Life Support

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New at Reason: Ron Bailey considers the case for keeping Terri Schiavo alive.

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  1. So she’s in a permanent vegetative state. Can she still percieve pain on some level? Can she still suffer on some level? If so, isn’t it incredibly cruel to starve her to death? Can’t they just inject her with something and give her a suffering-free death?

  2. The most sensible information on PVS I’ve seen on the web. But “Ron Bailey considers the case for keeping Terri Schiavo alive” is an interesting way of saying “Ron Bailey explains why Terri Schiavo is medically dead.”

  3. I watched the “ambiguous” video clips. I understand the medical interpretation of the clips as response to stimuli not accompanied by, nor requiring, cortical impulses. That said, if it was my family member, I would be Leonidas at Thermopylae, i.e., carried out on my shield by a SWAT team if doctors tried to induce starvation.

  4. Why is my world view so simplistic? Don’t answer.

    If “family” were sovereign, her husband would have already administered a humane lethal dose of something.
    But nooo.
    We and politicians want to use her situation to keep bashing everybody… and boring moi.

  5. A study a couple of weeks ago in the NEJM said hospice nurses, who witness many deaths, felt those patients who stopped eating actually died more pleasant deaths. My own experience watching my grandfather stop eating and fade away peacefully makes me think our perception of starving to death as terrible way to go may be based on our own rumbling stomachs and not. Any posters here ever starve to death?

  6. I think you may have misunderstood, xray. Not eating makes it easier and when whatever is killing you finishes the job over the last 3-5 days, instead of taking longer. But it’s still the cancer or whatever that kills you – starvation takes longer.

    In this case, she would really be dying of starvation, and it would probably take significantly longer.

    We’re kinder to our pets.

  7. A friend of mine starved himself to death when he was terminal with cancer. It was not pretty. Obviously the cancer played a significant role in the “not pretty” part, but I can assure you….

    Back on topic, who is paying the freight to keep Terri on life support? Florida taxpayers? the parents? The husband? The insurance?

    And lastly, a good argument for making one’s wishes known before the need arises.

  8. Xray-
    I do multiple fasts each year, but stop well short of death! My fasts usually range from 3 to 4 days. My experience is that the first day is always the tough one but it sure gets a hell of a lot more easier and more comfortable each day there after. I usually do this on weekends where I can lay on the couch and watch a game or read a book. Energy loss and lack of motivation are the only consequences I deal with. My next scheduled fast is for the 2nd weekend of November, maybe I should blog this one!

  9. Not to be flippant, but the biggest argument isn’t whether or not she’d be better off dead (not that that’s not an argument, just not a very compelling one). The crux seems to be the means and the decision maker. So couldn’t all this be solved by the husband going to the children’s ward, finding a sticky fingered brat with something infectious, and having said brat sneeze on Terry? Then refusing medical heroic care would probably end the situation relatively quickly, more humanely than starvation, and legally.

  10. So here is Ron’s latest, and I’m with him all the way to the last sentence. Ron has that nastiest of conservative traits; proclaiming “I know best, my will must be law”. I agree that she’s already dead, the question is who should be allowed to make the decision to pull the plug. My suggestion: NOT RON BAILEY.

    I also agree that it is outrageous that starvation is the only option to ending her heartbeat. Only lawyers could conclude, and impose on everyone else, that starvation is the only humane way to end a love one’s suffering.

  11. “And lastly, a good argument for making one’s wishes known before the need arises.”

    I believe that the husband claims that she did make her wishes known, and that’s why he’s advocating that she die. Her other family members disagree. Maybe it’s important to write it down in a will or something so there’s no doubt.

    And JSM, why the fasting?

  12. I’m with Concerned Citizen on this. The tapes do not seem all that ambiguous to me. Is there any evidence that she is suffering? Or is the “she’s suffering” crowd actually saying “we’re suffering?”

    From the Washington Post:
    “A persistent vegetative state is a condition in which a person who has experienced brain damage has no awareness of their environment. Because the more primitive parts of the brain continue to function, patients still cycle between sleep and wakefulness; their eyes open; and they can have reactions, such as facial expressions and responses to noise and movement, that appear as if they have some consciousness.”

    They also laugh and smile at their mothers apparently. But this “appearance of consciousness” has been thoroughly debunked by the highly accurate conciousness detectors the doctors have employed, right? I mean, they do have those don’t they?

    Also, there is no difference between starving her and giving her an injection. Except that the injections would be more painless. Junyo’s suggestion is monstrous, however.

  13. Monstrous how exactly? A good infection will kill you in a couple days if left untreated, and you’ll be in a coma for a good chunk of that. As opposed to hunger pangs and your body cannibalizing itself until you die of thirst. I’ll take a double shot of pneumonia with an influenza chaser over that any day.

