clarifications
Posted by David V. on March 20, 2005
Because I have published a paper titled "Against The Right To Die" and another paper (subscription required) arguing against physician assisted suicide; and because these papers are sometimes assigned in undergraduate courses; I worry that some former philosophy students may think that they remember having once read a justification for the way that Congress is currently interfering in the medical treatment of a patient in Florida. To my knowledge, there is no justification whatsoever for this interference. There certainly is none to be found in anything that I have written. [...]
16 comments:
My mother, who did have an ADR on her chart, recently passed away.
Though we knew her wishes, and wanted to follow them, in the hospital it was very difficult.
What you feel about extraordinary measures may not be what others feel about them.
Truth is then, that she did not want to use a CPAP machine, a machine that is uncomfortable to sleep in, claustrophobic, and evidently in use by thousands (or millions) of others that suffer sleep apnea.
She had one on. She improved. They took it off. She declined.
Is a CPAP "advanced?"
Could the doctors put it back on? She didn't want it. What did we want? Did what we want have anything to do with anything?
These issues are very difficult.
My biggest problem (I have others) is the concept of removing the feeding tube. If the concept is that she's brain dead, then why not end it quickly (lethal injection). If she's mostly brain dead (i.e., never going to gain conciousness but might still be "feeling" whatever that means) then either (a) she's still alive so don't kill her or (b) it's imperative that she die quickly and painlessly if it's decided that that for the best. I just can't fathom the logic that says remove the feeding tube and hope it not torture.
s. weasel, I'm glad I've prevented a burst spleen.
At the very least, why will they not allow the family to try and give her food or water by mouth? As he did several years ago when the feeding tube was removed, the judge has signed an order that "permission to provide Theresa Schiavo with food and water by natural means is DENIED."
What are they afraid of?
S. Weasel and others seem to think that there is credible evidence that Terri Schiavo's husband is some sort of scumbag who is just about money and who has no interest in Terri's well-being. A survey of 13 years of litigation of this matter, and the findings of multiple Florida courts, will not sustain this POV, as becomes quite clear in the Guardian Ad Litem report submitted to Gov. Jeb Bush by Jay Wolfson on Dec. 1 2003 Michael Schiavo has gone above and beyond what any loving spouse could be expected to do, and only after some three years, did he accept that Terri was gone and not coming back. Read for yourself, before you ignorantly condemn him.
Florida courts have ruled, based on unextrarodinary Florida law. CT scans reveal the woman's cerebral cortex is largely liquid, and totally shrunken. She cannot have cognitive, aware responses. Her parents sentiments to the contrary are wishful thinking, but they actually agree that even if they had in writing a notarized, advance directive from Terri, saying she would want artificial feeding tubes removed should her cerebral cortex become largely mush, they would override her, if they could.
What congress is doing here is wrong. Morally, and also because it has no legitimate jurisdiction at all to trump Florida state courts.
--Mona--
If she has no cognitive aware responses, what harm could there be in letting her parents assume responsibility and care for her? If she is being "allowed to die" what harm could there be in offering her a drink of water that might cause her to choke to death?
S. Weasel, the activities you quote are all possible as a result of brain stem and other "lower brain" areas other than the cerebral cortex; the "lizard brain," as some refer to it. Armies of neurologists who have examined Terri all agree she has no higher brain function.
But regardless, and whether you are convinced or not, Florida fact-finders, aka courts, have repeatedly found that Michael Schiavo is upholding his wife's wishes and that artificial feeding can constitute extraordinary life-saving measures which may be removed in the condition in which Terri has been reduced. (This last is also the law in my conservative state of residence, IN.) Who are any of us, or the House of Representatives, to intrude on the Florida courts and decide we "are not convinced"?
Artificial feeding tubes are just that-- artificial, and until a few decades ago she would have died of her injuries had she been resuscitated, because she could not eat. She still can't eat, and to a supremely high degree of medical certainty (the FL courts found), will never be able to do that or anything else evincing higher brain function.
If you or I contracted pneumonia and could not breath, it would be reasonable to expect our physician to hook us up to machines to suck fluid from our lungs and keep us breathing until we could again do so on our own. However, when my maternal grandfather kept contracting pneumonia, my devoutly Catholic parents -- in consultation with a priest -- agreed with the doctors not to keep hooking him up to that contraption; to let him die. He was in end-stage Parkinson's, was not going to get better, and keeping him alive as he was was only prolonging the torture. One could, of course, characterize this as my parents having let grandpa "die of asphyxiation." Of course, there was also a morphine drip and other measures to keep him free of pain and discomfort.
Medical technology that is a blessing in one context, can be inhuman and inhumane in another.
--Mona--
KCM asks: If she has no cognitive aware responses, what harm could there be in letting her parents assume responsibility and care for her? If she is being "allowed to die" what harm could there be in offering her a drink of water that might cause her to choke to death?
To your first question, the harm is that, as the FL courts have found, that is not what Terri said she would have wanted. (Other relatives than Michael Schiavo testified that these discussion occurred in the context of deaths and funerals -- I've had those discussions at such times, and I'll bet many or most here have as well. I believe that testimony, as the courts did, because it is consonant with contemporary, common experience.)
