By Rabbi Shmuley Boteach
I never believed that I would live in a country that would, in effect, execute a brain-damaged woman who never hurt anyone in her life. The story of Terry Schiavo should outrage every decent American. While our soldiers valiantly fight and die across the sea so that complete strangers can enjoy human rights, here at home an American woman who suffered severe brain damage fifteen years ago after a heart attack is about to be subjected to death by dehydration and starvation by order of a judge. Today, her feeding tube was removed.
The humanity of every society is determined first and foremost by how it treats its most helpless citizens, and a nation that is prepared to murder a feeble and vulnerable woman who can breathe, but not eat on her own, must take a deeper look at the source of its ethics.
Before Hitler came for the Jews and the gypsies, he first came after the mentally handicapped. He offered this rationale for euthanasia: “In nature there is no pity for the lesser creatures when they are destroyed so that the fittest may survive. Going against nature brings ruin to man. It is only Jewish impudence to demand that we overcome nature.” Hitler, who was a committed evolutionist and applied the ruthless principals of natural selection to the human species, opposed ‘artificial’ means of keeping the infirm alive. The species was strengthened when its weakest constituents perished, just as nature decreed.
Charles Darwin expressed his own belief in stronger and more feeble parts of the human family when he famously wrote, “The more civilized so-called Caucasian races have beaten the Turkish hollow in the struggle for existence. Looking to the world at no very distant date, what an endless number of the lower races will have been eliminated by the higher civilized races throughout the world.”
Thankfully, the United States does not derive its ethics from Darwin, but from Sinai. We do not believe in the quality of life, but in its sanctity. Since Hitler was the enemy of life, he despised not just Judaism, but Christianity, which in-turn embraced the Biblical idea of the infinite value of every human life and how each individual, regardless of the degree of brain cognition, was possessed of a speak of the divine. Hitler famously said, “The heaviest blow that ever struck humanity was the coming of Christianity … The deliberate lie in the matter of religion was introduced into the world by Christianity.” Hitler spent much of his table talk, faithfully recorded by Martin Bormann, attacking Judeo-Christian ethics: “This filthy reptile raises its head whenever there is a sign of weakness in the State, and therefore it must be stamped on. We have no sort of use for a fairy story invented by the Jews.”
How the United States could today devalue the life of the infirm by removing a brain-damaged woman’s feeding tube, and unwittingly ally itself with the euthanasia program of the history’s foremost monster, should send shivers down the spine of every American.
But Biblical ethics aside, there is also common sense and logic. Should we really take what might have been a throw-away comment from a wife to her husband about not wanting to live in a vegetative state as the rational to murder a human being? Apparently, Terry and her husband were watching some film about a person in a coma when Terry told her husband she would never want to live like that. But people make comments like that during movies all the time without really meaning them.
And even if Terry Schiavo expressly wanted to die, does that mean we should kill her? Dr. Kevorkian is sitting in prison for the rest of his life precisely because he killed people who wished to die. How is this different?
And what jurisdiction should Terry’s husband Michael have here? He maintains that he is fighting to remove his wife’s feeding tube in order to keep his pledge to her that she be allowed to die with dignity.
Now this is curious. The husband has taken other pledges to his wife, which apparently are far less meaningful to him. For example, in marrying her, he pledged to stand by her ‘in sickness and in health.’ Yet, many years ago he abandoned Terry, moved in with his girlfriend, and had children with this other woman. Apparently, his pledge of sexual fidelity did not mean much to him either. Now, I’m not suggesting that Michael Schiavo should have remained celibate for the last fifteen years, and I understand the need for human companionship. But he could easily have divorced Terry and left her in her parents’ care rather than cheating on her and having children out of wedlock. But staying married to your wife just to ensure that she dies sounds a lot to me like wanting to inherit her estate. But honestly, which sane judge, in this case Pinellas Circuit Court Judge George Greer, would allow a man who is living with, and has children with, another woman, to make life and death decisions concerning his wife? This is a shocking affront to basic decency.
Furthermore, Judge Greer accepted the opinion of doctors who said Ms. Schiavo, 41, is in a “persistent vegetative state,” the definition of which, according to the New York Times, is “damage to her cerebral cortex [that] has made her incapable of emotion, memory or thought.”
