Marc Siegel, M.D. Marc Siegel is a clinical associate professor of medicine at New York University.
Terri Schiavo has lingered for 15 years in what many neurologists call a persistent vegetative state. Because the public has seen her plight largely through a political prism – right to life vs. right to die – core medical issues have been overlooked and distorted.
Regardless of where one stands on this issue, as a physician, I’m disturbed that the medicine of this case has become an afterthought. Doctors have become the medical marionettes as the courts and attorneys pull the strings.
Though most end-of-life specialists are willing to remove feeding tubes, many of the rest of us – physicians who treat severely disabled patients – are not. The only consensus in the medical community on this issue is that we should be consulted, not expected to blindly follow judicial decrees.
Much has been made about the fact that Schiavo’s life lacks quality, but this assertion is not a permission slip to end it. The pathway to death should not be inhumane just because more humane choices, such as physician-assisted suicide, are not legal. Because she breathes on her own and is not in apparent pain, there is no quick
or rational way to end her life. Until there is, we should let her live.
Most neurologists would contend that Schiavo cannot feel anything, even pain or thirst. The problem with this assertion is that no one has come back from such a state of neurological impairment to verify or dispute this contention. She reportedly lacks upper brain function, meaning her thinking centers are still, but it cannot be proved that the lower brain would not allow her to feel discomfort.
I recall one brain-damaged patient in my hospital practice, not quite as sick as Terri, who did wake up. Initially, his eyes were open, but he didn’t respond. For months, he was fed through a tube, until the
day when his heart rate began to subtly increase whenever his family visited. A few months later, he was conversing and eventually was discharged to resume his life as a waiter in a restaurant where he
had been the chef.
Could Terri be blessed with such an outcome? There’s no indication from the court-appointed physicians that she could. Even so, the contrast is a useful reminder that each case should be weighed on its own merits – the medical ones, not solely the legal ones.
Drawing a line in which one life has quality and another doesn’t is contentious enough, but extending this to an initiative to withdraw nutrition is a legal move that doesn’t adequately consider the medicine. Even if Terri had a living will, many physicians would still not feel comfortable executing it in this manner. It shouldn’t be assumed that doctors can simply be ordered to starve their patients.
It is generally accepted that a physician’s role in health care is to prolong life or relieve undue suffering. The only time a true medical debate emerges is when these two roles come into conflict. The Schiavo case is not such a time. It is difficult to argue for euthanasiabecause she does not appear to be suffering. Working to prolong her life simply means providing nutrition, which physicians usually do without endless debate.
The case of a terminal cancer patient, for instance, is quite different because, by increasing morphine, a physician may legitimately choose relieving suffering over prolonging life. Treating cancer, a doctor can sometimes justify ending a pain-wracked life.
The most disturbing aspect of the Schiavo case is that the doctors are portrayed as those who will simply abide by the final decision and either put the tube back in or keep it out – a job for a medical yo-yo rather than a professional. But doctors are not court-appointed mechanics. Our own code of ethics and standards must drive us.
Removing feeding tubes is not part of my job description. It should not be part of a physician’s job at a Florida hospice either.
This doesn’t mean that I’m against hastening death to reduce suffering. In certain cases – use of pain medications to treat the terminally ill, for instance – such actions might be warranted. But the end in any
case would be rapid and controlled by medication.
In the Schiavo case, a physician removing a feeding tube of a patient who does not appear to be suffering could lead to a protracted, uncomfortable death. This would undermine a physician’s basic role – first, do no harm – as suggested by the Hippocratic Oath.
Marc Siegel is a clinical associate professor of medicine at New York University.
Most people have a very sanitized perception of the “end of life” experience thanks to the media and the lack of education available on the topic. Let’s face it. Unless you are a veteran nurse (I am) or caregiver with years of experience working with terminal patients, you don’t have a clue what it’s really like to be on the edge of death or in a vegetative state. Ordinary people have no idea what it really means to be dying, incapacitated, terminal.
Sure, if you are a visitor to the hospital, the nurses make everything look pretty for you during visiting hours. But that is NOT reality. Anyone that wants to keep Terri Schiavo in this state should immediately go to work in a nursing home as a nurse and stay there for a few years before even considering making comments about something they know nothing about. Trust me. The experience will change you for life.
What you don’t see when you are watching news footage of someone like Terri Schiavo is that she cannot communicate her needs, and she cannot communicate her emotions (rage, frustration, anger, depression) about that fact that her basic needs are not being met. Imagine for a moment being in Terri Schiavo situation and in any of these scenarios: 1) you could not convey to your caregiver that you are experiencing severe pain and this went on for years with you suffering and not receiving pain relief because you could not communicate your pain 2) you had miserable cramps in your legs and you couldn’t tell anyone so you were left with the torturous cramping 3) your feet were freezing cold and you were helpless because no one knew to cover you up.
