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Journal btlzu2's Journal: Killing Terri (highly recommended read) 29

Journal by btlzu2

This Journal article says it better than I ever could:

Killing Terri

By JAMES Q. WILSON
March 21, 2005; Page A16

Terri Schiavo is not brain dead as far as anyone can tell. If you are brain dead, you have suffered an irreversible loss of all functions of the brain. If agreed to by at least two physicians, that means you are legally dead, such that your organs can be harvested to help other people.

Instead, Ms. Schiavo is in what many physicians call a "persistent vegetative state" (PVS). That means that she lacks an awareness of her self or other people, cannot engage in purposeful action, does not understand language, is incontinent, and sleeps a lot. To be clinically classified as being in a PVS, these conditions should be irreversible. But from what we know, some doctors dispute one or more of these conditions and believe that it is possible that whatever her symptoms, they are not irreversible.

Her condition is hardly unique. In 1995, when the American Academy of Neurology published its report on people in a persistent vegetative state, it found that there were as many as 25,000 adults and 10,000 children in this country who suffered from PVS. Based on the best studies the Academy could find at the time, some adults in a vegetative state 12 months after a devastating injury or heart failure could recover consciousness and some human functions. The chances that such a recovery will occur are very small, but they are not zero.

If they are not zero, then withdrawing a patient's feeding tubes and allowing her to die from a lack of water and food means that whoever authorizes such a step may, depending on the circumstances, be murdering the patient. The odds against it being a murder are very high, but they are not 100%.
* * *

Many people, myself included, have allowed life-support systems to be withdrawn from parents who have no hope of recovery. My mother was going to die from cancer, and after all efforts had been made to help her, my sister and I allowed the doctors to withdraw the devices that kept her alive. She was dead within hours.

My case, and that of countless other people who have made that decision, differs from that of Terri Schiavo in two important ways. First, the early death of my mother was certain, but no one can say that Ms. Schiavo will die soon or possibly at any time before she might die of old age. Second, all the relevant family members agreed on the decision about my mother, but family members are deeply divided about Terri.

These differences are of decisive importance. When death will occur soon and inevitably, the patient does not starve to death when life support ends. Since there was no chance of our mother living more than a few more days, what my sister and I did could not be called murder. When death will not occur soon, or perhaps for many years, and when there is a chance, even a very small one, that recovery is possible, people who authorize the withdrawal of life support are playing God.

And in Terri's case, they are playing God when they do not have to. Her parents have begged to become her guardians. Her husband has refused. We do not know for certain why the husband has refused. I doubt that he wishes to receive for himself the money that still exists from her insurance settlement and, apparently, he has offered to donate that money to charity. Perhaps, being a Catholic, he would like her death to make him free to marry the woman with whom he is now living. Or perhaps (and I think this is the most likely case) he does not want his wife to live what strikes him as an intolerable life.

The intolerable life argument has support from many doctors and bioethicists. They claim that a person can be "socially dead" even when their brains can engage in some functions. By "socially dead" they mean that the patient is no longer a person in some sense. At this point their argument gets a bit fuzzy because they must somehow define what is a "person" and a "non-person." That is no easy matter.

By contrast, physicians have unambiguous ways of determining whether a person is brain dead. This means that brain death is a very conservative standard and, if it errs, it errs on the side of preserving life.

Some people believe that all of these issues can be resolved if everyone signs a living will that specifies what is to be done to them under various conditions. The living will is supposed to determine unambiguously when a "Do Not Resuscitate" sign should be placed on a patient's hospital chart. Terri Schiavo had not signed a living will. If she had, we would not be facing these issues.
* * *

But scholars have shown that we have greatly exaggerated the benefits of living wills. Studies by University of Michigan Professor Carl Schneider and others have shown that living wills rarely make any difference. People with them are likely to get exactly the same treatment as people without them, possibly because doctors and family members ignore the wills. And ignoring them is often the right thing to do because it is virtually impossible to write a living will that anticipates and makes decisions about all of the many, complicated, and hard to foresee illnesses you may face.

