The following was a column in today's SF Chron, by a very good writer Jon Carroll. Yes, a liberal (sign of the times that I feel the need to apologize for that??), but worth a read for liberals, conservatives, and everything in-between: "I do not in this column want to talk about the right to die. I do understand that it's a complicated issue, and many advocates for the rights of the disabled have serious reservations about it. I do understand that a persistent vegetative state is different from a coma. That's all interesting, but it's beside the point. I want to talk about political grandstanding. I know that accusing a politician of grandstanding is like accusing a shark of eating. There are, nevertheless, limits of human decency. The president and any number of GOP members of Congress have not just crossed those limits, they have stomped on them, burned them, obliterated them. Do we have no safe harbor from the pandering ideologues? Apparently not. As almost everyone knows, Terri Schiavo is a Florida woman who has been in a persistent vegetative state for 15 years. Her husband, her doctors, the courts and the man appointed by the courts to act as her advocate have all concurred that the most humane thing to do now would be to remove her feeding tube. Schiavo's sad case is not unique; feeding tubes are pulled every day in the United States. Patients are intentionally given overdoses of morphine every day in order to relieve their suffering. Sick people choose to die, and say so, and they do die, aided or unaided. This is the cycle of life. Sometimes the media gets wind of one such story, usually involving a relatively young white person like Terri Schiavo. Press conferences are held. Doctors are consulted. The courts get involved, which is regrettable but necessary. And then the evidence is heard, and a decision is made, and a life is ended. All lives end -- the idea that human life is sacred is not, alas, supported by the evidence. Politicians become involved in direct proportion to the amount of media publicity. They proclaim piously that they believe in the sanctity of life, which is code for "I'm still against abortion." They align themselves with a socially damaging faith-based theory that opposes even contraception, because every sperm is sacred. (In that belief system, the stain on Monica Lewinsky's dress is holy in the eyes of God.) The panderers and the publicly pious created a nine-ring circus around a private family decision, and they used a helpless young woman as a pawn. They did so apparently without conscience and without regret. Congress subpoenaed Terri Schiavo in an effort to prevent her feeding tube from being removed. President Bush flew in dramatically from Texas to sign a special emergency bill allowing a federal court to intervene in the case. Did any of them care about Terri Schiavo for the first 14.5 years of her vegetative state? They did not. Did they offer to pay for the extraordinary expense of keeping her alive? They did not. Did they sit by her bedside, read her books, play her music, bathe her bedsores? They did not. There's nothing to be gained from unpublicized compassion. There are elderly people all over this country dying every day from simple neglect. People just forget about them. Maybe Congress could subpoena them! That way, when they didn't show up, they'd be in contempt of Congress and someone would have to go find them and at least change their sheets and give them some hot broth. There are children in this country dying every day of preventable diseases. Would George Bush care to fully fund all family clinics, so that a baby would not die simply because it cannot be given antibiotics in time? Would George Bush care to spend as much money fighting HIV-AIDS in the African American community as he does building large bombers? Yeah, I know, it's a tired old liberal argument, and it's been discredited because well, you're gonna have to remind me again why it's been discredited. Never mind. Let's just concentrate on people in persistent vegetative states. I have no idea how many people fit into that category -- let's say 25,000. If every life is so damn sacred, then all these people must be allowed to live and live and live. With enough government support, they could outlive those of us in persistent animated states. What a triumph for the human spirit that would be. And let's not hear this blather about quality of life. It's quantity of life that we're after, just more and more living humans in various states of distress, but all of them joyously alive as God intended, until they die, also as God intended. But never mind the second part! Let's keep cranking out the comatose! Put them all under the care and the protection of the Congress of the United States, the fine fountain of loving-kindness. " http://www.sfgate.com/cgi-bin/article.cgi?file=/chronicle/archive/2005/03/23/DDG27BCCGI1.DTL
It's not an either-or proposition. Just because some kids die because their parents refuse or don't care enough to take them into one of the many free clinics available, just because some feeding tubes are removed due to a valid living will--which Terry doesn't have--just because some elderly--maybe many--die due to neglect or overdose or some "helpful humanitarian" nursing home worker who kills them via overdose, doesn't mean that we need let Terry die in a rather unprecedented manner and establish a perfectly awful precedent: starving a woman sans living will, on the testimony of an erstwhile husband who would apparently just as soon she were dead so he can get the whole unpleasant matter out of his hair. This qual;ity v. quantity argument is getting tiresome. Did you know that a late term, very viable baby was aborted in England recently on the basis of a cleft lip? This is where this mindset gets you. I'll take life, thank you, keep your culture of death.