Patients like Terri Schiavo are stiff with contractions (arms and legs fold up and become stiff as a board). It is VERY painful when caregivers have to move their limbs even to clean them up.
We have the technology now to keep people alive even though their bodies have started to decay (advanced bedsores) and many of their automatic body functions have failed (ability to swallow, breath, etc.). I am astounded at the propaganda that has been spread by the media. They only tell certain aspects of the story. But, not the whole picture. In the Terri Schiavo case, since she cannot communicate, she suffers every day in every way imaginable. To allow someone to suffer like that against her wishes, is inhumane – it’s abuse, and selfish of the parents. The companies that benefit from keeping decaying bodies alive are richly rewarded by Medicare and Medical (reimbursement). In my opinion, this is medical Auschwitz. I have worked with these patients for over 20 years. All efforts need to be made for those that cannot communicate their suffering, and that are decaying.
When you work in medicine, you quickly learn that Western medicine is all about big profits. It’s also a very big part of our Nation’s gross national product. There is a lot of healthcare and pharmaceutical special interest money powering this issue. I am pro-life. Still, there is a point where we need to get out of God’s way and let Him take his children home where they will be at peace. Not turn them into poster children for some politicians special interests.
My mission when interacting with patients and families is to turn on the light of truth about the importance of becoming empowered with knowledge about staying well, getting second opinions, seeking alternatives whenever possible before going under the knife or taking symptom-oriented medical treatments and for God’s sake, find and fill out an Advanced Healthcare Directive. It’s a one-page for that lets people know your wishes should you not be able to express them yourself. You can google on Advanced Healthcare Directive and find a free form to download.
Best Wishes
But that’s another topic for another day.
“Still, there is a point where we need to get out of God�s way and let Him take his children home where they will be at peace.”
Christ commanded the twelve disciples in Matt 10:8 “Heal the sick, cleanse the lepers, RAISE THE DEAD, cast out demons. Freely you have recieved, freely give.”
How is it that man gets out of God’s way for him to take ones life? Is this theologically sound?
As D. Hayworth suggests, we are not even able to fully appreciate or measure the physical suffering of the body let alone the experience of the person. People who no longer want to live, die. My great grandmother,whom I never met, was an active, fully aware person. She got up one morning came out to breakfast and announced to everyone that she was tried of living. She went back to bed and was dead within a few days.
I would suggest that perhaps Terri’s continued life in a convuluted, incapcitated and tortured body might be proof that she did want to be here still, despite her condition.
Mr. Hayworth, Its About Due Process and Standards of Proof
The best argument against what is going on in the Schiavo case is a DUE PROCESS argument. What evidence and what process is required BEFORE a Court may order the end of a person’s life. This case was handled under the CIVIL law of Florida and the standards of proof were either “preponderance of the evidence” or “clear and convincing evidence.” Both of these standards are far below the criminal standard of “beyond a reasonable doubt.”
In other words, as a prosecuting attorney I would have to produce a greater abundance of higher quality evidence to convict a defendant of ordinary theft than the evidence that was presented of TERRI’S WISHES. This is NOT a medical decision, this is a legal decision of what Terri truly intended.
The quality and quantity of proof supplied to this Judge was abysmal. People are rightly shocked that the Left will argue for repeated appeals and new trials for persons who have been proven guilty beyond a reasonable doubt, BUT, will not protest that a woman’s life will end on uncorroborated hearsay evidence from a person with a strong vested interest in the outcome.
If the action of Michael Shiavo is all so compassionate why doesn’t Terri get the lethal injection that convicted criminal’s get?
Missourian,
They want to lethaly inject. Don’t be fooled. The reason you don’t hear arguments for it yet is because it looks too much like killing. Removing the tubes appears passive, a cessation, rather than active killing. Don’t forget the arguments heard even here: food and water are “extraordinary care.” These same people will soon argue we should use lethal injections because it is more “humane.”
Missourian writes: “In other words, as a prosecuting attorney I would have to produce a greater abundance of higher quality evidence to convict a defendant of ordinary theft than the evidence that was presented of TERRI’S WISHES. This is NOT a medical decision, this is a legal decision of what Terri truly intended.”
