My daily Schiavo post

8

Category : General, Legal issues, Medical Rants

I am continuing to post concerning this patient because of the great interest that she engenders. First, the American people agree with the courts:

USA TODAY/CNN/Gallup Poll results

I greatly admire Charles Krauthammer. He trained as a physician, and I believe practiced psychiatry. I find him thoughtful, logical and well considered in his opinions. Between Travesty and Tragedy

If I were in Terri Schiavo’s condition, I would not want a feeding tube. But Schiavo does not have the means to make her intentions known. We do not know what she would have wanted. We have nothing to go on. No living will, no advance directives, no durable power of attorney.

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That is why this is a terrible case. The general rule of spousal supremacy leads you here to a thoroughly repulsive conclusion. Repulsive because in a case where there is no consensus among the loved ones, one’s natural human sympathies suggest giving custody to the party committed to her staying alive and pledging to carry the burden themselves.

Let’s be clear about her condition. She is not dead. If she were brain-dead, we would be talking about harvesting her organs. She is a living, breathing human being. Some people have called her a vegetable. Apart from the term being disgusting, how do they know? How can we be sure of the complete absence of any consciousness, any awareness, any anything “inside” this person?

The crucial issue in deciding whether one would want to intervene to keep her alive is whether there is, as one bioethicist put it to me, “anyone home.” Her parents, who see her often, believe that there is. The husband maintains that there is no one home. (But then again he has another home, making his judgment somewhat suspect.) The husband has not allowed a lot of medical testing in the past few years. I have tried to find out what her neurological condition actually is. But the evidence is sketchy, old and conflicting. The Florida court found that most of her cerebral cortex is gone. But “most” does not mean all. There may be some cortex functioning. The severely retarded or brain-damaged can have some consciousness. And we do not go around euthanizing the minimally conscious in the back wards of mental hospitals on the grounds that their lives are not worth living.

Given our lack of certainty, given that there are loved ones prepared to keep her alive and care for her, how can you allow the husband to end her life on his say-so? Because following the sensible rules of Florida custody laws, conducted with due diligence and great care over many years in this case, this is where the law led.

For Congress and the president to then step in and try to override that by shifting the venue to a federal court was a legal travesty, a flagrant violation of federalism and the separation of powers. The federal judge who refused to reverse the Florida court was certainly true to the law. But the law, while scrupulous, has been merciless, and its conclusion very troubling morally. We ended up having to choose between a legal travesty on the one hand and human tragedy on the other.

There is no good outcome to this case. Except perhaps if Florida and the other states were to amend their laws and resolve conflicts among loved ones differently — by granting authority not necessarily to the spouse but to whatever first-degree relative (even if in the minority) chooses life and is committed to support it. Call it Terri’s law. It would help prevent our having to choose in the future between travesty and tragedy.

Eugene Robinson also comments – Life and Death in Florida

Almost all of the doctors who have conducted a real examination believe it’s impossible that she’s in agony. They’re convinced that she is in a “persistent vegetative state,” which means she is gone. They say there’s nothing behind that smile — no warmth, no delight, no recognition, nothing except the reflexive firing of autonomic neurons.

Assume that they, and the husband, are right. In that case, there is no “Terri Schiavo” inside that shell. Michael Schiavo might want to follow his wife’s wishes, but she doesn’t realize that she’s been fed through a tube all these years. She doesn’t realize anything. If her husband is sure she’s gone, then her wishes become just one of many factors he should weigh.

Another factor for him to consider is that her family feels so passionately about keeping the empty shell of Terri Schiavo alive. If doing so causes no harm to his wife while providing great comfort and joy to the family, why not allow them to take over her care?

Neither the husband nor the family has an absolute solution. Only Terri Schiavo does, and she can’t tell us what to do.