Thanks for the read Tom. I've changed my mind on this issue since I first became familiar with it about two years ago. At first, I couldn't understand why Michael Schiavo just didn't hand over guardianship of Terri to his parents. The fact that he didn't, conjured up notions of mal intent on his part. However, after considering that 9-10 different judges (over 20 now) had sit in judgement on various parts of this case and had ruled that Michael had the responsibility of making the decision on behalf of his wife based on his proving to the court that this was Terri's wish, who am I to second guess this? Who is the Congress or the President to second guess the proceedings of due process in Florida? I don't have any problem with working to change the law of the land to fine tune our legal process with respect to end-of-life cases; however, I find the whole process of Congress trying to impose its will on the judiciary for the sake of one person a bit too totalitarian for my tastes. I wonder whether the quick rulings by the federal courts are an implicit slap on the hands for Congress and the President?
little fauss, There is nothing unprecedented about it - as you yourself admit. You make Carroll's point perfectly. Apparently, if Terry Schiavo had a living will which instructed those caring for her in just such a situation to pull her tube, you would not have a problem with it. In that case, the "perfectly awful" starvation of her would be just dandy. In the absence of such a document you would rather meddle in the affairs of her family (which has been caring for her for 15 years - is that what you mean by "erstwhile"?), and make presumptions about the motivations of her husband. Talk about a tiring argument. And, yes, this is the indirect way of trotting out the abortion argument again, as you have done quite predictably. Did you know that "pro-life" advocates have bombed and murdered mothers, doctors, and nurses at abortion clinics? If you want to pull out extreme cases to make your point, I can match you incident for incident, and I can do you one better in every case. The Schiavo case does not lead inexorably to your point about abortion. I'm with you about preferring a culture of life. We differ on what constitutes that life. I don't see Republicans like Delay breaking down the door to give Terry a warm bath, feed her, or read her books. I trust that the husband that you conveniently toss in the trash heap has had to do all of that for 15 years. Now suddenly he is a potential murderer. Would you be willing to give of your time to help care for Terry Schiavo? Perhaps give some of your salary? How about at the local nursing home where there may be someone just like Terry Schiavo? The argument cannot be boiled down to the insertion, or not, of a feeding tube. It has everything to do with the 15 years leading up to it. As Carroll eloquently pointed out, the current grandstanders had nothing to say or offer during those years, which makes their apparent caring now seem awfully hollow and disingenuous.
Tom: A living will ensures that the person who's life is at stake has a say. As she doesn't have one, she doesn't have a say. I don't care if 1,000 judges said kill her, it's still unprecedented to yank a feeding tube with no living will. And if you can find a precedent, show me. I'm talking about the law, here. As for the meddling in family affairs, heck, Tom, she has a family willing to take care of her and the most nominal of husbands who wants her dead. The couurt wants to lock the family out and kill her. Who's meddling in family affairs. BTW, what do you think about the "enlightened" actions of the doctors who killed the baby in England? No problem with it? Or if you do have one, I'd love to hear how your rationale fits into your general world view. My guess is you won't have the guts to give me an answe, you'll just ignore the question, shoot the messenger like you did in your last post, or give me some lame sophistry about it being a"profoundly difficult choice that yes, must in all circumstances be between a woman and her conscience" (yeah, right, to kill a baby over a condition that requires a minor surgical correction!). Why in the heck does Tom Delay or anyone else have to give her a sponge bath or their efforts to save her should be discounted? That's probably the worst, most side-splitting argument I've ever heard! Perhaps only exceeded in its foolishness by the argument in the article that until you've solved every single problem in the country, you dare not try to save a woman from being starved to death. Goodness, what passes for enlightened thought these days!
Based on the sequence of events, I can only assume that this means that you want to disregard the law. I would like to have states disregard the law when it comes to abortion, but because I'm a civilized person I obey the laws even as I might work to change them. In this case there are too many people who feel that the law needs to be ignored and their will used to usurp the husband's responsibility to execute the wishes of his wife. This is very scary. Perhaps even as scary as Timothy McVey's offenses or abortion clinic bombers.