Missourian, please keep in mind that the vast, huge, overwhelming number of such cases never make it to court. I can think of Schiavo, Quinlan, and Cruzan. Are there others? None come to mind. I can’t imagine that more than a tiny fraction of one percent of cases make it to court. Because the Schiavo case made it to court, that means that this case has had tremendously more consideration than the typical case. Had there not been a disagreement between family members you never would have heard of this case and Terri Schiavo would have passed away years ago.
This is because other than the family dispute virtually everything that has happened in the Schiavo case has been in accordance with standard practices approved by the American Medical Association. I don’t want to trivialize the case, but other than the controversy there’s really nothing remarkable about this situation. In particular, check out the AMA report on “Persistent Vegetative State and the Decision to Withdraw or Withhold Life Support.”
http://www.drslawfirm.com/amareport.pdf
Jim, don’t lecture me on legal procedure
You note that the majority of cases “don’t make it to court.” My consistent theme in my comments has been that we Americans have permitted a system to exist which controls the life and death of humans beings BUT which does not afford the human being whose life is in question adequate DUE PROCESS. The fact that the majority of these cases do not come to Court is irrelevant.
Let me repeat for you Jim. I have stated this 20 times and as ususal you have ignored it. If I wanted to control the distribution of my property after death I would have to:
A) put my wishes in writing
B) get three disinterested witnesses to witness my signature
C) have a public official, a notary, witness my signature
D) have a public official, a notary, witness the witness’ signatures
E) have a public official, a notary, examine proof of my identity such as a
driver’s license
F) have a public official, a notary, examine proof of identity of the witnesses
This is what is legally required to document a valid will. Terry Shiavo was killed based on testimony of some comments she allegedly made decades ago. The testimony came from people who would BENEFIT from her death.
Why the passion for death Jim?
Lethal Injection
Fr. Jacobse, you are, of course, correct. Jeffrey Feiger, Kervorkian’s attorney, appeared on Scarborough County and argued the same thing. He stated that “Dr.” Kervorkian used lethal injections rather than starvation and wasn’t it a terrible shame that Dr. Kervorkian is in jail because of it. So the argument is being made now.
Right to a Jury Trial;Probate Court Not Designed for Living Will Constroversy
One of the reasons that the right to a jury trial is embedded in the Constitution is that the Framers rightly understood that justice is better served by the review of a case by 12 citizens picked from the community than a single individual. If twelve people review the facts of the case, the outcome is less likely to be skewed through the influence of an unreasonable or prejudiced individual. The unreasonable person will be outvoted by the remaining reasonable people.
Terri Shiavo, to my knowledge, has never had a jury trial. If she had been a criminal, she would have been entitled to a jury trial and the ACLU would have been up in arms if one had been denied. The facts in Shiavo’s case were ruled upon by a JUDGE not a jury. This means that procedurally the judge was the “trier of fact.” This is not uncommon in the probate court. Probate is that division of the Court that handles wills and conservatorships and guardianships. Probate proceeding were not designed to handle this type of case. Factual controversies are generally decided by the judge not a jury as is required in most non-probate cases.
Missourian writes: “My consistent theme in my comments has been that we Americans have permitted a system to exist which controls the life and death of humans beings BUT which does not afford the human being whose life is in question adequate DUE PROCESS.”
In your opinion what would due process look like? I’m interested because I hear a lot of complaints about the “liberals,” the “culture of death,” and so on, but almost nothing on what kinds of changes to the process should be done. In all the megabytes of discussion that have occurred here the last year I don’t recall ever seeing a single specific recommendation for how the process for making these decisions should be changed.
Remember, we’re talking about changes to a process that potentially could impact all cases in which some potentially life-extending intervention is being withheld or withdrawn from a non-communicative patient. We’re talking potentially about every time a decision is made not to put someone on a ventillator, not to administer antibiotics, not to administer CPR, and so on.
Missourian: “The fact that the majority of these cases do not come to Court is irrelevant.”
It’s relevant if you’re suggesting changes to a process that potentially could bring thousands of cases into an official and possibly lengthy legal process.
But at this point I’m not sure what changes you would suggest, or the scope of those changes.
Note 7: I think, Missourian, that you are taking issue with marriage law as it currently exists. What is the required “due process” in every other situation when the spouse makes a decision for or against life? If the family wishes the plug to be pulled but the spouse does not, is there a hearing?
No one’s really answered this to my satisfaction: should spouses be able to make life and death decisions for their spouses and if so, to what situations should it be limited to? For example, should we remove that ability when there’s evidence of infidelity or even alcoholism, drug abuse? Does it depend on WHAT choice they make?
As I’ve stated before, this could all be resolved by requiring that a living will be part of the civil marriage license. This fiasco would never have happened.
