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More on Schiavo
I thought I might link to two of the best posts I've seen on the underlying merits of the Schiavo case, one by Rivka focused on the medical facts, and one by David Velleman on the moral problematics. Give 'em a look.
March 20, 2005 | Permalink
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» More on Schiavo from PoliBlog: Politics is the Master Science
In an attempt to better understand this situation I have done some more reading on the subject.
The University of Miami's Ethics Program has a great deal of information including this Timeline which is of interest to anyone who wants a fuller view ... [Read More]
Tracked on Mar 20, 2005 4:25:40 PM
Comments
Hilzoy at Obsidian Wings has a great piece covering the bioethics angle. I got a lot more out of that than I did out of Velleman's. She reviews some key issues on patient autonomy and argues that the current version law does a far better job of respecting it than any of the changes being argued for in the Schiavo case.
Posted by: washerdreyer | Mar 20, 2005 2:57:57 PM
Problematic is an adjective only, I checked.
Using it as a noun has adversely impacted me.
Posted by: Michael7843853 | Mar 20, 2005 3:07:36 PM
The one thing that turns me off the most in this whole story goes back to 2003, I think.
The parents had made something approaching their peace with Terri's death, they went to the hospital with their priest to give Terri last rites, and the lawyer with the help of two police officers prohibited last rites from being given because the law had said that Terri wasn't allowed to get food/water (which entailed the Host).
If the priest had been allowed to place a tiny flake of the Host on her tongue, I assume we wouldn't be discussing this today.
Woulda coulda shoulda.
Posted by: Jaybird | Mar 20, 2005 3:11:17 PM
http://www.tampatrib.com/MGBCBB3DH6E.html
Last Rites Given
As judges at the local, federal and state Supreme Court levels considered and rejected attempts to block the feeding tube's removal, the Schindlers sat by their daughter's bedside while Monsignor Thaddeus Malanowski administered the last rites of the Catholic Church, the priest reported afterward.
Circuit Judge George Greer, who has repeatedly ordered the feeding tube's removal based on his findings at a 2000 nonjury trial, had granted special permission for Terri Schiavo to receive communion via her feeding tube prior to its removal.
Malanowski said he anointed Schiavo with holy oil, then used an eye dropper to transfer a few droplets of consecrated wine into the feeding tube.
``Everybody was calm and peaceful,'' the priest said. ``I thought the mother [Mary Schindler] might faint but no, the mother was strong until just a half-hour ago.''
Posted by: Barbar | Mar 20, 2005 3:33:12 PM
Why starve the woman to death? Does not the world have plenty of experience in humanely wheeling the disabled into a gas chamber and then cremating the remains.
Posted by: Abdul Abulbul Amir | Mar 20, 2005 4:11:29 PM
The moral issues do not derive from an analysis of the level of functioning of Terri Schiavo’s brain alone. But such an analysis is necessary because it may guide us, both regards to hope for recovery, and pain issues.
Medically, as far as Ms. Schiavo’s sense of pain goes, her brain is not functioning at a high enough level to perceive pain in the frightful way that higher functioning people do. Painful stimuli cannot be perceived as pleasant to her, but it is a romantic biological exceptionalism that ascribes a terror to a human brain that is functioning in a less sophisticated way than a mouse. It seems offensive to be making comparisons to lower animals, and I don’t mean to demean the full measure of humanity that I think resides in Ms. Schiavo, but an earthworm gives every evidence of a more terrified response to pain than Ms. Schiavo can. I understand that the MRI’s show a brain that is atrophied beyond what we ever see in the rare people who wake up after profound coma.
In more than 25 years in medicine, I have twice seen people with lobotomies (a vestige of our ignorant past). I had occasion to draw blood from one, and asked about the pain of the procedure. I was told by the woman that she experiences pain when she hurts herself, but that it didn’t really bother her much. Pain involves far more than just a sensation. The affective component is key to the power of pain in our minds. Ms. Schiavo is functioning at way to low a level for us to ascribe the word pain, as we understand it, to her. And starvation does not add to her discomfort, because she will not starve to death, she will dehydrate. And from the testimony of the many people who roll into the ER obtunded and dehydrated whom we revive, dehydration is very unpleasant. Certainly not a terrifying prospect, especially for the unaware. Except as it offends her dignity, nothing we do will much matter to Ms. Schiavo, whether she is kept in this situation (she’s not suffering) or if we let her dehydrate and die (which won’t hurt either). Basing a decision on sparing her current feelings is specious.