But woe is to a nation that determines that the sanctity of life is determined by a capacity to feel emotion, memory, or thought. Before he died, Ronald Reagan was so ravaged by Alzheimer’s that he had lost all memory and all capacity for cognitive thought. But could one only imagine a sane individual arguing that Reagan should have been denied food years before his 2004 death because he had become worthless? The same applies to millions of the elderly who inhabit our homes for the aged. A great many do nothing but sit in a chair, or lie in bed, with scarcely movement or memory. How far are we from a time when calls will go forth to deny them all food as well?
What comes to mind in the story of Terry Schiavo is the famous quotation of Pastor Martin Niemöller concerning moral failure in the face of the Nazis: ‘First they came for the Communists, but I was not a Communist, so I said nothing. Then they came for the Social Democrats, but I was not a Social Democrat, so I did nothing. Then came the trade unionists, but I was not a trade unionist. And then they came for the Jews, but I was not a Jew, so I did little. Then when they came for me, there was no one left to stand up for me.’ Terry Schiavo has no voice, so we must become her voice.
I shudder for my country to think that such acts of barbarity can take place in the world’s foremost democracy and humanity’s guarantor of liberty and freedom.
Rabbi Boteach writes: “And even if Terry Schiavo expressly wanted to die, does that mean we should kill her? Dr. Kevorkian is sitting in prison for the rest of his life precisely because he killed people who wished to die. How is this different?”
This is a monumentally wrong comment from someone who has to know better. In medical ethics there is an important and obvious distinction between withdrawing or withholding medical care and actively killing the person. I mean, this is taught in Medical Ethics 101 on the first day of class. On the second day of Medical Ethics 101 patient autonomy is taught. The Rabbi knows this. I cannot believe some of the comments that have been spawned by this case.
Again, you assert that withholding water and food is “medical treatment.” This assertion is in no way universally accepted, as you should know, but is often touted as fact by euthanasia advocates.
In reality, the assertion functions as a euphemism, kind of like “extraction of fetal matter” instead of killing an unborn baby. If giving food and water is called “medical treatment,” then withholding treatment disguises the fact that death is imposed through starvation and dehydration. George Orwell, call your office.
Then, if we can hide the fact that an intentional killing is taking place, murder loses it edge. “Though shatl not kill” is selectively applied, replaced with the new commandment “Thou shalt not abridge ‘patient autonomy'” — “patient autonomy” of course defined by the new arbiters of life and death. Who says the culture of death is not alive and well?
Witholding food and water from Terri Schiavo is intentional killing. Give her the basics that every human being needs to live and she would not die. In Hitler’s concentration camps the Nazi’s gave gas instead of air. Of course the killing was seen as a positive good since the legal establishment already decided six million Jewish lives and seven million Gentile lives were not worth living. The court made the same judgment about Terri Schiavo.
You make no real defense of killing Terri Schiavo apart from the assertion the judge ruled she should die, so she must die. Her parents are willing to take over her care, one million dollars was offered as a gift to support her, all sorts of facts are in dispute, yet we kill her.
Rabbi Boteach is right. Killing Terri Schiavo is really is no different than Jack Kervorkian’s murders except for the means employed to kill her.
Fr. Hans writes: “Again, you assume withholding water and food is ‘medical treatment.’ This is assertion is in no way universally accepted, as you should know, but it touted as fact by euthanasia advocates.”
Well, come on. It’s not just euthanasia advocates. We’re talking about artificially administered nutrition and hydration. It can be administered through an IV, through an NG tube, or directly into the intestinal tract. Two of the three are invasive procedures. No matter the means of administration, it can only be done through a physician’s order. Air is even more fundamental than nutrition, but being hooked up to a respirator is definetly a medical intervention. Related to the case in question, I believe Florida law also recognizes artificial nutrition and hydration as medical interventions. So your task would be to argue that something that cannot be administered except through a physician’s order is not a medical procedure, even though it may involve an invasive procedure.
When discussing cases in medical ethics remember that in a sense we’re “legislating” for all cases. In other words, our policy recommendations are not limited only to the Schiavo case, but to all cases.