James, Don’t correct my knowledge of marriage law
James I would appreciate it if you would give me credit for being competent at what I have done for the last twenty years. Please don’t correct or lecture me on law.
YOU ARE FALSELY ASSUMING THAT STATE LAW COMPELLS THE APPOINTMENT OF A SPOUSE AS A GUARDIAN FOR AN INCAPACITATED SPOUSE. YOU ARE WRONG.
What is probate court? Probate court is a special type of court that deals in civil matters. These matters include adminstering estates, supervising guardianships, supervising conservatorships and overseeing adoptions.
Terri Shiavo is living under a GUARDIANSHIP. Guardianship refers to the legal control of one person by another. Parents are the natural guardians of their children. Parents have broad rights as guardians to control their childrens lives. When an adult is incapacitated, he needs a guardian. Now, most guardianship statutes merely state that the Court shall appoint a suitable guardian. Guardians are generally drawn from family members, who else would want to do it? Courts do not have the authority to draft someone against their will to be a guardian, so they have to choose from willing family members.
The laws of most states DO NOT compell the appointment of a spouse as a guardian.
In most cases, the spouse is the natural person to take on the responsibility of being the guardian of an incapacitated adult. However, in most states the SUITABILITY AND COMPETENCY of the GUARDIAN can be challenged for good cause.
I don’t know why the Shindler’s had such difficulty getting Michael removed. In the 25 years that I have practiced law, no probate judge would keep a guardian in place if there was a WHISPER of suspicion as to that person’s suitability. No on has a right to be a guardian of an incapacitated adult and the judge should and would put the interest of the incapacitated adult first. In other words, the judge would err in favor of removal rather than risk mistreatment of the injured person.
Procedure should match the gravity of the issues at stake
The entire concept of the “right to die” is foreign to the tradition of the Common Law. Based on Judaeo-Christian concepts of morality, suicide has been illegal in most states up through WWII. The point of criminalizing suicide was not to punish a mentally ill person who attempted suicide but failed. The point of the criminalization of suicide was to deter others from helping, assisting or contributing to the suicide of another; such acts would be felonious in their own right. The reason being is that so many people can benefit from the death of a relative that the law must include a disincentive to murder by assisted suicide. This avoids the case where a beneficiary under a will kills grandmother and then states that he was just helping her commit suicide.
This long standing and wise policy was attacked in the late 20th century. Hard cases made bad facts and everyone was told that the “solution” was for each one of us to have a living will. Unfortunately, the laws surrounding living wills arose in the context of probate court. Probate court is a civil division of the court system and the burden of proof on factual matters is much lower than in the criminal divisions. Proceedings in probate court do not benefit as many Constitutional protections such as the right to a jury trial that is mandated in criminal courts.
As I have pointed out repeatedly, I do not think that having each adult put a living will in place solves all problems. My proposal would involve the following:
a) the overall concept that anyone has a “right to die” should be rejected. The existing policy of delegitimizing suicide should remain in place.
b) living wills should be given force in extremely limited circumstances
c) living wills must be authenticated with as much formality as standard wills
d) living wills should expire unless reaffirmed periodically
e) guardianship law should permit the easy removal of any guardian who may have a conflict of interest with that of the incapacitated person
f) procedural protections should be added to the law of probate such as: requiring a panel of three medical experts to review medical questions; requiring periodic review of fresh medical evidence; allowing for the prompt removal of a guardian whose motives are in any way suspect; allowing for a jury trial prior to the entrance of any order resulting in the death of a human being, requiring a criminal standard of proof which is beyond a reasonable doubt.
I would allow the use of so-called living wills however I would restrict them to a very narrow range of cases.
If you say that this will create a huge burden on the court system you are right. I consider the “root cause” of this burden to be the acceptance of the idea that suicide is acceptable and that someone has the “right to die.” Everything flows from that.
No Big Deal to Remove a Guardian
Somehow people have seized on the idea that a husband is legal guardian for a spouse. State law may begin with a presumption that the husband is the legal guardian but there are plenty of provisions which allow for the standing of a guardian to be challenged. Guardianship refers to decisions about the welfare of person and it includes literal physical control of the body of a person. Conservatorship refers to the control of an incapacitated person’s finances. Normally the conservator and guardian are the same person.
Both guardians and conservators have to file annual reports with the Court. A hearing can be held on the report. The point of the hearing is to review the conduct of the guardian/conservator. The Court has full authority to remove a guardian/conservator if he sees fit. The burden on proof is on the guardian/conservator to defend his conduct.