For example, suppose you say that you want the plug pulled if you have advanced Alzheimer's disease. But then it turns out that when you are in this hopeless condition your son or daughter is about to graduate from college. You want to see that event. Or suppose that you anticipate being in Terri Schiavo's condition at a time when all doctors agree that you have no chance of recovering your personhood and so you order the doctors to remove the feeding tubes. But several years later when you enter into a persistent vegetative state, some doctors have come to believe on the basis of new evidence that there is a chance you may recover at least some functions. If you knew that you might well have changed your mind, but after entering into a PVS you can make no decisions. It is not clear we would be doing you a favor by starving you to death. On the contrary, we might well be doing what you might regard as murder.

There is a document that is probably better than a living will, and that is a durable power of attorney that authorizes a person that you know and trust to make end-of-life decisions for you.

Terri Schiavo's case could be decently settled by a judge who recognizes that there is some small chance of recovery and that several family members are willing to take responsibility for managing that process in hopes that a recovery of even small human features will occur. The judge in Florida ignored this and ordered her feeding tubes removed. The Florida appellate courts have not stayed his hand, and the U.S. Supreme Court, perhaps for want of jurisdiction, has not intervened.

This is a tragedy. Congress has responded by rushing to pass a law that will allow her case, but only her case, to be heard in federal court. But there is no guarantee that, if it is heard there, a federal judge will do any better than the Florida one. What is lacking in this matter is not the correct set of jurisdictional rules but a decent set of moral imperatives.
* * *

That moral imperative should be that medical care cannot be withheld from a person who is not brain dead and who is not at risk for dying from an untreatable disease in the near future. To do otherwise makes us recall Nazi Germany where retarded people and those with serious disabilities were "euthanized" (that is, killed). We hear around the country echoes of this view in the demands that doctors be allowed to participate, as they do in Oregon, in physician-assisted suicide, whereby doctors can end the life of patients who request death and have less than six months to live. This policy endorses the right of a person to end his or her life with medical help. It is justified by the alleged success of this policy in the Netherlands.

But it has not been a success in the Netherlands. In that country there have been well over 1,000 doctor-induced deaths among patients who had not requested death, and in a large fraction of those cases the patients were sufficiently competent to have made the request had they wished.

Keeping people alive is the goal of medicine. We can only modify that policy in the case of patients for whom death is imminent and where all competent family members believe that nothing can be gained by extending life for a few more days. This is clearly not the case with Terri Schiavo. Indeed, her death by starvation may take weeks. Meanwhile, her parents are pleading for her life.

This discussion was created by btlzu2 (99039) for no Foes, but now has been archived. No new comments can be posted.

Killing Terri (highly recommended read) More

Killing Terri (highly recommended read)

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  • That means that she lacks an awareness of her self or other people

    What is being described is no longer a human being. Even "lower" animals have a sense of awareness of self. Once that's gone, why bother? There's nobody home.

    "Turning out the lights" is neither cruel nor merciful to the former person, since these both imply awareness. However, it gives finality to everyone else, and keeps resources from being futilely wasted. I seem to recall someone saying "Let the dead bury their dead." While I'm not a b

    • What is being described is no longer a human being.
      That alone describes someone who is sleeping or someone who had been in a coma for 1 day, but may come out of it in a few hours. Not enough. If there's a scientific possiblity of recovery, it's not enough. We do not know even scientifically if she is incapable of recovery because the husband won't allow some simple tests.
      • Even when you're asleep, a part of you is aware of what's going on around you. Think about being awakened by a loud noise - how do you remember that it was a loud noise that awoke you? Why don't you "just come awake" with no knowledge of what woke you up?
        • That depends on what stage of sleep you're in at the time.

          If you're in REM you're likely to remember; if something jolts you out of a deeper sleep stage you probably won't (though your mind may retcon it if the source of the noise is still evident once you're awake).

          That's probably not the best example to make your point with anyway; the auditory startle response is an autonomic function and has little to do with consciousness (even invertebrates share the Mauthner system with us).
          • If you're in REM you're likely to remember;
            I dreamt I had eaten the worlds biggest marshmallow - now my pillow is missing ...

            Do you think it means something? I mean, aside that I need some new material :-)

            In all seriousness, sleep is a good example. We sleep, then we wake up, even if there is no external stimulus to wake us up. There is no "Terri" to wake up any more.

            • I guess we differ as to what constitutes a "Terri".

              Given the state of her cerebral cortex (it's mostly spinal fluid), no, I don't expect her to experience a normal wakeful state again (I have to qualify that since like many PVS patients she does still undergo sleep/"wake" cycles, such as they are).
      • Well, to be fair to the GP, I think what he meant was specifically a permanent lack of awareness.