Legally the most relevant case is the Supreme Court’s decision in the 1990 Nancy Cruzan case. Nancy Cruzan was cared for by her mother after being rendered unresponsive 7 years earlier by a car accident. She could breathe, but required a feeding tube, just like Schiavo. After 7 years, the mother gave up hope, and requested to be allowed to remove the tube, but the Ohio Attorney General stepped in to stop it using a state law that forbid it, as I recall. The case went to the Supreme Court and they ruled that if there were clear evidence Cruzan wouldn’t want the tube in, it could be pulled. A friend of the mother’s then suddenly recalled just such a conversation, the tube was pulled, and she died 12 days later. The courts clearly don’t want to be involved, and this is right. To me, the larger principle is whether, absent some demonstrable conflict of interest, do you trust the courts or your loved ones to decide? Obviously the Cruzan case is closely analogous to the Schiavo case, except the husband and the mother disagree. Probably the husband is right about what Ms. Schiavo would want. Legally there is little question he may do what he is doing. He may even feel a deep loyalty to his wife’s previously stated desires, but she doesn’t care now, and I think he is more responding to his own horror at the situation.
If you polled the American people whether we should let Schiavo starve, most would say no. If you asked whether you would like to be kept alive in her situation, the answer would be a contradictory no again. Ms. Schiavo almost certainly would like the tube out, and most of us would rather our spouses, not our parents, making such a decision. Having said that, it won’t hurt Ms. Schiavo to be kept alive, and if this pleases the mother, and she has the resources to do it, why let a mother see a daughter dehydrate before her eyes when she thinks it’s wrong? Let the mother have her. I doubt Mr. Schiavo cares as much as his wife’s mother.
As to the politics: Nobody wants a set of rules for the end of life, now that we can make it so prolonged and unnatural, that would force families to keep relatives in a painful or degraded condition. If Republicans in Congress wants to make such rules, let them have the courage to do so. To intervene in one case is grandstanding. It is a sideshow. Like Saddam is to the bin Laden, like anabolic steroids in baseball players is to the healthcare of America’s children, like the prescription bill for Medicare is to the problem of drug prices in America. Gutless abnegation of duty.
And the prayer vigils are morbid and self-indulgent. We all love to pity others:, it makes us feel superior and well intentioned at the same time: “I’m so glad I’m not like Terri Schiavo, poor thing, and how wonderful of me for being so caring.” Death and degradation is our common fate. Many fall to disease and traumas daily. Terri Schiavo fell long ago. If you care, get off your knees and help those who actually could use it.
Posted by: epistemology | Mar 20, 2005 4:14:01 PM
Dehydration is NOT very unpleasant I should have said. Sorry. I hate that. I suck as a proofreader. (And a writer and thinker Abdul is thinking).
Posted by: epistemology | Mar 20, 2005 4:17:33 PM
Barbar, that's interesting, but the story I remember from 2003 involved lawyers and police and whatnot.
Posted by: Jaybird | Mar 20, 2005 4:52:37 PM
If the priest had been allowed to place a tiny flake of the Host on her tongue, I assume we wouldn't be discussing this today.
Why do you say this (especially in light of the fact that she apparently just received last rites and that doesn't seem to be impacting anything)?
Do you have a somewhat objective news source for the "denied last rites" story (one that doesn't go on to say "Michael Schiavo is a horrible man who beat his wife into a coma and has spent the last 15 years becoming a nurse and making sure that his wife doesn't get the treatment she needs to get better and testify against him")?
Posted by: Barbar | Mar 20, 2005 5:21:58 PM
The most sickening thing was hearing Tom DeLay calling the husband, Michael, 'a man of questionable morals', and then some other slimy Republicans calling him a bigamist, because he's had kids w another woman, rather than waiting for a vegetable, which she is, and courts and doctors have determined she is.
Were I Michael I'd lick those simebags asses back to their home states.
Yet, the thing that I wonder of the most is, ala Nicole Simpson, Laci Peterson, and JonBenet Ramsey, would anyone give a damn of her were she black or Hispanic? DAN
Posted by: Dan Schneider | Mar 20, 2005 6:12:26 PM
Yes, but; someone should note somewhere that PVS is a pretty dicey diagnosis. In particular, not many commentators seem to appreciate that the best study on recovery from PVS found a combined misdiagnosis/recovery rate of 75% - that is, of forty people diagnosed as PVS, only ten were (Andrews et al, Misdiagnosis of the vegetative state: retrospective study in a rehabilitation unit. BMJ. 1996 Jul 6;313(7048):13-6).
I have written on this matter for the Journal of Medical Ethics, Issues in Law and Medicine, Neurorehabilitation, Neourological Rehabilitation, and Bioethics Review, and my full papers are available online at http://home.vicnet.net.au/%7Eborth/PVS.htm.
