Terri Schiavo

[I, Brian]

So, the debate over Terri Schiavo continues, and with her feeding tube removed the issue of a final resolution in this issue of ethics is pretty urgent:
http://news.bbc.co.uk/1/hi/world/americas/4368055.stm

Two things concern myself about this case, though:

1. That the decision to remove her feeding is based on an imposition of standards without justification.

Namely - if Terri were determined to be in great physical pain, in addition to having no hope of recovery, then it could be argued that removing feeding was an act of compassion.

Instead, what seems to be argued is that as she is living in a condition that other people determine that she would not have liked to live in.

This argument seems vague at best, and not simply potentially superficial, but also potentially dangerous in the long run. How far do we apply other people standards in determining whether a life is worth living or not?

2. The second concern is that, according to the BBC report, Terri Schiavo exhibits no "consciousness":

But in this case, critics say, lawmakers in both houses of Congress allowed themselves to be swayed by an emotional argument and repeated broadcasts of a video showing Mrs Schiavo apparently awake and alert, even though many doctors say she has no consciousness.

We don't even understand what consciousness is, and although there are features such as alpha and beta waves that neuroscience is familiar with, these remain part of a larger enigma. It seems rather remarkable that such an overwhelming conclusion can be made as to whether a person has consciousness or not, particularly in the instance of where such a person otherwise exhibits conscious activity, such as being awake and alert.

I'm aware that this issue highlights an issue of practice already occuring in hospitals - however, what the Terri Schiavo highlights is the argument over whatcriteria are required to make such decisions.

So the question for debate is: is it ethical for Terri Shiavo to have her feeding tube removed?

[Kaldayen]

Yes it is.

How can a government justify his "pro-life" actions on people who would want to die in those conditions when, at the same time, he kills people who do want to live (death sentence).

According to many doctors, that woman has no hope of regaining consciousness. Her brain has had severe damage. Even if by some miracle she did wake up, what life would she have?..

Also, we should be legally allowed to leave a note to our family and friends stating what should be done with our own lives if such a situation occurs, instead of preventing some family members to mourn by holding to a false dream.
___
Kal

[I, Brian]

Originally Posted by Kaldayen

According to many doctors, that woman has no hope of regaining consciousness. Her brain has had severe damage. Even if by some miracle she did wake up, what life would she have?..

Ah, but now you're imposing your own value judgements according to what worth life may have. After all, if people being unable to recover from brain-damage is such an issue in such a judgement, then why not euthanasia on the mentally and physically handicapped?

[brucegdc]

I think it is ethical, for the following reasons:

1) There is sufficient evidence, according to the court, that her wish was not to be kept alive artificially in a vegetative condition. (One of the reasons I have a living will - it is perfectly clear that way what my wish is, without having to rely on comments and memory - I strongly urge everyone to put it in writing).

2) Multiple doctors have examined her and determined that she is in a persistent vegetative state. As far as I can see from the various press coverage, no doctor who has examined her in the past 5 years has said otherwise.

3) In the words of my favorite nurse (who works in the Neurology ICU unit, and sees brain damage constantly), looking at the CT scan from the reports "I've seen brains of dead people in better shape". Yes, she's not a neurologist, but the large dark areas are cerebro-spinal fluid, and the light areas are brain - and there's about 90% dark, 10% light, mostly in critical areas.

Now, if she had said clearly up front "keep me alive no matter what" instead of what is apparently the reverse, I'd say no way - don't pull the tube. The job of a court in this situation is to serve as an independent arbiter of her wishes - and this has been litigated incessantly. The judge did the right thing a couple of years ago when he ordered the tube reinserted when the parents claimed a new witness - but the finding *after the new evidence* was that it was her wish NOT to be kept alive artificially in this condition.

Most unfortunately, politicians seem to have grabbed this for their own purposes, ignoring the judicial findings and what appear to be her own wishes - expressed multiple times. There's no good solution.

To look at the other side of the equation - how much effort should be put into keeping bodies going when the brain won't/can't? We could put someone on a heart-lung machine, with feeding tube, and other gadgetry and keep the body going darned near forever - should we do that for everybody? According to most religious beliefs, at least one person has come back from the dead, so why not give everyone a chance - put 'em on machines just in case.... (since you like reductio ad absurdam...)

[juantoo3]

Kindest Regards, Kal!

Originally Posted by Kaldayen

How can a government justify his "pro-life" actions on people who would want to die in those conditions when, at the same time, he kills people who do want to live (death sentence).

