Friday, March 25, 2005
For those of you who are upset about the removal of Terri Schiavo's feeding tube, I recommend reading this website discussing the legal aspects of the case in light of Florida law. There are some important points here that need to be considered. Like it or not, Florida law does not say that life-ending decisions should err on the side of life in the absence of a living will (though perhaps it should), but neither does it give the next-of-kin freedom to do whatever he wants. Rather, it says that an effort should be made to determine what the patient would have decided for herself were she able. This was done through a full and formal trial back in 2000, with the verdict that Terri would have chosen to be taken off life-support in her current situation. I recommend reading the judge's conclusion to the case, which is fairly short and accessible to the layman. This decision may or may not have been correct, but it was certainly defensible, and I believe there ought to be a place for respecting the integrity of the judicial system. It is important to recognize that all of the legal wrangling since then has not considered the substantial issues of the case. Rather, it has focused on Terri's parents trying to prove that the judge did not do his job correctly. Certainly, no one should support them in this contention without at least having read what the judge has to say for himself. This blog item by the author of the above-mentioned Florida legal site has a good point in bemoaning the abuse this judge has suffered, when all he has done is discharge his duties as best he could.
Also, like it or not, Florida law treats the administration of food and water as no different from life-saving medical treatment. Although many might believe that withholding food and water is an inhumane way to cause death (an argument I find to have some weight), Florida law says differently, and there is no legal way to change that in Terri's case. In fact, the removal of feeding tubes is a somewhat common occurrence in this country -- it's probably happened thousands of times since the Schiavo case began. Will any lasting good come from getting worked up over this one situation? What is the purpose in trying to undo what was effectively decided 5 years ago, by passing narrowly-tailored legislation that applies only to Terri and no one else? If you think something is wrong with the way our society does things, then find ways to work towards meaningful change. Must we reward the politicians whose main purpose is to make you angry at their enemies, so that they can do what they want and take it for granted that you'll vote for them in the next election?
For those of you who are horrified at the prospect of being forced to live a "useless" life like Terri's, I recommend reading this perspective from a sufferer of neuromuscular disease. Also (and I forgot to include this until 3/28), this article by a women who recovered from a coma is very challenging and instructive. There is certainly a place for accepting that one's time has come, and refusing life-saving medical treatment. That is a personal decision which must be preserved, and that should be especially obvious to Christians who profess that "death has lost its sting." On the other hand, taking positive steps to end a life creates problems very quickly, because it inevitably leads to evaluating the value of a human life based on its "usefulness." Does someone who is severely mentally impaired still have value as a human being? I myself am tempted to say no, but I have come to realize that the value I tend to place on the intellect (though it is a good thing) must not take precedence over the Image of God that we all bear. There are thousands of people today with disabilities, with varying degrees of physical and mental ability. Their ability to interact with others in spirit, mind, and body, is not what I'm used to, but I don't think that anyone -- not even someone in a coma -- is devoid of all interaction. I certainly wouldn't want to be in their place, but is it acceptable to proactively choose death in order to avoid that?
This does not mean that we must always keep someone alive at all costs. I think Terri's parents believe it does, and I would disagree with them for (among other things) fighting legitimate requests from Terri's guardian to refuse life-saving antibiotic treatment for infection, on at least one occasion. But it does mean that we cannot end a life whenever it suits us. Life is a terribly solemn thing, and it should be treated with awe, as the gift of God. I am deliberately not saying where a feeding tube stands in this discussion. Is it medical treatment that can be discontinued, or a fundamental staple of life that cannot be humanely withheld? Arguments could be made on both sides, especially when the tube is surgically implanted. But that is what we should be talking about, not trading insults and engaging in political and journalistic theater.
Update 3/28: Motivated by the rights of the disabled, many Democrats are looking to join together with pro-life Republicans on a broader bill to protect the interests of patients in end-of-life decisions. This is exactly the kind of substantial constructive dialogue that I think we need, and I applaud it.
Also, like it or not, Florida law treats the administration of food and water as no different from life-saving medical treatment. Although many might believe that withholding food and water is an inhumane way to cause death (an argument I find to have some weight), Florida law says differently, and there is no legal way to change that in Terri's case. In fact, the removal of feeding tubes is a somewhat common occurrence in this country -- it's probably happened thousands of times since the Schiavo case began. Will any lasting good come from getting worked up over this one situation? What is the purpose in trying to undo what was effectively decided 5 years ago, by passing narrowly-tailored legislation that applies only to Terri and no one else? If you think something is wrong with the way our society does things, then find ways to work towards meaningful change. Must we reward the politicians whose main purpose is to make you angry at their enemies, so that they can do what they want and take it for granted that you'll vote for them in the next election?
