The Other Self-Righteous Fanatics

Whatever else the Schiavo case might be, it's a circus of self-righteous certainty. And I'm not just referring to the save-Terri side -- the folks who just prompted Cathy to write this:

I don't think the religious right is our own homegrown Taliban, but maybe it's about as close to a Taliban as you can have in modern American society. These are people who really do want the state to enforce their vision of "what God wants."

If anything, the forces of dehydration are even more of a headache. At least the pro-lifers -- not all of whom hail from the religious right -- know that they're on a moral crusade. Much of the pro-death side pretends that they're neutral bystanders who don't want to "interfere" with a family's private business, even as they actively argue for one side of the family dispute. They say they want to respect the woman's wishes, even as they refer more readily to what they'd want for themselves in such a situation. And they warn gravely of a slippery slope to theocracy, without pausing to wonder whether there are any other slippery slopes to worry about.

It's a conservative Christian, Nancy Valko, who has best expressed why some of us non-conservative non-Christians can't be so blase about pulling Schiavo's feeding tube:

Most people assume that either they or their families will have the right to decide about medical treatment when they become seriously or critically ill. The biggest problem, people are told, is that they or their loved one will be tethered to a machine forever if they do not sign a "living will" or other health care directive. The "right to die" movement has convinced most people and medical personnel that the ability to refuse treatment is one of the most important aspects of medical care to prevent patients and families from needless suffering. Indeed, poll after poll shows that most people say they would rather die than be a "vegetable". And many people automatically assume that they would never want their lives prolonged if they had a terminal illness, were paralyzed or senile, etc. Most people assume that refusing treatment, like assisted suicide (the other goal of the "right to die" movement), means choice and control.

But a funny thing happened on the way to this supposed "right to die" nirvana.

Some families and patients did not "get with the program" and insisted that medical treatment be continued for themselves or their loved ones despite a "hopeless" prognosis and the recommendations of doctors and/or ethicists to stop treatment. Many doctors and ethicists were appalled that their expertise would be challenged and they theorized that such families or patients were unrealistic, "in denial" about the prognosis or were mired in dysfunctional family relationships. (In contrast, families who agree to withdraw treatment are almost always referred to as "loving" and their motives are spared such scrutiny.)

At a 1994 pediatric ethics conference I attended, one participant was even applauded when he suggested that parents who refused to withdraw treatment from their "vegetative" children were being "cruel" and even "abusive" by not "allowing" their children to die. In some cases, doctors and ethicists have even gone to court to force withdrawal of treatment over a family's objections. These ethicists and doctors were stunned when judges were often reluctant to overrule the families.

Yet over the years and unknown to most of the public, many ethicists have still refused to concede the choice of a right to live and instead have developed a new theory that doctors cannot be forced to provide "inappropriate" or "futile" care and treatment to patients deemed "hopeless". This theory has now evolved into "futile care" policies at hospitals in Houston, Des Moines, California and many other areas. Even Catholic hospitals are now becoming involved.

In the July-August 2000 issue of the Catholic Health Association's magazine Health Progress3, Catherine M. Mikus and Reverend Peter Clark -- a lawyer and an ethicist -- argue that it is "time for a formalized medical futility policy" in Catholic hospitals. Like many such articles in secular ethics journals, the authors refrain from being too specific about what conditions and which patients would be subject to such a policy. The authors concede that even the American Medical Association says that medical futility is a concept that "cannot be meaningfully defined" and is a "subjective judgment" on which there is no widespread agreement.

Mikus and Clark make it clear that they are not talking about treatments that are "harmful, ineffective, or impossible", the traditional concept of medical futility that, of course, is not ethically obligatory. For example, no doctor would honor a family's request for a kidney transplant for a person who is imminently dying. Instead, the authors argue for a new definition of futility to overrule patients and/or families on a case-by-case basis based on the doctor's and/or ethicist's determination of the "patient's best interest". Ironically, the "right to die" movement was founded on the premise that patients and/or families are the best judges of when it is time to die. Now, however, we are being told that doctors and/or ethicists are really the best judges of when we should die.

Scare-mongering? Maybe. Maybe not. As threatening scenarios go, it looks a lot more plausible than any American Taliban nightmare.

For a libertarian, the crux of the Terri Schiavo case is the woman's own preferences; and of course, her preferences are a matter of dispute. That's why, of all the plug-pulling cases in the country, it's this one that's become so polarizing: Each side can project its own wishes onto a woman who can't speak for herself.

Reasonable people reading the evidence can differ as to what Schiavo would have preferred, but one thing they can't do is declare there's no question about what she wanted 16 years ago. In the last few weeks, alas, reasonable people have sometimes been scarce.