  14. i heard on the news that they were withholding water also. don’yt know if its true but it will take a lot less time for her to die.

  15. Monstrous in the sense of inducing a fatal illness in a helpless woman.

  16. This thread needs some Monty Python “I’m not dead yet!” references!

    Coroner: Bring out your dead!
    Husband: Here’s one.
    Jeb Bush: She’s not dead!
    Coroner: What?
    Husband: Nothing, here’s your fee…
    Jeb: She’s not dead!
    Coroner: I can’t take her like that, it’s against regulation.
    Husband: Can’t you wait around, she won’t be long?
    Coroner: Naw, Halloween’s coming up and I have to get back to the morgue and get ready for idiots who die in stupid pranks.
    Jeb: She feels fine!
    Husband: No, she doesn’t.
    Jeb: I think she’ll go for a walk now. She feels happy! She feels happy!
    Husband: Look, isn’t there something you can do?
    (Coroner knocks out Jeb Bush and accepts corpse.)
    Husband: Thanks!
    Coroner: Not at all! See you Thursday!

  17. JDM,

    For someone who likely has very little real information about this case, aside from things told to you by others, you sure do seem to have a lot of certitude.

  18. Florida obviously needs a better way of inducing death in this situation; maybe they can apply their vast knowledge of death penalty technology to this field.

  19. I’m surprised no one has remarked the contradiction in the last sentence. How can anyone let her go in peace, if there is no one there to be let go?

  20. Ok, maybe the tapes are doctored. I don’t think so. The parents seem to feel like she is still alive from their interaction with her, and absent any other way to judge another’s consciousness, and with no evidence to say this woman is suffering other than the reaction people have to seeing the state she is in, I think it is wrong to kill her.

  21. In response to the quesiton about who pays:

    This lady and husband were awarded a large malpractice settlement (seven figures) after the incident that left her brain-damaged. Her family is making the implication that hubby wants her dead before medical expenses eat up the whole settlement. Obviously no one directly involved with this is impartial, so I don’t know who to believe.

    My gut feel is that the money is there; she’s not a burden on the state, so let her live. Her husband should divorce her and move on with life. The fact that he has not done this certainly fits in with the theory that he wants her dead so he can keep the remainder of the malpractice money.

  22. in the washington post article that was linked to in the writeup (first link), it mentions that a CAT scan of Schiavo shows massive atrophy of the brain.

    It would not be necessary to “doctor” the videos on the site- just run the camera long enough, and just edit it down to the good parts – where it can be made to appear that she is responding.

    What is pretty weasily is that the husband apparently testified in a malpractice case that he was going to attempt to nurse her back to health, and that the $750k she was awarded would be used for that purpose. (I may by mangling that factoid, and the original article I read it from may not have been accurate.)

  23. He may also just be a loyal and devoted husband who can’t ‘move on’ until she is actually dead. And so what if he wants to keep some of the money? I would imagine that his wife would like to see him happy after so much misery. I know if I ever meet the same fate as she, I would want my loved ones to be able to move on by having me pass and hopefully have a wonderful rest-of-their-lives with the money, the more the better!

    But of course I’ve always believed very strongly in a person’s right to die on their own terms, as long as it’s not by taking a plane full of others with them or something equally ghastly. And the fact that the governor actually jumped in is just plain silly.

  24. “I know if I ever meet the same fate as she, I would want my loved ones to be able to move on by having me pass and hopefully have a wonderful rest-of-their-lives with the money, the more the better!”

    My point in all of this is that no one knows what state she’s in.

  25. If you have an old dog and you let it starve to death instead of putting it to sleep you go to jail.

  26. Dear Everybody,

    For an excellent and thorough (sorry Thoreau) read try this article, many of your assumptions in this case are a tad bit off. If of course, the article isn’t.

    Regards,

    Steve

    PS Loved the adapted Holy Grail bit T!

    🙂

    Long and bitter battle for Terri Schiavo’s life.

  27. Tom,

    You are right, and one should be punished for torturing an animal by starvation. Mrs. Schiavo isn’t even close to the emotional awareness of a beloved family dog, but that is beside the point. What this case OUGHT to bring about is a Dignity in Dying Act or some such, so that her body could be “turned off,” by much faster means such as barbituate overdose or something similar.

    Regards,

    Steve

  28. Dignified Euthanasia Authorization Decree

    Since I know how Congress just loves acronym laws.

  29. “Mrs. Schiavo isn’t even close to the emotional awareness of a beloved family dog”

    Thanks for letting us know. You’ve apparently not only run your consciousness detector over her, but also fed the output through your emotional awareness analyzer. Or are you just taking a guess?