For those of you who are horrified at the prospect of being forced to live a "useless" life like Terri's, I recommend reading this perspective from a sufferer of neuromuscular disease. Also (and I forgot to include this until 3/28), this article by a women who recovered from a coma is very challenging and instructive. There is certainly a place for accepting that one's time has come, and refusing life-saving medical treatment. That is a personal decision which must be preserved, and that should be especially obvious to Christians who profess that "death has lost its sting." On the other hand, taking positive steps to end a life creates problems very quickly, because it inevitably leads to evaluating the value of a human life based on its "usefulness." Does someone who is severely mentally impaired still have value as a human being? I myself am tempted to say no, but I have come to realize that the value I tend to place on the intellect (though it is a good thing) must not take precedence over the Image of God that we all bear. There are thousands of people today with disabilities, with varying degrees of physical and mental ability. Their ability to interact with others in spirit, mind, and body, is not what I'm used to, but I don't think that anyone -- not even someone in a coma -- is devoid of all interaction. I certainly wouldn't want to be in their place, but is it acceptable to proactively choose death in order to avoid that?
This does not mean that we must always keep someone alive at all costs. I think Terri's parents believe it does, and I would disagree with them for (among other things) fighting legitimate requests from Terri's guardian to refuse life-saving antibiotic treatment for infection, on at least one occasion. But it does mean that we cannot end a life whenever it suits us. Life is a terribly solemn thing, and it should be treated with awe, as the gift of God. I am deliberately not saying where a feeding tube stands in this discussion. Is it medical treatment that can be discontinued, or a fundamental staple of life that cannot be humanely withheld? Arguments could be made on both sides, especially when the tube is surgically implanted. But that is what we should be talking about, not trading insults and engaging in political and journalistic theater.
Update 3/28: Motivated by the rights of the disabled, many Democrats are looking to join together with pro-life Republicans on a broader bill to protect the interests of patients in end-of-life decisions. This is exactly the kind of substantial constructive dialogue that I think we need, and I applaud it.
Posted by Matt on 3/25/2005 04:56:00 PM 
Comments:
I can't see how the perspectives of pepole with "neuromuscular disease" or those who have recovered from comas are relevant. Terri Schiavo does not have some kind of disability. Nor is she truly in a coma despite the widespread misuse of the word in our media. A coma is much like being stuck asleep. The mind is undamaged. In contrast, Terri is awake, but not aware. Her brain is heavily damaged and any doctors who are not being paid to say otherwise agree that what used to be Terri is now gone. Her situation is not "recoverable" like a coma would be. Nor is she merely inhibited by some physical ailment. Her body is perfectly fine, she is simply not there.
A person need not have the same condition as Terri in order to have a relevant perspective. That would make it rather difficult to discuss the issue, no?
I'm not sure I'm comfortable with the certainty people seem to have that "she is simply not there." She is not brain dead, despite the widespread misuse of that word. I thought the coma survivor's account of what it was like to be in an incapacitated state was very compelling, and it may be that Terri has had a similar experience. In her case, you are right that she almost certainly will never recover and be able to tell us whether that's true, but I don't think that negates the imperative to treat her with compassion and humanity.
I'm not sure I'm comfortable with the certainty people seem to have that "she is simply not there." She is not brain dead, despite the widespread misuse of that word. I thought the coma survivor's account of what it was like to be in an incapacitated state was very compelling, and it may be that Terri has had a similar experience. In her case, you are right that she almost certainly will never recover and be able to tell us whether that's true, but I don't think that negates the imperative to treat her with compassion and humanity.
If you had no intention of likening the disability and coma recovery to Terri's situation why mention their conditions at all? I understood that you were suggesting that these people's experience gave them some authority about Terri's issue. If I misinterpreted your remarks then I apologize.
As for the suggestion that Terri was not brain dead, I'm surprised you would defend such a position. Brain dead is, as far as I know, defined as:
complete, permanent cessation of brain activity in the cognitive and sentient areas of the brain.
Scans of Terri's brain have clearly shown a total abscence of activity in such areas. Small activity in the random motor controls (in the cerebellum) and in the brain stem are certainly not consciousness and can be present in some cases of "brain death". But, the part of Terri that held her personality, awareness, etc was irreprably damaged. It has been shown repeatedly in court that these areas are permanently destroyed and show absolutely no activity. Continuing to insist that Terri is merely in a coma or might recover borders on willful ignorance.
As for the suggestion that Terri was not brain dead, I'm surprised you would defend such a position. Brain dead is, as far as I know, defined as:
complete, permanent cessation of brain activity in the cognitive and sentient areas of the brain.