Imagine a situation in which artificial hydration and nutrition are NOT considered medical interventions, but routine care such as warm rooms and bed baths. Imagine in that situation a person with terminal cancer, suffering from severe pain and nausea, who is kept alive by artificial nutrition but who will slowly waste away over a year. The person wants to discontinue artificial nutrition. But under your view it’s not considered medical care. It’s considered routine care and thus cannot be discontinued. So we end up forcing this person to exist in a state of suffering against his will. Even if he’s discharged from the hospital into a nursing home the nursing home is obligated to continue artificial feeding. Thus the patient’s wishes to have artificial nutrition would be refused.
Fr. Hans: “If giving food and water is called ‘medical treatment,’ then withholding treatment disguises the fact that death is imposed through starvation and dehydration.”
It doesn’t disguise anything, and death does result. If that’s what the patient wants, then so be it. But look, be careful what you wish for. As I mentioned a couple of weeks ago, my own mother, at age 83 and with a number of other health problems, was diagnosed with an ischemic bowel (lost the blood supply to her bowel.) She opted not to have surgery, which the physician figured would probably kill her anyway. Over a period of around 6 weeks she eventually passed away from that condition, and was given morphine for pain in addition to other comfort care. Under your view, she should have been forced to have an IV line placed in order to give her nutrition. The effect of that would have been to have her linger some months or weeks longer against her will. Is that a result that you really want? Because that’s exactly what happens if you decree that artificial nutrition and hydration are not medical care.
Fr. Hans: “Then, if we can hide the fact that an intentional killing is taking place, murder loses it edge. ‘Though shalt not kill’ is selectively applied, replaced with the new commandment ‘Thou shalt not abridge ‘patient autonomy” – ‘patient autonomy’ of course defined by the new arbiters of life and death.”
How is patient autonomy defined by “arbiters” of life and death? And the death is not intentional. It is a consequence of withdrawing an intervention, but the purpose is not death. The purpose is to honor the patient’s wishes.
Fr. Hans: “You make no real defense of killing Terri Schiavo apart from the assertion the judge ruled she should die, so she must die. . . . Rabbi Boteach is right. Killing Terri Schiavo is really is no different than Jack Kervorkian’s murders except for the means employed to kill her.”
He didn’t rule anything of the sort. I feel embarrassed to explain this to clergy, but there is a tremendous difference between withdrawing or withholding medical care vs. killing a person. This is a distinction that is part of basic Catholic medical ethics, and probably Orthodox medical ethics as well, if there is such a thing (and I’m beginning to doubt there is). Every day across the country hundreds of respirators are turned off. Hundreds of decisions are made not to administer antibiotics to patients. Hundreds of decisions are made to discontinue chemotherapy. And probably thousands of patients are given DNR (“Do Not Resuscitate”) orders. Certainly you must understand this. But you seem to be arguing for the principle that all possible interventions should be given to a patient, regardless of the patient’s wishes, until the patient literally dies — that the patient’s life should be prolonged as much as possible, for to do any less is murder. Is that your argument? If not, what is the argument?
Jim, please. There is a difference between intentional killing and allowing a person who has entered the stage of dying to die. Terri Schiavo and the example of your mother are two entirely different situations.
I’ve been with dying people. I’ve been part of decisions whether or not to resuscitate, probably more than most people here, and most likely a lot more than you. I’ve been in hospices more than I care to count.
Withholding care from Terri Schiavo is killing her. Your argument reads as if we allow her to live, a principle is invoked that all dying people must undergo heroic measures to save them. Real life requires us to draw clearer distinctions.
Why the eagerness to see her dead? Why the unwillingness to consider new facts? Just yesterday there was testimony from Terri’s attorney that Terri verbalized a desire to live.
In any case, it looks like Congress is going to remove this case from Judge Greer’s jurisdiction. That’s good.
Fr. Hans writes: “There is a difference between intentional killing and allowing a person who has entered the stage of dying to die.”
