Dealing with the demented

Yesterday’s Star Tribune editorial should have been published today in honor of April Fool’s Day: “Dr. Ronald Cranford: A powerful antidote to lunacy.” But, hey, every day is April Fool’s Day over at the Star Tribune editorial board.
Paul Krugman inspired yesterday’s Star Tribune. Krugman had asked: “Where are the doctors fiercely defending their professional integrity? I think the American Medical Association disapproves of politicians who second-guess medical diagnoses based on video images — but the association’s statement on the Schiavo case is so timid that it’s hard to be sure.” In its editorial, the Star Tribune answered: “Dr. Ronald Cranford of Hennepin County Medical Center. He’s your fierce man, but he could use more than a little help.” The editorial reported:

Cranford examined Terri Schiavo three years ago at the request of her husband, Michael Schiavo. Then, in court, he testified that she is in a persistent vegetative state. He has stood by that testimony through thick and thin, lots of it. On Monday night, he went toe-to-toe with Joe Scarborough on MSNBC’s “Scarborough Country.” It was not pretty — for Scarborough.
The interview was opened by Lisa Daniels, an MSNBC daytime anchor. Soon, Cranford had to correct her misinformation: “Wait a minute. You are not accurate on a lot of things here. You’re saying a lot of — she’s not starving to death. Do you understand that? She is dehydrating to death.” Daniels asked: “Well, why do you say that? Tell us how you came to that conclusion?
Cranford responded: “Can I tell you why? Because I have done this 25 to 50 times. I don’t know how many times Joe has done it, but I’ve done it 25 to 50 times in similar situations. ….”

If the removal of a patient’s feeding tube causes the patient to die of dehydration rather than starvation, is Dr. Cranford’s riposte to Lisa Daniels a devastating distinction, as the Star Tribune thinks, or a distinction without a difference, as ordinary laymen might think? The Star Tribune editorial concludes that “it is absolutely critical that learned people stand up to the know-nothings and charlatans who are waging war on law and reason and science and medicine in the United States.”
Two weeks ago NRO published Rev. Robert Johansen’s column “Starving for a fair diagnosis.” In the eyes of the Star Tribune, Reverend Johansen is one of the know-nothings and charlatans waging war on law and reason and science and medicine. He also makes the devastating error (in the eyes of the Star Tribune) of equating starvation with dehydration.
His column, however, performed the service of linking to Dr. Cranford’s 1997 Star Tribune op-ed column apparently advocating the dehydration of Alzheimer’s victims: “Just as we’ve tried to come to grips with appropriate care of PVS patients, we’ve got to confront the dilemma of dealing with the demented. Comfortable solutions aren’t easy to find.”
Dr. Cranford encourages us to look to Europe for inspiration in the appropriate treatment of Alzheimer’s victims:

In Europe, feeding tubes are rarely seen in nursing homes. Once a patient is so severely brain-damaged that only artificial nutrition can sustain life, many doctors and families rightly ask, “What’s the point?” In many civilized countries, the question wouldn’t be asked — because placing a feeding tube in someone with end-stage dementia wouldn’t even be considered.
But here in the United States, many caregivers wouldn’t consider not placing a feeding tube in the same patients.
It’s hard to understand why. If we want our loved ones to live and die in dignity, we ought to think twice before suspending them in the last stage of irreversible dementia. At it is, it seems that we’re not thinking at all.

On this much I agree with Dr. Cranford. The “solution” advocated by his 1997 column is not “comfortable,” but it is “advanced” in a deeply European way. Yesterday’s readers of the Star Tribune’s editorial might even have found Dr. Cranford’s 1997 column “englightening” in one way or another. In this case, however, they would have had to look to a know-nothing like Rev. Johansen for enlightenment.


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