  30. Thanks for the link to that article Steve. One line in this article might be new information to most of us:

    “Terri’s medical care is now paid for with federal tax dollars through Medicaid,”

    The other money has run out.

  31. Andy D:

    Fasting is a good cleansing method to rid the body of toxins and helps the immune system. I suffer from a liver that over produces way too much uric acid, fasting will keep me from suffering gout as an old man (or so my Ayurvedic doctor says!) Regardless, I found fasting makes me feel ten times better when I am done and its good to keep the excess pounds off. Now that I said that, I am been home the last couple of days with the stomach flu, hence why I have been commenting much more than normal! 😉

  32. I’m not going to defend Medicaid, but that’s a side issue. The same fundamental ethical dilemma would persist even if her care was funded 100% by private sources.

    More relevant is that her husband refused an offer of $700,000 in return for letting the wife’s relatives take care of her, and that he made his own offer, that he would donate any remaining money to charity if the family would let him end her life. This is important because there was some question about his motive: Does he just want to walk away from her and take the money, or does he feel a compassionate need (however misguided or noble or whatever it may be) to end her suffering?

    He may or may not be right in his goals, but he apparently cares about her and sees this as a fight to end her suffering, rather than a selfish pursuit.

    Also, the family has criticized him for denying her care. The example that I saw in the article is that he didn’t pursue speech therapy. In a case where somebody apparently lacks even the most basic motor control, the sophisticated action of speech would probably be a low priority relative to other actions (e.g. facial expressions, simple movements to indicate “yes” or “no”, swallowing food, etc.). Perhaps he denied other therapies not listed in the article, but it sounds to me like the demand for speech therapy was wishful thinking, and that most physicians would not recommend spending time on speech therapy until other signs of recovery were present.

    I am no longer on the fence about the guy’s motives. He has my sympathy (assuming the newspaper article is accurate).

  33. Steve in Co, thank you for that link. What is abundantly clear is that Michael Schiavo has behaved impeccably, unto going to nursing school in order to care for Terry. He flew across the country with her to try an experimental procedure that failed to restore any cognitive ability. He fought the good fight for her, and then, as courts repeatedly found — after taking copious medical testimony — Terry is gone and almost certainly is not coming back. All, or nearly all, of the cerebral cortex, the seat of thought and emotion, is irrevocably destroyed in Terry Schiavo. Michael Schiavo did not say that, a bunch of neurologists did.

    And, there is no more money in Terry’s trust fund, so Michael has no improper motive pushing his position.

    A salient point from that article is this:

    “Before the feeding tube became common in the 1980s, every person who suffered similar brain damage died,” said Dr. Arthur Caplan of University of Pennsylvania’s Center for Bioethics. “When people hear about taking them away, they think, ‘Oh how cruel. You’re starving her to death.’ But No. 1, no one would confuse a feeding tube with eating. It is artificial nutrition, green globby stuff put in through your stomach. And two, most very sick people can’t eat food. Most of us know someone who didn’t want to eat or drink toward the end of their lives. I guess you could call it ‘starving’ but it’s the body’s way of preparing for death.”

    Medical technology is usually a very great benefit of Western, capitalist democracy. But not always, and certainly not in cases like these. Terry cannot eat; her body wants to die, and in virtually all other times and places, it would have. Continuing to insert this “gruel” into her is repulsive and apparently a violation of what she wanted for herself.

  34. Thanks Mona and Thoreau, it keeps my faith in Michael that he maintains undying love for this woman while getting on with is life.

    Now if only the rest of the family as well as Florida and Jeb Bush can get on with their lives!

    She will soon be memorialized in the history books.

  35. I, for one, don’t see what bearing the husband’s intentions have on whether or not he should be able to kill his wife. If a person lays out in a living will the conditions under which they want the plug pulled, I’d have to say their wishes need to be honored. I don’t like the idea of pre-consent to possible murder, since a person can not know at the time of creating their will what their actual state of mind will be at the time the plug is pulled, but I think it is the right of everyone to make a reasoned judgement about what constitutes life when the life they are gambling is their own. But in this case, it comes down to the state deciding that this woman is already dead, over the objections of her parents.

  36. The husband claims to be a witness to her expression of her wishes. That makes his motives relevant, as they affect his credibility.

  37. But in this case, it comes down to the state deciding that this woman is already dead, over the objections of her parents.

    Actually, JSM, I think it comes down to her husband deciding, if not that she is dead, at least that nature be allowed to take its course. The state’s intervention is to override his decision (and hers, if his testimony is to be believed).

