Paralyzed Outdoorsman Chooses To End Life Support (Tim Bowers, 32)

Read this.  I keep telling all of you to preplan your final death arrangements, funeral home AND cemetery, and pay for it so your loved ones don't have to do this at a most difficult time.  We never know when we will die.

INDIANAPOLIS (AP) - Tim Bowers got to decide for himself whether he wanted to live or die.

When the avid outdoorsman was badly hurt Saturday in a hunting accident, doctors said he would be paralyzed and could be on a ventilator for life. His family had a unique request: Could he be brought out of sedation to hear his prognosis and decide what he wanted to do?

Doctors said yes, and Bowers chose to take no extra measures to stay alive. He died Sunday, hours after his breathing tube was removed.

"We just asked him, 'Do you want this?' And he shook his head emphatically no," his sister, Jenny Shultz, said of her brother, who was often found hunting, camping or helping his father on his northeastern Indiana farm.

The 32-year-old was deer hunting when he fell 16 feet from a tree and suffered a severe spinal injury that paralyzed him from the shoulders down. Doctors thought he might never breathe on his own again.

Courts have long upheld the rights of patients to refuse life support. But Bowers' case was unusual because it's often family members or surrogates, not the patient, who make end-of-life decisions.

Medical ethicists say it's rare for someone to decide on the spot to be removed from life support, especially so soon after an injury. But standard medical practice is to grant more autonomy to patients.

The heart-wrenching call to remove life support is more often left to relatives. Even when a patient has outlined his wishes for end-of-life care, the decision can tear families apart.

In this undated photo provided by Jenny Shultz is her brother, Tim Bowers, 32, of Decatur, Ind. Bowers, who fell about 16 feet from a tree and was left paralyzed from the shoulders down after a hunting accident, told his family he wanted to be taken off life support rather than be dependent on others for the rest of his life. He died Sunday, Nov. 3, 2013, the day after the accident, about five hours after doctors removed his breathing tube. (AP Photo/Courtesy Jenny Schultz)

Shultz, an intensive care nurse in Las Vegas, has seen it happen in her job. But her medical training also meant she understood the severity of her brother's injuries. His C3, C4 and C5 vertebrae were crushed.

Though his brain was not injured, his body was irreparably broken. Surgery could fuse the vertebrae, but that would only allow Bowers to sit up. He would never walk or hold his baby. He might live the rest of his life in a rehabilitation hospital, relying on a machine to help him breathe.

Shultz said her brother - the youngest of four siblings - wanted to talk but couldn't because the ventilator tube was still in place. If the tube were removed, she told him, doctors were not sure how long he would live. But when she asked if he wanted the tube reinserted if he struggled, Bowers shook his head no.

Doctors asked Bowers the same questions and got the same responses. Then they removed the tube.

The last five hours of Bowers' life were spent with family and friends, about 75 of whom gathered in the hospital waiting room. They prayed and sang songs.

Through it all, Shultz said, her brother never wavered in his decision to die.

"I just remember him saying so many times that he loved us all and that he lived a great life," she said. "At one point, he was saying, 'I'm ready. I'm ready.'"

Patients often change their minds after they have had time to meet with spiritual advisers and family, said Art Caplan, director of the medical ethics program at New York University's Langone Medical Center in New York City.

Dr. Paul Helft, director of the Charles Warren Fairbanks Center for Medical Ethics in Indianapolis, said cases in which the patient makes the decision usually involve a debilitating illness such as Lou Gehrig's disease, which compromises the body but leaves the mind intact.

"We give patients autonomy to make all kinds of decisions about themselves," he said. "We've recognized that it's important that patients have the right to self-determination."

Shultz said her family had an idea what her brother would want because he had previously talked with his wife, Abbey, whom he married Aug. 3, about never wanting to spend his life in a wheelchair.

She knows that not everyone would make the same decision. But she's thankful her brother was able to choose for himself.

"No outcome was ever going to be the one that we really want," she said. "But I felt that he did it on his terms in the end."

___

Associated Press writer Tom Murphy contributed to this story.

Pa. case fuels debate on assisted suicide

Barbara Mancini and lawyer Fred Fanelli. Mancini faces charges for giving her father morphine he used to kill himself. (MICHAEL BRYANT / Staff Photographer)

MICHAEL VITEZ, INQUIRER STAFF WRITER

POSTED: Wednesday, October 23, 2013, 2:01 AM

If she lived in Oregon, Washington state, or Vermont, Barbara Mancini could have handed her terminally ill father the morphine he wanted, and there the story would have ended.
But in Pennsylvania, it was just the start of a legal saga that has refueled the national debate over assisted suicide and cast the 57-year-old Philadelphia nurse as either a compassionate daughter comforting a dying man, or a criminal enabler in his death.
Under the state penal code, "a person who intentionally aids or solicits another to commit suicide is guilty of a felony."
Mancini was arrested Feb. 7 and so charged. Conviction could mean up to 10 years in prison.