Someone people have come to think that American marriage law compel the appointment of a spouse as guardian and that the spouse can never be removed from that position after his or her appointment. That is a false idea.
Some municipalities spend tax dollars to hire professionals, usually social workers, to serve as guardians/conservators for incapacitated people who do not have competent family members to serve in that post. I had a good friend that did this, a noble task.
Note 10. Jim, for the record, you have advocated the death of Terri Schiavo for three years. You offer no justification for your position except to throw up you hands and mutter protests about how many other people are in the same position. Then you complain about those who conclude such thinking serves the culture of death.
We already have a process to protect innocents. The problem here is a renegade judge, and a bias towards death among the architects of the policy he ratified. And if you don’t think religion plays a part in the thinking of pull-the-tubers, take a look at Felos’ writings. His spirituality of euthanasia may be self-centered, contrived, and immature, but it is religious nonetheless. (Kevorkian had a similar macabre fascination with death.)
Your inability to posit any ideas about how to deal with the tragic problem of Terri Schiavo apart from killing her makes you an apostle of that culture of death. Your discomfort with the term won’t change this fact, not any more.
Don’t have the Time or Energy to Decide Life and Death Cases
Jim Holman writes:
“Missourian: ‘The fact that the majority of these cases do not come to Court is irrelevant.’
It’s relevant if you’re suggesting changes to a process that potentially could bring thousands of cases into an official and possibly lengthy legal process. But at this point I’m not sure what changes you would suggest, or the scope of those changes.”
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It should would be terribly INCONVENIENT if society had to invest time and energy to ensure that decisions regarding the LIFE OF A HUMAN BEING were made correctly. We properly invest that kind of time and energy ensuring that the life of a convicted criminal isn’t taken improperly. (By the way, I oppose the death penalty)
Terri Shiavo is SO DARN INCONVENIENT. We know that she isn’t having fun eating, watching TV, driving in her car, what kind of life is that? We certainly don’t want to spend time and medical resources and legal resources on her. End her life.
Missourian writes: “the overall concept that anyone has a ‘right to die’ should be rejected. . . . living wills should expire unless reaffirmed periodically. . . . If you say that this will create a huge burden on the court system you are right.”
I appreciate your taking the time to sketch out some recommendations. A few comments:
1) in many cases the living will is all that we have, even if it’s some years old. Believe me, it is very frustrating to physicians to be presented with cases in which little is known about the patient’s wishes. Imagine a situation in which an incapacitated elderly person literally has no living will, no family, and no known friends. Imagine that you are the physician involved in end-of-life care decisions. It’s very difficult to know what to do. So I’m a big fan of the living will or advanced directive. It may not be perfect, but in some cases it’s all we have.
2) in my opinion, keeping cases OUT of the court system is very important. Whenever possible our preference should always be not to go to court. There’s a very practical reason for this. In many instances end-of-life decisions have to be made very quickly, sometimes within minutes or hours. Courts often cannot respond to these timelines. In addition, as I mentioned earlier, the court is a very blunt instrument when it comes to dealing with these issues.
3) one thing that I have not seen mentioned at all during this discussion is the importance of the patient-physician relationship. Unfortunately we live in a time of managed care and shifting insurance coverage that makes a long-term relationship with a single physician difficult. But the patient-physician relationship is one of the most important factors in end-of-life decisions.
4) it seems to me that under your proposals we would have so many cases entering the court system as to be unmanageable. Imagine a situation in which the family of every 93 year old grandmother suffering from multiple organ failures has to go to court in order to get a “no code” order. Bottom line: not gonna work.
5) I would say that the issue is not so much “right to die” as “right to reject medical interventions.” In rejecting a particular medical intervention the death of the patient may result. But this is a decision that people should be able to make, whether conscious or through a proxy if unable to communicate.
Point by Point to Jim Holman:
Jim Holman writes:
appreciate your taking the time to sketch out some recommendations. A few comments:
1) in many cases the living will is all that we have, even if it?s some years old. Believe me, it is very frustrating to physicians to be presented with cases in which little is known about the patient?s wishes. Imagine a situation in which an incapacitated elderly person literally has no living will, no family, and no known friends. Imagine that you are the physician involved in end-of-life care decisions. It?s very difficult to know what to do. So I?m a big fan of the living will or advanced directive. It may not be perfect, but in some cases it?s all we have.
Missourian replies:
I don’t see that it is difficult to know what to do. We care for people as best we can until they die. That is life. Your entire paragraph is premised on searching, searching and searching for ways to justify ending life. Life doesn’t always end tidily and we shouldn’t attempt to make it do so. Birth is messy and uncertain, life is messy and uncertain. We should care for our weak and ill. Again, Jim why are you so entranced with the idea of death.