The same way abortion can be justified once the fetus is quickened.

Also, we should be legally allowed to leave a note to our family and friends stating what should be done with our own lives if such a situation occurs, instead of preventing some family members to mourn by holding to a false dream.

Can't speak for anybody else, but in the states, specifically here in Florida, people are allowed. It is called "advance directive." I deal with them all the time at the hospital. A living will and a durable power of attorney for healthcare are two examples of advance directives. Shiavo did not have any advance directives.

I find myself torn on this issue. Like Shiavo, I would not want to remain in a vegetative state, and I have no living will. Yikes! However, it seems to me she is breathing on her own, so she is technically being starved to death, which I don't think is right either. This seems too much like being between a rock and a hard place. This has really been dragged through the courts for far too long. The girl should have been allowed to die with dignity a long, long time ago. But since the artificial rescue attempts have restored some elemental body functions, she is technically alive. So, do we consider this a retro-abortion? I am much too torn to even decide, I can see both sides, and I can find fault with both sides. Getting the media and the (federal!) government involved is really wrong, and only increases the circus atmosphere surrounding this whole thing.

[Faithfulservant]

I would like to clear a few things up.. one doctor said she was in a vegetative state..others have said that she is responding and could possibly be able to feed herself if her husband would have allowed therapy..another interesting thing is that it took 7 years of her being locked up in a room denied sunlight denied any outside stimulation denied anything any human would be allowed to have in the same situation 7 years for her husband to say that she would not want to live like this... might I add that he also aquired a common law wife and had a couple children in this time period? I believe that she is right now being murdered.

If you watch the tapes of her smiling as that same doctor who said she was in a vegetative state..smiling as he tells her shes doing good for following the balloon... she reminds me of a child who would follow that balloon and smile at the voice of a parent... that same child would need to be fed.

Its also interesting that in that same state a convicted felon would not be allowed to starve himself to death he would be force fed yet this woman who is alive and innocent is being starved of water and nourishment.

This whole thing disgusts me.. There are accusations being made of abuse and a nurse did an interview she was terminated after telling the authorities of things she witnessed after the husband would hole himself up in the room with terri,,, she described terri as being agitated.. how vegetative is that???

[BluejayWay]

... might I add that he also aquired a common law wife and had a couple children in this time period? I believe that she is right now being murdered.

Right. I believe the husband ceded any moral authority when he established a relationship with another person. At that point he should have had the decency to let her family have custody of Terri.

This case is exposing a lot of hypocracy in the US political system--much of it on the left, but some on the right as well. A consistent stand against the taking of life is missing on both ends of the political spectrum.

[BluejayWay]

The right in the US generally supports the death penalty and use of lethal force in enforcement situations, and is staunchly antiabortion. I'm not sure how the taking of life in one situation is justified, and unjustified in another. War kills the innocent along with the combatant.

Just a couple of illustrations of what I see as problems with the conservative position in this case:

Last weekend, Republicans in Congress pushed through unprecedented emergency legislation aimed at prolonging Schiavo's life by allowing the case to be reviewed by federal courts.

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The vote caused distress among some conservatives who say that lawmakers violated a cornerstone of their philosophy by intervening in the ruling of a state court.

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David Davenport of the Hoover Institute, a conservative research organization, said he felt that due process had been overlooked. "When a case like this has been heard by 19 judges in six courts and it's been appealed to the Supreme Court three times, the process has worked - even if it hasn't given the result that the social conservatives want. For Congress to step in really is a violation of federalism," he said.

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Some conservatives, who generally applauded the goal of trying to keep Schiavo alive, said they were concerned about what precedent had been set.

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"My party is demonstrating that they are for states' rights unless they don't like what states are doing," said U.S. Representative Christopher Shays of Connecticut, one of five House Republicans who voted against the bill.

~~From the International Herald Tribune

Placing ideology over ethical concerns certainly isn't confined to the right, and this is obviously a minority opinion among the Republican members of the House, but there is a strong strain of hewing to the party line no matter what the cost.
And yes, the Demos do it too. Campaigning against war and the death penalty is commendable, but insisting on unrestricted abortion rights tends to nullify their supposed occupation of the moral high ground. So is pulling the plug on, at best, hearsay evidence of Terri Shaivo's wishes.
More troubling is this specific instance:

And reporters are now raising questions about a right-to-die law Bush signed as Texas governor, contradicting his position in the Schiavo case. Just last week, the law was applied for the first time, allowing doctors to remove a critically ill infant from life support against his mother's wishes. According to the Houston Chronicle, this marks the first time in American history that courts allowed a pediatric patient to die against the wishes of their parent.[7] As the Knight Ridder News service reports:

"The mother down in Texas must be reading the Schiavo case and scratching her head," said Dr. Howard Brody, the director of Michigan State University's Center for Ethics and Humanities in the Life Sciences. "This does appear to be a contradiction." Brody said that, in taking up the Schiavo case, Bush and Congress had shattered a body of bioethics law and practice."[8]

~~MoveOn

Anyway, my point being that I think neither party can claim a consistent 'right to life' program, and the reaction of the American public illustrates this (again from the International Herald Tribune article):

At least one public poll conducted this week suggested that the lines in the battle over withholding life-sustaining care were not strictly based on labels like Democrat and Republican, liberal and conservative. A new CNN/USA Today/Gallup poll found that 62 percent of Democrats, 54 percent of Republicans, and 54 percent of independents agreed with the Florida state court order to remove Schiavo's feeding tube.

Turning those numbers around shows 38% of Demos and 46% of Republicans and independents disagreeing with the courts on this issue--a sizable minority that cuts across party lines.
I'm hoping people of faith and goodwill can recognize that they have a lot more in common with their moral and spiritual positions than they have differences in their political ideologies, and act in such recognition.

[I, Brian]

Originally Posted by Faithfulservant

If you watch the tapes of her smiling as that same doctor who said she was in a vegetative state..smiling as he tells her shes doing good for following the balloon... she reminds me of a child who would follow that balloon and smile at the voice of a parent... that same child would need to be fed.

Indeed, that's part of my concern - and also as for the husband, it's hard not to see a great deal of conflict of interest.

Did she voice an intention to never want to live like this? Wouldn't be surprising if she had, as many people would be revulsed by the lack of personal freedoms.

However, does this mean that, given quality of care that she cannot enjoy some basic quality of life?

As for the other issues of death-life issues - let's try and give those their individual threads, and try and keep this one focussed on euthanasia issues if possible, please.

[brucegdc]

Having done some major digging (I really need to get into Nexis and see what's there one of these days)... here's what I found the court has found:

1) She did state her intention to her husband, apparently multiple times. One of those was at the funeral of a friend who had been in a similar circumstance to where she is now - declared to be in a persistent vegetative state and requiring artificial life support.

2) In 2002 a panel of 5 doctors (2 appointed by the parents, 2 by her husband, and one by the court when they couldn't agree on a neutral 5th party) examined her. The two doctors appointed by the parents said she was not in a vegetative state, the other three (and her primary physician) said she was. According to the court ruling, the reasons given for her not being in a vegetative state were not consistent with each other, and in fact contradictory. One of the two doctors has been disciplined by the Florida Medical Board for false and misleading claims about the process he claims would "cure" Mrs Schiavo.

At present, she is apparently unable to swallow (which is why the feeding tube was necessary) - and feeding her without a tube now would kill her by choking. There are very set guidelines for when the option of refusing mechanical assistance (including feeding tubes) becomes possible. Patients ALWAYS have the right to refuse treatment. If they cannot speak for themselves, the next of kin have to serve as their voice. (Hope all of us have our living wills done, so this can be somewhat avoided with us.... with family disputing with family over what we'd want).

I feel sorry for everyone involved in the family (and contempt for both Bushes for dragging this into a political issue). This is not an easy decision - yet it is made routinely in hundreds/thousands of hospitals around the country. There is a reasonable chance that my wife saw one of these decisions made last night - she's a nurse in an ICU. Familes have to make the decision on how much to intervene to prolong death - and that is what's happening here.

The question about "enjoying basic quality of life" is, indeed, key here - multiple doctors have examined her, and the weight of evidence is that she's in a non-cognitive state - the CT scan is showing little brain tissue left, the responses are consistent with "startle" reflexes (including the smiling, and response to music - it's amazing what reflexes we have to loud sounds). The doctors examining her could not get consistent reactions to the stimuli - which would indicate cognitive thought. She's gone, let her body follow.

As for conflict of interest - he's certainly not in it for the money, despite the charges leveled at him by her parents - if he were, he would have taken one or more of the million-dollar offers made to him to turn over custody of Terri to her parents. I think he's doing (as I would for my wife) what he knows she's expressed to him in the past she would want done. I think the parents are trying to hang on to their daughter no matter what - which I understand as well. The ones behaving abysmally are the interest groups and politicians by dragging what should be a family dispute into the public spotlight and turning it into a circus.