These thoughtful commentaries allow us to maintain the middle ground. Obviously, one can construct opposing viewpoints which both speak towards morality. We never do well in debating morality because our underlying constructs differ so greatly. I find the continued maintenance of her organs – without any cognitive neurological function – cruel and unusual. Others believe that life is life, regardless of her lack of cognition. These differing viewpoints are irreconcilable. We always fail when we try to debate religious beliefs – because belief trumps all other arguments.

Thus, as the commentors have stated more eloquently than I ever will, we have the most undesirable of all situations. Whether the husband or the parents prevailed in this patient’s care, the other side will have resentment and hate. But we can never have an objective way to reach an agreement because the two sides have such different philosophical and religious constructs.

This patient’s story only gets uglier when politicians seek to make political hay. The courts have spoken. While I am quick to argue with our legal system (see numerous previous posts), we do live by the rule of law – and judges have the power to interpret those laws. We often disagree, but on balance our country is great because of our legal system.

Perhaps this patient’s story will influence people to develop advanced directives. Perhaps we will have legislatures consider new rules on durable power of attorney when no document exists to designate such.

The Bioethics Discussion Blog weighs in – Schiavo case: Professional Standards of Practice Leading to Judgment and Diagnosis

I feel that many in our Congress and perhaps the President himself and, indeed, the public itself either out of political bias or emotion or lack of knowledge, haven’t taken into consideration the standards of practice requirements that are part of the judicial and medical systems and how they played out in the Schiavo case. Decisions must be made in either discipline, sometimes swiftly. But everyone should know that if the established standards are followed faithfully, the decisions can and should be accepted. I think it would be rational and realistic at this time we accept them for the Schiavo case and go on to other issues with the goal to make life for the living better. Don’t you?

Amen.

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Comments (8)

DB,
Congratulations on an excellent discussion of this terrible case, more balanced and thoughtful than I’ve seen in any other venue.
As a practicing physician myself, it’s been my observation that one of the most fundamental characteristics of the human organism is the need nad desire to take nourishment. Absent some obvious reversible interference with this, the loss of the instict for food and liquids frequently seems to signal the end of meaningful life. The elderly patient with a long history of dementia will suddenly stop eating. The patient with cancer will lose interest in food after months of participating in aggressive treatment. Thee patient with chronic CHF sill start losing weight despite family forcing food on him. The list goes on. Placing a feeding tube rarely ends well in these or other cases.
Terry’s apparent lack of interest in food and hydration signals to me that meaningful life functions are probably lacking.
The case is complicated by legal definitions of guardianship, moral and religious wrangling over the meaning of life and death. But this simple observation in my experience usually provides insight into what course to follow.
Keep up the good work.
Steve Seiden

And then there is the sworn testimony of several of the nurses who have cared for her over the last ten years that she could swallow, but only thin liquids, and that she seemed to enjoy them.

If there was recent testing from doctors who don’t have a history of finding PVS patients under every rock, (all of whom apparently want to die), who agree that “no one is home”, I’d be a lot less uncomfortable with this. And I do agree with Krauthammer, that if there really is no one home, then keeping the shell alive if it benefits the parents isn’t harming her, so why not, if they and others are willing to pay for the care? What else was that malpractice award for anyway?

I like the idea of a “Terri’s law”, to presume for life whenever there is any doubt or disagreement. For those of us who are religious, perhaps that is why Terri is still here after all these years, for this debate to become huge and public, and for our society to be allowed to discover what it really believes and act on it.

Krauthammer draws out the grounds for his own sympathy with keeping Terri Schiavo alive, not to argue that this should in fact be done, but only to show how and why he personally feels troubled with the conclusion that the legal proceedings have reached. And yet, he remains explicitly respectful of that legal process, a characteristic that distinguishes his commentary from many others.

What I find most exemplary in his writing is his willingness to explicitly separate his moral sentiments from his appreciation for the role and functioning of the law in this case. Most of us wish to see the law embody our moral sentiments, and we feel offense when it does not. We are tempted to denigrate the judge, the jury, the process…surely no process is fair which reaches a conclusion alien to where our own moral compass pointed, right?

