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March 19, 2005

"The time has come to let Terri Schiavo die"

By Byron LaMasters

I could not say it better myself. I will simply say an Amen to this column. I would urge you all to read it.

I could not imagine the horror of living 15 years attached to a feeding tube without the ability to think or communicate for myself. Given the choice of a brainless PVS existence or death, I would choose to die - the choice that Terri Schiavo and her husband have made. That is much more humane than allowing someone (and their spouse) to suffer for years on end. I pray that their suffering is nearing its end.

Posted by Byron LaMasters at March 19, 2005 01:33 AM | TrackBack

Comments

I hope that should I ever fall into such a condition, that I will have an advocate for my freedom as tenacious and unyielding as Terri has had in Michael.

Not that I can get married, of course. But still.

Posted by: Kirk McPike at March 19, 2005 02:40 AM

In reality, is Terry the one suffering? If she is brain dead, she has no perception and therefore cannot suffer. In these situations, it is everyone else that suffers. The suffering stems from the lack of finality - some wanting an end to a tragic situation so that they can move on and others refusing to yield to the reality that the injured is NOT going to get better.

The question is who gets to make these difficult decisions? Those that know the injured best or the community at large (in the form of "government"). The question answers itself - those near & dear. Then even among those near & dear, someONE has to be able to make the ultimate decision.

Historically, this decision-making authority has always been vested in the spouse for a married person. Whatever the decision may be, this is the decision of the spouse. He has made a decision and it should be respected.

Posted by: WhoMe? at March 19, 2005 08:26 AM

This is a really hard decision. It should be. I agree the gov. has no business in this and it should be decided by the ones who love Terri. Had our Congress really wanted to address this issue for all Americans, they had oh, 16 years to do it.
But as a parent, I tried to put myself in her parents shoes. This husband has gone on with his life. He has children that he loves. He has a new partner. He has given up his right to be the husband of Terri. I can't get over that. If the care of Terri were to be given to the parents, maybe someday they would reach the decision that Terri was not getting better and let her go. Maybe they would not. But at this moment I feel they love Terri more. Were Terri my daughter, I think I would be fighting Michael as well. I don't know for sure, no one will ever know for sure until they are there where these people are.
And now for a question? Will Terri be offered water with a spoon and maybe liquid food by a spoon? Can she swallow?

Posted by: Nancy at March 19, 2005 09:22 AM

You pro-killing guys are caught in your own catch-22.

Which is it? If she's "brainless", then she's not suffering at all. Only her husband is, and he's killing her to relieve his suffering, not hers.

Or is she "suffering", as you say? In that case, she can't be brainless. And if she's suffering now, then surely being killed by dehydration/starvation would be painful? And if she has the capacity to "suffer", she most likely has significant brain function left.

The problem, of course, is that we don't know how brain-damaged she really is, and how much function she could recover with therapy. We don't know, because the husband won't allow her to receive therapy.

And yes, the husband has the legal right to determine her treatment. But providing her with food is not treatment. She is alive on her own, without medical assistance, and starving her to death is nothing more than a deliberate killing. Even injecting her with sodium pentobarbital would be more humane than denying her food and water.

Posted by: TM at March 19, 2005 10:08 AM

This is not really all that tough a case.

I was married for a long time (30+ years), and I have married offspring.

I have made my own intentions clear (although no, not legally documented yet -- I know I have to do that).

I cannot for a moment imagine interfering in this part of my offsprings' affairs. They are adults, with their own beliefs and values. As a parent, the most I really have the right to ask is "Are you sure?" I think that's a fair question.

Language is crucial here: Terri is no longer her parent's CHILD, she is their offspring. At some point in time in the past, she took responsibility for her own life.

Parents have a lifelong right to offer advice and counsel (i.e., nag), and, I believe, a lifelong responsibility to offer psychological support (since you know/remember parts of your offspring that no one else can to the degree you do). Financial support is nice if you can do it, but I don't think it rises to the same level.