As to permitting the parents to try to feed her or give her water by mouth, perhaps as Dickens said "the law is a [sic] ass," but there are legal distinctions between letting someone die, and committing an act that is highly likely to kill them. Terri cannot swallow, and would likely choke to death or contract pneumonia. Personally, I have no objection to letting them try, but FL law may have driven the court's contrary ruling.
In an ideal world, a lethal injection might seem most humane here, but then we have doctors affirmatively killing people, as opposed to letting nature take its course. For good or ill, we do not let doctors kill people.
--Mona--
Mona;
If she cannot eat, why was it necessary for the judge to issue a separate order denying permission for her to be provided food and water by natural means?
Sorry Mona;
Your post overlapped my question to you. I am still struggling with this. And the fact that a husband's decision should take precedence over other family members when he stands to inherit his wife's estate.
S. Weasel -- I agree that Terri's lower brain stem means she can feel some pain; this is not in dispute. If that is a possibility, I have no doubt the hospice she is in, and her doctors, will take whatever measures are necessary to keep her comfortable. Any measures that would ameliorate whatever pain she is capable of feeling should be taken. No one other than a monster would take another position, and I'd be surprised, very surprised, if that other has been taken. (I haven't read any reports that her parents are demanding such measures, and presumably they would given that they have lost their battle, and if the feeding tube has been withdrawn with no attention to appropropriate paliative relief.)
About you other point: anyone is free to protest whatever they like. But what they should not be doing is seeking to have the United States Congress overrule the probate or family courts of any state in an area in which Congress has no constitutional authority. I also question that you or I are qualified to second-guess the doctors and judges who have done extensive fact-finding in this long and complicated case. And that is what has been going on here -- questioning their findings of fact and holdings from a base of pretty severe ignorance.
S. Weasel: I do not know whether tests of her swallowing ability have taken place since that 12/03 GAL report, but I do know that her ability to swallow has been an issue thoughout this litigation and testimony has been copious that she cannot. At one point, Terri's parents were claiming she could have recovered that ability if Michael had been more aggressive in pursuing therapy to reteach her that skill. As I recall, that argument was rejected as inconsistent with PVS and with the record of the case.
I do, btw, understand KCM and other's discomfort with the fact that Micahel stands to inherit his wife's estate. But he did offer to disclaim that inheritance if her parents would let him remove the feeding tube, and they declined the offer. (And based on the record showing that he has been though hell with this case and acted lovingly and honorably, and had to endure ignorant cheap shots from some in the public who are unaware of all of his early, rather extraordinary efforts to bring Terri back, I think he deserves it.)
--Mona--
S. Weasel writes: If it weren't entirely possible that different judges and different doctors would come to different conclusions, what would be the point of moving the issue to different courts? (Which would be, I gather, the effect of what Congress is trying to do).
If any one thing comes through clearly in that GAL report, it is that in all of their opportunities to bring forth medical testimony to suppor their claims, Terri's parents failed to meet their burden. Wolfson stops short of calling their experts quacks, but does say they did not testify in scientific terms and relied on anecdotes. He also finds that the bona fide medical scientists, like neurologists, all substantially agreed with Machael's position.
Where does the United States Constitution empower the House of Representatives to set aside these FL state court holdings and findings?
--Mona--
Mona I haven't read at this time any account of the bill signed into law so I realize i'm out on a limb here,but. But since when has the federal gov't stopped interfering in a states affairs? Given the absence of a living will and any witnesses to her verbal wishes,other than hubby,on what basis do the courts decide this{death] is her desire. The decision that this is fact is more based on her medical condition which gets us nowhere. I have heard she makes verbal responses to her father,is this a function of the limbic system and if so can crocodile's talk? Possibly this bill can be grounded in 14th amend due process,if not Congress made a mistake,everything else seems to be.
As I've written here, there are theoretically three choices regarding Terri Schiavo:
1. Actively terminate her life (injection to stop heart). In this case there would be no, or at least very brief, pain, even if she has the capability to feel pain.
2. Passively terminate her life (remove feeding tube). Starvation/dehydration is a horrible way to die if one can feel pain, basically torture.
3. Keep her alive. A miserable existence if she can feel anything.
(2) sounds just so awful to me that I can't support it. It feels morally wrong to me. Indeed, I hadn't contemplated death by starvation before, and if in her position, I say please don't do that to me! (1) and (3) are fine (well, not fine, but at least fathomable), but not (2)! If I'm in a permanent coma, you can remove a breathing tube, you can stop medication, you can sneak in to my room in the middle of the night and inject something lethal, but please don't starve me!
They didn't ask her if she'd mind being starved to death. I think it's a stretch to assume that she would've said yes.
As we now know, Terry Schiavo was given morphine to alleviate pain she may have experienced. Nonetheless, it would have been preferable for her to die quickly and painlessly, via injection perhaps. (Perhaps some extra morphine? The fact that she survived so long shows, to me, that they used restraint in the amount of morphine they administered.) I would not let my dogs starve to death that way. But I do not blame Michael Shiavo. The law should permit lethal injections in circumstances like Terry Schiavo's, where death is the inevitable result of removing artificial support.
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