    I think that is wrong, but not because I have any particular view about whether the plug should be pulled. Rather, I do not want the state making decisions about my life when I am laid up, and I am extending her the same courtesy. I would rather have a wrong decision by her husband in her case (and others), rather than any decision by the state in this matter.

  38. David,

    I mean it in the sense that his intentions do not give him the right to pull the plug. Not in the sense that it’s not relevant to the case as the court actually decides it. I think there should be a very strict standard about when it’s OK to kill someone. The court’s best determination of the person’s previous wishes isn’t a high enough standard for me. Especially when the parents are pleading for her life.

    RC Dean,

    That’s JDM. I think JSM ought to come up with a new moniker. The state protects (or ought to protect) anyone’s right to life. If it retracts that protection from someone at their request, there should be no ambiguity. It should not simply retract it at the request of a spouse or anyone else. Doing so in this case is the same thing as declaring her already dead. Why don’t the parents have the right to continue care for a child they see as incapacitated, but still alive? The state staying out of the decision would lead to the parents continuing care. (Questions of who’s paying aside.)

  39. I agree with JDM, and no confusion with the moniker, either. S/he hits the nail right on the head. We can only infer the subjective state of another, but this inference is fraught with uncertainty. A lot of the opinion here appears to be motivated by revulsion at Terry Schiavo’s current state and the thought : “I would NEVER want to be like that.” Of course, if you WERE like that, would you (could you?) feel the same?

    ‘Suffering’ is something that is felt; if a person is capable of suffering, then that person is not “vegetative” in any moral sense. Contrariwise, if the person is incapable of suffering, then maybe she is vegetative, but why kill her at all if there is no suffering to relieve or prevent? It’s too expensive? While I do not begrudge others their opinions on this, saving money is a little too crass a reason for me (but that’s me).

    On a more nuts’n’bolts level, another point I’d like to address is the meaning of atrophy. The real question is whether the cortex has undergone systemic neuronal necrosis, i.e., are all the neurons actually dead? If the neurons are merely dormant and their associated glial cells are still viable there is still a chance, however remote, that neuronal activity can resume at some later time. Biomedical progress being what it is, this is certainly a nontrivial consideration. A lot of terminally ill people (admittedly many of them of questionable sanity) bet on this biomedical progress by having themselves frozen. While I might not go that far (I would never want to outlive my children), the anti-Luddite in me can certainly sympathize.

    It all revolves around hope, which Mr. Schiavo has apparently lost, while Terry’s parents have not. Scoff if you like at what you might perceive as pointless sentimentality, but this is the essential nature of hope. Now, if in a prior legal document a person instructs his/ her caretakers that they do not wish to go on in a so-called ‘vegetative’ state, then so be it. But in the absence of any such cut-and-dried instructions, the state, if it must get involved, must err on the side of life.

  40. I agree with JDM, and no confusion with the moniker, either. S/he hits the nail right on the head. We can only infer the subjective state of another, but this inference is fraught with uncertainty. A lot of the opinion here appears to be motivated by revulsion at Terry Schiavo’s current state and the thought : “I would NEVER want to be like that.” Of course, if you WERE like that, would you (could you?) feel the same?

    ‘Suffering’ is something that is felt; if a person is capable of suffering, then that person is not “vegetative” in any moral sense. Contrariwise, if the person is incapable of suffering, then maybe she is vegetative, but why kill her at all if there is no suffering to relieve or prevent? It’s too expensive? While I do not begrudge others their opinions on this, saving money is a little too crass a reason for me (but that’s me).

    On a more nuts’n’bolts level, another point I’d like to address is the meaning of atrophy. The real question is whether the cortex has undergone systemic neuronal necrosis, i.e., are all the neurons actually dead? If the neurons are merely dormant and their associated glial cells are still viable there is still a chance, however remote, that neuronal activity can resume at some later time. Biomedical progress being what it is, this is certainly a nontrivial consideration. A lot of terminally ill people (admittedly many of them of questionable sanity) bet on this biomedical progress by having themselves frozen. While I might not go that far (I would never want to outlive my children), the anti-Luddite in me can certainly sympathize.

    It all revolves around hope, which Mr. Schiavo has apparently lost, while Terry’s parents have not. Scoff if you like at what you might perceive as pointless sentimentality, but this is the essential nature of hope. Now, if in a prior legal document a person instructs his/ her caretakers that they do not wish to go on in a so-called ‘vegetative’ state, then so be it. But in the absence of any such cut-and-dried instructions, the state, if it must get involved, must err on the side of life.

  41. Ooops! Sorry about the double post.

  42. “In Florida, they are breaking new ground in saying that it should not be a family member of the patient”

    You’re ignoring that the family is divided.