Finally (and here I'm really on the soapbox), the issue raised here is one that is reprised frequently in the many moral issues raised by the Shiite Religious Right: the individual has a right to be wrong, God forbid, even a right to sin.

If you think alcohol is illegal, don't drink. When your drinking has the ability to impact others (like driving) that's different.

If you think gambling is wrong, don't.

If you think pre-marital,or extra-marital boinking is wrong, don't.

But, you must accept that I have the right to not believe what you do, and the right to not behave as you would. This is what Terri Schiavo's parents apparently refuse to accept: She apparently chose differently than they would have.

Guys, that's called growing up: becoming an adult. Taking responsibility for your own decisions.

Right? Wrong? Maybe someday someone will know. But it's her decision, apparently communicated through her spouse.

Let her go.

Posted by: Lord North at March 19, 2005 11:09 AM

Ok, well I changed the wording a little bit to better reflect my views on this given that I wrote this rather late last night.

My position is very clear on this issue, and Jim said exactly what I believe on Andrew's post.

This is an issue regarding the sanctity of marriage. Ideally someone in Terri's status would have a will to have her position recorded while she was still able to do such. However, most 20-somethings don't have a will, so we have to do the next best thing...

That means 1) trying to determine how she would wish to be treated given the sitution or 2) allowing her fate to be decided by the closest relative. In both cases that means allowing Terri to die. First, she indicated to her husband that she would not wish to live in such a state. Second, it is my understanding that the law allows for someone's spouse to make these decisions for their spouse regardless of the view of other relatives. While it is unfortunate that the family is in such harsh disagreement over what should be done, it is even more unfortunate that the Florida legislature and the U.S. Congress should intervene in what is a very personal family issue.

Posted by: Byron L at March 19, 2005 07:16 PM

Where's the right-wing moral outrage over the baby in Houston whose life support was pulled in spite of objection from the mother?

http://www.nbc5.com/health/4286333/detail.html??z=dp&dpswid=1167317&dppid=65194

How come Tom DeLay's not upset over this one?

Posted by: LC at March 20, 2005 02:26 PM

Byron, I agree with what you have to say about the closest relative (the husband) being able to make the call. But, in this case, it seems to me that since he has seemingly moved on to live with and have children with another woman, he has basically given up his rights as her husband. I realize that he has to move on with his life, but in doing so, he needs to realize that he can't have two "wives." He should move completely on.

TM- Terry Schiavo most certainly is not living without medical assistance. The whole reason she may die is because they will stop giving her medical assistance. Say what you will about whether you want her to die or not, but being unclear about her current condition is certainly no way to argue for her life. It reminds me of a protester I saw on the news whose sign said something like, "Terry is alive, she said I love you." I understand the emotions involve here, but how on earth is dishonesty going to help anything?

Posted by: TA at March 21, 2005 09:01 AM

Michael could have taken the easy way out a long time ago by divorcing Terri, walking away, and letting her parents have their way. I give him a lot of credit for sticking around and fighting for what he truly believes that Terri would want. I truly feel for the guy.

Posted by: Daniel at March 21, 2005 11:39 AM

Terry Schiavo told her husband that she did not want to live if she ever was in a state like that. Since she did not leave a living will, we all must go by what the husband says were her wishes (and further, even if she HADN'T told him her wishes, that is even more reason to go by what he says: He is her LEGAL GUARDIAN); certainly in the case of my marriage, should either my wife or I get into a coma-type state like Shiavo's, the other would be legally within his or her rights to make the decision.
But here comes her parents, who have some kind of religious objection. They have dragged in every nasty piece of weaponry they can find in their fight to keep her alive, no matter the cost to themselves or their daughter, including ruthless right-wing politicians eager to exploit this situation to get votes from the Christians. I say, let her die.

Posted by: Lance Ash at March 22, 2005 12:53 PM

http://www.philly.com/mld/inquirer/4437797.htm
Posted on Mon, Nov. 04, 2002

Penn hospital to limit its care in futile cases
Severely brain-damaged patients won't get certain treatments, as a rule.
By Stacey Burling
Inquirer Staff Writer

The Hospital of the University of Pennsylvania is taking another crack at one of medicine's thorniest issues: how to treat people who have no hope of recovery.