[Faithfulservant]

She did state her intention to her husband, apparently multiple times. One of those was at the funeral of a friend who had been in a similar circumstance to where she is now - declared to be in a persistent vegetative state and requiring artificial life support.

I find it interesting that she only said this to him in private and noone else seems to have ever heard it.. and once again I point out that it took 7 years 1 common law wife and children for this to come up...

I also find it interesting that he wouldnt allow the blinds to be opened up or for her to be allowed to be taken outside or any therapy...Why would that be?

At present, she is apparently unable to swallow (which is why the feeding tube was necessary) - and feeding her without a tube now would kill her by choking.

No actually she has been able to swallow on her own for awhile now.. if she had not been able to she would have choked on her saliva.. you can see her swallow for yourself as you watch the tapes. What she cannot do is chew there is a difference between chewing and swallowing. Her mother used to give her ice chips and she had no problems swallowing.

I feel sorry for everyone involved in the family (and contempt for both Bushes for dragging this into a political issue). This is not an easy decision - yet it is made routinely in hundreds/thousands of hospitals around the country. There is a reasonable chance that my wife saw one of these decisions made last night - she's a nurse in an ICU. Familes have to make the decision on how much to intervene to prolong death - and that is what's happening here

My sympathy goes to terri actually.. an MRI would have been a simple thing for them to do to find out the actual cause of her collapse.. why have they never done an MRI?? They say that she cannot feel pain.. how does that explain the interviews done by nurses that said she showed that she felt pain? So what was it the Bush's did that was so bad.. Made a law allowing issues like this to be taken to federal courts?? Thank you President Bush. I do believe this very situation is murder.. Do you know that she does not like to be alone?? Her caregivers say that she recognizes them.. and lets them know her likes and dislikes..does that sound like a vegetative state?? Once again I say shes being murdered.

The question about "enjoying basic quality of life" is, indeed, key here - multiple doctors have examined her, and the weight of evidence is that she's in a non-cognitive state - the CT scan is showing little brain tissue left, the responses are consistent with "startle" reflexes (including the smiling, and response to music - it's amazing what reflexes we have to loud sounds). The doctors examining her could not get consistent reactions to the stimuli - which would indicate cognitive thought. She's gone, let her body follow.

You have to be kidding me...startle reflexes. Sounds a lot to me like telling the mother of an infant that wasnt a smile that was gas. They havent done a CT scan in a long time.. They still have never done an MRI...If anyone understands how the brain works would know that many things can be relearned.. think of people that have strokes they are told they will probably never walk again and have to relearn the basics of everything but they do it with therapy which Terri has been denied by her husbands orders.

Who has the right to judge a persons quality of life..??? There are children born with severe congental conditions that have a poor quality of life by my standards.. should they be starved to death??? what about paraplegics? They cannot do anything I can do.. should they be allowed to starve to death?? What about severaly mental retardation?? Or Alzhemiers patients?? Please put it into that perspective.. She is not dead she is very much alive.. she is in the same condition as many other people that cannot do things for themselves.... are those same people "not there"?

As for conflict of interest - he's certainly not in it for the money, despite the charges leveled at him by her parents - if he were, he would have taken one or more of the million-dollar offers made to him to turn over custody of Terri to her parents. I think he's doing (as I would for my wife) what he knows she's expressed to him in the past she would want done. I think the parents are trying to hang on to their daughter no matter what - which I understand as well. The ones behaving abysmally are the interest groups and politicians by dragging what should be a family dispute into the public spotlight and turning it into a circus

Its not just her parents making charges against him.........Its friends and people that knew her.. Do you not even consider that he cannot marry his common law wife without her death? If she remained alive forever he could never marry this woman that he has had children with. I have never heard about million dollar offers.. How can this family have that much money? Have you considered that when Terri dies he recieves the rest of the money that was there for her care for the rest of her life?

Im very anti-media... but in this situation I am totally in support of it. Do you think that man will ever have a moment of peace if he murders that woman? Family disputes... smacks to me of generations of families that kept abuse quiet because family disputes should be kept private. "keep it in the family Its noone elses business"

Even children recieve more rights in our court systems.. they get a guardian ad litem that is there for the sole purpose of making sure the childs welfare is met and that they legally have a voice.

[brucegdc]

Originally Posted by Faithfulservant

Even children recieve more rights in our court systems.. they get a guardian ad litem that is there for the sole purpose of making sure the childs welfare is met and that they legally have a voice.

And Terri has had at least two appointed, at different times, as the battle runs on. Both times, they have agreed that it was in her best interest to no longer be kept alive through artificial means.