    “You are happy with the prospect of Jeb Bush, Arnold Schwarzenegger, Jesse Ventura, and the like deciding whether or not to pull the plug on your parents or children?”

    In this case, the court has decided that the husband should be allowed to kill his wife in spite of the fact that parents want to keep caring for her. If Jeb wanted to kill her in spite of the husband’s wishes instead of keeping her alive in spite of the husbands wishes, I’d be even less happy with that. The default position of the state should be to not allow people to kill each other.

    I agree that lucid terminal patients (or anyone else who is lucid) has the right to refuse treatment, or jump of a bridge, though I would personally consider it a tragedy each time. By extension, anybody should be able to set down a living will – in writing – which defines under exactly which conditions they choose to refuse treatment. Absent that, I don’t think that going by the court’s best *guess* about what the patient’s desires would have been if they had made out a living will is a good idea.

    I also don’t buy arguments about a life being worth less because of diminished cortical activity, mental retardation, or general stupidity. Nor do I pin any arguments about her right to life on whether or not she is going to recover. No one – not me, you, Jeb Bush, her husband, parents, or the doctors know what her state of being is.

    I don’t doubt the motivations of those arguing that the husband should be allowed to pull the plug, I’m sure you believe that is what her wishes were, I just don’t think the court has the degree of certainty necessary to allow him to do that.

  43. David Tomlin,

    Sorry about that. Rough night and all, plus insufficient caffeine levels in the bloodstream:)

    As for the strange perspective, I don’t know what is really so strange. I suppose it depends on whether one considers suffering as a cognitive state. I think it is, albeit an elementary one, though you may disagree. Recent research has shown that such states are associated with the pre-frontal cortex, so presumably suffering involves cortical activity. If we allow that suffering is indeed a cognitive state, then the presence of suffering means there is cognition and the person cannot be considered ‘vegetative’; thus undercutting the argument that she should be allowed to die due to her mental state. If, on the other hand, she is ‘vegetative’, then she cannot be suffering (by definition), and there is again no moral imperative to allow her to die. The only things remaining are hope, which argues in favor of sustaining her, and cost, which argues the opposite.

  44. Sorry JDM,
    I am just using my initials. My employer uses it as my identity as standard practice, we used to have to many JM’s so they adopted the middle initial a few years back. I liked it since my employer before that identified me by 223. Somehow, 223 always seemed a bit cold and impersonal and left me feeling like the true cog that I was!

    I’ll consider a new moniker.

  45. JSM,

    I was just joking. Change it to JDM if you like. There used to be another JDM who posted here as well. To confuse things further, I could barely tell his posts from mine, so I know no one else could.

  46. surely you do not eschew all state involvement such as judicial oversight?

    I think that, where the patient has not appointed a surrogate, the courts have a role in establishing who the surrogate is. After they do that, they should step out. The surrogate stands in the shoes of the patient; if we allow judicial oversight of the surrogate’s decisions, then the door is open for judicial oversight of patient decisions.

    Absent a clear directive from the life in question, is it not the proper role of the state to defend that life?

    The default position of the state should be to not allow people to kill each other.

    I don’t doubt the motivations of those arguing that the husband should be allowed to pull the plug, I’m sure you believe that is what her wishes were, I just don’t think the court has the degree of certainty necessary to allow him to do that.

    I believe these positions can be summarized by stating that legal guardians should be prohibited by the legislature or the Governor from pulling the plug on any patient, regardless of their mental state or future prospects, because this amounts to killing the patient.

    I object to this argument on a couple of grounds. First, it is substituting the judgment of the state for that of the guardian. If you are fine with this, then be aware that you have crossed a line and that the ultimate results may not be to your liking. Be careful the powers that you give to government, because they will be exercised by people that you do not agree with, to do things that you find abhorrent.

    Second, it incorrectly categorizes the failure to intervene to prevent a death as a killing. I believe the distinction between putting a bullet in someone’s head and declining to apply all the resources of modern technology to keep their heart beating is a real one. If you also believe this distinction is real, then you should use a term besides “killing” for the withdrawal of heroic life support.

    If you believe that withholding or withdrawing permission to apply heroic measures for someone is killing them, then you must also believe that refusing to allow those measures on yourself is suicide, and thus is illegal under current law. Refusal to consent to medical treatment on your own behalf is not suicide, of course, and so refusing to consent to medical treatment for someone else is not murder.

  47. “First, it is substituting the judgment of the state for that of the guardian.”

    The state is not making a judgement, anymore than it is when it denies the husband the right to kill his wife if she is able to communicate. Allowing the husband to prevent the parents from caring for her is making a judgement about the worth of her life.