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2) in my opinion, keeping cases OUT of the court system is very important. Whenever possible our preference should always be not to go to court. There?s a very practical reason for this. In many instances end-of-life decisions have to be made very quickly, sometimes within minutes or hours. Courts often cannot respond to these timelines. In addition, as I mentioned earlier, the court is a very blunt instrument when it comes to dealing with these issues.
Missourian replies: First, it was the entire concept of “right to die” and “living wills” that brought this into the court system in the first place. Second, when a HUMAN LIFE is at stake, it is perfectly appropriate for it to be brought into the court system. It is inconceivalbe to me that you cannot appreciate how calculating and cold your statements are. No one suggests that we shouldn’t bring an appeal in a criminal case into the court system. We supply the court resources that need to be supplied to effectuate justice.
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3) one thing that I have not seen mentioned at all during this discussion is the importance of the patient-physician relationship. Unfortunately we live in a time of managed care and shifting insurance coverage that makes a long-term relationship with a single physician difficult. But the patient-physician relationship is one of the most important factors in end-of-life decisions.
Missourian: Yes, the physician-patient relationship is based on trust. How can I trust my doctor if I think that he is lying in wait for me until I am too sick to defend myself. What is older persons do not reveal certain illness and problems that they have because they fear their relatives will want to “help” them by killing them.
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4) it seems to me that under your proposals we would have so many cases entering the court system as to be unmanageable. Imagine a situation in which the family of every 93 year old grandmother suffering from multiple organ failures has to go to court in order to get a ?no code? order. Bottom line: not gonna work.
Missourian: Again, an ethic in which we cared for our sick until they died would not require the intervention of the court system. An ethic which gives standing to the concept of “right to die” and to “living wills” is what brought cases into the court system. Your argument is expediency. You are saying we, as a society, cannot devote resources to making sure that decisions of this kind as done properly because we just don’t want to spend the money. Wow, some time for liberals to start being economical with public money.
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5) I would say that the issue is not so much ?right to die? as ?right to reject medical interventions.? In rejecting a particular medical intervention the death of the patient may result. But this is a decision that people should be able to make, whether conscious or through a proxy if unable to communicate.
Missourian: You can “say” whatever you want, however, the public debate has developed a concept called “right to die” which is taken very seriously by a large number of people. This is a poisonous concept and should not allowed to take root in our society.
As I explained before the Common Law of England before is was the Islamic Kingdom of Britain addressed this. Suicide all kinds was outlawed so that people could not evade murder charges by claiming to be assisting someone in their right to die.
Jim I have to say that your seeming utter lack of regard for the value of a life of a sick person is amazing. This view just might change if you found yourself in a wheelchair needing a great deal of help.
Jim, Missourian’s comment “the overall concept that anyone has a ‘right to die’ should be rejected” is a moral statement. Your response is medical technocrat.
Do you have any real idea of what has been unleashed here? Why not even a hint of awareness of the moral dimension of this issue?
Even liberals are repulsed by what they are witnessing. Those who aren’t are trying to craft a moral argument for their position, not very successfully, but at least they implicity acknowledge the moral dimension.
By ignoring the moral character of Missourian’s statement, you implicitly stake out a position of moral neutrality. The problem is that no moral neutrality exists when a human being is slowly starving to death. There is only right and wrong.
I didn’t murder grandmother, I assisted her lawful right to die.
Grandmother Smith was found smothered to death. Her granddaughter, Jane Smith, admitted that she helped her grandmother die by smothering her. Jane Smith filed a formal defense to murder charges by alleging that Grandmother Smith had wanted to die. In the months before the smothering, Grandmother Smith had suffered from gout, diabetes and heart disease. She was confined to a wheelchair after an amputation made walking difficult. Friends and neighbors of Grandmother Smith reported that she was often depressed especially over the loss of her beloved husband,Bernie, who had been dispatched by his physician after the septagenarian lost his power of speech.
Attorneys for Jane Smith state that allegations that their client wanted to hasten the time that she would inherit Grandmother Smith’s tidy home and savings account was an outrage and that Ms. Smith would fight the fundamentalists who failed her honor her grandmothers “right to die.”
Our forefathers who left us the gift of English Common Law built on Judaeo-Christian moralality had already considered this issue. They already came up with the best solution: suicide is immoral, suicide is illegal and life is precious.
The Chinese have a saying: One mother can care for six children and six children cannot care for one mother. Human nature, the same all over the world.