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In a hearing two weeks ago, state Senior Deputy Attorney General Anthony Forray said that Mancini pressured a hospice to prescribe morphine for her father, that she handed him the drug believing it would kill him, and asked for more when it didn't.
Mancini's lawyer, Fred Fanelli, said she acted out of love in giving Joseph Yourshaw, 93, of Pottsville, the morphine upon his request. Fanelli also contended that what Mancini did was legal even under Pennsylvania law, because Yourshaw did not need her help - he could have obtained the morphine himself - and his intention when he took it is unknown.
Laws that went into effect in Oregon 15 years ago, in Washington state four years ago, and in Vermont this year would allow actions like Yourshaw's and Mancini's. So would current bills in Pennsylvania and New Jersey. Both are patterned after Oregon's law, which says that if two doctors deem a terminally ill person mentally competent, he or she has the right to be prescribed a lethal drug dose. A daughter could pass it to her father without fear of penalty.
In Pennsylvania, and in this case, the issue is intent: Did Mancini hand Yourshaw the morphine knowing he would end his life? Or did she do it so he could ease his pain?
In Oregon, that distinction is not important.
Perhaps the most telling aspect of that law is how few take advantage of it.
Among the 32,000 Oregonians who died last year, 77 ended their lives after legally obtaining lethal doses; 38 others got drugs but didn't use them.
Yourshaw was under hospice care, with end-stage diabetes, renal failure, and heart disease, when he drank the morphine Feb. 7. Against his daughter's wishes, a hospice nurse called police, and Mancini was charged that day with aiding a suicide. Yourshaw was revived at a hospital, only to die four days later.
Mancini has been suspended from her job in the emergency room of a local hospital. Her legal fees have topped $90,000, said her husband, Joe.
Supporters of Oregon's statute say that laws against assisted suicide, such as Pennsylvania's, were not intended for cases like Mancini's. They apply to putting guns in the hands of unstable people, or bullying teens into killing themselves.
"Joe Yourshaw wasn't suicidal, even if he did intend to advance the time of death," said Barbara Combs Lee, who led the effort in 1997 to pass the Oregon law and founded the advocacy group Compassion & Choices.
"That's a rational end-of-life decision: I'm dying. My only choice is how long the process goes on, what it feels like for me, and what memories I leave my loved ones."
Opponents of Oregon-type laws argue that doctors should save lives, not help end them with lethal prescriptions.
In 1997, the Supreme Court unanimously ruled that Americans do not have a constitutional right to assisted suicide. But, Chief Justice William H. Rehnquist wrote, "it is widely recognized that the provision of pain medication is ethically and professionally accepted even when the treatment may hasten the patient's death."
Justice David Souter concurred that terminally ill patients may take medication "to alleviate pain, even when the medication is so powerful as to hasten death and the patient chooses to receive it with that understanding."
In 2006, the justices upheld Oregon's law and urged states to serve as laboratories.
"It's quite moving when you look at the evidence in Oregon," said State Sen. Daylin Leach (D., Montgomery), who introduced a bill like Oregon's. "There has not been a single case of demonstrated pressure or fraud. Look what happened. People get the medication, and . . . often they don't wind up taking it. Knowing that if it gets too bad, they have a way out is all they need."
His bill, however, "isn't going anywhere right now," he said. And until it does, "situations like this will continue to happen."
A similar bill introduced in New Jersey by Gloucester County Assemblyman John J. Burzichelli has cleared the health committee and is "working its way through the process," he said Tuesday.

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mvitez@phillynews.com
215-313-3518
@michaelvitez

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Prepare For Chicken Death & End Of Life Decisions-Yes Chickens!

5 Ways to Prepare for Chicken Illness, Injury, Death & End of Life Decisions

Sunday, June 16, 2013  119 comments

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by Kathy Shea Mormino, The Chicken Chick

Most of us spend a great deal of time preparing for the arrival of our first chickens, but few of us give much thought to how we would handle serious injuries, illnesses and end-of-life decisions until they are upon us. My recent experience with a dying chicken made me realize that I could have been better prepared to handle certain aspects of her fatal illness, which make an already difficult time, more stressful. My hope is that by sharing my experience that you will be prepared to face the toughest part of chicken-keeping when the time comes.