The hospital's ethics committee has approved unusual new guidelines that include limits on high-tech treatment for patients with severe brain damage.

Under the guidelines, intensive care would not routinely be given to patients in a persistent vegetative or minimally conscious state. Only patients who had explicitly requested such care would get it.

#####So, now you have to explicity write that you WANT care######

The guidelines, which will not be implemented for at least a year, also say what the hospital will do for patients, both when there is hope for recovery and, later, when the goal shifts to providing good "hygiene, preservation of dignity, and alleviation of discomfort or suffering."

#####FULL recovery WITHOUT disability?#######

The rules are meant to define good care, just as the hospital does for conditions such as asthma or diabetes.

"Over the last 20 to 30 years, medicine has evolved a notion that limits are taboo, that whatever patients want or demand, they have every right to expect," said Horace DeLisser, a pulmonary and critical-care doctor who also cochairs the ethics committee. "What we're saying is that we think that care is not simply about giving more machines, that care has to be tailored to these patients."

Communication with families about patient prognosis and treatment will remain an important part of care, he said, and an assertive family could probably successfully fight the new policy. Penn also has a conflict-resolution process and offers the option of transferring the patient to another hospital.

About a quarter of deaths now occur in intensive-care units, said Robert Truog, professor of anesthesia and medical ethics at Harvard Medical School. More than half of those occur after withdrawal of life-sustaining treatment.

Although more than 90 percent of people say in surveys that they would not want to be kept alive in a vegetative state, less than a quarter make it clear in advance when they would want doctors to give up, said Robert Perkel, chairman of the ethics committee at Thomas Jefferson University Hospital.

Wesley J. Smith, a California lawyer and author of The Culture of Death: The Assault on Medical Ethics in America, is a longtime critic of hospital policies that limit care when doctors think patients lack sufficient quality of life. This approach is dangerous because it "creates a hierarchy of human worth," he said. "What is going on here is a statement that certain lives have less value than other lives, and that the values of the institution trump those of the patient."

Doctors who work in ICUs say they are sometimes asked to perform grotesque procedures on people who are capable of feeling little more than pain. CPR can break bones. It is almost impossible to insert certain types of intravenous lines in bodies twisted by a long period of brain damage, DeLisser said. "It approaches assault. You're really just attacking these patients."

#####I assume that he is talking about Contractures here in disabled patients. Their bodies are not "twisted" by long periods of brain-damage. Their bodies develop contractures, like Terri, because they have not had Range of Motion, Botox Injections or Phenol Injections to limit the spasticity.########

Doctors and nurses go home after treating such patients feeling not only that they have done no good, but that they have caused pain, only to delay an inevitable death.

#####So, now we have to worry about how Doctor's and Nurse's FEEL about treating disabled people?###########

Under the new Penn guidelines, DeLisser said, if a patient in a persistent vegetative state - a step above coma - were transferred to the Hospital of the University of Pennsylvania with a fever, he would get the sorts of treatments he could receive as an outpatient: blood tests, antibiotics, a chest X-ray, urine tests. He might be admitted to a general medical bed. But, in the absence of an advance directive from the patient, he would not be admitted to an ICU. He would not be put on a ventilator or breathing machine. (If he were already on a ventilator, the hospital would not take him off.) He would not get surgery.

#######SO, Dr. Caplan already believes in making decisions FOR Families and FOR patients without family consent and without patient consent. He is GOD? This is who testified against Terri and exchanged two emails with me.########

Doctors at HUP now use a hodgepodge of approaches, DeLisser said, but "for the most part... the unwritten approach is actually what we've written in the guidelines."

At Penn, there are one or two intractable conflicts each year, said John Hansen-Flaschen, chief of Penn's pulmonary, allergy and critical care division. The most recent involved an elderly woman with many medical problems. She suffered a serious stroke after refusing amputation of a leg. The woman had been "rescued over and over again," but she was "dying from the outside in," Hansen-Flaschen said. Both legs had gangrene; she had large bed sores. "Portions of her body looked like a cadaver pulled out of a grave," he said. The family would not sign a do-not-resuscitate order. She eventually died after a failed resuscitation attempt.