And if TS isn't unconscious, she's had to listen to people discussing her death in her hearing about five times. Cruel and unusual punishment.
Chris Borthwick
Posted by: chris | Mar 20, 2005 6:42:59 PM
Jaybird, judging by this story it's under dispute what happened. World Net Daily seems to have your version of the story but they're extremely unreliable.
Here's a story from the Tampa Tribune in 2003:
Attorneys on both sides also traded faxes Wednesday in a dispute over whether the family priest or a priest summoned by the hospice should administer last rites.
Bob Schindler said one of his daughter's childhood friends, visiting from the Philadelphia area, was turned away during an attempt to visit Wednesday.
But Monsignor Thaddeus Malanowski, who has been visiting Terri Schiavo on a weekly basis, was able to visit along with the Schindlers on Wednesday.
Malanowski said he administered the anointing of the sick, as he has done in the past, and also blessed Schiavo using a cloth relic that once belonged to Mother Teresa. According to Malanowski, Mary Schindler was sad Wednesday as she kissed, caressed and hugged her daughter. ``She just stared at her mother,'' Malanowski said of Schiavo's reaction.
The article also makes me think that the Schindlers were still actively fighting the case before last rights came up.
Posted by: Matt Weiner | Mar 20, 2005 6:49:43 PM
chris:
Yes, but; someone should note somewhere that PVS is a pretty dicey diagnosis. In particular, not many commentators seem to appreciate that the best study on recovery from PVS found a combined misdiagnosis/recovery rate of 75% - that is, of forty people diagnosed as PVS, only ten were
You don't understand the nature of the medical evidence in the Schiavo case. Go read the post by Rivka that Matthew links to above.
Posted by: Don P | Mar 20, 2005 6:58:41 PM
chris borthwick,
I looked at your abstracts, and they say nothing about specific diagnostic information such as the published CAT scans in this case. It may be that a population of patients diagnosed as PVS may have a high recovery rate. But for Terri Schiavo we have findings showing that almost all of her cerebral cortex is gone. Discussing rehabilitation is like planning on restoring writing skills for someone whose arms are amputated. Since she has been in this condition since shortly after her cardiac arrest 15 years ago, your accusations that people have tortured her by discussing her case in her presence suggest that you are are in need of therapy to restore a sense of decency. Taking advantage of her plight to push some personal agenda is way out of line, though perhaps less psychopathic than our Republican members of Congress.
Posted by: Roger Bigod | Mar 20, 2005 7:08:56 PM
I am stopping by to deliver this action alert. Regardless of what you may think of the merits of this case, one thing seeems quite certain. Congress is using this opportunity to change the balance of power.
**********ACTION ALERT*********************
NO ONE IN CONGRESS IS ANSWERING THEIR PHONES.
WE MUST CONTACT THE MEDIA TO PUT PRESSURE ON CONGRESS TO BUTT OUT OF THE SCHIAVO CASE. THERE IS A REAL THREAT TO THE SEPARATION OF POWERS GOING ON, NOT TO MENTION CONGRESS MAKING MEDICAL DECISION AND PERSONAL DECISION AND THE DISGUSTING ASPECTS OF PLAYING POLITICS WITH PEOPLE LIVES THAT WE HAVE BEEN TALKING ABOUT FOR A FEW DAYS HERE.
THE PLAN: HERE IS A MEDIA LIST OF THE MAJORS AND THE NEWS ORGANIZATIONA THAT ARE WORKING THIS WEEKEND:
[email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], www.nytimes.com, [email protected]
EMAIL ALL OF THEM PLEASE. TELL THEM FROM YOUR HEART WHAT YOU THINK OF WHAT'S HAPPENING AND TELL THEM THEY NEED TO REPRESENT THE "OTHER" SIDE OF THIS STORY, THAT TOM DELAY IS SLANDERING MICHAEL SCHIAVO, THAT CONGRES IS BUTTING INTO PEOPLE'S PERSONAL LIVES, THAT YOU ARE DISGUSTED BY WHAT THEY ARE DOING. TELL THEM WHAT YOU THINK.
TIPS: KEEP IT SHORT. THREE SENTENCES PER PARAGRAPH, NO MORE THAN THREE PARAGRAPHS. NO ESSAYS, THEY DON'T READ THEM.
CONGRESS WON'T HEAR US, SO WE NEED TO PRESSURE THE MEDIA. .
PLEASE DO IT NOW. WHAT ELSE YOU GONNA DO WHILE YOU WAIT FOR DEADWOOD, HUH?