The protests from members of the public, and the actions by Congress (and threatened actions by Governor Jeb Bush of Florida today) all seem to fail to approach the standard that Krauthammer surmounts.

As much as we struggle with the questions surrounding the life and death of Terri Schiavo, however, it seems important to point out that countless others have died today, or this month, or this year, all over the world, and that at least some of those deaths occurred needlessly and in ways that perhaps we had the power to prevent. Whether one speaks of the thousands who have died in the less-and-less discussed (but ever-ongoing) genocide in Darfur, or the 25 U.S. troops who died in Iraq this month, or persons dying of treatable conditions all over the world, it’s hard to argue that our reflections should be restricted only to this one tragic case in Florida.

It is easy to voice our opinion when we sit at home or work in a confortable situation. I am a parent and a wife. I know that I love my children more than anything in this world. It is my natural born instinct as a mother to fight for their life no matter what. I really trust Terri’s parents and siblings more than her husband to make a decision what is best for Terri. From interviews with nurses and doctors that have come in contact with Michael they have spoken of him being arrogant and uncaring to Terri’s care. Her parents have only showed love and care. My God…..who are we going to trust? Its pretty clear to me. It a sad day when we are more concerned about following the law then following are hearts. I weep for us all.

I have posted on my blog regarding this post. It was relatively long and I didn’t want to post that much here.

Your nod the legal sphere of power in this nation is interesting. I personally take exception to a judge in Florida taking this womans life into his hands. As more and more information is released about this case it is more and more obvious that the legal establishment is just that. An established position with no thought for circumstance. The “Legal History” that makes up precedent has no room for amendment it would seem. Of course I speak from a particular viewpoint and one formed only by that media information available to me. What I see is the will of the people thwarted by elitist legal positions that do not account for the merits of someones life and only account for the right of the husband. The right of the wife to live is immediately assumed to be null and void because the husband says so and the few doctors that have actually been involved in the case agree with him. I would be perfectly content with this “unusual” case ending as it is, if the following had occurred.
1-New tests conducted by specialists with no connection to the case and no known “life or death” agenda to support were given orders by a federal court to review her current diagnosis and condition with all modern capabilities.
2-A full review of the case by a federal court instead of some sort of appeal process that was used to shuffle this case under the rug after the people made known their wish that Terri be given the benefit of the doubt.
3-Assuming that the husband and judge are so absolutely right, I would ask that they end the “shell” of Terri, by administering a lethal injection proscribed for Fair and Humane treatment for death row killers. Allowing a living breathing “shell” of a human being to starve to death is murder by cruel and unusual punishment.

The fact that some doctors swear she feels nothing does not mean they are right. If you are in essence going to kill someone then by all means at least face your decision head on and have the balls to do what is right. Unwanted Dogs get better treatment than this woman.

[…] to be a case in Florida involving a woman named Terri Schaivo-the scoop’s been had, RANTS DB! Some excellent summaries of points you won’t hear on cable news. F […]

As a future consumer of terminal medical care, as we all must be someday, I say a plague on both houses. No, I don’t want lawyers and politicans and judges and experts sticking their noses in. No, I don’t want to die of starvation and thirst either; dogs and cats receive more humane deaths. Really, as I roll this one around, I come to the conclusion that either the religous nut fringe or Dr. Kavorkian is absolutely right. It’s the people who aren’t willing to go either way who make a ghoulish mess of it.
Now, you doctors don’t have to comment on this if you don’t want to, but years ago, never mind who, when and where, the guy who delivered me told my mother that he’d routinely arrange for babies with birth defects to be left by an open window in the maternity ward. Many years later, when my father was dying, miserably, of brain cancer, our family learned the verb “to snow”, which we requested of the staff treating him, quite informally as you can imagine. They didn’t; perhaps by mentioning the practice, we blew it. Perhaps times have just changed, but definitely not for the better!

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