Hospitals have wrestled with the controversial concept of medical futility for more than a decade. Many have decided that it is futile to try to define futility. A growing number have opted for creating a procedure for dealing with conflicts about withholding or withdrawing care, an approach the American Medical Association has endorsed. Massachusetts General Hospital, Children's Hospital of Boston, and, in this area, three hospitals in the Mercy Health System have developed such procedures. In Texas, hospital conflict-resolution procedures are now backed up by a state law.

But Lawrence Schneiderman, a medical ethicist at the University of California San Diego, says hospitals also need to define when that process is justified, as many California hospitals do. Most judge appropriateness of treatment on the basis of patient awareness and potential for appreciating the care.

Penn's guidelines, and another set of rules it has governing withholding or withdrawal of life support, do not use the word "futility." They do say, "The purpose of intensive life support is to sustain or restore a meaningful survival for the patient, where meaningful refers to a survival that can be valued and appreciated by the patient."

######BY THE PATIENT OR BY SOCIETY? WHO DEFINES MEANINGFUL? DR. CAPLAN DECIDES MEANINGFUL FOR MY SON? KEEP YOUR KIDS OUT OF PENN###########

The weak point of virtually all policies is that hospital leaders fear they would lose a lawsuit if they denied care demanded by a family. They will rarely back doctors all the way, so there's little case law on the subject.

Cathy Mikus, associate counsel for the Mercy system, said that in the year since its policy went into effect, all disputes have been resolved. She is confident the hospital would support its staff if agreement could not be reached. "If we have to go all the way through this process," she said, "we have physicians who feel very, very strongly that the care is not appropriate under the circumstances."

####Because life as a disabled person is grotesque to some doctors#######

Etienne Phipps, director of the medical ethics program at Albert Einstein Medical Center, doubts her hospital could successfully fight a family in "this current legal environment." She also doubts it would want to. It is "highly likely" the administration would side with the family, she said, "because of the values of the hospital toward supporting the patient and family values over everything."

The issue of when to limit care arose in the 1970s, after it became clear that life-sustaining treatments such as mechanical ventilation can sometimes be "more burdensome than beneficial," said Eric Krakauer, associate director of the palliative care service at Mass General.

Back in those days, however, doctors were the ones more likely to want to "do everything," and families of patients such as Karen Ann Quinlan were asking to pull back. At the same time, the patient empowerment movement was gaining steam, and doctors began paying more attention to patient and family wishes in medical decisions.

By the early 1990s, many doctors began to worry that some dying patients were getting too much care. Patients and their families, concerned that HMOs and money-conscious hospitals were trying to cut costs, were getting less trusting. Now, conflicts are more likely to be between families who want more and doctors who want less.

Arthur Caplan, director of Penn's Center for Bioethics, said doctors have compounded the problem by offering families a menu of choices.

######So, TAKE AWAY family Choices!#####

"That's not the best way to approach the family," Caplan said, "because it makes the family feel responsible for ending the life of their loved one."

It's better to say, "In our best judgment, sadly, there's nothing more we can do. We're going to begin the process of stopping aggressive care."

#######BUT: Don't tell them that is what your doing. Most people are medically not very knowledgable, so HE CAN LIE and withhold information on how a patient can be treated#####

Doctors could also head off disagreements by explaining life support better on the front end. "You should never start an intervention, a feeding tube, dialysis, where you haven't had a little bit of discussion about when you're going to stop it," Caplan said.

DeLisser says it's vital to define the type of care patients will get, no matter what, because families often fear the hospital will stop taking care of their loved one if they agree to limit life support. "Medicine, I don't think, has recognized that what patients and their families really want is... they don't want to be abandoned."