    “refusing to consent to medical treatment for someone else is not murder”

    I agree, but someone killed by an accident, someone else’s best intentions about whether she would like to be alive in a dimished capacity, or murder, is just as dead.

  48. Monstrous in the sense of inducing a fatal illness in a helpless woman.

    If death is the outcome, the means only matter in terms of how much pain it potentially causes and how quickly it’s lethal. Inevitably this woman will die, whether 30 years from now or tomorrow. A person who actually has cognitive function has to make the call on whether Terri’s quality of life makes those 30 years worth the real or percieved indignity and pain of her present life, since Terri either cannot or, if you’re a hopeless optimist, cannot communicate her decision. Once the live/die decision is made, what would be monstrous is anything that prolonged her life/suffering. That inducing a fatal illness upsets sensibilities is unfortunate, but it would almost certainly be among the quickest, most painless, and probably legal ways to accomplish the task at hand.

    That being said, Terri made her choice, beyond a Living Will, beyond a DNR, when she got married. Marriage carries more than tax benefits. It also conveys legal guardianship, and the coresponding right to make life and death decisions for you in the event of your incapacitiation on your spouse. Terri’s parents would have standing if they pushed the husband down a flight of stairs, they’d have standing if they got Terri to blink out “I want a divorce, he’s trying to kill me” in Morse code(and got it on tape). But in the absence of these circumstances, the parents are the second string, not on the field, and therefore don’t get to call the play. It’s not a complex issue at all if sentimentality isn’t allowed to intrude. Terri chose death (in this particular parallel universe) when she said “I do”.

  49. Mark: I don’t know what is really so strange . . .

    It’s your use of the word “crass” that I find puzzling.

  50. RC Dean:

    I didn’t use the word “killing” — you did –because I do not equate that term with the failure to protect. In fact, what you quoted from my post was a question, not a statement, because I’m not quite sure what that failure to protect amounts to. Similarly, is feeding someone who cannot feed him/herself “heroic life support”? In this case, it may appear to be, but could you fail to feed an infant or an elderly parent in your care and not face charges of neglect? I don’t see clear answers. I do know that my questions haven’t been answered to any level of satisfaction:

    Is higher brain function the proper way to define life?

    Mr. Bailey argues persuasively that the potential (of higher brain function) for Terri Schiavo is extraordinarily less, but does the slimness of that chance invalidate a life?

    And, restated:
    Does/should legal guardianship render moot the state’s role in protecting a life absent a clear directive from the life in question?

  51. Kari asks” Does/should legal guardianship render moot the state’s role in protecting a life absent a clear directive from the life in question?”

    I generally agree with what R.C. Dean has posted in these threads, but I part from him on the issue of judicial oversight. Family should have standing to contest a spouse and/or guardian’s decision because there are often motives for such decision-makers to put their interests before the patient’s. *IF* Terri Schiavo did interact with people, and had a reasonable prospect of being restored to some cognitive function, and her husband stood to gain financially from her death, then withholding treatment would not be in accord with what apparently were her wishes(and those most of us would also hold for ourselves), and her husband’s decision would be strongly suspect. Family should be able to make such arguments, but of course, courts should, after taking testimony from them as well as from medical experts, be able to uphold the decision-maker’s call.

    While I strongly approve of Michael Schiavo’s position, I also completely believe that there needs to eist recourse to a tribunal that will make sure (as much as is humanly possible) that the wishes of the individual at issue can be reasonably ascertained, that treatment is not being withheld when there is some realistic propsect for recovery from a dying process, and that improper motives are not driving a decision that ignores such prospects. It much seems to be the case that Michael Schiavo is acting properly underthese particuar circumstances, but human nature being what it is, that is not always true.

  52. Oops – anon at 7:24 was posted by me.

  53. . . . saving money is a little too crass a reason . . .

    If there is a person who can’t survive without heroic life support, in a form so expensive it requires taxing the rest of the human race down to minimum subsistence, you think it would be “crass” not to do so?

  54. Bailey convinces us that the prognosis is poor, but didn’t give us the affirmative case for withdrawing life support. How do you get from “She’ll probably never recover” to “Kill her?” I’m guessing that the reason is “To save money.”

  55. “If there is a person who can’t survive without heroic life support, in a form so expensive it requires taxing the rest of the human race down to minimum subsistence, you think it would be “crass” not to do so?”

    Well, that’s just silly. Of course a line must be drawn somewhere, and I thought I allowed as much when I said that “While I do not begrudge others their opinions on this…”. Draw your line where you like. Terry Schiavo is nowhere near that large of a drain on the resources of society or the economy. In addition, I would argue that she could be maintained MUCH less expensively if market forces were allowed to more strongly influence medical costs. As it is, the plethora of stultifying bureaucracies involved, from hospital admin to the FDA to the state reg agencies, etc., drives the cost of most medical procedures through the roof. But that is a separate issue.