My standard closing has become “heaven help us” said as I throw up my hands up in the air.
Missourian. Terri’s death is going to sharpen the focus of many people whose minds were dulled by the endless chatter of “ethicists” who surreptitiously seek a culture of death. This fight will continue, but some of the cultural lethargy will lift. The rank injustice of her killing will shake many into a greater moral and thus intellectual sobriety.
I do not believe Terri’s death is in vain. I believe she serves as a martyr. I will explain this in an essay a few weeks down the road when I see things more clearly.
Looking forward to your essay.
Yes, I think Terri’s death has caused people to take a close look at where our culture is going, so some good will come from it, hopefully, a great deal of good will come from it.
Jim writes, “In rejecting a particular medical intervention the death of the patient may result. But this is a decision that people should be able to make, whether conscious or through a proxy if unable to communicate.”
Wesley J. Smith writes (Culture of Death: The Assault on Medical Ethics in America; p.84-85):
“Today, although fear of having life artificially prolonged remains widespread in the public, forcing people to receive unwanted medical treatment is considered by professionals to be a profound violation of their bodily integrity. Except in a few extraordinary situations, patients must give their explicit permission before being medically treated, including those times when refusing treatment will likely lead to death. Thus, mentally competent patients who don’t want to be hooked up to medical machines don’t have to hooked up to medical machines. If they don’t want to be hospitalized, they can refuse to be admitted. If they want to leave the hospital, even when their doctors disagree, then can be discharged against medical advice. If they wish to refuse chemotherapy or any other urgent treatment needed to stay alive, then so be it. This patient-empowering reform was a profound victory for patients, improving the practice of modern medicine and helping to move the health care system toward a more patient-centered ethic. For this, it must be said, bioethics deserves much of the credit.
“And yet … patient choices do not necessarily occur in a social vacuum. Indeed, preexisting cultural biases of medicine have been turned inside out. Whereas providing intensive treatment used to be the preferred choice, today the bias is against expensive care, particularly when the patient is dying or significantly disabled. In fact, [as was shown in example cases provided in the book] patients or families who request “disfavored” treatments often find themselves pushed, pressured, and cajoled – by doctors, nurses, social workers, hospital chaplains, and bioethics committees – to change their minds. Moreover, the intense emphasis placed on autonomy by bioethics training has made it far easier for health care professionals to accede to requests to terminate life-saving care made by vulnerable, depressed people in their darkest hours. Indeed, bioethics’ campaign against medical paternalism may have succeeded too well, allowing “respect for persons” to sometimes mask acts of discrimination against people with significant health problems and disabilities.”
–end snip–
In another post I noted a comment by a nurse who said that Terri Schiavo should simply have been given a lethal injection. A doctor on this blog has stated that withholding care is the medically correct thing to do in some cases. A bioethics panel in Texas decided to withold care and remove an infant from life support against the wishes of the mother, resulting in the baby’s death. Patient autonomy requires that patients make fully informed decision for their own care based on information provided by a medical community that is there to support life, not push for death. Would you trust this nurse, doctor and ethics committee to give you unbiased and complete information when facing end of life decisions? In theory, patient autonomy sounds very nice. But in the real world, the culture of death has literally turned a “right to die” into a “duty to die.”
This phrase “culture of death” is used an awful lot on this blog. However, the Church calls for our death to earthly passions. Especially now in this time of Lent, the Church embraces a culture of death. True, it is a culture of death which leads to a new life, but it is the dead Christ which the Church celebrates as the “King of Glory” who has “trampled down death by death”.
The political sloganeering of “pro-life” vs. “pro-death” strikes me as misleading and somehow inappropriate. I often get the sense that a lot of “pro-life” people would put to death those they proclaim as “pro-death”. Stem-cell research adds more confusion as to what kind of life and death is really being discussed. It seems that what is really being hotly contested in these “life/death” characterized issues is really an understanding of what humanity is, or an anthropology. I believe the Church is in a unique position to address this, however, the “life/death” emphasized terminology strikes me as the wrong path.
As a side note, I was quite suprised to find an article by Dr. Marc Siegel on this blog as he happens to be my primary care physician here in New York. I have also sought the medical consult of his wife, who is an esteemed neurologist. I especially appreciated his comments regarding the scenario which surrounds Terri. Thanks, Fr. Hans, for printing this.
Stephen, I see where you are going but a corrective is necessary. In the anthropology of the Church fathers, passions arise because the body, the part of material creation spoken into existence — the “dust” into which God breathed so that man became a living soul — is fallen along with the rest of material creation.
