http://www.timesleader.com/mld/times...n/11245844.htm
Death from dehydration a gentle process, scientists say
BY STACEY BURLING AND MICHAEL VITEZ
Knight Ridder Newspapers
PHILADELPHIA - (KRT) - Terri Schiavo is dying now as many aged and sick people have for eons.
Though some people see letting her die of dehydration as inhumane, doctors say it is a surprisingly gentle process.
"Nature has given us a wonderfully peaceful way to exit this life," said Ira Byock, director of palliative medicine at the Dartmouth Hitchcock Medical Center in New Hampshire. "The dominant way that mammals die is that, at some point, they lose interest or the ability to eat or drink. The physiology and experience of people who are unable or refuse to eat or drink after progressive or advanced illness is one that is very gentle and very comfortable."
John Hansen-Flaschen, chief of pulmonary, allergy and critical care at the University of Pennsylvania Medical Center, made a similar point, saying, "This is the way many, many people died over all of the millenniums until medicine got so actively engaged in the process."
Courts have ruled that Schiavo is in a persistent vegetative state. By definition, she has no awareness of herself or her environment and no ability to experience pleasure, pain or, for that matter, thirst, Hansen-Flaschen said.
Paul Marik, director of the division of pulmonary and critical care at Thomas Jefferson University Hospital, said Schiavo may react reflexively to pain, but only the most primitive part of her brain, the brain stem, is working. The higher parts of her brain are incapable of perceiving that pain.
"Pain is a conscious interpretation of what's happening," he said. "If you can't interact with the environment, if you're not awake and you're not conscious, you can't perceive pain."
Schiavo, who began her ninth day without nutrition or water Sunday afternoon, will die of dehydration, not starvation, the doctors said. It will cause her kidneys to fail. Toxins will build up in her blood, eventually causing her heart to stop beating. Dehydrated patients gradually weaken, drift into a coma, and appear to die painlessly, Marik said.
"It's a very painless and very compassionate way of dying," he said.
Even a normal, healthy person would feel little discomfort after the first few days of thirst, the doctors said.
Caregivers typically moisten the mouths of patients who have stopped eating and drinking, Byock said. Many, Hansen-Flaschen said, also give morphine, more to relieve the worries of relatives than to lessen pain.
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