“The case of Terri Schiavo raises complex issues. Yet in instances like this one, where there are serious questions and substantial doubts, our society, our laws, and our courts should have a presumption in favor of life. Those who live at the mercy of others deserve our special care and concern. It should be our goal as a nation to build a culture of life, where all Americans are valued, welcomed, and protected and that culture of life must extend to individuals with disabilities.” White House Press Release, March 17, 2005.Terri Schiavo and the question as to whether her feeding tube ought to be disconnected touches on so many issues of morality, law, and family, that is often difficult to sort out the conflicting issues so that they may be carefully and precisely weighed. The White House statement above is just a restatement of the common sense notion that on matters of life and death one ought to act with reasonable caution. As this is being written, Ms. Schiavo’s feeding tube has been removed and unless it is restored, she will likely die of starvation and dehydration in two weeks. At the same time, both houses of Congress are scrambling to open up the possibility of a review by the Federal courts of the decision by state Judge George Greer to allow the removal of the feeding tube.
About 15 years ago, Terri Schiavo suffered a stroke that left her severely disabled. The degree of her mental impairment is at the center of this case. Presently, Ms. Schiavo’s parents and siblings wish to care for her and maintain her life, while her husband, de jure if not de facto, insists the his wife would have wanted the feed tube removed. Ms. Schiavo has no living will stating her preferences for treatment. By both common law and state law, the discretion in this case is given to the husband.
Part of the popular confusion of the case derives from the fact that many of us have or will be faced with ostensibly similar situations with respect to ailing relatives. In the last week of her life, as my aunt was dying of pancreatic cancer, she asked not to be fed. As her body was shutting down, the addition of more food and water was her causing extreme discomfort. The lack of food was less uncomfortable than being fed. She insisted that she not be fed in the final days of her life. Her express wishes were honored.
This and similar situations should not be confused with Ms. Schiavo’s circumstances. Until the feeding tube was removed and despite the fact that her husband placed her in a hospice facility, Ms. Schiavo was not a terminally ill patient. She is being killed by starvation because the state court of Florida has determined that in her “persistent vegetative state” it is permissible for her husband to decide that her life is not worth living.
Despite the years of litigation, there are important issues that ought to be resolved before the state permits Ms. Schiavo’s life to be taken. Consider the following two important questions:
- Is Ms. Schiavo in truly in a persistent vegetate state? There are apparently important medical tests, including MRI’s and PET (Positron Emission Tomography) that have not been performed that can more clearly assess the actual extent of Ms. Schiavo’s brain damage. Surely, if we can delay the execution of convicted criminals pending the results of DNA tests, we can wait for more dispositive tests in the case of Ms. Schiavo. The state judge in the case refused to allow the new tests.
- Michael Schiavo, Terri’s husband, long ago moved in with another woman and has fathered two children by her. It is possible to understand how a person might decide to move on with his life. However, after having done so, should this person’s discretion now take precedence over parents in determining what is to happen to Terri Schiavo? In addition, given the fact that physical and other therapy that might have improved Ms. Schiavo’s condition were not permitted by her husband, there seems to be evidence that he may not have his wife’s best interests at heart.
There is no pressing need to kill Ms. Schiavo now. If she is really mentally dead and incapable of feeling pain, then a little more time connected to a feeding tube should not be an issue. A headline at MSNBC opines that “The time has come to let Terri Schiavo die.” This mode of thought perfectly misunderstands the situation. Until it can be unequivocally stated that Ms. Schiavo has no brain function and it will not return, the removal of her feeding tube is not letting her die. It is killing her, just as surely as if the feeding tube were pulled from any number of other disabled people, like the late Christopher Reeves.
New Questions on Long-Term Care
Sunday, March 27th, 2005Conservatives and Liberals tend to have different ideas about the sphere within which individuals ought to be allowed free rein for their discretion. Liberals believe that young teenage girls have the moral insight and experience as well as the right to decide to undergo abortions without parental notification. At the same time, they hold that adults are incapable of managing a portion of their social security payments in private retirement accounts. The decisions of teenage girls on an issue of intense moral significance are sacrosanct, while adults require government supervision to manage their retirement.
On the other hand, Conservatives are eager to extend freedom by lowering tax rates and allowing taxpayers to keep more of their own money. The Conservative intuition holds that control of personal resources broadens the scope of personal discretion and thus freedom. But, woe to anyone who wishes to spend their money on recreational drugs.
Even the Libertarian position has its problems. Liberations claim to want to maximize freedom of choice and believe drug use ought to be a matter of personal choice. However, if abused, recreational drug use certainly curtails the freedom of the user. It is an open question as to which policy concerning drug use effectively maximizes freedom
The Terry Schiavo case also raises interesting and important questions about the extent and limits of personal sovereignty. There appear to be two questions that are at issue here. The issues are separate but abrade against one another. The first question is: What level of treatment would Ms. Schiavo have wanted? In the absence, of clear documentation of her preferences, who should decide on her behalf? At this point, her husband and her parents are at odds as to Ms. Schiavo’s wishes and the law gives the spouse presumptive guardians status. The second issue is the determination of the mental status of Ms. Schiavo. Is she in “permanent vegetative state” with no consciousness and no realistic prospects of consciousness returning? Is she is a semi-conscious state with some awareness of her surroundings and some ability to interact?
Let us lay aside for a moment the particulars of this case and ask more general questions about the limits of personal sovereignty and autonomy? Do we wish to grant people personal sovereignty in all cases? When we are not considering palliative care in the terminal stage of life, but long term care, do we expect others to grant all our wishes with respect to care? Christopher Reeve, the actor made famous in the Superman movies who was paralyzed in an accident, required medical care to stay alive, but lived many years before his final illness. He could not feed himself or take care of other needs, but was perfectly conscious and aware. If he asked that his medical care be stopped because he did not want to accept the quality of life afforded a quadriplegic, would we be obliged to honor and assist in this request? Ought we refuse and thereby limit his personal discretion? Can the state step in and prevent assisted suicide by someone who decided that he does not like the quality of his life? Is a person’s life and existence entirely his own, or do we all have an important interest in everyone else’s life?
If a person is in a persistent vegetative state, if he has no conscious, should that person be considered dead? While we would all concede the necessity to exercise extreme caution in coming to this diagnosis and the necessity to resolve any doubt by presumptively asserting that there is latent consciousness, it is possible to conceive of situation where all are morally certain that there is no “there” there. In such a case, is there any obligation to maintain life even if that person had earlier requested such extraordinary treatment? Are we obliged to honor the wishes of someone who would have directed us to maintain their bodily functions, even after brain death?
Much has been made as to what Terry Schiavo would have wanted. However, few are asking broader questions that have escaped noticed as people have argued about the facts of this case. Do individuals have the right to refuse long-term care because of quality of life issues? Do individuals have the right to ask that life sustaining care be continued after a careful diagnosis of brain death? With ever more capable and expensive medical care and with the Baby Boom generation entering the last third of third lives, these questions are sure to be asked more and more frequently.
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