I won't comment on John Carroll, beyond saying that trying to turn this troubling and very emotional slow motion death drama into an occasion for attacking "the GOP" is itself the worst sort of political grandstanding. I will say that I strongly support the idea of assisted suicide in the case of the terminally ill. I've seen people attached to tubes and machines in ICUs, suffering unspeakably, while their hospitals milk a few extra days out of them. It seems to me that hospitals just want to avoid the threat of lawsuits (and to drain big bucks from the patient's insurers). BUT... It has to be suicide. In other words, death has to be the patient's own choice, either expressed in real time or previously in writing. I'm less comfortable when other people assume the right to make that decision for you. In the Terry Schiavo case, I assume that the courts satisfied themselves that it was Terry's wish to die in these circumstances. But everything still seems to be coming from her husband. Maybe the law says that spouses have absolute authority to speak for incapacitated spouses or something (I don't know the legal details of this case), but it still troubles me. Let me put it this way: If the courts want Terry Schiavo to die, then why not put a revolver to her head and just blow her brains out? Inject her with a massive overdose of barbiturates or something. Why screw around? Just put the woman down. If any of you don't like that suggestion and think that it's barbaric, then maybe you had better rethink what's presently happening. If death by gunshot wound is over some kind of line, then why isn't deah by intenional dehydration? It's even more troubling when when the woman isn't terminal and doesn't seem to be suffering. (It's actually part of the pro-death side's arguments that she can't be suffering.) Add the fact that videos show her with her eyes open, apparently tracking movements and even showing a little emotion, and all kinds of rights-of-the-disabled issues arise as well. I don't know. I certainly don't have the answers. But all in all, I'd prefer that the state error on the side of caution.
BillDayson, You point to one of the oddest features of this area of law; a person has to be sane and able to communicate in order to receive assistance in suicide. It's weird because in order to make the living will have any meaning, we have to assume that the person has the same wish NOW that she had THEN despite a MAJOR change in circumstances, to wit: the medical disaster, whatever it may be. Frankly, it looks like logical nonsense to me but I have nothing better to put in its place.
For 'little Fause" Hold on, pardner. Don't you think it's painful to have a feeding tube inserted? Isn't reinsertion of the feeding tube only a means to prolong death rather than save a life. It's ironic how the most religious people are the ones who want to prolong death. Is it that you think your loved one needs to suffer as Jesus did before they can find salvation? Do you think people that are killed instantly cannot go to heaven? For all of you that want to prolong Mrs. Shiavo's suffering, ask yourself, "What would Jesus do?" My God is kind and merciful, maybe yours is not.
Hi Bill, Vietnam vets have a saying, “Blame the war not the warrior.” If you were around in those days you’ll no doubt recall how unpopular an institution the military became. Regrettably, for many, their trauma was reinforced when they stepped off the ‘freedom bird’ back here in ‘the world’ to accusations of baby killer … or worse. Career soldiers were looked upon as ‘lifers’ out for ‘three hots and a cot’ who couldn’t negotiate anything that resembled a real job. ‘Military intelligence’ became the definition of a contradiction in terms. And so on. I’ll never know the pain of that soldier or marine who got off the plane to a hostile reception but I do recall I avoided being seen in public in my National Guard uniform. I wore it on the way to drill but I’d change into tie dyes and bell bottoms on my way out the door at the end of the day. I believe there is a parallel with healthcare in today’s climate where healthcare facilities and clinicians are the warriors and healthcare economics is the war. Hospitals by and large, I think, struggle to stay afloat and are populated by dedicated, hard working, frequently overwhelmed staff. Are there pigs at the healthcare trough? Of course. The pharmaceutical industry which is coming to be known as Big Pharma is a prime example. One constant in the decades I’ve worked in medical centers is the navy of drug reps who float on oceans of kitsch to dispense. Andy Rooney could easily do a sketch on unnecessary medically related gimcracks and gewgaws with 30 seconds preparation by going through my desk. I’ll never, ever need to purchase another pen, pad, or post it note. All of which is expensive. The apex or nadir, in my viewpoint, came about with the passage of the Medicare drug bill. Unlike the Veteran’s Administration, Medicare is prohibited from realizing cost containment by negotiating price. On both sides of the isle we have the best politicians PAC money can buy. I made a personal decision at that point I would never avail myself of another drug company free lunch. Clearly, they aren’t; you and I shoulder the burden every time we fill a prescription. Do clinicians and healthcare facilities run scared of lawsuits? Of course and the result is defensive medicine but not an intentional effort to squeeze blood from the HMO stone. If anything the zeitgeist among clinicians in my experience is in favor of preventing hours of, as you say, unspeakable misery in end of life situations. I practice psychology in a teaching hospital for a living and I sometimes I find myself reminding young clinicians the individual has the right to decide how he or she wishes to die. I guess I’m becoming that curmudgeon I hated when I was starting out. One often sees this around the issue of CPR where the clinician looks askance at the aged, infirm patient who elects to be a ‘full code.’ Why do they adopt this position? I don’t find that it stems from the person being coarse and unfeeling or in the service of euthanasia. It seems to come from a reluctance to inflict pain and suffering. My next day of medical or nursing school will be my first but what my colleagues tell me is that CPR especially in the case of the infirm, aged frequently fractures the sternum causing pain and suffering and, in the end, isn’t especially successful. The concept of the slow code isn’t new news. My personal opinion is that heaven has a special place reserved for nurses. We all hope and pray that if we or a loved one should wind up in an intensive care situation the RN hasn’t been ‘mandated’ and in her 15th hour of duty and at risk for making an error either from exhaustion or distracted with worry about how her children are faring. Mandated in nurse-speak refers to being required to work a second shift at pain of termination for refusal to comply because the replacement called in sick. Perhaps out of exhaustion from a similar grueling 16-hour tour. Nursing staff work so very thin nowadays it just isn’t possible to absorb additional responsibilities. Additionally, we all hope and pray we aren’t subject to something like head trauma in a county or region where the last neurosurgeon closed up shop and relocated because she could no longer afford malpractice insurance. Bill, I’ve enjoyed reading your posts over the years and I’ve always found you to be a reasonable man. In this instance, I’d ask you to reconsider and blame the war not the warrior. I’ve worked palliative care, long term care, and I’ve pulled my share of ICU consults. People don’t go into healthcare with ghoulish motivation and its physicians and nurses who make the calls not ‘the hospital.’ In all my years I know of only one situation where extraordinary attempts were made to defeat the grim reaper and that wasn’t to squeeze the HMO stone. It was to ensure the survivors would qualify for benefits.
But the really weird thing about this case is that Terri Shiavo has no living will and never did have one. This decision was made solely by her husband, who for quite some time has been a husband by law but not by practice. Yes there have been reviews by several judges but it seems to be nine reviews of the same thing, that Judge Greer initially established her husband's word as fact with absolutely no supporting documentation. Her husband originally sued for malpractice claiming that he needed the money for her care and rehabilitation. So why then, within three months of winning that suit and receiving the money, did he order all rehabilitative efforts ceased? Why did he order feeding-by-mouth therapy stopped and a feeding tube inserted? (Terri has since lost the ability to swallow but according to affadavits she did have that ability previous to the order to stop rehabilitative feeding.) When she had had several infections over the years since her incapacitation, why did he order that she receive no antibiotics? Why did he order in 1995 that she receive no further teeth cleanings, which resulted in her needing six teeth removed in 2003? Why, at the time of his malpractice lawsuit, did he make no mention of once having heard his wife say that she would want to die if she ever were to be in the circumstance she is in now? Only more than seven years after the fact did he suddenly remember such a conversation. Why was his sudden recall ruled to be fact with no supporting documentation or evidence? Recently, while being interviewed, he made the statement "We don't know what Terri's wishes are, but this is what we want." "We" who? Her parents, siblings, and their lawyers aren't part of that "we", so who was he talking about? Was he speaking of himself and his current girlfriend? Why did he ask for, and get, an order form Judge Greer that Terri is to be immediately cremated upon her death with no autopsy? This is not only also against the wishes of her family, who would like a burial, but it also seems a very odd thing to request when she is still alive. He has long since moved on with his life, which many (but not all) people may have done since this has gone on for 15 years. But why didn't he just complete that process and allow her parents' petition for a divorce for their daughter with the provision that he would have no further responsibility for her as they would assume all responsibility? Why didn't he do the noble thing and take that opportunity to step aside instead of persisting with what seems to be a rather convenient sudden recall of a conversation that he apparently did not remember through at least seven years and one malpractice suit? Add it all together and it does seem something may well be rotten in Denmark. Kit
Bill Dayson and I disagree profoundly on the assisted-suicide question, but I deeply appreciate the sober and sobering character of his post (and of most of this thread, too). I also appreciated what Tom57 said in his own words. Rather than take shots at shady DeLay or the Oregon Dem who started ranting about nobody's bedroom being safe (two blazing eejits in my book, even if I happen to agree with DeLay on this issue), it might be better to reflect compassionately, or pray if that is your wont, on the very solemn human tragedy still being played out here in the lives of several people. Recognizing that speaks better of our humanity than passionate argument, let alone political name-calling.* *Don't get me wrong, I'm usually in favour of political name-calling (within reason), but maybe both sides ought to give it a rest, just for once, on this event. That's called decency--not the partisan code word, just the real thing. Best wishes to all of you. J.
Some one can explicate to me, how the US Courts guarantee the order to no reconnect the woman to the piece of equipment, in others words, the police force, the armed forces or some type of Marshall is near the apparatus?