Ok, so far so good. One problem — the phrase “stage of dying” doesn’t have any significance to this case or to any other case. While it is true that most decisions of whether to pursue or continue life-saving or life-extending treatment happen when death is imminent or predictably close, that’s not necessarily the case. For example, someone who could live for years on a respirator could decide that he or she didn’t want to live that way. Someone with cancer could decide to forgo chemotherapy, even if the chemo had a very high liklihood of extending life a number of years.
These might not be decisons that you or I would make. They might not be decisions that would be consistent with this-or-that religious edict, church council, or dogma. But they are decisions that people have a right to make. Some years ago an elderly neighbor died of complications related to an untreated leg ulcer. Why didn’t it get treated? He didn’t want it treated. He didn’t like doctors. He didn’t want to be in a hospital. His wife wanted him to get it treated, but he wasn’t interested. Personally, that’s not the decision I would have made. But it’s a decision that was his right to make.
Yesterday I asked you a series of specific questions, and you replied with some web site references. One of those questions I really would appreciate an answer to, and the answer might point out a fundamentally different view of medical ethics.
I asked:
“Do you agree that the primary consideration in this case is what Terri Schiavo would want for herself? For example, if a signed and notarized advanced directive from Terri Schiavo were discovered, should we act in accordance with that document? And even if she stated explicitly that she didn’t want to be maintained in a PVS? If her wishes are not the primary consideration, then what is?”
For the Schindlers the primary consideration in this case is not Terri’s wishes, but THEIR wishes. As I mentioned yesterday, the 2003 report of guardian ad litem Dr. Jay Wolfson said “Within the testimony, as part of the hypotheticals presented, Schindler family members stated that even if Theresa had told them of her intention to have artificial nutrition withdrawn, they would not do it.”
Now you might say that whatever Terri Schiavo said she wanted 15 years ago, she’s changed her mind now. You note that Terri’s attorney say that Terri “verbalized a desire to live.” Did you read that article? Let me quote the relevant portion:
“I stood up and learned over Terri. I took her arms in both of my hands. I said to her, ‘Terri if you could only say ‘I want to live’ this whole thing could be over today.’ I begged her to try very hard to say, ‘I want to live.’ To my enormous shock and surprise, Terri’s eyes opened wide, she looked me square in the face, and with a look of great concentration, she said, ‘Ahhhhhhh.’ Then, seeming to summon up all the strength she had, she virtually screamed, ‘Waaaaaaaa’ . . . . I promised Terri I would tell the world that she had tried to say, ‘I want to live.'”
Well . . . these kinds of actions and vocalizations are completely consistent with a diagnosis of PVS. The problem that the Schindlers don’t talk about is that Terri does things like that when no one says anything, or when no one is even in the room. I suppose had the attorney asked Terri to recite the Gettysburg Address we’d be reading this morning about how Terri Schiavo recited the Gettysburg Address with “Ahhhhhhh.” This is the same problem that we have with the famous video tapes. The Schindlers excerpt out 30 seconds of tape showing Terri’s “interactions” with her mother. If you look at the entire four hours you see that Terri makes the same motions and vocalizations no matter what is going on or who is in the room.
So where did we start and where are we now? Five years ago a Florida state judge, upon hearing from several parties on both sides of the issue, determined that “clear and convincing” evidence demonstrated that Terri Schiavo would not want to be maintained in her current state. Today, we have a family attorney interpreting “Ahhhhhhh” and “Wahhhhhhhh.” Tomorrow perhaps we’ll have a phrenologist and a fortune-teller weigh in.
Fr. Hans: “Withholding care from Terri Schiavo is killing her.”
What if those are her wishes? What if you reviewed the transcripts of the hearing and determined that Judge Greer’s opinion appeared to be correct — that Terri Schiavo would not want to be maintained in her current state. Would that be relevant? You see, I don’t care what we call it. You want to say “killing her.” You want to say “starving her to death in a manner reminiscent of the holocaust.” Great. My point is that we need to do for her what she would have wanted done, regardless of whether it is something we would chose for ourselves, and regardless of what label we put on it.
Fr. Hans: “Why the eagerness to see her dead?”
There’s no eagerness. But the case has gone on for years, literally for years. The case has been litigated to death, no pun intended. Even the court noted that it is unlikely that any such case in history has had so much evidence and review.