Scans of Terri's brain have clearly shown a total abscence of activity in such areas. Small activity in the random motor controls (in the cerebellum) and in the brain stem are certainly not consciousness and can be present in some cases of "brain death". But, the part of Terri that held her personality, awareness, etc was irreprably damaged. It has been shown repeatedly in court that these areas are permanently destroyed and show absolutely no activity. Continuing to insist that Terri is merely in a coma or might recover borders on willful ignorance.
I don't believe I ever even implied that Terri's condition might improve. To me, that was not relevant to the issues that were at hand (Terri, of course, passed away this morning).
Brain Death is defined as "the irreversible loss of all functions of the brain" (emphasis mine). In this condition, a person is legally dead and can donate organs. I do not believe I was in error in saying that this was not Terri's condition.
Although I never described Terri's condition as "merely a coma," it is true that PVS is considered a form of coma. I don't know whether or not Terri experienced any of the sensations that have been described by coma survivors, but my point was that we do not know enough to assume that she didn't.
Both of the articles in question do a fine job of describing how each author's condition contributes to her perspective on Terri. I suggest you read them.
Brain Death is defined as "the irreversible loss of all functions of the brain" (emphasis mine). In this condition, a person is legally dead and can donate organs. I do not believe I was in error in saying that this was not Terri's condition.
Although I never described Terri's condition as "merely a coma," it is true that PVS is considered a form of coma. I don't know whether or not Terri experienced any of the sensations that have been described by coma survivors, but my point was that we do not know enough to assume that she didn't.
Both of the articles in question do a fine job of describing how each author's condition contributes to her perspective on Terri. I suggest you read them.
PVS is a very general descriptive term, not a specific diagnosis, nor is it a sub-set of coma. The page you point to notes that some cases of coma may also qualify as PVS. However, this does not imply all cases of PVS are comas. You are using the same kind of logical fallacy as the "Dogs are mammals; Men are mammals; thus men are dogs." The doctors who use the term coma only seem to do so if their definition of coma includes brain death. Perhaps it does depend partly on definition. Especially since "comatose" can also be a generic word meaning "prolonged unconsciousness".
As for the definition of brain dead, I suppose it is debatable. I doubt anyone seriously suggests that literally 100% of brain activity must be gone. If this were so, the person would no longer regulate the heart, etc and the entire body would also be dead. If that were strictly the definition then the term "brain death" would have no meaning and be exactly the same as "dead". The fact that medically the term exists points that some limited brain activity can still occur in a state of brain death (at very least in the brain stem). Certainly the degree of brain activity which qualifies for "brain dead" is debatable. In Terri's case the sentient and cognitive parts of the brain were utterly gone. Though I'm no doctor, it seems to me, that such damning destruction warrants the term brain dead. Most of the doctors Terri has seen in the last 7 years agree. A professor at the University of Southern Florida in Tampa even went so far as to say that, "Her death occurred some time ago". Even if you define the term "brain death" in strict terms as to excude Terri's condition it is difficult to argue that Terri's mind or personality still existed inside her head in any tangible way. You can't define a human being by sputtering motor activity or a beating heart. Terri was gone years ago. It's tragic her mind was destroyed. But, it's also tragic so many people have fanatically attached meaning to her body, trying to unnaturally preserve her body indefinitely.
As for the definition of brain dead, I suppose it is debatable. I doubt anyone seriously suggests that literally 100% of brain activity must be gone. If this were so, the person would no longer regulate the heart, etc and the entire body would also be dead. If that were strictly the definition then the term "brain death" would have no meaning and be exactly the same as "dead". The fact that medically the term exists points that some limited brain activity can still occur in a state of brain death (at very least in the brain stem). Certainly the degree of brain activity which qualifies for "brain dead" is debatable. In Terri's case the sentient and cognitive parts of the brain were utterly gone. Though I'm no doctor, it seems to me, that such damning destruction warrants the term brain dead. Most of the doctors Terri has seen in the last 7 years agree. A professor at the University of Southern Florida in Tampa even went so far as to say that, "Her death occurred some time ago". Even if you define the term "brain death" in strict terms as to excude Terri's condition it is difficult to argue that Terri's mind or personality still existed inside her head in any tangible way. You can't define a human being by sputtering motor activity or a beating heart. Terri was gone years ago. It's tragic her mind was destroyed. But, it's also tragic so many people have fanatically attached meaning to her body, trying to unnaturally preserve her body indefinitely.
You may have noticed that there were a couple of hyperlinks to medical reference websites in my last comment. I think they're interesting reading.
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