Posted by: spinnaker | Mar 20, 2005 7:17:07 PM
For my take, see:
Schiavo, Mill and the Culture of Living"
Posted by: Jon | Mar 20, 2005 9:21:42 PM
The most sickening thing was hearing Tom DeLay calling the husband, Michael, 'a man of questionable morals', and then some other slimy Republicans calling him a bigamist, because he's had kids w another woman, rather than waiting for a vegetable, which she is, and courts and doctors have determined she is.
I do agree it's unfair to disparage Micheal Schiavo in any way. Let's all walk a mile in his shoes before we criticize his decision to build a new life with another partner.
Still, I can't help but think, whatever the legalities, he no longer has a moral right to make decisions on behalf of this woman. It may well be that the woman's parents are going against the wishes of their daughter. But it's equally true that this man is no longer the vegetable's husband in any sense except a narrow, legal one. Something isn't quite right about allowing the remarried (in a common law sense, at least) husband to proclaim to the world what his ex-wife (again, in the common law sense) would have wanted. It's all a little too convenient.
Posted by: P.B. Almeida | Mar 20, 2005 10:58:31 PM
chris:
I think the possibility that Schiavo has a possibility of recovery to the point of being able to communicate approaches zero. In a case this celebrated, with the amount of money spent by both sides on making their points, I can't believe there is an ability to communicate that is being missed.
Even if there were, the courts have indicated that she would have a right to no treatment, and this includes feeding tubes, if she desired. And her husband's recollection of her desires would satisfy most courts. Few people would choose to live in a state where their only communication were pointing with their eyes. Not that I necessarily judge that life to be not worth living. It is for the loved ones to decide. Shame they can't agree. But certainly not unusual.
Posted by: epistemology | Mar 20, 2005 11:20:58 PM
PB Almeida:
What Michael Schiavo is doing is convenient? He is getting death threats, do you understand? The easy thing to do would be to walk away. I assume he is doing this to honor the wishes and protect the dignity of someone he loves. What basis, other than your own bias, do you have for saying otherwise.
It is much more psychologically likely that the mother is unable to face her daughter's death, and would make a living shrine of her to satisfy her own needs.
But I assume the mother does it because because she thinks she is doing the right thing too. People can have honest disagreements on issues like this. I do think that it would be best for Mr. Schiavo to accede to the wishes of his wife's mother, Terri won't know the difference either way.
Posted by: epistemology | Mar 20, 2005 11:31:41 PM
Also, to P.B Almeida - Michael Schiavo didn't make the decision. The courts did, based on what it found to be her wishes. It took his testimony as it would that of any other witness. So the issue of his standing is irrelevant.
Posted by: John | Mar 21, 2005 3:32:36 AM
"Still, I can't help but think, whatever the legalities, he no longer has a moral right to make decisions on behalf of this woman."
He isn't making decisions. Under current law, the basis for the decision to terminate life support is the patients wishes. There was a court proceeding in which he and others gave testimony about her wishes. Her parents had a chance to present their side. The court decided.
Whether this happened before or after he started living with another woman is irrelevant. He already had a conflict of interest because he was heir of the estate. This was acknowledged at the proceedings. But no one else had as much information about her wishes. It looks like he was appearing more as an expert on her attitudes about terminal care than as a husband.
Posted by: Roger Bigod | Mar 21, 2005 8:46:57 AM
I agree- Michael cd easily give up and walk away. That he has not says alot of his charcater and love for his long dead wife. DAN
Posted by: Dan Schneider | Mar 21, 2005 8:51:03 AM
Dan Schneider, Terri really is not dead yet. To say so is intentionally, and hurtfully provocative, esp to those struggling with terrible disabilities.
Posted by: epistemology | Mar 21, 2005 10:54:49 AM
Chris Borthwick, surely you aren't suggesting that the disgnosis is incorrect in this case?
Posted by: Gregory | Mar 21, 2005 12:17:19 PM
Still, I can't help but think, whatever the legalities, he no longer has a moral right to make decisions on behalf of this woman.
Well, P.B., while I -- and more importantly, the courts -- disagree with you, it may comfort you that he is not. At Michael's request, the courts held a hearing to determine what Terri herself would have wanted, and found by clear and convincing evidence that she would not want her physical existence to be prolonged by artificial means. Terri's parents have had all opportunity to challenge this finding and have failed. Therefore, at issue here is whether Terri's will, as best as can be determined, will prevail. Shame on the Republicans for overriding this woman's wishes to score political points.
Posted by: Gregory | Mar 21, 2005 12:22:04 PM
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