Fr. Hans: “Why the unwillingness to consider new facts?”
Because there will always be new facts. The Schindlers will make sure of that. They’ve been arguing the same things over and over for years. They will extend this thing out year after year, decade after decade. So forget all the previous court orders and unsuccessful appeals. Forget the medical concensus. Forget Terri Schiavo’s wishes as determined in a court hearing. No, forget all that because today we have “Ahhhhh” and “Wahhhhh,” as reported by and interpreted by an objective observer, the attorney paid for by the Schindlers. And if “Ahhhhh” and “Wahhhh” don’t work, tomorrow we’ll have “Ughhhh” and “Gluggg.”
The strategy is to litigate at the state level until you get what you want. If litigation doesn’t work then you legislate. If legislation doesn’t work, then you
litigate at the federal level.
What’s happening here has little to do with Terri Schiavo and a lot to do with right-wing politics. This is the right-wing flexing their muscles and declaring that they will prevail because they have the power to prevail.
Were we to discover a previously unknown, signed, and notarized advanced directive from Terri Schiavo stating that she did not want to be maintained by artificual hydration and nutrition in a PVS or anything that looked like a PVS or anything that some doctor thought might be a PVS, that would have absolutely no effect whatsoever on the outcome of this case: “Well, you know, that was 15 years ago, she could not have forseen this happening, she was young, she would have changed her mind. And just today she said ‘Ahhh” and Wahhh” and that means ‘I want to live.'”
That’s because this is ultimately not about Terri Schiavo’s wishes, but about the Schindler’s wishes AS STATED DURING AN OFFICIAL COURT PROCEEDING, and about the Schindler’s allies using her for political advantage. This case will go to federal court. If the right wing doesn’t get the results they want there, then some other legislation will put the case in some other part of the court system. Eventually they’ll get the result that they want. It may take years, but they’ll get it. Meanwhile, Terri Schiavo will lay there in bed, unaware, insensate, moving and gurgling, kept alive in a state that she never wanted to be in. But rejoice! The right will will have won. They will have defeated “the culture of death.”
You don’t know the content or context of Terri Schiavo’s vocalizations so to conclude they are consistent with characteristics of PVS is premature at best. Second, experts in the field who were not called to testify indicate that it is questionable whether Schiavo is PVS at all, and even with the brain damage she exhibits there is still a chance for improvement provides she gets the proper therapies. Why not allow them to examine Terri?
A lot of your conclusions are based on the testimony allowed by Judge Greer. The complaint against him however is that the testimony was highly selective, based too much on the sole desires of Michael Schiavo who was counseled by two euthansia activists. The judgment was not impartial, which is one reason why Congress is seeking to remove Judge Greer from the case.
As for this being about the Schindlers wishes, well, yes, of course. Absent a directive this is entirely appropriate. The same is true of the other side. Michael Schiavo has no directive either.
I still don’t understand however, given the contrary opinions and evidence (see again the links I provided), you object to an impartial review. This is what I mean when I say “eagerness” to see her die. Did you read what George Felos said yesterday, that reinserting the tube is punishment? It’s madness. In Felos’world, trying to save life is cruelty, killing life is benevolence. Are these the values you hold?
Finally, your imputed assumption, that Terri Schiavo wishes this for herself, can’t be sustained. The only word we have is Michael’s, and that consists of a comment after a television show. We have no way of knowing if he is telling the truth.
This case is not about Terri’s wishes at all. It’s about euthanasia advocates trying to score a kill. They like the idea of medical technocrats deciding who lives and dies, as they do in Holland (but not Germany…I wonder why?).
What if Terry Changed Her Mind After She Lost the Ability to Speak?
Assume now that a document is signed by an adult that clearly directs a medical professional to withhold care if the adult has reached some stage of ill-health. Unlike Terry Schiavo’s case, let’s assume that there are no questions about the authenticity of the document. Let’s also assume that the signor was in good physical and mental health at the time the document was signed.
