From The Wall Street Journal
Killing Terri
By JAMES Q. WILSON March 21, 2005; Page A16
Terri Schiavo is not brain dead as far as anyone can tell. If you are brain
dead, you have suffered an irreversible loss of all functions of the brain. If
agreed to by at least two physicians, that means you are legally dead, such that
your organs can be harvested to help other people.
Instead, Ms. Schiavo is in what many physicians call a "persistent vegetative state" (PVS). That means that she lacks an awareness of her self or other people, cannot engage in purposeful action, does not understand language, is incontinent, and sleeps alot. To be clinically classified as being in a PVS, these conditions should be
irreversible. But from what we know, some doctors dispute one or more of these
conditions and believe that it is possible that whatever her symptoms, they are
not irreversible.
Her condition is hardly unique. In 1995, when the American
Academy of Neurology published its report on people in a persistent vegetative
state, it found that there were as many as 25,000 adults and 10,000 children in
this country who suffered from PVS. Based on the best studies the Academy could
find at the time, some adults in a vegetative state 12 months after a
devastating injury or heart failure could recover consciousness and some human
functions. The chances that such a recovery will occur are very small, but they
are not zero.
If they are not zero, then withdrawing a patient's feeding
tubes and allowing her to die from a lack of water and food means that whoever
authorizes such a step may, depending on the circumstances, be murdering the
patient. The odds against it being a murder are very high, but they are not
100%.
* * *
Many people, myself included, have allowed life-support
systems to be withdrawn from parents who have no hope of recovery. My mother was going to die from cancer, and after all efforts had been made to help her, my
sister and I allowed the doctors to withdraw the devices that kept her alive.
She was dead within hours.
My case, and that of countless other people who
have made that decision, differs from that of Terri Schiavo in two important
ways. First, the early death of my mother was certain, but no one can say that
Ms. Schiavo will die soon or possibly at any time before she might die of old
age. Second, all the relevant family members agreed on the decision about my
mother, but family members are deeply divided about Terri.
These differences are of decisive importance. When death will occur soon and inevitably, the patient does not starve to death when life support ends. Since there was no chance of our mother living more than a few more days, what my sister and I did
could not be called murder. When death will not occur soon, or perhaps for many
years, and when there is a chance, even a very small one, that recovery is
possible, people who authorize the withdrawal of life support are playing God.
And in Terri's case, they are playing God when they do not have to.
Her parents have begged to become her guardians. Her husband has refused. We do not know for certain why the husband has refused. I doubt that he
wishes to receive for himself the money that still exists from her insurance
settlement and, apparently, he has offered to donate that money to charity.
Perhaps, being a Catholic, he would like her death to make him free to marry the
woman with whom he is now living. Or perhaps (and I think this is the most
likely case) he does not want his wife to live what strikes him as an
intolerable life.
The intolerable life argument has support from many doctors and bioethicists. They claim that a person can be "socially dead" even when their brains can engage in some functions. By "socially dead" they meanthat the patient is no longer a person in some sense. At this point their argument gets a bit fuzzy because they must somehow define what is a "person"and a "non-person." That is no easy matter.
By contrast, physicians have unambiguous ways of determining whether a person is brain dead. This means that brain death is a very conservative standard and, if it errs, it errs on the side of preserving life.
Some people believe that all of these issues can be resolved if everyone signs a living will that specifies what is to be done to them under various conditions. The living will is supposed to determine unambiguously when a "Do Not Resuscitate" sign should be placed on a patient's hospital chart. Terri Schiavo had not signed a living will. If she had, we would not be facing these issues.
* * *
But scholars have shown that we have
greatly exaggerated the benefits of living wills. Studies by University of
Michigan Professor Carl Schneider and others have shown that living wills rarely
make any difference. People with them are likely to get exactly the same
treatment as people without them, possibly because doctors and family members
ignore the wills. And ignoring them is often the right thing to do because it is
virtually impossible to write a living will that anticipates and makes decisions
about all of the many, complicated, and hard to foresee illnesses you may
face.This is a tragedy. Congress has responded by rushing to pass a law that
will allow her case, but only her case, to be heard in federal court. But there
is no guarantee that, if it is heard there, a federal judge will do any better
than the Florida one. What is lacking in this matter is not the correct set of
jurisdictional rules but a decent set of moral imperatives.
* * *
That moral imperative should be that medical
care cannot be withheld from a person who is not brain dead and who is not at risk for dying from an untreatable disease in the near future. To do otherwise makes us recall Nazi Germany where retarded people and those with serious disabilities were "euthanized" (that is, killed). We hear around the country echoes of this view in the demands that doctors be allowed to participate, as they do in Oregon, in physician-assisted suicide, whereby
doctors can end the life of patients who request death and have less than six
months to live. This policy endorses the right of a person to end his or her
life with medical help. It is justified by the alleged success of this policy in
the Netherlands.
But it has not been a success in the Netherlands.
In that country there have been well over 1,000 doctor-induced deaths among patients who had not requested death, and in a large fraction of those cases the patients were sufficiently competent to have made the request had they wished.
Keeping people alive is the goal of medicine. We can only modify
that policy in the case of patients for whom death is imminent and where all
competent family members believe that nothing can be gained by extending life
for a few more days. This is clearly not the case with Terri Schiavo . Indeed,
her death by starvation may take weeks. Meanwhile, her parents are pleading for
her life.
Mr. Wilson has taught at Harvard, UCLA and Pepperdine and is the
author of "The Moral Sense" (Free Press, 1997).
Highlights added by Atlas Shrugged, Citizen Journalist
My Comments
Who can be morally trusted to hold the rights to someone else's life?
I didn't hear much of this Schiavo case until today where i caught a glance on the papers. My GP teacher would go totally ballistic at the negligence of my general knowledge. But this incident would have provided grounds for many insightful articles and comments from students. I would not be surprised if this was one of the debate topics in my GP class in school.
I cant remember why i loved GP so much. I still do. The cut and thrust of opinion, the dazzle of debate, and the academic thoughts that dominate morality in an ideal world.
Now to rephrase the first sentence of my comments:
Can you trust a person to be morally responsible and answerable to the lives of 27 men after less than a year of specific training?
Thats something only time will tell.