As I think I said above, I did a lot of scouring to get to real data - there's a lot of hype out there and LOTS of political pandering. And, to be honest, a LOT of misinformation - particularly from the "Keep her alive" camp. (Not surprising, if the decisions were going the other way, the other side would have the incentive to play the disinformation game more strongly).

Basically, though, this should be a private decision between the doctors and the family, taking into account Terri's wishes, not this flipping media and political circus act. This is dead wrong.

[Faithfulservant]

Arent her parents her family also? How can her husband who has since moved on and formed a new family have her best interests in mind more so than her parents and siblings?

[alexa]

Originally Posted by I, Brian

So the question for debate is: is it ethical for Terri Shiavo to have her feeding tube removed?

Difficult question with all the political fuss around her. Damn politicians !

My answer in Terri's case is NO.

If she would have been in coma, after 16 years, I'll vote YES. But she is not in coma. She has severe brain damage, but she is not different than a mental retarded person. I am pro euthanasia when the person is in severe pain, without any possibility of recovery and cannot stand life anymore. But if the person doesn't feel pain and has no written wishes how to end her life, her husband or anyone else has no right to decide for herself. I don't understand why he doesn't leave the medical care to her parents if they want to. This will be a burden for them, but they seem ready to take it.

Does anyone know why she collapsed ? At 26 years old ? Hmm.

[brucegdc]

She collapsed because she was bulimic and as a result, the potassium balance in her body got severely out of whack. The original lawsuit for malpractice was because the doctors did not diagnose this condition, and hence didn't treat it.

As for why her husband "doesn't leave the medical care to her parents" - He feels strongly that Terri does NOT want to be kept alive in this condition - he's testified as to her wishes being expressed (and by, the way, FS - I don't know about you, but my wishes about medical care aren't generally topics of conversation - situations like this where people are openly talking about their wishes in response to a news item are rare - the Karen Quinlan case is the last one I recall that brought a lot of this into "public" discussions - so it's not surprising that "she only said this to him in private"). He has had numerous opportunitities to just walk away - including being "bought off" by millions of dollars, and has not taken them. I would do the same for my wife. Could I bring someone to testify that she had expressed those wishes to me? Heck no - although we've gone through a similar feeding tube/no feeding tube decision in the past year, when my mother in law was dying - I know what Megan wants, but it's not something that was discussed with others around. Her dad can't say - she didn't discuss her wishes with him (although he has told her his - she's his medical POA, so she made sure she knows)

From the legal perspective, your statement "But if the person doesn't feel pain and has no written wishes how to end her life, her husband or anyone else has no right to decide for herself." is dead wrong. Her husband is (legally) the next of kin. In the absence of her being able to express her wishes, *by law* he is the one who must decide what her wishes would be and communicate them to the doctors. The only way to supercede that is to have a medical power of attorney held by someone else. After the husband, (at least in the MD/DC area) it devolves to the adult children (in age order), then to (I think) parents, and siblings, in age order - I may have the last two reversed, though.

As for " She has severe brain damage, but she is not different than a mental retarded person.", that's not apparently the case. A mentally retarded person has some cognitive function. What's been found by multiple medical professionals who have examined her is that she does not have cognitive function left. Some others disagree - which is where the courts have had to step in to weigh the evidence. To do that, they ask more doctors (for example, the panel of 5 in 2002) to examine the patient, and determine the result. The judge's ruling in 2002 went into considerable detail about how he came up with the result - basically the two doctors who disagreed that she was in a persistent vegetative state did so in ways that contradicted each others findings, while the other doctors findings and analyses were consistent with each other, although developed independently. From the viewpoint of the legal system, that has to be taken into account - their job is to determine the facts and apply the law.

There's a good discussion of what "persistent vegetative state" means at http://sfgate.com/cgi-bin/article.cg...3/23/TERMS.TMP - it's a tough call for anyone. (My living will states I don't want to be kept alive in that condition, by the way...if there's ever any question...).

I guess the reason I feel strongly about it here is that this is one of the hardest decisions a family has to make - and it's been turned into a circus by outside interests. I understand both sides of the equation - but deciding this in the public forum is shameful and wrong. The tactics being used in the press, including the rumor and innuendo towards her husband are dead wrong. Yes, he's formed a new relationship - so have thousands of other folks, including those still married to awake, aware & cognitive spouses. That doesn't change her wishes - and that she has the right to pass with dignity, which has been stripped from her by this media and political circus.