Passions (lusts, inordinate desire) arise when the desire of soul for Life (God, who is the source of life), is directed through the physical body. Driving this desire through the body inflames the natural and appropriate bodily desires (food, sexual desire in some cases, etc.). When this process spirals completely out of control addictions arise, appetites for depravity develop, etc.
Here is where the brilliance of the Fathers shows through: the foundation of all desire, they teach, is a desire for God. Desire is not a bad thing, but when spiritual desire is directed through the passions of the body, if sated, leads to death. It’s the difference between temptation and sin. We might be tempted, but temptation is not sin. If we sin however, we experience death, because the sin (seeking God through created materiality, that is, through the desire of our bodies — the “flesh” the Apostle Paul calls it), leads to places where God cannot be found.
Think of Adam in the Garden. Everytime we sin, we eat the fruit, that is, we look to the creation instead of the Creator for the life that only the Creator can give. Adam’s desire for knowledge, IOW, could not be met by satisfying his stomach.
This is why we fast. If we can bring the most basic appetite under control, that is, return the river back to its banks, then we can master every other desire as well. Sin can be overcome. The life that God bestows can be experienced in greater measure. (This is why fasting must be accompanied by prayer, as well as care for the poor, the later being concrete obedience to commandment to love the neighbor through whom we love God — 1 John.)
The only death the Church advocates, is the death of death. In scripture Paul says to put our early members to death, by which he means take control of the passions that lead to sin, and thus death. He says that “death’ works within us, which again means that in our falleness, the disorientation between body and soul generates a real force that, if not fought against (spiritual warfare), will lead us to sin, and thus death.
Here’s the corrective. This is not a “culture of death” idea but a resounding affirmation of life.
Death can only be overcome by Christ. The death in us, the passions that we must fight against can actually be transformed, that is, the desire informing the passion, energizing it as it were, can be restored to its proper place. Another way of saying this is that sin can be overcome and a deeper life in God known and experienced. Christ accomplishes this in us (“let Christ be born in you” Paul writes) through the Holy Spirit — who is God.
This interior regeneration is possible because Christ rose from the dead. He made death dead. Death is not overcome by death, but by life. Think of the Paschal hymn: “Christ is risen from the dead, trampling down death by death…” He was raised from the dead because He was righteous, he knew no sin, so the existential penalty of sin — death, could not hold him. Keep in mind Christ did not raise Himself. He was raised by the Holy Spirit after being found righteous by the Father. I’m speaking here strictly in terms of how Paul presents it in scripture.
Christ’s conquering of death has reoriented and transformed the entire universe and reveals the God’s final and complete repudiation of death. In our world the battle still continues, and Christians are called to bring life, which includes fighting the forces of death — the culture of death — in their corner of the world whenever they find it, in a judicious and responsible manner.
Only life can vanquish death. Where the culture of death advocates have it wrong is that they believe death can conquer death.
Stephen,
Although I can’t improve on Fr. Hans’ teaching in his response, perhaps I can offer a few points to go along with it. The first is that the Church does not embrace a culture of death during Lent, but rather the fundamental paradox preached by Scripture from Genesis through Revelation, that through dying to ourselves we may be raised up to life in and for God. St. Paul’s Letter to the Romans teaches this throughout, as do the famous “Suffering Servant” passages in Isaiah, on which the New Testament’s understanding of Christ’s identity is based. The second point is that the Church does not acclaim the dead Christ as “the King of Glory” who has “trampled down death by death,” but the risen Christ, the Christ who lives again.
Even after the Resurrection, we still die. But because of Christ’s saving work, if we die in a death like his, God will raise us to life with Himself. (I’m paraphrasing Romans.) Death is not a natural and good aspect of life, as some philosophies say, but an opponent conquered by Christ. As you stated in your post.
Fr. Hans,
I should probably realize that the term “culture of death” carries a lot of baggage with it. What I mean, though, is exactly what you mention, that the Church advocates, through the life of Christ, putting to death those passions which lead us to death. In practical terms, it is struggle. The cultural life of the Church, by ascetic strivings, cultivates death to passions which lead us away from God. A “passion for life” needs to be replaced with a “passion for Christ’s death”. This is the “culture of death” which I refer to. It is actually a resounding affirmation of resurrected life in Christ.
Bill,
My reference to the “King of Glory” title of Christ comes from icons depicting Christ’s death on the cross. Christ’s death is glorious because of His resurrection, but His death is the actual pinnacle of glory.
Stephen, yes, I could see where you were going. I just wasn’t comfortable using the term “culture of death” since, culturally, it’s applied to the anti-sanctity of life crowd, and thus unclear when used in a different context.