTH351.DTL

"Defining the differences in these states of being is the work of neurologists such as Dr. Wade Smith, director of the Neurocritical Care Unit at the UCSF Medical Center. He regularly teaches a course on the subject to young medical students, many of whom are entering a lifetime of counseling families on difficult choices of life and death in the midst of trauma and tragedy.

Without her feeding tube or water, and barring legal intervention, Schiavo probably has less than two weeks to live. But in a vegetative state, does she feel hunger, thirst or pain? "As a neurologist, I would say no," said Smith.

A person who is unconscious will feel no more hunger or pain than a patient who has undergone general anesthesia. The awareness functions of the higher brain are no longer a factor. "It is why anesthesia works," Smith said. "

***

From MedPage
http://www.medpagetoday.com/tbindex.cfm?tbid=753

Patients in a persistent vegetative state do not feel pain, nor do they "suffer," says Michael De Georgia, MD, head of the neurology-neurosurgery intensive care unit at the Cleveland Clinic Foundation here.


Pain, as well as suffering, requires consciousness, which is lacking in a person in a persistent vegetative state, says Dr. De Georgia.


"Certainly these patients don't suffer," he adds. "Suffering is really that whole emotional aspect of pain: fear, anxiety, panic surrounding pain. You have to have consciousness to experience these emotions. So just as a person in a persistent vegetative state can't experience pain because of a lack of consciousness, they also don't suffer."

********

That said -- elderly people and animals often stop eating prior to letting go and dying. My husband's grandmother is in this state right now, (got pneumonia last week, and was in hospital for several days -- is back at nursing home now, and has refused solid food for several days -- drinking minimally) -- though some are treating it as depression, others have warned his mother that this is the "final" step...

[blondeatlast]

29. Hospice care is entirely about alleviating any suffering.

The entire idea is palliative care for those who no longer are expected to live.

If she can feel pain, which is very unlikely, she won't, because they are giving her morphine. There is no reason to not administer it on a patient that cannot recover, so they give it freely, actually.

[TheModernTerrorist]

32. actually

most of us who die natural deaths (as in not caused by cancer/car accident/getting shot in war/etc) would die a similar death... that is, by starvation. Essentially what the body does is it switches over to the reserves (fat, tissue, that sort of thing). The neurons that once carried pain signals to the brain no longer function properly, due to the lack of the chemicals that aide those responses, and instead, the endocrine system (I believe) releases other chemicals into the bloodstream, creating a "euphiroc" effect, so in scientific terms, her ability to feel pain subsides, and most that die this death are reported to be calm, content, and somewhat blissful-looking, and should be allowed to let nature run it's course through their body. This prolonging of her life by means of a feeding tube through her abdomen may do more harm to her than letting her die. Since when has death been an undignified response to life? Arthur Miller once wrote "In this world nothing is certain but death and taxes", so why should we as Americans look at death in such a light as it is being portrayed today? And I always thought that these religious wing-nuts would be the ones PRAYING for a peaceful death, so that she can be with her Maker and rest in PEACE! When did THIS shift happen?

[Tinoire]

33. Because sound science says those who are different from us feel no pain.

From the 1940s when the Nazis instituted their T4 Eugenics program against the mentally impaired whom they said felt nothing

to the 1970s when we operated on babies without anesthesaia because science said they felt no pain http://www.time.com/time/reports/heroes/childs3.html

to today... very little progress.

[moobu2]

35. I dont give a crap if I felt pain or not, if I ended up in that condition

I dont want a f-ing feeding tube!!!!!!!!!!!!!!!!!

People have the right to make that choice whether anyone likes it or not!

[Tinoire]

39. Fine. Don't have one.

What's your hallucination? I don't see anyone begging you to have one :shrug:

Perfect illustration of one of the main points of this case. Moobu2 wouldn't want to live like that ERGO Terry could not possibly want to either.


And what does that have to do with this? Other than to project your fear of living in that state to justify killing someone?


====

KING: Do you understand how they feel?

MICHAEL SCHIAVO: Yes, I do. But this is not about them, it's about Terri. And I've also said that in court. We didn't know what Terri wanted, but this is what we want.

Larry King Show, March 18, 2005 - 21:00 ET

http://transcripts.cnn.com/TRANSCRIPTS/0503/18/lkl.01.h...


====

"How the hell should I know we never spoke about this, my God I was only 25 years old. How the hell should I know? We were young. We never spoke of this."

Cindy Brasher Shook. Michael Schiavo's first girlfriend, May 2001 deposition

[FredScuttle]

52. Funny how Judge Greer

and the 21 other judges who reviewed the case believed this was Terri's wish.

[Donailin]

53. project a fear?

I don't know of anyone who would want to live in a persisitent vegetative state for the rest of their natural lives, let alone 15 years because they're afraid. That simply doesn't wash. They wouldn't want to live that way anymore than they'd want to . . live without a brain?? Brain that doesn't give self consciousness/conscios thought is NO BRAIN. It is perfectly reasonable to believe that a brief offhand remark by Terry that "she wouldn't want to live like that" would be exactly the way she felt, especially now.

[Tinoire]

45. dupe delete

[sonicx]

51. she's on morphine just in case

even so, your Nazi comparisons are silly.

[LSK]

42. please tell me how she would know what pain is

Or anything else for that matter??? Does a tree feel pain when you break a branch????

[CAcyclist]

46. This doctor thinks she feels pain:

http://sfgate.com/cgi-bin/article.cgi?file=/chronicle/archive/2005/03/25/EDG47BUCCM1.DTL

"To the casual observer, when Terri Schiavo's eyes are closed, she appears to be asleep. But unlike Sleeping Beauty, Schiavo cannot be aroused. She is unable to recognize and respond to her surroundings except in one way -- she can respond to noxious stimuli.

"This is one of the reasons her parents, and Congress, argue to keep her body alive. But "responds to noxious stimuli" is a euphemism for "reacts to pain." The doctor's test for this is usually to run his or her knuckles firmly on the breastbone or press down hard on the fingernails or eye sockets. Try it. It hurts.

"So there Terri Schiavo lies -- unable to move, poked and prodded, turned and repositioned. Her bowels and bladder flow uncontrollably, and if they don't, a catheter is inserted or an enema given to make sure they do. "Noxious stimuli" are applied regularly to make sure she is still "there." Just try to sit without moving a muscle for one hour. I can't. Yoga practitioners take years to master this painful exercise. Schiavo has been doing it for 15 years.

"In short, Schiavo is being kept alive so that she can continue to experience pain.

>snip<

Dr. William S. Andereck is a physician and director of the Program in Medicine and Human Values at California Pacific Medical Center in San Francisco.

[Cleita]

47. Two things are wrong about your premise.

First you are allowing them to frame the process as starvation. It's actually a natural process of dehydration when death is coming. Even conscience people lose their appetite and don't want to eat. I know my husband did this before he died.

Secondly, pain killers are routine in hospice care so that people don't feel pain and discomfort if it's possible for them to do so. It's probably more painful for her to process food if her body is rejecting it and if she can feel pain. Also, the lungs and organs can fill up with liquid making the dying person more uncomfortable and in pain than withholding food and water.

[sonicx]

48. Please read this thread

http://www.democraticunderground.com/discuss/duboard.php?az=show_topic&forum=104&topic_id=3321086