Map of life expectancy at birth from Global Education Project.

Wednesday, April 27, 2005

A Final Word (I fervently hope) on Terri Schiavo

Now that the dreckstorm has settled, ethicist George J. Annas makes clear for us the non-issues underlying the Terri Schiavo case. (New England Journal of Medicine, 21 Apr.) (And in case you're thinking what I'm thinking, the idea of a professional "ethicist" does seem kinda strange. You need a Ph.D. and a faculty appointment to talk about what's ethical? But George J. is thoughtful and well-informed. The great thing about ethicists is that, in constrast to physicists, you don't have to buy what they say.)

Annas asks,
"How did the U.S. Congress conclude that it was appropriate to reopen a case that had finally been concluded after more than seven years of litigation involving almost 20 judges? Has the country's culture changed so dramatically as to require a fundamental change in the law? Or do patients who cannot continue to live without artificially delivered fluids and nutrition pose previously unrecognized or novel questions of law and ethics?"

The answer is no, and nope. The issues in the Schiavo case were fully settled in law by the precedents of the Karen Quinlan and Nancy Cruzan cases, the latter decided by the Supreme Court in 1990. Essentially, it has been the law of the land for 15 years that a feeding tube constitutes medical intervention, and that people have a right to refuse it. If there is no reasonable possibility of a person returning to a "cognitive, sapient state," life-sustaining treatment can be removed (Quinlan), and the states can establish the standards of evidence to determine what non-communicative persons would have wished (Cruzan).

The dispute in the Florida courts about Terri Schiavo did not concern what her wishes might have been. A judge found in 1998, based on the evidence, that Terri was in a persistent vegative state and that if she could make her own decision, she would terminate feeding. The decision was upheld on appeal and the Florida Supreme Court declined to review it.

Terri's parents returned to court claiming they had new evidence, not about her wishes, but about her condition, claiming she was not in a persistent vegetative state. The court allowed physicians to examine her, and concluded that she was indeed in a persistent vegetative state, and the appeals court upheld the decision, saying, "Despite the irrefutable evidence that her cerebral cortex has sustained irreparable injuries, we understand why a parent . . . would hold out hope . . . .But in the end this case is not about the aspirations that loving parents have . . . . It is about Theresa Schiavo's right to make her own decisions."

The bottom line is that there was no ethical issue involved. This dispute was not about morality, or the culture of life, or Christian belief. It was about facts. Subsequently Terri's parents, persisting in their state of deep denial, enlisted religious fanatics to generate a public controversy based entirely on falsehoods. and shamefully, the Republican Party and the Catholic Church joined them as co-conspirators. It was only then that we started to hear slanders about Michael Schiavo, and doubts raised about Terri's wishes. The dispute was never about that, it was about her medical diagnosis, which was in fact incontrovertible.

Now that this disgraceful episode is over, nobody can even say what point the Republicans were trying to make. There is no issue of public policy to be decided, no law left to be made, no significant controversy over the ethics of such situations. This was a passion play about nothing.

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