Should society bow to this wish? Isn’t such a document still a form of suicide pact with a medical professional? After a person has lost the ability to speak how do we know that THEY HAVEN’T CHANGED THEIR MIND?. After a person has lost the ability to speak how do we know that they wouldn’t want to hang on in the hope that medical science would provide relief in the future what seems to be a hopeless case in the present. How do we know that the sick person wouldn’t see things differently if new developments occurred in their lives after they signed the death document. We don’t.
Schiavo’s case demonstrates the ill-effects of granting the legal power to end the life of another to a fallible human being. There are tremendouse incentives for relatives to evade the psychological and economic cost of caring for a loved one.
Why Such a Hurry to Kill?
If we err in favor of death in the Shiavo case we run the obvious risk of killing someone who wants to live. We run the risk of kiling someone who may in the future benefit from a medical discovery and be able to recover. It is a irremediable mistake that snuffs out a life and harms all who loved the person who was killed.
If we err in favor of life, the worst consequence is that Terry Schiavo’s alleged intent is violated. However, at this very point, advocates for her death maintain that she has no meaningfull consciousness and she cannot experience distress at the violation of her wishes. Given that her parents stand ready to provide her with a loving home and the dignity of loving personal care, how can Terry be said to be harmed?
What is the great harm in letting her live even if it does violate her original intent? Until recently society did not tolerate suicide or those who assisted suicide, even by the seemingly sane.
Shouldn’t she get the presumption in favor of life that even serial killers get in in the American legal system?
Fr. Hans writes: “As for this being about the Schindlers wishes, well, yes, of course. Absent a directive this is entirely appropriate. The same is true of the other side. Michael Schiavo has no directive either.”
The case shouldn’t be about Schindlers’ personal wishes or Michael Schiavo’s wishes. The case is about Terri Schiavo’s wishes; the Schindlers and Michael Schiavo are simply people who offer testimony concerning her wishes.
Fr. Hans: “I still don’t understand however, given the contrary opinions and evidence (see again the links I provided), you object to an impartial review.”
The question I would ask is when is the case over? Or is it ever over? I mean, when the Schindler’s paid attorney says that “Ahhhhhh” means “I want to live” and that constitutes “new evidence,” when does this thing ever end? Part of the reason for having a defined judicial process is so that there is closure. In the legal system you’re supposed to receive a fair hearing. That doesn’t mean that you receive a perfect hearing, nor does it mean that you receive a particular outcome. (Perhaps for the Schindlers it does, but not for anyone else.) It doesn’t mean that you can rehash the same issues over and over again until you get the result you want. All of the issues that you want to revisit have been already decided. In most cases they’ve been appealed and uphelp on appeal.
You basically want to rehear the case from scratch, as if none of the legal proceedings over the last five years mean anything — that somehow all the court orders and findings are disposed of and the entire process starts anew. Well, it doesn’t work that way.
Fr. Hans: “Finally, your imputed assumption, that Terri Schiavo wishes this for herself, can’t be sustained. The only word we have is Michael’s, and that consists of a comment after a television show. We have no way of knowing if he is telling the truth.”
If you read the court order, you find that there were five or six people who testified, not just Michael Schiavo. I believe that all of them were also deposed prior to testifying. Michael Schiavo did not control the process. He did not dictate what would happen; he was one of the people who testified. In that hearing the court was acting as Terri Schiavo’s guardian, for the purposes of determining what her wishes were. Judge Greer commented at length on issues related to credibility, consistency, and reliability of testimony. Both sides of the family had an opportunity to present witnesses.
Fr. Hans: “This case is not about Terri’s wishes at all. It’s about euthanasia advocates trying to score a kill.”
I completely disagree with that. This has absolutely nothing to do with euthanasia, and everything to do with the right of a person to refuse unwanted medical interventions.
Missourian writes: “Should society bow to this wish? Isn’t such a document still a form of suicide pact with a medical professional? After a person has lost the ability to speak how do we know that THEY HAVEN’T CHANGED THEIR MIND?”
Of course there is no way to know that, unless the person changed the advanced directive to reflect the new wishes. An advanced directive is as accurate and up-to-date as you make it.
If you’re arguing against advanced directives, all I can say is that they aren’t perfect, but millions of people have found them of value, and you should see what happens when people don’t have them. And remember, you can have an advanced directive that authorizes every possible kind of intevention that might possibly extend your life. I think that “pull out all the stops” advanced directives are not common, but people can have them.