  56. “Prognosis Negative” — isn’t that a fake movie title from a “Seinfeld” episode?

  57. That’s just silly.

    No, it’s not silly. I misunderstood your intention, but that doesn’t mean my interpretation of what you wrote was “silly”.

    My question wasn’t rhetorical, and I wasn’t playing “gotcha”. Your perspective on this matter is very strange to me. I asked a question because I honestly want to understand how you feel, and why.

  58. Andy D:

    Thanks for pointing out that the settlement money ran out. That removes any unpure motive for the husband’s actions as far as I’m concerned. Also, after giving it more thought, I think I would also actively try to “end it”, if I had to see my wife in that condition for so long.

  59. I just enjoy the subtle ironies in america. The soldier who jumps on a grenade to save his friends receives the medal of honor for basically an act of suicide. The glorification of suicide before surrender in popular culture. The willingness to spend a bajillion dollars on a pet and then put it out of its misery. And the unwillingness to do the same for a person.

  60. JDM – so you have no problem with the state overriding the decision of a legal guardian with respect to terminal health care decisions? You are happy with the prospect of Jeb Bush, Arnold Schwarzenegger, Jesse Ventura, and the like deciding whether or not to pull the plug on your parents or children?

    Assume that the person involved has left no decisive statement of their intent. At that point, the question becomes who decides. In Florida, they are breaking new ground in saying that it should not be a family member of the patient, but rather should be the Governor. This sets a precedent for the Governor or his delegates pulling the plug, as well as putting it back in.

    You may disagree with the husband, but first you have to establish why the state, rather than the husband, should be making these decisions, and not just in the Schiavo case, but in every case. Including yours, someday.

    Further, I don’t think it is a given that the baseline here is providing all possible heroic support measures to keep the heart monitor beeping. The baseline, in my opinion, is letting nature take its course. The Governor isn’t “retracting protection from someone at their request” when he lets nature take its course.

    The Governor is ordering treatment here, and I think that goes well beyond the state’s brief for protecting someone’s life. There is no force or fraud here; rather there are citizens handling their private affairs as they see best. State intervention is a major, major departure from the way we handle informed consent to health care, and it is fraught with danger.

    I keep coming back to the question – do you want the Governor shoving your spouse or family aside so he can use your health care to prop up his poll ratings? If you find this repellent, you should be opposed to what is being done in Florida.

    Someone has to decide what will happen to people in Terri Schiavo’s condition. I would rather leave to family members’ discretion, rather than give control to the Governor. I may disagree with family members from case to case, but I find that much less disturbing than the spectacle of the state seizing control.

  61. “It’s your use of the word “crass” that I find puzzling.”

    From Merriam- Webster Online:

    crass, kras adj. 2. “guided by or indicative of base or materialistic values”

    I think making the case that her life should be terminated because of the cost of sustaining her fits this definition exactly.

  62. R.C., I agree you with about this spectacle of Gov. Bush doing as he has done, but surely you do not eschew all state involvement such as judicial oversight? That latter process appears to have worked well in the Schiavo case, and it is important to determine that she is in an end-life state as opposed to one that might resonably be considered temporay. Like most of us, it appears she wished to refuse treatment only for a virtually irrevocable condition such as she has been found to be in.

    For those of you who see this as murder, that is not so. Refusing medical treatment is not an act of either suicide or homicide. Not even when death is the certain outcome, and not even when, as here, the refusal allows nature to take its course. The common law, garden variety right to refuse treatment (and not a right to die per se) is fundamental to liberty, and the courts were persuaded that is what Terri wished. It makes sense, and a lot of us who are competent strongly feel the same way. I had a client who, over some of her family’s fierce objections, preferred to die of gangrene from diabetes, rather than amputate any more of her body(and she had myriad other severe nfirmities) — she was competent when she made that decision, as every one of her physicians testified. Dying of gangrene might strike us all as awful, but that is what the lady chose to do, in a matter the media incorrectly framed as a “right to die” case, when it was simply a right to refuse treatment matter — Kevorkian was not involved. He’s not in the Schiavo case, either.

    Interfering with nature is a great gift of modern capitalism, most especially in the area of medicine. But in a case where the dying process is held in abeyance so that a body may continue to function, and where fatal injuries have destroyed all semblance of personality and personhood, not all of us would think that a blessing.

  63. Now the ACLU has entered the fight. I wish I could believe this was based purely on their commitment to principle, rather than their institutional hatred of Jeb Bush.

  64. Terri Schiavo has brain function; even her husband’s doctors agree. She appears to have little or no higher brain function. Is higher brain function the proper way to define life?