######NO: We want our disabled loved ones to be treated the same way Dr. Caplan would treat a 30 year old attorney with three kids, a huge home, and fifteen cars, who paid cash for their care, that comes in with appendicitis. By this doctor and these bioethetists standards, if I bring my son in for appendicitis, because he has profound mental retardation, they may not want to "treat" him aggressively. The term, "aggressive" will have different meanings with different people, based on disability. If patients are DNR/DNI they DO GET less efficient care. I have to say to myself, OK: This patient just doesn't want to be resuscitated or intubated. They didn't say that they wanted hospice and no treatment. You would be AMAZED at what goes on behind closed doors and nursing stations and doctor/nurse phone calls. Maybe, I'll keep a list and write a book one day.#######


--------------------------------------------------------------------------------
Contact Stacey Burling at 215-854-4944 or sburling@phillynews.com.



--------------------------------------------------------------------------------

© 2002 Philadelphia Inquirer and wire service sources. All Rights Reserved.
http://www.philly.com

Posted by: Kathy at March 22, 2005 08:16 PM

Michael Schiavo is a SNAKE. He is right now enacting the worst form of domestic violence. He is killing his ESTRANGED WIFE. He has gone on with his life. He has a girlfriend. They have kids together. HER FAMILY HAS ASKED HIM TO DIVORCE TERRI. He refuses, despite the fact that the MARRIAGE HAS NO SANCTITY IN IT. He is a snake. He drives around in a Benz and a huge home, while he has FORCED Terri to live in that little room with no sun, no outings, no nothing. He is a killer and a piece of crap.

There are thousands of disabled people just like Terri all over these United States. Do you people want to kill them all? Should all people like Terri have their gastrostomy tubes removed?

Terri's WISHES ARE NOT KNOWN.

IF HE REALLY BELIEVED THAT SHE DID NOT WANT A G-TUBE:

WHy did he give written consent to have the gastrostomy tube surgical placed. G-tubes are NOT DONE in the ER under an emergent situation. They are done for the LONG TERM. They are to feed a disabled person for a long time, if not they would have done TPN and Lipids, or a NasoGastric tube. I am an RN. I work with G-tubes all the time.

Terri is an adult female with disabilities, being euthansize by a low-life hunk of junk, ESTRANGED Husband.

Kathy

Posted by: Kathy at March 22, 2005 08:28 PM

Where were her parents and husband when she was killing herself with Bulimia? Why do we allow the courts to continually reward a lack of personal responsibility. The results of Bulimia weren't a secret fifteen years ago. Moreover, the person with the disorder knows they have a problem, that's why they go to great lengths to hide it. Is the doctor reponsible when a patient withholds pertinent information? Sure, she's a victim of societal pressures, but where does the buck stop? If there's any question as to what Terri Schiavo wanted, look at her priorities. She chose thiness over consciousness.

Posted by: Carol at March 24, 2005 11:57 AM

First of all, you don't KNOW that is what Terri Schiavo wanted. That is only what Michael Schiavo claimed after getting control of over $1 million approximately 6-7 years after her collapse.

Second, the diagnosis of Terri being in a brainless/PVS is at least disputed and at best just flat out wrong!

Third, just because it is something you would want does not mean Terri would want it.

Fourth, starving someone to death, denying them food and water if they can swallow on their own, (which it has been shown Terri can do) even if they may be only remotely aware of their surroundings is humane?

Fifth, if Michael had not denied all treatment (almost all, I guess he did allow some sort of experimental electrode implant) for Terri over the years, she may have been doing these things for herself now.

Should we starve Stephen Hawking? Should Christopher Reeve have been denied food and water since he couldn't feed himself? If Terri has such a death wish, how do you explain her surviving three, possibly four (if you consider the credible evidence she was a victim of foul play) attempts to kill her over the years?

Posted by: Dave at March 24, 2005 03:58 PM

I totally agree with the notion "Let Terrie Die". It's just incredible how much hypocrisy is going on with the Christians these days. Feeding tube is NOT what we would consider natural. If we did not have the medical advancement we have today, Terri would have died 15 years ago.

Posted by: SL at March 30, 2005 04:53 PM
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