Missourian: “Given that her parents stand ready to provide her with a loving home and the dignity of loving personal care, how can Terry be said to be harmed?
What is the great harm in letting her live even if it does violate her original intent?”
If you’re going to have a system of medical ethics that is not based on what the patient wants, on what is it based? I mean, authorizing what can and cannot be done to your own physical body is perhaps the most important and intimate decision that can be made. Why wouldn’t we want to honor that decision? Under that logic why should we even honor wills?
I think there’s really a larger philosophical question here. The question is: who is in charge here? In current medical ethics the patient is in charge. I think there are a lot of people who don’t like that. For example, I’ve tried several times to pin down Fr. Hans on the issue of patient autonomy, but he always slips around the question. I think he agrees that in the case of a terminal illness when death is imminent the patient should be in charge. Beyond that, I don’t think he thinks the patient should be in charge. I don’t know that for a fact, but having tried unsuccessfully for a clarification several times I think that’s probably his opinion. The problem is that if the patient isn’t in charge in these decisions, who is? The government? The church? The Republican party?
“The question is: who is in charge here?”
The Oregon Death With Dignity law was opposed by many because it allowed doctors to prescribe (not administer) lethal doses of prescription drugs to terminally ill patients (after informing them of available treatment options). While this may be unethical from a religious standpoint, from a legal perspective it’s hard to oppose: the doctor could alternately inform the patient of the “toxic dose” of a drug they’re already taking (wink wink). What’s the difference? Still, many opposed it despite the presence of clear directives from the patient involved. Based on that, I’m willing to bet that there would still be a resistance to removing the feeding tube even if Terri’s wishes were clear, though perhaps not as strong.
My personal opinion is that a living will needs to be an addendum to every marriage license so that situations like this do not arise again. We cannot legally allow people to make decisions for others and then complain about those decisions when we do not agree with them. There’s no point in granting that ability in the first place, then.
If a patient has an advanced directive, end of life decisions are a lot easier to make. There is no real issue here except when that directive ought to be enforced. This is ultimately a family decision, although I think you are looking for something codified and enforceable by medical bureaucrats. Dying is not a clean business though.
On several occassions I have seen people at the edge of death come back and live for six more months, with a relatively good quality of life.
Once I went into the room of a man with cancer who had extreme swelling of the brain. He awoke from unconciousness when I started the prayer, received Holy Communion, and slipped back into unconciousness. I expected a call later that night telling me he died. When I didn’t get it, I went back the next morning and he was sitting in a chair completely alert and talking coherently.* He went home, moved to Florida, and spent his remaining six months getting to know his grandchildren.
*The doctor said his brain stopped swelling one half hour after receiving Communion.
Sometimes it works in the other direction. A man afflicted with Alzheimers was scheduled to undergo an operation and the family asked me to go and see him the morning of the procedure. He was sleeping so I woke him up, and for the ten minutes I spoke to him it was as if the Alzheimers had left him. He was the person I remembered, an accomplished engineer, completely lucid, intact memory, etc. We prayed, he took communion, and then he said he was tired and wanted to go back to sleep. He passed away during the operation.
I’ve seen people healed of cancer, but I’ve also seen children die.
My problem with your “patient autonomy” approach is it appears you think that end of life decisions can be codified, as if dying is a cut and dried process with distinct stages that mark when actions can be taken. Your defense of pulling Terri Schiavo’s feeding tube however, tells me that a bias on the side of life is not a factor in your approach. Fundamentally I don’t trust this approach, just like I don’t trust the counsel of doctors and lawyers with a history of euthanasia activism.
This approach mirrors the medical technocracy of Holland. It’s dangerous. Life becomes cheap.
Death is a communal event and preparing someone for death involves more people than the person dying. It also involves families, friends, others. Any understanding about the proper way to employ technologies must factor in these other considerations as well. Reducing the discussion to “patient autonomy” alone risks the establishment of a medical autocracy with the power to decree life and death with no regard of these other considerations — a lot like what we saw with Terri Schiavo.