    Terri Schiavo’s brain is still in charge of the integrated bodily functions that physically define life: respiration, circulation, etc. — even sleeping and waking states. We’re not talking about “pulling the plug” in the that sense. For example, withholding food and water from a person unable to feed herself would be considered a crime if if that person were a newborn. Newborns have limited cognitive function, although certainly they have high potential for rapid development. Mr. Bailey argues persuasively that the potential for Terri Schiavo is extraordinarily less, but does the slimness of that chance invalidate a life?

    I won’t question the motives of her husband, her parents, or any of the doctors involved. It would be a terrible situation to be in. I do question what the proper role of the state is in this case. It’s often argued here that the role of the state is to be limited to essential protections, and the first ennumerated is life. Absent a clear directive from the life in question, is it not the proper role of the state to defend that life?

  65. I continue to hold the opinion that this is a case of “custody.”

    I do not know if custody is a federal or state matter. I do not know if a husband or parents have “custody.”

    I would be surprised if this is not spelled out in the law (despite my ignorance of it).

    If, in the state she (you) reside in, the spouse is given “custody” (if there is no living will) if one meets the criteria for being “brain dead” (and, again, I assume, in this point in time that criteria has been set — even if it is having “three” doctors testify that any given patient meets the criteria — I don’t see the legal basis for dispute.

    It seems a pretty cut-and-dry case to me, if parameters for legal custody are in place (again, I don’t know the situation here). If the Florida basis for legal custody is established, Bush’s “interference” in the case is without merit (as is “interference” by the judiciary).

    I think the laws of Florida must afford some ambiguity, otherwise I don’t see why this would be an issue.

    (Personally, I would argue for a divorce by the husband, and transfer of custody to the parents, but I wonder what *current state law* stipulates.

  66. Although I have concluded (assuming that my understanding of the facts is correct) that the husband should have the right to remove the feeding tube, I have to take issue with those who argue “This is a family decision that the state should have no authority over.”

    Normally I’m all for keeping the state out. But when one person wants to end the life of another, that’s an exception.

    Now, detractors will start pointing to all sorts of reasons why in this case the state should let Mr. Schiavo make his own decisions. And I say “Exactly! The facts of this case justify his decision, not some bogus principle that anybody can end his wife’s life whenever he wants. The only reason he gets to end her life here is because a sober consideration of the facts (apparently) shows that she has no chance of ever returning to this world and he’s acting out of sincere concern rather than a conflict of interest.”

    So there ought to be some sort of legal standard before one person ends another person’s life. Outside of this would-be libertopia that wouldn’t be a controversial statement. Now, one good legal standard already in place is the living will. Although many states (wrongly) put restrictions on living wills (e.g. you can refuse a ventilator but you can’t request a painkiller overdose to hasten your exit), it’s still a pretty good mechanism because the state is saying “If somebody makes clear his wish to not have a procedure done then his wish is respected.”

    But Mrs. Schiavo didn’t leave explicit instructions. So before he just asserts the power to end her life, some agent of the state should really take a look and make sure it’s justified under the law.

    Now, of course, in this case courts have spent years looking at it and consistently sided with him. So I’d say in this case the state has more than fulfilled its duty. And I think this should be a judicial matter and that the FL Legislature acted improperly in granting the governor the power to intervene. (Whether that law is in conflict with the FL or US Constitution I have no idea, so let’s leave that alone since it’s a question of what the law actually says right now, not a question of what the law should say if the gov’t is to be kept properly in check.) Courts are supposed to decide between alternatives presented by opposing parties in accordance with law and evidence. The executive branch sets policies according to whatever discretion it is given by the law. I don’t want Jeb Bush making people’s medical decisions, but I want a court to make sure that somebody making medical decisions is not interfering with the liberties of another person. There’s a big difference. One says “Do whatever you want as long as you don’t infringe her liberties.” The other says “Do what Jeb Bush wants.”

    Anyway, my basic point is that I don’t have any knee-jerk objection to gov’t getting involved when somebody wants to end another person’s life without that person’s express written consent. If that makes me a statist, so be it.

  67. Last night/this morning, I left a comment, regarding Reason’s libertarian view on this issue, at this entry of William Luse – it is currently the second from the bottom.

    Mr. Luse mentioned that article by Mr. Bailey in his entry, and my comment is about the libertarian viewpoint on issues such as this.

  68. My mom was not given any feeding tube when she had a massive stroke. Hospice was there to watch over her daily & I received daily phn calls.

    Any time mom showed any sign of discomfort, morphine was given to her. Why isn’t Morphine mentioned any where? I’m sure the hospice my mom was with isn’t the only one.

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