Of all the arguments for the extraordinary effort to keep Terri
Schiavo alive, the most powerful has always been that removing her
feeding tube and allowing her to starve and dehydrate amounts to
torturing her to death. Does it?
In theory, no — whether or not Schiavo is neurologically
capable of feeling pain, which is in dispute. When a feeding tube
is removed, pain medicine is administered to stave off hunger pangs
and thirst. No pain, no torture. But in the case of Kate Adamson,
the author of Kate’s Journey: Triumph Over Adversity,
something went wrong. After a stroke, Adamson was misdiagnosed as
being in a permanent vegetative state, when in fact she was in a
“locked-in state,” conscious but unable to move. She recovered to
tell the tale of what it felt like when her feeding tube was
removed so that doctors could perform surgery to remove a bowel
obstruction that had developed.
Adamson felt everything, from the starvation and thirst to the
surgery itself, for which she was not sufficiently anesthetized.
She has described her hunger pangs and thirst as “sheer torture”
that went on for days and was “far worse” than the hours she
endured abdominal surgery.
Adamson apparently was either not given pain medication, or not
given it in a sufficient dose. How could that happen? It happens
every day, and not only to patients who are incapable of
communicating their discomfort to their doctors. A Brown University
study, reported in the Journal of the American Medical
Association in 2002, found that 40 percent of nursing home
patients with acute or chronic pain nationwide did not get
treatment that brought them relief. Also in 2002, a study written
by a panel for the National Institutes of Health estimated that
between 26% and 41% of cancer patients are inadequately treated for
pain.
Dr. Paul Frame of the Rochester University School of Medicine, a
member of the NIH panel, pointed to federal and state drug
regulations as exacerbating the problem. “Sometimes doctors don’t
want to go to the hassle of prescribing a triplicate drug,” said
Frame, referring to the forms that must be filed in many states
when strong drugs are prescribed. “They may decide to use something
less effective instead.”
In 2003 alone, the Drug Enforcement Agency arrested 50 doctors
and investigated hundreds more. The most prominent recent case was
that of Dr. William Hurwitz, a chronic pain specialist convicted in
December of drug trafficking because a small percentage of his
patients misused the drugs he prescribed or sold them on the black
market; federal prosecutors are seeking a life sentence. Small
wonder that doctors are reluctant to treat pain as aggressively as
they should. “Physicians’ fears of using opioid therapy, and the
fears of other health professionals, contribute to the barriers to
effective pain management,” says the American Medical Association on its
website.
The DEA’s actions don’t just affect the doctors who have to
worry about whether they can trust their patients or even the
chronic pain sufferers who have trouble finding doctors willing to
help them. Remember, even patients in hospitals and nursing homes,
many of them on the verge of death, are being undertreated for
pain. This isn’t a new problem — it was first identified in the
1970s — and since at least the mid-'90s experts have urged doctors
to be less stingy with synthetic and natural opioids than the
conventional wisdom once advised. Surely, they’d have more success
if drug warriors weren’t sending the opposite message.
Whether or not you think Terri Schiavo ought to be allowed to
die, there is no reason for her to die in pain. We can only hope
that she is being medicated sufficiently. And if it’s your loved
one whose pain needs treatment, don’t merely hope. Insist.