Esther was one of my oldest chickens and she came to me as a day old chick with scissor beak. She managed very well in spite of her disability. At the end of last month, she became less active than normal and within a few days, I noticed abnormal poop on the droppings board underneath her spot on the roost. I brought her into the house for closer observation and noticed that she was not eating or drinking, so I began dropper-feeding her water withvitamins & electrolytes. Her condition did not improve and I decided she needed to be seen by a veterinarian.

Esther in foreground.

These droppings are abnormal, the dark green indicates she has not been eating and the
vast amount of white (urates) indicates organ failure. 

When I began my search for an avian veterinarian, it was Friday leading into Memorial Day weekend and I found myself scrambling to find a trained, experienced, avian veterinarian to see her. While I ultimately found an avian vet in town, it was difficult to get Esther seen as we were not established patients. Once I got past the receptionist, the avian vet was happy to see Esther. Her preliminary findings were that Esther had a tumor that was causing fluid to build up in her abdomen, a condition she said was common for older birds like Esther (at the ripe ol' age of four, she is considered "older"). The vet and I concluded that putting Esther to sleep immediately was the kindest choice possible for her as she was most certainly in a great deal of pain. I made arrangements for Esther's remains to be transported to the state poultry pathology lab where a postmortem examination (necropsy) was performed, which confirmed the vet's diagnosis. (see report, below)

 Here are five ways to be prepared for illness, injury, disesase and death of one of your chickens:

1. Have a well-stocked first aid kit & infirmary set up ready
Many injured and sick birds can be cared for by the average backyard chicken-keeper at least until professional veterinary care can be obtained. Having some first aid essentials such as vitamins & electrolytes, a dropper or syringe, Vetrap and Vetericyn Wound Care spray, on-hand is critical to being able to deliver emergency medical aid and may mean the difference between life and death.

Having a dedicated crate or special location to keep a sick or injured bird is important so that they can be closely observed during their crisis.

dog carriers serve as excellent, temporary infirmaries for sick or injured birds

2. Find an avian veterinarian in your area before you need one
Find an avian veterinarian nearby before there is an emergency and keep their phone number in your chicken first aid kit. This vet will likely not be the same vet that already treats your other animals. A visit to the office to introduce yourself to the staff can be the difference between being seen during a crisis and being told the vet has no time to examine your bird. Have a backup plan. Find out who covers for that vet when they are on vacation and keep their number handy too.

There is a list of board certified avian vets here--> http://www.aav.org/search/index.php

3. Have a euthanasia plan

There will inevitably come a time in every flock when a sick or injured bird will need to be euthanized. Some people are capable of euthanizing their own bird by a variety of humane methods. Learn which methods are available and whether you are capable of following through with one when the need arises. 

Some people are more comfortable having a professional euthanize their chickens. Most vets, even if they do not ordinarily treat chickens, will euthanize a sick or injured bird. Inquire of your dog/cat/goat/horse 's vet whether this is a service they would be willing to render, but do so in advance of needing these services if possible.

4. Locate your state veterinary diagnostic laboratory & get a necropsy done
Each state has a veterinary lab that will run tests and perform postmortem examinations on animals to determine the cause of death. Know where your lab is, how to contact them and which services they offer.  If a bird dies unexpectedly, it is extremely important to get a necropsy done to determine the cause of death. Some illnesses and diseases are contagious and the rest of the flock may be at risk. A determination of the cause of death can provide some peace of mind.

If you will be transporting a deceased bird to the lab yourself, it is critical to get her there as soon as possible after the time of death and that the body is stored properly until then. It should be placed inside two plastic bags, sealed and kept under refrigeration (not frozen) until it can be delivered to the lab. Some labs will send a courier to pick up the remains.

In Esther's case, my avian vet was unaware that our state diagnostic lab would transport Esther to their facility, euthanize her and perform the necropsy- all free of charge. I was aware that they offered these services, so I was able to share that information with my vet and make the necropsy arrangements for Esther myself.  Since Esther was in pain, I didn't want her to wait until the next morning to be put to sleep- I asked the vet to draw blood for the lab, (at their request) euthanize her and store her remains until the courier picked her up the next morning.

5. Request a copy of the Necropsy Report
While the lab will send a report to the veterinarian automatically, I think it's important to request a copy to learn what they found and keep it on file as part of your flock's health history. I have medical training and experience, so I understood the report, but if you do not, discuss the necropsy report with your vet and let them know if you do not understand the terminology they are using.

While I was making Esther's transportation arrangements, I asked the lab to send me the necropsy report, but they forgot. I followed-up with them several weeks after the necropsy and they gladly emailed it to me. As you can see from the report, she had ovarian cancer. The tumor was enormous and the cancer had spread throughout her other organs. Poor girl. I was thankful to have had access to the services of a knowledgeable vet who was able to put her to sleep peacefully.