        Of course, as you point out it's not wholly clear that her situation IS permanent. I'm wondering whether even her present situation, permanent or not, would be an issue.

        As you you point out in your original entry, brain death is a relatively more clear-cut consideration (I'm afraid it's still a bit dicey to determine sometimes without waiting and seeing). With actual brain death, no matter how aggressive the
  • Then remove all of her life support systems. Keeping her alive is playing God. Put her out on the sidewalk, or hell even in her parents care without any of the fancy hospital machinary.

    Just because we have the technology to keep someone 'alive' doesn't always mean we should.
    • That's the thing though. Her "life support systems" consist of being fed regularly through a tube because she can't chew or swallow (or at least has difficulty). That's it.

      Just because we can feed someone doesn't mean we should?

      She's not on a ventilator or heart-lung machine or anything particularly aggressive like that. The original argument might make more sense if she were.

      I don't think it helps matters that a slow (i.e. a week or two) death from starvation and dehydration is a really, really horri
      • If that is her only problem, then her parents can keep her alive themselves with a blender and careful feeding. Get her out of the hospital bed.

        Yes, I have no compassion. As I've stated in other threads, I have no problems with her being euthanized, but current Florida law prohibits it.

        • If that is her only problem, then her parents can keep her alive themselves with a blender and careful feeding. Get her out of the hospital bed.

          Dude, have you been following this at all? Her parents have asked to be allowed to take her home, but her husband wouldn't authorize it!

          They've been pleading with him to divorce her so they can assume guardianship...

  • a good synopsis of the issues?

    Point noted and taken; I'll give teh wife durable power of attorney (fitting, since she IS an attorney). She knows my preference of having my plug pulled; however I've entered a binding contract that spans multiple lifetimes and existences (thats what happens when you marry an attorney! ;) so she gets the final call.

    Being reduced to a nigh-vegetative state is not my idea of life. Heck, even a significant loss of high-order brain function is not my idea of a life, either. Eve

  • I really don't.

    If she had written a will stating her wishes on any form of artifical means to keep her alive, there would be no debate.*

    If she had clearly made her wish known to her family and relatives, there would be no debate.

    If there is no evidence one way or another, the decision falls on her next of kin and guardian, her husband. And I fully and to 100% believe that the spouse should have that right as he is assumed to be acting in her interest and on her behalf.

    If my wife was incapacitated and

    • f she had clearly made her wish known to her family and relatives, there would be no debate.

      Having your wishes known is no guarantee that they will be respected.

    • If she had clearly made her wish known to her family and relatives, there would be no debate.

      Isn't the assumption here that she and her husband had discussed matters like this, and he therefore knew she wouldn't wanna be kept alive in this way? That would make this whole fiasco an excellent example of why making discussing this issue with your spouse is *not* sufficient.

      I've assumed all along that this must be the case. Otherwise, why would the husband be putting himself through all this? The path of lea
      • Isn't the assumption here that she and her husband had discussed matters like this, and he therefore knew she wouldn't wanna be kept alive in this way?

        Exactly. Even if they had never discussed it at all, he is the one who makes the decision based on what he thinks she would have wanted. Even if he just makes an educated guess it is his right.

        That would make this whole fiasco an excellent example of why making discussing this issue with your spouse is *not* sufficient.

        Rather I'd say that it's an excellen

        • Gotta love those "conservatives" who want the gubmint to butt out of our lives, huh?

          • Yep. The republicans don't know which way to turn on this in order to gain the most points. Individuals right to choose vs the basic right of life.

            That's why I'm a socialist libertarian :-)

          • <sarcasm>
            Until last night I thought the Repubs stood for state's rights. And Florida, after all, is run by the President's brother.
            </sarcasm>

            Well, I guess state's rights are good except when the states make the "wrong" decisions. OK. I guess they don't really stand for state's rights after all. I guess they're just like the Dems who believe in the Feds having the final say, not the states.

            And why is it that -- present company excluded as the folks in this discussion do not fit thi

    • the decision falls on her next of kin and guardian, her husband.

      What if her husband has moved on and is with someone else? If I got together with another one while my wife was in that state, I would effectively be forfeiting my claim on her and her parents or children (if we had any) would step up to the plate in my stead.

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